Inflammatory mediators in adults undergoing cardiopulmonary bypass: comparison of centrifugal and roller pumps.

BACKGROUND: The nonocclusive centrifugal pump is used for cardiopulmonary bypass (CPB) and mechanical cardiac assistance. This study examined its impact on proinflammatory cytokine release. METHODS: Forty-one patients undergoing elective coronary artery bypass grafting were randomized prospectively to either a standard roller pump group (n = 21) or a centrifugal vortex pump group (n = 20) for CPB. The two groups were well matched in age, sex, severity of disease, and duration of CPB and aortic cross-clamping. Plasma levels of the cytokines tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, and interleukin-8, as well as terminal complement, neutrophil counts, and leukocyte elastase, were analyzed before, during, and after CPB. RESULTS: In both groups, traces of tumor necrosis factor-alpha were observed infrequently and interleukin-1beta was not detected. Plasma levels of interleukin-6 and interleukin-8 increased during and after CPB, reaching a peak at 2 hours after protamine administration in both groups before returning toward baseline at 24 hours. The release of interleukin-6 was significantly greater in the centrifugal group (p < 0.05), whereas the interleukin-8 concentration did not differ between the groups throughout the study period. Levels of terminal complement increased in both groups perioperatively, reaching a peak 30 minutes after protamine administration, whereas neutrophil counts and elastase peaked 2 hours after protamine administration. Plasma terminal complement, neutrophil counts, and elastase release were significantly higher in the centrifugal group (p < 0.05). Peak terminal complement correlated (r = 0.64, p < 0.01) with peak elastase in the centrifugal group only. CONCLUSIONS: This study confirms the proinflammatory nature of CPB in adults and demonstrates that use of the centrifugal pump induces a greater systemic inflammatory response than use of the standard roller pump.

Derivation of the sequence of the signal peptide in human C4b-binding protein and interspecies cross-hybridisation of the C4bp cDNA sequence.

A 5' cDNA clone coding for human C4b-binding protein (C4bp) was isolated, characterised and sequenced to complete the cDNA sequence coding for residues 1-32 thus confirming the protein sequence data of Chung et al. [(1985) Biochem. J. 230, 133-141]. The sequence extended to allow derivation of the putative leader peptide sequence which was 32 residues in length and showed a high of hydrophobicity typical of other documented leader sequences. Cross hybridisation was detected between the human C4bp cDNA probes and genomic DNA isolated from various species on Southern blots suggesting that genomic sequence homologous to that coding for C4bp has been conserved during evolution.

Miliary tuberculosis presenting as adult respiratory distress syndrome.

We report the history of a 27-year-old Caucasian girl who died of adult respiratory distress syndrome secondary to miliary tuberculosis (MTB), after treatment with antibiotics to which the organism was sensitive, and a long period of ventilation. This case emphasises the importance of considering MTB as the cause of respiratory failure when another aetiology is not apparent.

Studies on the structure of the human C4b-binding protein gene.

Protein and cDNA sequence data have shown human C4b-binding protein to contain eight internally homologous repeat units, each approx. 61 amino acids in length. Repeat units conforming to the same consensus sequence have been found in other complement and non-complement proteins. Southern blot analysis together with isolation, characterisation and sequencing of genomic clones has allowed the study of intron/exon organisation in the human C4b-binding protein gene and the identification of a Bg/II restriction fragment length polymorphism.