RESUMO
We report on improvements in cryoprobe design and techniques of cryoablation as a minimally invasive alternative to open surgery for the treatment of benign breast tumors. In the study, which was conducted in 12 centers, 124 lesions in 102 patients were monitored for a period of 12 months after cryoablation. Two different treatment techniques were used: Double HI FREEZE and Tailored Freeze. In patients treated with the Tailored Freeze technique significantly better results were recorded 12 months after the procedure: the median reduction in tumor volume was 91%, 73% of all tumors treated were nonpalpable, 84% of lesions less than 2.5 cm in maximum diameter were nonpalpable, and none of the 31 mammograms performed yielded abnormal findings. Patient satisfaction was good to excellent in 92% of the patients. The safety profile of this technique was excellent; all complications were minor. Evolution of cryoablation freezing techniques, coupled with improvements in cryoprobe design, has resulted in significant improvements in both safety and effectiveness.
Assuntos
Neoplasias da Mama/cirurgia , Criocirurgia/métodos , Fibroadenoma/cirurgia , Adulto , Biópsia por Agulha , Neoplasias da Mama/diagnóstico , Feminino , Fibroadenoma/diagnóstico , Humanos , Mamografia , Pessoa de Meia-Idade , Resultado do Tratamento , Ultrassonografia MamáriaRESUMO
Although models of high-quality family planning services for men exist in Latin America, few if any have been organized within the complex and resource-constrained national public health systems. This study provides evidence from the Santa Barbara project in southern Brazil showing how vasectomy was introduced into the municipal health system. It demonstrates that once the necessary operational and quality-of-care improvements were in place, and sufficient political and technical support existed to proceed, it was possible to establish low-cost, well-used, and sustainable vasectomy services free of charge. The findings show that careful attention to the development of strong technical competence and an informed choice process resulted in high user satisfaction. Focus-group discussions with men who underwent vasectomy indicate that they had no objection to being served in the context of a women's health center and that they act as opinion leaders who draw an increasing clientele to the service.
Assuntos
Países em Desenvolvimento , Planejamento em Saúde/organização & administração , Saúde Pública , Vasectomia , Adulto , Brasil , Comportamento do Consumidor , Feminino , Humanos , Masculino , Centros de Saúde Materno-Infantil/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administraçãoRESUMO
This article presents findings from a participatory action research project in a municipality in southern Brazil that models a new and holistic approach to broadening women's contraceptive choices. The project encourages a collaborative process between researchers, community members, and public health managers to diagnose service-delivery problems, to design and implement interventions, and to evaluate their effectiveness. Findings from the baseline evaluation revealed major constraints in availability of and access to family planning and reproductive health services for women, as well as severe deficiencies in quality of care. Interventions designed to address these weaknesses, bound by the limited resources of the public sector, focused on training, restructuring of providers' roles and service-delivery patterns, the management process, the creation of a referral center, and the introduction of injectables, vasectomy services, and a program for adolescents. Evaluation results show the project's considerable impact in broadening reproductive options, although not all issues, especially those related to sustainability, have been resolved.
Assuntos
Comportamento de Escolha , Serviços de Planejamento Familiar/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Mulheres/psicologia , Adolescente , Adulto , Brasil , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde , Saúde Holística , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Inquéritos e QuestionáriosRESUMO
This article addresses women's participation in an organization development project designed to improve public sector family planning and reproductive health services in Brazil. Although community women collaborated in aspects of the intervention and research, the project nonetheless raises the basic question whether such involvement of community women does or does not correspond to what scientific writers consider to be the essence of participatory research. We review key project features in the context of recent literature and conclude that although the project is committed to the sharing of power and control, it does not fully correspond to the characteristics of participatory research. Moreover, we argue that given the project's central focus on reproductive health outcomes, complete adherence to the process-oriented, pure version of participatory research would have been inappropriate.
