Bilateral multifocal renal oncocytoma--a case report and literature review.

A case of bilateral multifocal renal oncocytoma is reported. The incidence, diagnosis and management of such tumors is discussed.

Interleukin-6-induced protection in hyperoxic acute lung injury.

Hyperoxic lung injury is commonly encountered in patients who require treatment with high concentrations of inspired oxygen. To determine whether interleukin (IL)-6 is protective in oxygen toxicity, we compared the effects of 100% O(2) in transgenic mice that overexpress IL-6 in the lung and transgene (-) controls. IL-6 markedly enhanced survival, with 100% of transgene (-) animals dying within 72 to 96 h, 100% of transgene (+) animals living for more than 8 d and more than 90% of transgene (+) animals living longer than 12 d. This protection was associated with markedly diminished alveolar-capillary protein leak, endothelial and epithelial membrane injury, and lung lipid peroxidation. Hyperoxia also caused cell death with DNA fragmentation in the lungs of transgene (-) animals and IL-6 markedly diminished this cytopathic response. The protective effects of IL-6 were not associated with significant alterations in the activities of copper/ zinc superoxide dismutase (SOD) or manganese SOD. They were, however, associated with the enhanced accumulation of the cell-death inhibitor Bcl-2, but not the cell-death stimulator BAX, and with the heightened accumulation of the cell-death regulator tissue inhibitor of metalloproteinase-1 (TIMP-1). These studies demonstrate that IL-6 markedly diminishes hyperoxic lung injury and that this protection is associated with a marked diminution in hyperoxia-induced cell death and DNA fragmentation. They also demonstrate that this protection is not associated with significant alterations in SOD activity, but is associated with the induction of Bcl-2 and TIMP-1.

Paediatric burns in Iceland. Hospital admissions 1982-1995, a populations based study.

Epidemiological data of 290 children admitted to the Paediatric Department, University Hospital of Iceland, over a 14 year period, 1982-1995, are presented. The sex ratio boys/girls was 1.6. 72.8% were children four years and younger. Hot fluids was the most common cause of burn injuries, mostly caused by geothermal hot water. Only one child suffered from electricity burn injuries and none from corrosives. Most of the accidents occurred at home (81.4%). A decreasing number of children suffering from electricity and corrosive burn injuries reflects heightened awareness and improved safety in the home. We found a significant increase in the incidence of hot fluid burn injuries in Icelandic children compared to previous studies. This calls for preventive measures with regard to geothermal and other hot water burns in Icelandic children.

Targeted lung expression of interleukin-11 enhances murine tolerance of 100% oxygen and diminishes hyperoxia-induced DNA fragmentation.

Acute lung injury is a frequent and treatment-limiting consequence of therapy with hyperoxic gas mixtures. To determine if IL-11 is protective in oxygen toxicity, we compared the effects of 100% O2 on transgenic mice that overexpress IL-11 in the lung and transgene (-) controls. IL-11 markedly enhanced survival in 100% O2 with 100% of transgene (-) animals dying within 72-96 h and > 90% of transgene (+) animals surviving for more than 10 d. This protection was associated with markedly diminished alveolar-capillary protein leak, endothelial and epithelial membrane injury, lipid peroxidation, and pulmonary neutrophil recruitment. Significant differences in copper zinc superoxide dismutase and catalase activities were not noted and the levels of total, reduced and oxidized glutathione were similar in transgene (+) and (-) animals. Glutathione reductase, glutathione peroxidase, and manganese superoxide dismutase activities were slightly higher in transgene (+) as versus (-) mice after 100% O2 exposure, and IL-11 diminished hyperoxia-induced expression of IL-1 and TNF. Hyperoxia also caused cell death with DNA fragmentation in the lungs of transgene (-) animals and IL-11 markedly diminished this cell death response. These studies demonstrate that IL-11 markedly diminishes hyperoxic lung injury. They also demonstrate this protection is associated with small changes in lung antioxidants, diminished hyperoxia-induced IL-1 and TNF production, and markedly suppressed hyperoxia-induced DNA fragmentation.

[The epidemiology of serious burn injuries in Iceland 1988-1992.].

