RESUMEN
OBJECTIVES: Tumor necrosis factor alpha (TNFα) plays a pivotal role in the inflammatory host response. The serum-level of TNFα and the production of TNFα by lympho/monocytes, however, seem to show high individual variations. The goal of the present study was to investigate the variations and inducibility of TNFα-activity in two age-groups of healthy volunteers. METHODS: Sixty elderly, healthy volunteers were studied. These persons were free of malignant diseases, and within three months, they did not have any trauma or inflammatory disease and were not taking any steroids or nonsteroid anti-inflammatory drugs. Thirty young volunteers were also included. Blood samples were taken; lympho/monocytes were separated and cultured with or without endotoxin (LPS) stimulation. Serum and culture supernatant TNFα levels were determined by bioassay using WEHI 164 cells. RESULTS: The results indicated significant individual variations in TNFα levels of healthy volunteers irrespective of age. Subgroups with low, middle, and high serum TNF-levels were distinguished. In about 50% of volunteers with low serum-TNFα activity, LPS stimulation failed to increase the TNFα production by isolated lympho/monocytes. CONCLUSION: Our data suggest a chance to select individuals with enhanced sensitivity for septic complications.
Asunto(s)
Leucocitos Mononucleares/inmunología , Factor de Necrosis Tumoral alfa/sangre , Adulto , Anciano , Anciano de 80 o más Años , Línea Celular , Femenino , Humanos , Inflamación/inmunología , Leucocitos Mononucleares/efectos de los fármacos , Lipopolisacáridos/inmunología , Lipopolisacáridos/farmacología , Masculino , Ciclo Menstrual/inmunología , Persona de Mediana Edad , Factor de Necrosis Tumoral alfa/inmunología , Adulto JovenRESUMEN
PURPOSE: A prospective study was initiated 7 years previously to assess the efficacy of endoscopic dextranomer based implants for pediatric structural incontinence. Preliminary results revealed that at 3 years 50% of the patients were either dry or significantly improved. We report long-term results in the same cohort of patients. MATERIALS AND METHODS: A total of 33 children and adolescents 5 to 18 years old with severe incontinence due to sphincteric incompetence (exstrophy-epispadias complex in 13, neuropathic bladder in 16, bilateral ectopic ureter in 4) were enrolled. Of the patients 13 underwent 2 and 4 underwent 3 treatment sessions to achieve a definitive result. Mean injected volume was 3.9 ml (range 1.6 to 12) per session. At each evaluation patients were considered cured (dryness interval 4 hours), significantly improved (minimal incontinence requiring no more than 1 pad daily and no further treatment required) or treatment failures (no significant improvement). Videourodynamics were used to study the evolution of the bladder capacity, activity and compliance. A total of 31 patients were followed 3 to 7 years after the last injection. RESULTS: At 3 years after treatment 15 of 30 patients (50%) were dry or improved. One patient who had leakage after 3 years of dryness due to bladder deterioration subsequently underwent ileocystoplasty. At 4 years 12 of 25 patients (48%) were dry or improved. At 5 years 9 of 21 patients (43%) were dry, as were 4 of 11 (36%) at 6 years and 2 of 5 (40%) at 7 years of followup. The success rate according to pathological evaluation was comparable in neuropathic bladders (7 of 14, or 50%), exstrophy (3 of 6, or 50%) and epispadias (3 of 7, or 43%). Of 12 patients who underwent bladder neck plasty before the injection of bulking agent 7 (58%) were either dry or improved. The success rate was higher in males (13 of 23, or 57%) than in females (3 of 8, or 38%). Also, at puberty 2 males who were improved became dry. Bladder capacity increased in 12 of 18 initially small bladders and remained normal and stable in 9, while 4 initially dry patients had development of recurrent leakage secondary to bladder deterioration and underwent augmentation. Otherwise, there were no long-term side effects observed related to the injection of the bulking agent. CONCLUSIONS: Endoscopic treatment of severe organic urinary incontinence with dextranomer is durable for up to 7 years of followup in 40% of the patients.