Assuntos
Participação da Comunidade/métodos , Serviços de Planejamento Familiar/organização & administração , Programas Nacionais de Saúde/organização & administração , Medicina Reprodutiva/organização & administração , Projetos de Pesquisa , Brasil , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Avaliação de Programas e Projetos de SaúdeRESUMO
The introduction of new contraceptive technologies has great potential for expanding contraceptive choice, but in practice, benefits have not always materialized as new methods have been added to public-sector programs. In response to lessons from the past, the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction (HRP) has taken major steps to develop a new approach and to support governments interested in its implementation. After reviewing previous experience with contraceptive introduction, the article outlines the strategic approach and discusses lessons from eight countries. This new approach shifts attention from promotion of a particular technology to an emphasis on the method mix, the capacity to provide services with quality of care, reproductive choice, and users' perspectives and needs. It also suggests that technology choice should be undertaken through a participatory process that begins with an assessment of the need for contraceptive introduction and is followed by research and policy and program development. Initial results from Bolivia, Brazil, Burkina Faso, Chile, Myanmar, South Africa, Vietnam, and Zambia confirm the value of the new approach.
PIP: In response to difficulties associated with the introduction of new contraceptive technologies to public sector service systems, the UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction has formulated a new model. The strategic approach to contraceptive introduction shifts the emphasis from the promotion of a particular technology to quality of care issues, a reproductive health focus, and users' perspectives and needs. It further entails a participatory approach with collaboration among governments, women's health groups, community groups, nongovernmental providers, researchers, international donors, and technical assistance agencies. The underlying philosophy is that method introduction should proceed only when a system's ability to provide high-quality services exists or can be generated. Since 1993, WHO has provided support for the implementation of this perspective in public sector programs in Bolivia, Brazil, Burkina Faso, Chile, Myanmar, South Africa, Viet Nam, and Zambia. Preliminary assessments in these countries revealed major structural, managerial, and philosophical barriers to high-quality family planning services. In cases where assessments have indicated the feasibility of new method introduction, this has been implemented through a carefully phased, research-based process intended to encourage the development of appropriate managerial capacity and to promote a humanistic philosophy of care.
Assuntos
Anticoncepção , Atenção à Saúde/métodos , Países em Desenvolvimento , Serviços de Planejamento Familiar/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Organização Mundial da Saúde , África , Sudeste Asiático , Participação da Comunidade , Anticoncepção/métodos , Anticoncepção/psicologia , Anticoncepção/normas , Atenção à Saúde/organização & administração , Serviços de Planejamento Familiar/organização & administração , Liberdade , Implementação de Plano de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Cooperação Internacional , Modelos Organizacionais , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Formulação de Políticas , Desenvolvimento de Programas , Qualidade da Assistência à Saúde , América do SulRESUMO
OBJECTIVE: To examine the role of the intestinal mucosa in bacterial translocation, in vitro bacterial passage across ileal mucosal segments mounted in Ussing chambers were studied in control and endotoxin (lipopolysaccharide)-treated rats. DESIGN: Experimental study. MATERIALS AND METHODS: Three groups of rats were studied. The experimental group received an intraperitoneal injection of lipopolysaccharide, while controls received an equivalent volume of saline solution; a third group received no treatment. Twenty-four hours later, all groups underwent laparotomy and organ culture to assess bacterial translocation. At the same time, a segment of mucosa from the terminal ileum of each animal was mounted in a Ussing chamber, and the transmucosal passage of labeled Escherichia coli from the luminal to serosal surface was assessed by results of serial cultures. RESULTS: In vivo bacterial translocation occurred in 100% of the lipopolysaccharide-treated animals, significantly higher than the incidence seen in controls (25%; P < .05). In vitro passage of labeled E coli across ileal mucosa in the Ussing chamber occurred in 78% of lipopolysaccharide-treated animals, while in controls transmucosal passage was seen in only 14% (P < .05). Histologic examination of mucosa from both groups using light and transmission electron microscopy demonstrated no structural differences between groups. CONCLUSIONS: Increased permeability to bacteria at the mucosal level contributes to the bacterial translocation seen in endotoxemia.