INTRODUCTION: Due to widespread access to hot water in Iceland it has been suspected that the incidence of burn injury is higher compared to other countries. The epidemiology of severe burn injury needing hospitalization was studied. MATERIAL AND METHODS: The files of all patients who were diagnosed with burn injury and admitted to the four largest community hospitals in Iceland were retrospectively reviewed. Only those 266 patients admitted primarly because of the burn injury were included. The incidence of severe burn injury needing hospitalization was 20.5/100.000/year. RESULTS: Scald burns were most common and children younger than five years old were more prone to such burns than older patients. Tap-water burns are considerable more common in Iceland compared to other countries. In the relatively few hot spring water burns, 72.8% of the victims were foreign tourists. The main findings are that one third of all severe burns needing hospitalization in Iceland occur in children younger than five years old. The incidence of burns seems to be similar to reported series. More than half of all burns needing hospitalization in Iceland are scald burns and the incidence of burns due to tap water is higher in this country than elsewhere. CONCLUSION: We conclude that it should be possible to reduce the risk of severe burn injuries in Iceland through education campaigns and also by legislating maximum temperature of the tap-water at 52-54 degrees C.

[Burn injuries in children in Iceland between 1982-1995.].

OBJECTIVE: To increase our knowledge of burn injuries in children in Iceland and to induce education and prevention in order to reduce the incidence of burn injuries among children. MATERIAL AND METHODS: Data was collected from hospital records of all children 15 years and younger admitted with burn injuries to the University Hospital of Iceland, Paediatric Department, from 1982-1995. RESULTS: There were 290 children admitted, 179 boys and 111 girls, sex ratio 1.6. Children four years and younger were 72.8%. Approximately 21 children were admitted annually. Seasonal variation was noted with most admittances in December. The times when the injuries occurred peaked at lunch and dinner times. Scalds was most common, hot water caused 45.8% of the burn injuries, most frequently due to bathwater (15.2%). Hot liquids caused 26.9%, most often caused by coffee-, tea- and cacao drinks (19.3%). Flames caused 12.4% of the burn injuries, fireworks 5.5% and hot object 5.2%. Most of these accidents occurred at home (81.4%). CONCLUSION: Children four years and younger are most susceptible for burn injuries. Hot water and liquids caused most of these burn injuries. Burn injuries are common in childhood. Our data provide basis for better prevention.

Interleukin-11: stimulation in vivo and in vitro by respiratory viruses and induction of airways hyperresponsiveness.

To address the role of IL-11 in viral airways dysfunction, we determined whether infectious agents that exacerbate asthma stimulate stromal cell IL-11 production, determined whether IL-11 could be detected at sites of viral infection and evaluated the effects of IL-11 on airway physiology. Respiratory syncytial virus (RSV), parainfluenza virus type 3 (PIV3), and rhinovirus (RV) 14 were potent stimulators while cytomegalovirus and adenovirus only weakly stimulated and herpes simplex virus type 2 and bacteria did not stimulate IL-11 elaboration. IL-11 was not detected or barely detected in nasal aspirates from children without, but was detected in aspirates from children with viral upper respiratory tract infections. The levels of IL-11 were highest in patients with clinically detectable wheezing. IL-11 also caused nonspecific airways hyperresponsiveness in BALB/c mice. These studies demonstrate that three major causes of viral-induced asthma, RSV, RV, and PIV, in contrast to other viruses and bacteria, share the ability to induce stromal cell IL-11 production. They also demonstrate that IL-11 can be detected in vivo during viral respiratory infections, that the presence of IL-11 correlates with clinical bronchospasm and that IL-11 is a potent inducer of airways hyperresponsiveness. IL-11 may be an important mediator in viral airways disorders.

Rhinovirus stimulation of interleukin-6 in vivo and in vitro. Evidence for nuclear factor kappa B-dependent transcriptional activation.

To further understand the biology of rhinovirus (RV), we determined whether IL-6 was produced during RV infections and characterized the mechanism by which RV stimulates lung cell IL-6 production. In contrast to normals and minimally symptomatic volunteers, IL-6 was detected in the nasal washings from patients who developed colds after RV challenge. RV14 and RV1A, major and minor receptor group RVs, respectively, were potent stimulators of IL-6 protein production in vitro. These effects were associated with significant increases in IL-6 mRNA accumulation and gene transcription. RV was also a potent stimulator of IL-6 promoter-driven luciferase activity. This stimulation was modestly decreased by mutation of the nuclear factor (NF)-IL-6 site and abrogated by mutation of the NF-kappa B site in this promoter. An NF-kappa B-DNA binding activity, mediated by p65, p50, and p52 NF-kappa B moieties, was rapidly induced in RV-infected cells. Activator protein 1-DNA binding was not similarly altered. These studies demonstrate that IL-6 is produced during symptomatic RV infections, that RVs are potent stimulators of IL-6 elaboration, and that RV stimulation IL-6 production is mediated by an NF-kappa B-dependent transcriptional stimulation pathway. IL-6 may play an important role in the pathogenesis of RV infection, and NF-kappa B activation is likely to be an important event in RV-induced pathologies.