Asunto(s)
Dextranos/administración & dosificación , Prótesis e Implantes , Incontinencia Urinaria/terapia , Adolescente , Niño , Preescolar , Cistoscopía , Femenino , Estudios de Seguimiento , Humanos , Inyecciones , Masculino , Estudios Prospectivos , Factores de TiempoRESUMEN
OBJECTIVES: Helium as a component of inspired gas decreases turbulent flow and airway resistance. Helium-oxygen mixtures have been used since the 1930s in the management of patients with upper airway obstruction. The objective of this study was to evaluate the efficacy of helium-oxygen mixtures in relieving upper airway obstruction in a pediatric population. STUDY DESIGN: Retrospective chart review of 42 pediatric patients who received helium-oxygen mixtures for upper airway obstruction within a 3-year period. METHODS: The study protocol included 42 pediatric patients, aged 1 week to 14 years, who were admitted to the Children's Hospital of Philadelphia from June 1997 to December 2000 and who received a total of 44 treatments of helium-oxygen therapy for upper airway obstruction. Response to treatment was determined by reduction in work of breathing noted on the chart. RESULTS: Thirty-two of 44 helium-oxygen treatments resulted in a positive response (73%). There were no significant differences in demographic characteristics between responders and nonresponders, except all of the premature infants were responders and 6 of the 9 patients with syndromes were nonresponders. CONCLUSIONS: Helium-oxygen therapy is a useful adjunct therapy for upper airway obstruction. Controlled clinical trials are necessary to better define the appropriate settings for use of helium-oxygen.
Asunto(s)
Obstrucción de las Vías Aéreas/terapia , Helio/uso terapéutico , Terapia por Inhalación de Oxígeno/métodos , Oxígeno/uso terapéutico , Adolescente , Factores de Edad , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/patología , Obstrucción de las Vías Aéreas/fisiopatología , Resistencia de las Vías Respiratorias , Broncoscopía , Niño , Preescolar , Quimioterapia Combinada , Femenino , Helio/química , Helio/farmacología , Hemangioma/complicaciones , Humanos , Lactante , Recién Nacido , Infecciones/complicaciones , Intubación Intratraqueal/efectos adversos , Enfermedades de la Laringe/complicaciones , Laringoscopía , Masculino , Oxígeno/química , Oxígeno/farmacología , Estudios Retrospectivos , Factores de Riesgo , Estenosis Traqueal/complicaciones , Traqueítis/complicaciones , Resultado del Tratamiento , Trabajo RespiratorioRESUMEN
The authors investigated the difficulties of differential diagnosis in diabetes, beginning in young age. They analysed the case records of fifteen young diabetics. The authors pointed out, that clinical diagnosis, carried out early, has utmost importance both of theoretical and practical significance, for correct classification according to the type of diabetes determines the therapy. In building the diagnosis, the clinician needs correct anamnestical, clinical data, immunogenetic markers (ICA, HLA), and the capacity of endogenous insulin secretion as well. In three patients they have observed a long period without insulin treatment that could be classified as remission phase. In eleven cases the treatment has started with oral antidiabetic drugs, one patient has got at he very beginning insulin treatment. At present, there is only one patient, still taking oral drugs. This diabetics has an ICA positivity in high titer, but he is refusing the recommended exogenous insulin treatment. In all of their cases the amount of injected daily insulin is low (0.3-0.6 IU/body weight/24 hours). Authors state by their careful analysis, that in all of their 15 diabetics there is existing a slowly developing type I IDDM, I/b, or very recently 1 1/2 diabetes form. The so called autoimmune form--described originally by Bottazzo--could have been disclosed in all of their cases.
Asunto(s)
Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Adolescente , Adulto , Factores de Edad , Diabetes Mellitus Tipo 1/inmunología , Diabetes Mellitus Tipo 2/inmunología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Authors analyzed the case history of 25 young diabetic patients, whose disease has been diagnosed before the age of thirty. The question that has been raised: is it allowed to treat young diabetics with oral drugs? By classifying the patients, they stated followings: In the 1. group they classified 16 verified MODY/NIDDY patients. In the second group they classified 3 young diabetics, whose disease had been evaluated as slowly progressing IDDM (autoimmune form). 3 patients belonged to the 3 group. They had been classified as MODY/NIDDY patients, however an extremely long lasting remission period--due to the short observation time--can not be excluded. The remaining 3 diabetic patients belonged to the IDDM group, with a long remission period. They were treated incorrectly with oral hypoglycemic drugs. Young diabetics can be treated with oral drugs only in case, when they are proven MODY/NIDDY patients. The precise differential diagnosis between this form and autoimmune IDDM, as well as long lasting remission periode, is extremely important.
Asunto(s)
Biguanidas/administración & dosificación , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Compuestos de Sulfonilurea/administración & dosificación , Administración Oral , Adolescente , Adulto , Factores de Edad , Niño , Preescolar , Contraindicaciones , Evaluación de Medicamentos , Estudios de Evaluación como Asunto , Femenino , Humanos , Recién Nacido , MasculinoRESUMEN
The authors deal with the clinical picture of total remission in diabetes, among young patients (below 30 years). In their interpretation "complete remission" means total withdrawal of insulin treatment for at least 2 months. Out of 14 patients with complete remission, the classified 7 patients--by clinical and immunogenetical parameters--as noninsulin-dependent diabetes in the young (MODY-NIDDY). 1 diabetic patient belongs to the autoimmune-subgroup of IDDM. The remaining 6 patients could be classified as IDDM-s. However their clinical and immunogenetical parameters were rather atypical. In conclusion they raised the possibility that this subgroup is heterogenous with in IDDM.
