Corticosteroids increase blood interleukin-10 levels during cardiopulmonary bypass in men.

BACKGROUND: Interleukin (IL)-10 is a potent antiinflammatory cytokine inhibiting the release of tumor necrosis factor--alpha (TNF-alpha) and IL-8 by activated macrophages and polymorphonuclear leukocytes. Cardiopulmonary bypass (CPB) represents a unique situation where an inflammatory reaction is predictably induced. The present study examined the influence of CPB on the release of TNF-alpha, IL-1 beta, IL-8, and IL-10 and also defined the effects of pretreatment with corticosteroids on the release of these cytokines. METHODS: The study included 22 patients undergoing coronary artery bypass graft operations, including eight control patients and seven patients who received dexamethasone, and seven patients who received methylprednisolone 4 hours before the operation. Cytokines were measured with the enzyme-linked immunosorbent assay technique before treatment, before anesthesia induction, immediately before heparin administration, before aorta declamping, 10 minutes and 90 minutes after aorta declamping, and 4 hours after the end of CPB. RESULTS: In the control patients the TNF-alpha levels and especially the IL-8 levels increased during CPB and reached their maximal levels 4 hours after CPB. IL-10 levels rose moderately and transiently, reaching peak values 90 minutes after aorta declamping. Notably, administration of corticosteroids prevented IL-8 release but increased IL-10 levels, which were tenfold higher than in the control group 90 minutes after aorta declamping (dexamethasone, 271 +/- 128 pg/ml; methylprednisolone, 312 +/- 213 pg/ml; control, 17 +/- 12 pg/ml, p < 0.05). IL-1 beta was not detected in any group of patients. CONCLUSIONS: The present data indicate that IL-10 is released together with proinflammatory cytokines during and after CPB and that pretreatment with corticosteroids markedly enhances this release. The release of IL-10 may play an important role in the antiinflammatory effects of corticosteroids.

Prolonged infusion of atracurium in an infant.

Atracurium is a neuromuscular blocking agent that spontaneously degrades by Hoffmann reaction. This study of a prolonged infusion (7 days) in an infant of 6 months shows an increase in infusion rate requirement from 0.7 mg/kg/h after 96 h of infusion to 1.8 mg/kg/h at the 7th day. The plasma laudanosine levels remained relatively constant (977-1,515 ng/ml) and well below the reported potent convulsive levels during the study despite a 3-fold increase in the atracurium requirement. No side effect or accumulation of the drug was observed. The reasons for the increase in atracurium requirement are discussed.

[Primary neuraminidase deficiency with prenatal disclosure]. / Déficit primitif en neuraminidase à révélation anté-natale.

The authors report a case of infantile sialidosis with hydrops fetalis and heart failure. At birth the baby presented a dysmorphic syndrome with histological anomalies. A storage disease with deficiency of neuraminidase activity, sialidosis type II, was confirmed. Amniocentesis with sialic-acid dosage or thin-layed chromatography seems necessary in hydrops fetalis with heart failure of unknown origin.

[Neonatal Caffey-Silverman disease with thrombocytosis, increase in C-reactive protein and immunoglobulins]. / Maladie de Caffey-Silverman néonatale avec thrombocytose, augmentation de la C-réactive protéine et des immunoglobulines.

An unusual case of Caffey-Silverman's disease with thrombocythemia and increased type M immunoglobulins and C-reactive protein levels is reported. These particularities were rarely reported in the literature. These conditions suggest that control should be exercised before steroid treatment in view of the known thrombocythemic effect of the drug. These hematologic abnormalities suggest that this syndrome is infectious in origin and emphasize the risk of steroid treatment.