Assuntos
Escherichia coli/fisiologia , Íleo/fisiologia , Mucosa Intestinal/microbiologia , Mucosa Intestinal/fisiologia , Lipopolissacarídeos/toxicidade , Animais , Permeabilidade da Membrana Celular/efeitos dos fármacos , Permeabilidade da Membrana Celular/fisiologia , Movimento Celular , Íleo/microbiologia , Técnicas In Vitro , Masculino , Distribuição Aleatória , Ratos , Ratos Sprague-DawleyRESUMO
BACKGROUND: Bacterial translocation is a process believed to result in nosocomial infections. Secretory IgA (sIgA) may have a role in the prevention of translocation by its ability to bind and aggregate bacteria, a function termed "immune exclusion." The present study was done to determine the effect of specific binding of sIgA to bacteria on the movement of these organisms across the intact epithelial membrane. STUDY DESIGN: Bacterial translocation across intact intestinal segments of rats were assessed in vitro using the Ussing model. Secretory IgA (0.25 mg per mL) from pooled human colostrum was added to the perfused segments of ileum in the Ussing system. Subsequently, the membranes were exposed to 5 x 10(9) cfu per mL Escherichia coli on their mucosal side. A second experiment tested the effect of human IgG when perfused with E. coli using the same preparation. All experiments had paired matched rats in a control group without immunoglobulin. The ability of sIgA and IgG to bind to E. coli was studied by an in vitro assay, as well as by transmission electron microscopy and immunofluorescence of random IgA/E. coli experiments. Measurements obtained in all experimental and control groups were the incidence and amount of bacterial passage and the potential difference generated by the intestinal segments (an index of viability). RESULTS: There were no differences in potential difference between control and experimental groups in either of the two experiments. Secretory IgA bound E. coli and completely prevented passage of E. coli as compared with rats in the control group. IgG bound E. coli; however, the incidence of passage was equal to that of rats in the control group. However, the presence of IgG resulted in a significantly reduced number of bacteria that passed when compared with controls (p < 0.05). Electron microscopic studies revealed intact surface morphology and immunofluorescence revealed aggregates of IgA and E. coli on the mucosal, but not submucosal, surface of the ileal membranes. CONCLUSIONS: This study provides direct evidence of immune exclusion by sIgA. When bound to bacteria, it prevents passage across a morphologically intact segment of viable intestinal tissue.
Assuntos
Escherichia coli/imunologia , Imunoglobulina A Secretora/fisiologia , Mucosa Intestinal/imunologia , Mucosa Intestinal/microbiologia , Animais , Imunofluorescência , Íleo/citologia , Íleo/imunologia , Íleo/microbiologia , Técnicas In Vitro , Masculino , Microscopia Eletrônica , Ratos , Ratos Sprague-DawleyRESUMO
Bone marrow transplantation is an accepted therapy for hematologic malignancies, aplastic anemia, metabolic disorders, and solid tumors. However, graft-versus-host disease (GVHD) and failure of engraftment have limited the widespread application of this technology to nonmalignant disease states. The use of purified bone marrow stem cells has been suggested as an approach to promote engraftment yet avoid GVHD. Although bone marrow stem cells, purified by cell sorting, engraft and repopulate lethally irradiated genetically identical recipients, they do not engraft in major histocompatibility complex (MHC)-disparate allogeneic recipients. We report for the first time the characterization of a novel cell population of donor bone marrow origin, separate from the hematopoietic stem cell, that facilitates engraftment of purified allogeneic bone marrow stem cells in an MHC-specific fashion without causing GVHD. Although 1,000 purified stem cells (c-kit+/Sca-1+/lineage-) reliably repopulate syngeneic mouse recipients, 10 times that number do not engraft in MHC-disparate allogeneic recipients. The addition of as few as 30,000 facilitating cells (CD8+/CD45R+/TCR-) is sufficient to permit engraftment of purified stem cells in MHC-disparate recipients. The cell surface phenotype of this purified cellular population differs significantly from other characterized lineages of lymphoid or myeloid origin. Based on multiparameter rare-events cell sorting, the facilitating fraction is CD8+, CD3+, CD45R+, Thy 1+, class IIdim/intermediate but alpha beta-TCR- and gamma delta-TCR-. This cellular population comprises approximately 0.4% of the total bone marrow and is separate from the hematopoietic stem cell. The coadministration of purified facilitating cells plus stem cells to optimize engraftment yet avoid GVHD may expand the potential application of bone marrow transplantation to disease states in which the morbidity and mortality associated with conventional BMT cannot be justified.
