Interferon-alpha in the treatment of high-risk haemangiomas in infants.

BACKGROUND: Haemangiomas are benign tumours that may occasionally compress vital structures, or cause consumptive coagulopathy and heart failure. We describe our recent experience with interferon-alpha as a treatment modality for high-risk haemangiomas. PATIENTS AND METHODS: Eight children with high-risk haemangiomas were treated with interferon-alpha, six of which had failed previous steroid therapy. RESULT: Seven children responded to interferon therapy, one boy with a liver haemangioma died. Mild leucopenia and granulocytopenia were observed in all treated patients. Neurotoxicity occurred in 3 patients and was the most frequent serious complication. CONCLUSION: Interferon-alpha is an effective treatment modality for high-risk haemangiomas in children, especially in steroid-resistant patients. The most serious complication was early neurological toxicity.

CD14+CD16+ monocytes in the course of sepsis in neonates and small children: monitoring and functional studies.

The phenotype and function of peripheral blood monocytes change after trauma and during sepsis. The aim of the study was to evaluate monocyte expression of human leucocyte antigen (HLA)-DR and Fc receptor III (FcR III) (CD16) in neonates and small children with high risk of sepsis (hospitalized at the intensive care unit). The reduced proportion of CD14+HLA-DR+ monocytes was observed in all patients at the intensive care unit, while the increase of CD16 expression on monocytes was observed in the course of sepsis. The measurement of CD16 expression on monocytes also proved to be more useful for monitoring patient. The proportion of both CD14dimCD16+ and CD14highCD16+ monocytes increased during sepsis; however, monocytes showed reduced ability to phagocytose Escherichia coli, compromised ability to cooperate with T cells and reduced CD86 expression in parallel to HLA-DR depression. The reduced interleukin (IL)-1 but rather increased IL-10 production was associated with sepsis. The differences between CD14+CD16+ monocytes of healthy donors and patients with sepsis are discussed.

[Sevofluran in pediatric practice--personal experience]. / Sevofluran w praktyce pediatrycznej--doswiadczenia wlasne.

Sevofluran a new inhalational anesthetic is a preferred anesthetic agent for induction and maintenance of pediatric anesthesia because of its rapid induction, recovery characteristics and acceptable cardiovascular profile--now also accessible in Poland. Sevofluran isn't an ideal anesthetic, and the issue of postoperative excitement, potential nephrotoxicity requires clarification. This study was designed to compare the emergence characteristics of sevoflurane with halotane anaesthesia in paediatric patients having various surgical intervention. 102 children divided for subgroup of premedicated and nonpremedicated, underwent inhalation induction with nitrous oxide/oxygen and sevofluran or halotane. Incremental doses of either study drug were added until loss of eyelash reflex was achieved. We didn't use higher concentrations of sevoflurane than 5.5 Vol% and 3.5 Vol% for halothane. Sevoflurane patients has a greater incidence of emergence agitation.

[Postop pain treatment in children]. / Usmierzanie bólu pooperacyjnego u dzieci.

In last years there has been an increasing consideration of pain and it's treatment in children. Pain is difficult to measure precisely and reliably in children and this has led to the proliferation of a multiplicity of pain measurement scores for neonates, infants and children. Most pain measurement scores try to assign a numerical value to just one of these dimensions: cognitive, physiological, sensory, behavioural, affective, sociocultural and environmental factors all affect pain assessment. Anesthesiologists are adequately trained and sensitive to the manifestations of acute pain in various age groups and are experienced in intervening safely, effectively and appropriately to control the pain. All children should be regularly assessed for the presence of pain, its intensity and its cause. Titration of analgesia to control pain and documentation of the efficacy and adverse effects of pain management should be routine in all age groups. Whichever scoring system is used, the assessments should be repeated regularly, appropriate interventions should be prescribed and their effectiveness in reducing the pain severity should be regularly documented.

Acute cholesterol depletion inhibits clathrin-coated pit budding.

Many biologically important macromolecules are internalized into cells by clathrin-coated pit endocytosis. The mechanism of clathrin-coated pit budding has been investigated intensively, and considerable progress has been made in characterizing the proteins involved in internalization. Membrane lipid composition and the lateral organization of lipids and proteins within membranes are believed to play an important role in the regulation of membrane-trafficking processes. Here we report that membrane cholesterol plays a critical role in clathrin-coated pit internalization. We show that acute cholesterol depletion, using beta-methyl-cyclodextrin, specifically reduces the rate of internalization of transferrin receptor by more than 85%, without affecting intracellular receptor trafficking back to the cell surface. The effect on endocytosis is attributable to a failure of coated pits to detach from the plasma membrane, as visualized by using a green fluorescent protein-clathrin conjugate in living cells. Ultrastructural studies indicate that acute cholesterol depletion causes accumulation of flat-coated membranes and a corresponding decrease in deep-coated pits, consistent with the possibility that flat clathrin lattices are direct precursors of indented pits and endocytic vesicles in intact cells. We conclude that clathrin is unable to induce curvature in the membrane depleted of cholesterol.

Identification of an insulin-responsive, slow endocytic recycling mechanism in Chinese hamster ovary cells.