A PC-controlled module system for automatic sample preparation and analysis.

A simple automatic analytical system, consisting of separate modules, for liquid chromatography has been constructed. The different parts of the automatic machine are an auto sampler, an auto dispenser, a selector valve with eight channels, a heater/cooler, a mixing chamber and a pressure air driven injector valve. The process was controlled by a PC from an easily changeable run protocol. The system was applied to analysis of primary amines. The analysis was performed as a pre-column derivatization reaction of the amines and separation by isocratic reversed-phase HPLC with fluorescent detection. Reproducibility and analytical precision have been studied. Comparison between automatically and manually made derivatization reaction and injection was also made. The automatic system was easy to handle, cost-effective and gave good reproducibility.

Epithelial interleukin-11. Regulation by cytokines, respiratory syncytial virus, and retinoic acid.

Interleukin-11 (IL-11) is a pleiotropic cytokine with effects that overlap with IL-6. To determine if IL-11 is produced by epithelial cells, we determined whether human alveolar A549 cells and airway 9HTE cells produce IL-11. We also determined whether retinoic acid (RA) altered this IL-11 production. Unstimulated cells produced low levels of IL-11, while IL-1, transforming growth factor (TGF-beta 1), and respiratory syncytial virus (RSV) stimulated IL-11 protein production and mRNA accumulation in a time- and dose-dependent fashion. IL-1 and TGF-beta 1 also interacted in a synergistic, and presumedly transcriptional, fashion since they augmented A549 cell IL-11 protein production and mRNA accumulation without altering IL-11 mRNA half-life. In contrast, IL-4 only weakly stimulated, and IL-7, hepatocyte growth factor, and herpes simplex virus Type 2 did not stimulate, IL-11 production. RA did not alter the IL-11 production of unstimulated or RSV infected cells. It did, however, inhibit rIL-1-stimulated and synergistically augment TGF-beta-stimulated IL-11 production. Thus, IL-1, TGF-beta, and RSV stimulate epithelial-like cell IL-11 production, and RA regulates these inductive processes in a stimulus-specific fashion.

Airway management in respiratory emergencies.

Securing the airway is an important first step in respiratory emergencies. In this article, general principles of airway management are reviewed. The techniques of tracheal intubation, including surgical routes of airway access, are discussed in reference to special circumstances that can arise in acute airway management.

Computerized capillary gas chromatographic analysis of hydrocarbon mixtures in workplace air.

The quantitative composition of white spirit vapours in workplace air may differ considerably from the solvent being used, although all components are the same. By calculating the hygienic effect from the threshold limit value (NGV) of each component, a more reliable estimate is obtained of the occupational hazard than by using the NGV for white spirit. In this method the analyses were performed by on-column injection onto a temperature-programmed capillary column. Retention indices based on n-paraffins and isooctane were calculated using spline functions. Index tables were established for different hydrocarbon mixtures. The validity of the retention indices was found to be satisfactory, depending on the stability of the column and the possibility of optimizing the indices when replacing one column by another of the same type and dimensions. Comparisons were made with alternative methods for determining the concentration of white spirit vapours in air samples. A polar column was used to check the total content of aromatics.

Advanced cardiac life support in the prehospital setting: the Reykjavik experience.

Since 1982 a mobile emergency care unit (emergency ambulance) manned by a physician has been operated in Reykjavik. During 1982-1986 there were 138 attempted resuscitations in sudden cardiorespiratory arrest from cardiac causes. Twenty-four patients (17%) were discharged home, all but one without mental impairment. Seventy-three patients presented with ventricular fibrillation, 21 (29%) of which were discharged. The mean ambulance response time was 5 min. Bystanders initiated cardiopulmonary resuscitation (CPR) in 40 cases (29%) which significantly improved the outcome. In witnessed arrests, 19 of 36 patients (53%) with bystander-initiated CPR were discharged compared to 5 of 62 patients (8%) where CPR awaited the arrival of the ambulance team. These results are comparable to those obtained in larger metropolitan areas. In small urban areas the size of Reykjavik (population of 110,000), an advanced and efficient prehospital care can be organized as an extension of the emergency departments role.

Streptococcal gangrene of the eyelids. Case reports.

Following a brief review of the literature, three patients with fulminating periocular infections resulting in necrosis of the eyelids are reported on. The case histories demonstrate certain common features, different aetiological factors and diverse end results. The pathogenesis, microbiology and treatment are discussed.

Repair of the contracted eye socket using a flap from the upper eyelid.

Repair of the contracted eye socket with a flap from the upper eyelid is proposed. The availability of nearby tissue with good blood supply could make this a method of choice in many patients with this condition.