Assuntos
Células da Medula Óssea , Transplante de Medula Óssea , Sobrevivência de Enxerto , Transplante de Células-Tronco Hematopoéticas , Células-Tronco Hematopoéticas/imunologia , Imunofenotipagem , Animais , Medula Óssea/fisiologia , Complexo CD3/análise , Antígenos CD8/análise , Separação Celular , Citometria de Fluxo , Células-Tronco Hematopoéticas/citologia , Células-Tronco Hematopoéticas/fisiologia , Antígenos de Histocompatibilidade Classe II/análise , Antígenos Comuns de Leucócito/análise , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Microscopia Eletrônica , Receptores de Antígenos de Linfócitos T/análise , Antígenos Thy-1/análiseRESUMO
Pulmonary hypertension is a major complication of congenital diaphragmatic hernia (CDH). Inhaled nitric oxide (NO) is a selective pulmonary vasodilator because it produces vasodilatation of the pulmonary vasculature without systemic hypotension. In experimental and clinical studies, inhaled NO ameliorates pulmonary hypertension and improves gas exchange. The goal of the present study was to determine the extent to which infants with CDH respond to inhaled NO. Four newborn infants with CDH complicated by severe respiratory insufficiency and right-to-left shunting received inhaled NO. In three patients, postductal oxygenation improved in response to small concentrations of NO (5 to 10 ppm); two received NO after operative repair, and the third both before and after repair. However, tachyphylaxis developed in all cases within 1 to 6 days. A fourth patient received inhaled NO in an attempt at weaning from ECMO. He did not respond, remaining hypoxic despite 80 ppm NO, and continued to require ECMO. In the three patients who responded to inhaled NO, plasma nitrites and nitrates (stable oxidative end products of NO) accumulated over time, but not in the patient who did not respond. The accumulation of nitrite and nitrate in plasma may reflect alveolar-capillary NO absorption, and may identify patients who will respond to continued inhaled NO. Methemoglobin remained below 1.9% in all four babies. Selected infants with CDH may respond to NO, but the benefit may be temporary.
Assuntos
Hérnia Diafragmática/tratamento farmacológico , Hérnias Diafragmáticas Congênitas , Hipertensão Pulmonar/tratamento farmacológico , Óxido Nítrico/administração & dosagem , Administração por Inalação , Oxigenação por Membrana Extracorpórea , Feminino , Hérnia Diafragmática/complicações , Hérnia Diafragmática/cirurgia , Humanos , Hipertensão Pulmonar/etiologia , Recém-Nascido , Masculino , Insuficiência Respiratória/etiologiaRESUMO
OBJECTIVE: Nitric oxide (NO) is a potent biologic mediator produced by hepatocytes following exposure to cytokines and lipopolysaccharide (LPS). These cytokines are also known to regulate induction of the hepatic acute-phase response. The objective of this study was to determine whether inducible nitric oxide synthase (iNOS), the enzyme that produces NO, is expressed as part of the hepatic acute-phase response. DESIGN: The gene expression for inducible NOS (iNOS) as well as alpha 1-acid glycoprotein (AGP), an established acute-phase reactant, was measured by Northern blot analysis in rat hepatocytes in vivo during endotoxemia (LPS injection) and during the acute-phase response produced by hindlimb turpentine injection. Hepatocyte iNOS messenger RNA (mRNA) levels were correlated with iNOS activity and circulating plasma nitrite and nitrate levels. In vitro, iNOS and AGP mRNA levels were determined in cultured hepatocytes stimulated with interleukin 6 (IL-6), interleukin 1 beta (IL-1 beta), tumor necrosis factor alpha (TNF-alpha), or dexamethasone. RESULTS: The AGP mRNA levels were increased in vivo following both LPS and turpentine injection, while iNOS expression was induced only by LPS injection. Hepatocyte iNOS activity and plasma nitrite and nitrate levels also increased after LPS treatment. In vitro, the cytokine combination IL-6, IL-1 beta, and TNF-alpha induced hepatocyte iNOS expression but had minimal effects on AGP in the absence of dexamethasone. Addition of dexamethasone alone markedly increased AGP mRNA levels, with further increases seen with TNF-alpha or IL-1 beta addition. In contrast, dexamethasone decreased iNOS expression. CONCLUSION: The results show that hepatocyte iNOS expression is not part of the acute-phase response induced by remote inflammation and indicates that iNOS is differentially regulated from the acute-phase reactant, AGP.