Asunto(s)
Diabetes Mellitus Tipo 1/diagnóstico , Adolescente , Factores de Edad , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/inmunología , Niño , Preescolar , Diabetes Mellitus Tipo 1/inmunología , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/inmunología , Diagnóstico Diferencial , Humanos , Inducción de RemisiónRESUMEN
Diabetes diagnosed in the so-called middle age of life is debated from the typological point of view. The authors investigated 45 diabetics, whose disease had been diagnosed between the age of 30-45 years. As a result of their observations they state that diabetes in this age range is heterogenous. Patients can be classified into insulin-dependent and non-insulin-dependent types of diabetes. Two of their patients could be classified into a newly described subtype (early onset diabetes, EOD). For the time being it seems that the exact delineation of this new diabetic subtype needs more detailed observations.
Asunto(s)
Diabetes Mellitus/clasificación , Adulto , Factores de Edad , Diabetes Mellitus/diagnóstico , Diabetes Mellitus Tipo 1/clasificación , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 2/clasificación , Diabetes Mellitus Tipo 2/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Growth hormone (hGH) reserve following arginine administration and the paradoxical hGH response to thyrotropin-releasing hormone (TRH) were studied in 30 diabetics without evidence of vascular complications. The diabetics were divided into 4 groups according to the type of their disease and to the metabolic condition within the IDDM group (insulin-dependent: IDDM, in acceptable response and in poor metabolic control; non-insulin-dependent: NIDDM, and juvenile diabetics not requiring insulin at least for two years after diagnosing their disease: NIDDY). The results were compared with controls of identical age and normal weight. A paradoxical hGH response to TRH stimulation was found only in IDDM patients in poor metabolic control. In this group the hGH reserve revealed by arginine was significantly larger than in the others. It was shown that the induced hGH release was independent of the sex distribution of the groups and of the basal hGH values. Magnitude of the hGH reserve and appearance of the paradoxical hGH response were not necessarily correlated but the substantial reserve was frequently associated with a paradoxical response. It can be assumed that the unfavorable metabolic condition is of decisive importance in giving rise to these anomalies. Our observations seem to confirm the need for good metabolic control if the pathological hGH secretion in diabetics is to be prevented.
Asunto(s)
Arginina/farmacología , Diabetes Mellitus/sangre , Hormona del Crecimiento/sangre , Hormona Liberadora de Tirotropina/farmacología , Adulto , Glucemia/metabolismo , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 2/sangre , Femenino , Humanos , Insulina/uso terapéutico , Masculino , Persona de Mediana EdadRESUMEN
The magnitude of hGH reserve was investigated in young (16-40 years old) diabetic patients. Forty patients were examined with the arginine infusion test, twenty three with a sensitized version of the L-Dopa test. The patients were divided into four groups based on the type of their illness (IDDM or NIDDY) and the clinical stage of IDDM. It was concluded that the hGH reserve of the various diabetic groups differs from the hGH reserve of healthy persons as well as from one another. Taking into consideration the possible causes of these differences, it is suggested that the hGH reserve depends primarily on the metabolic condition of the patients, while the type of diabetes (IDDM or NIDDY) and the insulin therapy used may also be important contributing factors. Achievement of a good metabolic control within the same type of diabetes leads to the normalization of the previously pathologic hGH reserve.
Asunto(s)
Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Hormona del Crecimiento/metabolismo , Adolescente , Adulto , Arginina , Femenino , Humanos , Levodopa , Metabolismo de los Lípidos , MasculinoRESUMEN
To test the claim that peculiar personality bias is detectable in multiple sclerosis (MS) we used the Szondi test to investigate the psychodynamic aspects of 110 MS patients in comparison with 200 healthy subjects. MS patients appeared to have a greater need for love in a passive form than normal people, rigid defense mechanisms, difficulty in resolving their inner conflicts either by sublimation or by internalization of satisfactory new emotional experiences, feelings of autoaggressiveness, and many symptoms of depression. Some of these aspects correlate with the severity of the disease, others seem to date back to early childhood as peculiar personality patterns. An investigation of childhood events in 110 controls confirmed that MS patients had had many more unhappy experiences in childhood than might commonly be expected. Further, the oft-reported psychiatric troubles preceding MS clinical onset suggest that at least in some MS patients there are specific gaps in personality structure dating back to early phases of their development.