In adipocytes, the insulin-regulated aminopeptidase (IRAP) is trafficked through the same insulin-regulated recycling pathway as the GLUT4 glucose transporter. We find that a chimera, containing the cytoplasmic domain of IRAP fused to transmembrane and extracellular domains of the transferrin receptor, is slowly recycled and rapidly internalized in Chinese hamster ovary cells. Morphological studies indicate that the chimera is slowly trafficked through the general endosomal recycling compartment rather than being sorted to a specialized recycling pathway. A chimera in which a di-leucine sequence within the cytoplasmic domain of IRAP has been mutated to alanines is rapidly internalized and rapidly recycled, indicating that this di-leucine is required for the slow recycling but not for the rapid internalization. Insulin stimulates a 2-3-fold increase in the recycling of the chimera and only a 1.2-fold increase in the recycling of the transferrin receptor. The effect of insulin on the recycling of the chimera is blocked by wortmannin, a phosphatidylinositol 3'-kinase inhibitor. GTPgammaS (guanosine 5'-3-O-(thio)triphosphate) increases the recycling of the chimera by 50% but has no effect on the recycling of the transferrin receptor. In these studies, we have identified in Chinese hamster ovary cells a novel, slow endocytic recycling mechanism that is regulated by insulin.

Cerebellar stimulation reduces inducible nitric oxide synthase expression and protects brain from ischemia.

A focal infarction produced by occlusion of the middle cerebral artery (MCAO) in spontaneously hypertensive rats induced expression of inducible nitric oxide synthase (iNOS) mRNA, measured by competitive reverse transcription-polymerase chain reaction. The mRNA appeared simultaneously in the ischemic core and penumbra at 8 h, peaked between 14 and 24 h, and disappeared by 48 h. At 24 h, inducible nitric oxide synthase (iNOS)-like immunoreactivity was present in the endothelium of cerebral microvessels and in scattered cells, probably representing leukocytes or activated microglia. Electrical stimulation of the cerebellar fastigial nucleus (FN) for 1 h, 48 h before MCAO, reduced infarct volumes by 45% by decreasing cellular death in the ischemic penumbra. It also reduced by >90% the expression of iNOS mRNA and protein in the penumbra, but not core, and decreased by 44% the iNOS enzyme activity. We conclude that excitation of neuronal networks represented in the cerebellum elicits a conditioned central neurogenic neuroprotection associated with the downregulation of iNOS mRNA and protein. This neuroimmune interaction may, by blocking the expression of iNOS, contribute to neuroprotection.

Brief electrical stimulation of cerebellar fastigial nucleus conditions long-lasting salvage from focal cerebral ischemia: conditioned central neurogenic neuroprotection.

The cerebellar fastigial nucleus (FN) was electrically stimulated for 1 h in anesthetized rats and the middle cerebral artery occluded at various times thereafter. Stimulation of the FN but not dentate nucleus reduced the volume of the focal infarction to 50%. Protection persisted for 10 but disappeared by 30 d. Intrinsic neuronal pathways which function to condition central neurogenic neuroprotection can protect the brain from ischemic injury by processes independent of cerebral blood flow.

Brief electrical stimulation of cerebellar fastigial nucleus conditions long-lasting salvage from focal cerebral ischemia: conditioned central neurogenic neuroprotection

The cerebellar fastigial nucleus (FN) was electrically stimulated for 1 h in anesthetized rats and the middle cerebral artery occluded at various times thereafter. Stimulation of the FN but not dentate nucleus reduced the volume of the focal infarction to 50%. Protection persisted for 10 but disappeared by 30 d. Intrinsic neuronal pathways which function to condition central neurogenic neuroprotection can protect the brain from ischemic injury by processes independent of cerebral blood flow.

[Foreign bodies in respiratory tracts of children treated at the Institute of Pediatrics in Krakow during the years 1987-1991]. / Ciala obce w drogach oddechowych u dzieci leczonych w Instytucie Pediatrii w Krakowie w latach 1987-1991.

Foreign bodies aspirated into respiratory tract may produce severe lung damage and threaten life. We have analysed retrospectively symptoms, physical findings, chest roentgenograms and bronchoscopy reports in 20 children with foreign body aspiration. Boys dominated in this group. Foreign body aspiration often accompanied by coughing, wheezing and vomiting. In chest X-ray examination it was revealed unilateral body trapping and obstructive emphysema. Foreign body aspiration should be considered in children with prolonged respiratory tract problems even when no adequate history is present and with negative chest roentgenograms.

Characteristics of clinical isolates of Pseudomonas aeruginosa. I. Resistance to serum bactericidal effect and production of proteolytic enzymes.

136 strains of Pseudomonas aeruginosa were tested for human serum bactericidal effect. Hundred (73%) of clinical isolates were resistant and 36 (27%) were effectively killed by human (undiluted or even 1000 times diluted) serum. Fifty six out of 136 (41.1%) had proteolytic activity and parallelly were resistant to bactericidal activity of normal human serum. Among serum susceptible strains only 6 out of 136 (4.4%) had proteolytic activity.