Assuntos
Reação de Fase Aguda/enzimologia , Aminoácido Oxirredutases/biossíntese , Endotoxinas/efeitos adversos , Fígado/enzimologia , Orosomucoide/biossíntese , Reação de Fase Aguda/sangue , Aminoácido Oxirredutases/efeitos dos fármacos , Aminoácido Oxirredutases/genética , Animais , Células Cultivadas , Endotoxinas/sangue , Indução Enzimática , Escherichia coli , Regulação da Expressão Gênica , Regulação Enzimológica da Expressão Gênica , Interleucina-1/farmacologia , Interleucina-6/farmacologia , Lipopolissacarídeos/efeitos adversos , Lipopolissacarídeos/sangue , Fígado/citologia , Masculino , Nitratos/sangue , Óxido Nítrico/biossíntese , Óxido Nítrico Sintase , Nitritos/sangue , Orosomucoide/efeitos dos fármacos , Orosomucoide/genética , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa/farmacologia , Terebintina/efeitos adversosRESUMO
This study investigated the self-image of individuals who donate bone marrow to strangers as part of the National Marrow Donor Program. Quantitative surveys were administered to donors before donating (N = 849), shortly after donating (N = 754), and a year after donating (N = 370). In addition, 52 donors were interviewed in-depth by telephone at the same three points in time. Many of these donors felt that by donating bone marrow they were actualizing a central trait in their identity. Thus, many donors believed that they were distinct from others in the centrality of the traits of helpfulness and generosity to their identities. This belief often stemmed from a strong emphasis on helping in their families of origin. Other qualities activated by donation included religious identity, being a helping professional, and desire to be a role model. Self-evaluation appeared to have been enhanced for some donors due to the donation.
Assuntos
Transplante de Medula Óssea , Autoimagem , Doadores de Tecidos/psicologia , Altruísmo , Coleta de Dados , Família , Feminino , Comportamento de Ajuda , Humanos , Transplante de Rim , Masculino , Religião e Psicologia , Identificação Social , Inquéritos e Questionários , Estados UnidosRESUMO
In this study, we investigated the psychosocial effects of unrelated marrow donation. Survey questionnaires were administered pre-donation, shortly post-donation, and 1 year post-donation to all donors through the National Marrow Donor Program over a 3-year period. Univariate, bivariate, and multivariate analyses were then performed. Donors were generally quite positive about the donation 1 year post-donation: 87% felt it was "very worthwhile" and 91% would be willing to donate again in the future. Marrow donors were more likely than kidney donors to feel better about themselves as a result of the donation (P < .001). Donors with longer collection times, in general, had less positive psychosocial outcomes from the donation. Donors who experienced lower back pain or difficulty walking as a result of the donation were more likely to experience the donation as more stressful and painful than expected, but no more likely to experience it as less positive emotionally than donors who did not experience these side effects.
Assuntos
Transplante de Medula Óssea , Doadores de Tecidos/psicologia , Obtenção de Tecidos e Órgãos , Anestesia/efeitos adversos , Transplante de Medula Óssea/efeitos adversos , Comportamento do Consumidor , Feminino , Humanos , Masculino , Programas de Autoavaliação , Inquéritos e Questionários , Estados Unidos , VoliçãoRESUMO
Lipopolysaccharide binding protein (LBP) is a serum glycoprotein that complexes with lipopolysaccharide (LPS) to facilitate macrophage response to endotoxin. To determine the conditions that stimulate LBP production in vivo, we measured the induction of LBP in models of inflammation produced by LPS, Corynebacterium parvum, and turpentine injection. Plasma aspartate aminotransferase and alanine aminotransferase concentrations and hepatocyte fibrinogen synthesis were elevated in all models. Northern blot analysis revealed 17-, 14-, and 20-fold upregulation of hepatocyte LBP mRNA following treatment with LPS, C parvum, and turpentine, respectively. Peritoneal macrophage interleukin 6 and tumor necrosis factor production following endotoxin stimulation was augmented by cultured hepatocyte supernatants, suggesting increased LBP synthesis in these groups. The results show that LBP mRNA is induced during hepatic inflammation and suggest that LBP is an acute-phase protein important in regulating the in vivo response to endotoxin.
