Is it worthy to perform appendectomy laparoscopically: clinical outcome and interleukin response

Laparoscopic appendicectomy [LA] was found to be as .safe as open appendicectomy [OA]. However, LA was also found to have higher cost than OA, Surgical injury and sepsis are known factors which stimulate the production and the release of a variety of cytokines that reflect the degree of stress, The aim of the present study was to find out if LA is less invasive than OA in terms of clinical outcome and interleukin response. Thirty patients clinically diagnosed as acute appendicitis were prospectively studied. Eight cases proved to have another pathology were excluded from the immunological study The two groups with proved acute appendicitis are: Group I [12 patients] operated upon by open approach and group II[10 patients] operated upon laparoscopically Assays for IL-1beta, IL-4 and IL-15 were performed by highly .sensitive in-house protocols assorted developed and standardized in our lab. The results showed an increase in IL-1 beta from preoperative level to a higher 2 hours level, thereafter the value declined. The values are higher in open surgery than in laparoscopic operations' although the difference did not reach statistical significance. IL-4 showed a decrease in open surgery and rather stable results in laparoscopic operations. IL-15 showed a blunted decrease to the lowest detectable level of the assay of 2pg/ml. Patients in groups II had shorter hospital stay, earlier return to activities and less wound infection. Laparoscopy allowed easier exploration and dealing with detected pathology. Based on the results of the present study, the laparoscopic technique is less stressfull. However it remains more expensive and needs more expertise. Moreover, it offers an extra value in doubtful diagnosis as it allows better abdominal exploration

Association of interleukin-1 and and respiratory syncytial virus infection: a possible role in the pathogenesis of bronchial asthma in children

Bronchial asthma is considered an ongoing inflammatory process. Respiratory syncytial virus infection early in life may be the cause of the airway hyperresponsiveness. Many factors take part in the pathogenesis. The proinflammatory Interleukin-[1] alpha [IL-[1]alpha] seems to have a critical initiating role. The aim of this study was to assess the IL-[1]alpha level and R. S. V. antigen in the nasopharyngeal secretion of respiratory tract infected [wheezing and non-wheezing] children and the possible associations among several factors leading to the development of bronchial asthma. The present work is a cross-sectional cohort study on one hundred children attending Allergy Outpatient Clinic of New Children Hospital, Cairo University. All children were subjected to full routine investigations as well as to some immunological parameters. They were divided into 3 groups. Group [I] was formed of 50 children who suffered from acute respiratory infections with wheezes [asthmatics], most probably due to respiratory syncytial virus, [R.S.V.]; group [II] comprised 30 children, they were chronic asthmatic who came for follow up and were apparently free from any infections or wheezes and finally group [III] was formed of 20 children, they were not asthmatic but were suffering from viral respiratory infection with no wheezes. The 3 groups were examined for antigen detection of R.S.V. and Interlukin-[1]alpha was assessed by solid phase enzyme immunoassay in nasopharyngeal secretions in a trial to find out any association [correlation] in order to evaluate the pathophysiological events occurring in the microenvironment of the infected airway epithelium. The results were as such: - In group [I]: R.S.V. was significantly positively correlated with Interleukin-[1]alpha level [[54.7 +/- 64.3] pg/ml], [r = 0.486]. Also it was significantly positively correlated with the presence of infection [clinically] [r = 0.611, P < 0.001]. The graded level of Interleukin-[1]alpha was positively correlated with clinically diagnosed infection and also with the presence of R.S.V. [r = 0.673, P < 0.001] In group [II]: There was no correlation between R.S.V. and the severity of asthma, IL-[1]alpha level [mean level of IL-[1]alpha = [3.9 +/- 4.4] pg/ml] or clinically diagnosed infection. There was no correlation between IL-[1]alpha and total leucocytic count [TLC], Ig[E] level, Ig[G] level and mean absolute eosinophilic count. In group [III]: There was no correlation between R. S. V. and the severity of asthma, Interleukin-[1]alpha level [[41.2 +/- 57.5]pg/ml], or clinically infection. Also there was no correlation between IL-[1]alpha level and mean T.L.C, mean absolute eosinophilic count, Ig[G] level and Ig[E] level

Humoral immunity in sickle cell anaemia

Sickle cell anaemia, a haemoglobinopathy with serious impacts represents a health challenge in the developing world. Patients are particularly susceptible to repeated infections that may endanger their lives. In this study 83 adults and 30 children were included. Cross-sectionally, serum immunoglobulins [Ig[G], Ig[A] and Ig[M]] and complement factors [C[3]and C[4]] were assessed. In addition prospectively all subjects were immunized by Hepatitis [B] vaccine [Recombinant Hepatitis [B] virus surface antigen] and the immune response was evaluated and followed up by antibodies to the selected antigen. Only serum Ig[A] was elevated in all sickle cell disease and sickle cell trait groups when compared to age matched healthy relatives and Serum Ig[M] was decreased only in sickle cell disease children group. The sickler groups showed close numbers of responders compared to controls in adult groups. The results denoted a possible quantitative difference in the level of Hepatitis [B] virus surface antibody. Further studies to delineate the implicated mechanisms in the immunodeficiency are suggested. Chemoprophylaxis and immunoprophylaxis are highly recommended, meanwhile