Relative concentrations of endotoxin binding proteins in body fluids in children during pyogenic infection

The serum protein lipopolysaccharide-binding protein [LBP] binds to the lipid A component of bacterial endotoxin and facilitates its delivery to the CD 14 antigen on the macrophages, where proinflammatory cytokines are released and a cascade of host mediators is initiated. The neutrophil granular protein bactericidal/ permeability-increasing progein [B P1] competes with LBP for endotoxin binding and functions as a molecular antagonist of LBP-endotoxin interactions. We have measured concentrations of BPI and LBP in abscess cavities, enclosed infected body fluids, and non-infected body fluids from 36 children whose age ranged between 2 to 12 years [21 males and 15 females]. The mean values +/- SD of BPI/LBP in different body fluids were 12.12 +/- 5.11 in abscess cavities, 0.778 +/- 0.104 in infected body fluids, and 0.022 +/- 0.0624 in non-infected body fluids. The differences in BPI/LBP ratio between the three types of body fluids were highly significant [P < 0.0001]. The mean BPI concentrations was higher in the 8 abscess cavities that contained gram negative organisms than in the 8 with gram positive or no organisms [P<0.005]. BPI concentrations were directly correlated with the quantity of neutrophils within abscess fluids [rs = 0.844, P<0.001] and in infected body fluids [rs = 0.484, P<0.05]. In conclusion, BPI is available in sufficient quantities within abscess cavities for effective competition with LBP for endotoxin. BPI may attenuate the local inflammatory response and the systemic toxicity of endotoxin release during gram-negative infections

Adhesive small bowel obstruction: early dicision making

A 2-year study of 38 patients presenting with adhesive small bowel obstruction is carried out. They were 20 males and 18 females, their ages ranged between 20 and 56 years[mean 34.5]. The onset of symptoms was from 2 weeks to 11 years after the last celiotomy [mean 1 4/12 year]. The main presentation was abdominal pain [78.9%], abdominal distension [78.9%], Nausea/Vomiting [76.3%] and tachycardia [84.2%]. Full clinical assessment, laboratory studies and plain abdominal roentogram were done for all patients. Gastrograffin follow through series is done for 37 patients. Thirty patients [78.9%] have free passage of gastrograffin through whole gut, have their attacks subsided within 1-2 days by non-operative treatment and all were discharged in 2-4 days. One patient had emergency laboratory on basis of clinical data and plain abdominal roetogram suggestive of intestinal strangulation. Seven patients explored on basis of follow through study conclusive of complete obstruction. Their hospital stay ranged from 4-8 days. No mortality was detected in the series. We conclude that gastrograffin follow through series early in adhesive small bowel obstruction help in early decision making and may have some therapeutic role in partial small bowel obstruction. Also, early surgical intervention, when indicated, reduces mortality and morbidity