Assuntos
Proteínas de Fase Aguda , Bacteriemia/imunologia , Proteínas de Transporte/biossíntese , Hepatopatias/imunologia , Macrófagos/efeitos dos fármacos , Glicoproteínas de Membrana , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Bacteriemia/sangue , Bioensaio , Northern Blotting , Proteínas de Transporte/imunologia , Modelos Animais de Doenças , Endotoxinas/imunologia , Estudos de Avaliação como Assunto , Fibrinogênio/análise , Inflamação , Interleucina-6/biossíntese , Interleucina-6/química , Interleucina-6/imunologia , Hepatopatias/sangue , Hepatopatias/patologia , Macrófagos/química , Macrófagos/imunologia , Masculino , Peritônio/citologia , Sondas RNA , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa/biossíntese , Fator de Necrose Tumoral alfa/química , Fator de Necrose Tumoral alfa/imunologiaRESUMO
Intragraft levels of cytokine mRNA were studied in an orthotopic rat left lung transplant model. Three groups of rats were compared at 7 days after transplantation. Isogeneic (Lewis to Lewis), allogeneic (Brown-Norway to Lewis) untreated, and cyclosporine-treated (25 mg/kg/day, intramuscularly) allogeneic animals underwent analysis of cytokine mRNA isolated from total RNA in freshly excised grafts. Reverse transcription-polymerase chain reaction amplification of interleukin (IL)-2, IL-4, and actin (control) mRNA was performed with custom-synthesized oligonucleotide amplimers targeted to known sequences of rat IL-2 and IL-4 cDNA. Semiquantitative analysis was performed by radioanalytic scanning of gel preparations. Sample specimens from the retrieved grafts were also graded histologically for rejection on a five-point scale. Rejection was most severe in the untreated allografts (p < 0.003). IL-2 mRNA was significantly greater in the untreated allografts when compared with isografts (p < 0.05) and cyclosporine-treated allografts (p < 0.05). No significant differences in IL-4 mRNA between groups were observed. We conclude that semiquantitative analysis of cytokine mRNA by reverse transcription-polymerase chain reaction is a useful and sensitive method for the study of acute rejection in lung grafts and that this technique may become an important tool in future studies of cytokine-mediated responses in cyclosporine-treated allografts.
Assuntos
Actinas/genética , Ciclosporina/uso terapêutico , Rejeição de Enxerto/genética , Interleucina-2/genética , Interleucina-4/genética , Transplante de Pulmão/imunologia , RNA Mensageiro/metabolismo , Animais , Rejeição de Enxerto/diagnóstico , Terapia de Imunossupressão , Masculino , Reação em Cadeia da Polimerase , Ratos , Ratos Endogâmicos BN , Ratos Endogâmicos Lew , Fatores de Tempo , Transcrição GênicaRESUMO
BACKGROUND AND METHODS: Nitric oxide synthesis occurs both in vitro and in vivo in response to inflammatory stimuli and can have profound effects on the local cellular environment. Hepatocytes, Kupffer cells, and endothelial cells produce nitric oxide in vitro, but the in vivo role of this reactive mediator in the liver is unknown. We assessed the role of nitric oxide synthesis during endotoxemia in mice by inhibiting its synthesis with NG-monomethyl-L-arginine after lipopolysaccharide injection and by determining the effects of this inhibition on hepatic damage. RESULTS: Injection of lipopolysaccharide in mice increased plasma nitrite and nitrate concentrations, the stable end products of nitric oxide metabolism, and caused mild hepatic damage as measured by increased circulating hepatocellular enzyme levels. NG-monomethyl-L-arginine decreased plasma nitrite and nitrate values, but increased the lipopolysaccharide-induced hepatic injury. NG-monomethyl-L-arginine caused no hepatic damage when given without lipopolysaccharide. The extent of hepatic damage with NG-monomethyl-L-arginine was proportional to the dose of lipopolysaccharide used and could be reduced with concurrent administration of L-arginine but not D-arginine. CONCLUSIONS: Nitric oxide synthesis provides a protective function against lipopolysaccharide-induced liver injury that increases in importance as the degree of endotoxemia increases. The production of nitric oxide is, therefore, an important part of the liver's response to a systemic inflammatory stimulus.
Assuntos
Arginina/análogos & derivados , Bacteriemia/complicações , Hepatopatias/metabolismo , Óxido Nítrico/farmacologia , Doença Aguda , Animais , Arginina/administração & dosagem , Arginina/efeitos adversos , Arginina/antagonistas & inibidores , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Avaliação Pré-Clínica de Medicamentos , Feminino , Inflamação , Lipopolissacarídeos , Hepatopatias/diagnóstico , Hepatopatias/etiologia , Testes de Função Hepática , Camundongos , Camundongos Endogâmicos BALB C , Óxido Nítrico/sangue , Óxido Nítrico/metabolismo , ômega-N-MetilargininaRESUMO
The effect of congenital heart disease on early social relationships was assessed by observing 42 infants with the disease and 46 healthy infants in a standardized laboratory setting with their mothers. Significantly fewer infants with congenital heart disease, in comparison with healthy peers, were considered to have secure relationships with their mothers. The quality of the infant-mother relationship in the group with congenital heart disease was not related to parents' reports of their own stress or psychologic well-being. Severity of illness did not have a direct effect on the quality of the infant-mother relationship, but securely attached infants showed more subsequent improvement in health than insecurely attached peers showed. Attention to the infant-mother relationship in clinical care may improve the social development of babies with congenital heart disease and may have positive effects on physical health as well.
Assuntos
Cardiopatias Congênitas/psicologia , Relações Mãe-Filho , Pais/psicologia , Estresse Psicológico , Adulto , Escolaridade , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Estudos Prospectivos , Índice de Gravidade de DoençaRESUMO
Cytotoxic T lymphocytes (CTL) are believed to play an important role in the regression of advanced malignancies in response to adoptive immunotherapy with interleukin-2 (IL-2) and lymphokine-activated killer cells or tumor-infiltrating lymphocytes. Because the current limitations to the use of adoptive immunotherapy are the IL-2 dose-dependent toxicities and the difficulty in expanding the effector cell population, recent investigations have focused on the development of newer methods for generating CTL in vitro. IL-1 and IL-6 have been shown to synergistically promote thymocyte proliferation; however, their effect on CTL development has not been studied. We investigated the ability of these two cytokines to induce CTL development from immature thymocytes. Thymocytes from 5-week-old BALB/c mice were cultured for 72 hours in the presence of Con A and recombinant IL-1, IL-6, or IL-1 plus IL-6. Cytotoxicity against 51Cr-labeled P815 target cells was then measured in the presence of submitogenic doses of PHA. Neither IL-1 nor IL-6 induced a significant number of CTL from immature thymocytes. However, these two cytokines synergistically induced maximal CTL development. The monoclonal antibody to IL-4 completely abrogated CTL development induced by IL-1 and IL-6, but antibody to the IL-2 receptor had no effect. The data suggest that IL-1 and IL-6 can provide an additional method for in vitro CTL generation in adoptive immunotherapy of advanced tumors.
Assuntos
Interleucina-1/farmacologia , Interleucina-6/farmacologia , Linfócitos T Citotóxicos/fisiologia , Animais , Anticorpos Monoclonais/farmacologia , Células Cultivadas , Concanavalina A/farmacologia , Sinergismo Farmacológico , Feminino , Interleucina-2/farmacologia , Interleucina-4/farmacologia , Camundongos , Camundongos Endogâmicos BALB C , Proteínas Recombinantes/farmacologia , Linfócitos T Citotóxicos/efeitos dos fármacosAssuntos
Rejeição de Enxerto , Interleucina-4/genética , Transfusão de Linfócitos , Linfócitos T Auxiliares-Indutores/imunologia , Transplante Homólogo/imunologia , Animais , Southern Blotting , DNA/genética , Interleucina-4/biossíntese , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Reação em Cadeia da Polimerase , Baço/imunologiaRESUMO
A case of malignant (ciliary block) glaucoma apparently induced by a large posterior chamber intraocular lens (PC-IOL) is presented. The involved eye was small, with an axial length of 21.7 mm and a preoperative refractive error of +8.25 D. An uncomplicated extracapsular cataract extraction with implantation of a PC-IOL with a 7 mm optic was performed. Within 1 week postoperatively, malignant glaucoma developed, for which surgical intervention was required. We recommend avoiding implantation of PC-IOLs with large optics in certain small eyes, since these implants may be more likely than lenses with smaller optics to induce malignant glaucoma in such eyes.