Basiliximab treatment for autoimmune bowel disease in a pediatric heart transplant patient.

Autoimmune-mediated bowel disease has been reported after pediatric heart transplantation. Recognition and treatment of these patients has been difficult. We describe a patient who responded to steroids and basiliximab therapy after an inflammatory process secondary to abnormal T-cell activation. Our patient is a 28-month-old female who received a heart transplant at five wk of age. At 24 months post-transplant, she developed fever and bloody stools. Initial investigations were significant for an elevated ESR (>120) and CRP (15.2). Symptoms persisted despite bowel rest and mycophenolate discontinuation. Endoscopic evaluation revealed discontinuous ulcerative disease involving esophagus, terminal ileum, right and left colon, necessitating extensive bowel resection. She had additional airway inflammation leading to a TEF at the site of esophageal ulceration, requiring tracheostomy. Immune evaluation revealed autoimmune dysregulation that responded to parenteral methylprednisolone. Chronic basiliximab therapy allowed for successful weaning of steroids with sustained remission. She has been transitioned to sirolimus and tacrolimus maintenance immunosuppression with plans to discontinue basiliximab once off steroids. In conclusion, bowel disease in the setting of pediatric heart transplantation can be severe and refractory to traditional treatment methods. Tailoring immune therapy to activated T cells can result in remission. Basiliximab therapy was used in our patient to maintain steroid-induced remission, but long-term complications of this disease process are unknown.

Fos rhythms in the hypothalamus of Rattus and Arvicanthis that exhibit nocturnal and diurnal patterns of rhythmicity.

This study compared patterns of Fos expression within the suprachiasmatic nucleus (SCN), the region immediately dorsal to the SCN (the lower subparaventricular zone, LSPV), and the supraoptic nucleus (SON) of grass rats (Arvicanthis niloticus) and lab rats (Rattus norvegicus). Among grass rats we also compared individuals exhibiting nocturnal and diurnal patterns of wheel running. In the SCN of both groups of grass rats, as well as laboratory rats, Fos was elevated during the light compared to the dark portions of the day, and was expressed in 7-12% of cells containing vasoactive intestinal polypeptide (VIP). Fos was higher in the LSPV during the night compared to the day in both forms of grass rats but not in laboratory rats. In the SON, Fos rose from day to night in the diurnal grass rats and in laboratory rats, but not in nocturnal grass rats. These patterns are consistent with the hypothesis that VIP cells in the SCN function similarly in nocturnal and diurnal rodents, but that the SON and the region dorsal to the SCN are associated with intra and interspecific differences in rhythmicity, respectively.

Electrophysiologic assessment of autonomic function in epilepsy.

Sudden unexpected death associated with epilepsy (SUDEP) is an important clinical problem. Peri-ictal autonomic dysfunction is thought to play a role in SUDEP and few means exist for clinical identification of patients at risk. Sympathetic function was assessed by measuring sympathetic skin responses (SSR) elicited in the hand by auditory or tactile stimulation or by inspiration. Parasympathetic function was assessed by recording the R-R interval (RRI) and determining its variability in subsequent heartbeats. Fifty epilepsy patients had significantly greater SSR amplitudes and latencies than controls. The RRI was shorter in patients than in controls and the mean successive difference (MSD) was less, but significance was not reached. Twenty patients at possible risk for SUDEP (male, generalized seizures, intermittent medication noncompliance, drug and alcohol abuse, traumatic or structural aetiology) differed significantly from controls in SSR and RRI. Epilepsy patients may differ in autonomic function from the general population, and these differences may be relevant to SUDEP. The SSR and the RRI may be a simple means of assessing autonomic function in epilepsy outpatients.

Comparison of monoamine oxidase in golden hamster islets and insulinoma.

We compared the properties of monoamine oxidase (MAO) in hamster islets and insulinomas. The tryptamine concentration at which the monoamine oxidase velocity was half maximal (Km) was higher in islets than insulinomas; the maximal velocity (Vmax) of monoamine oxidase was greater in islets than insulinomas. Both islet and insulinoma are more sensitive to inhibition by pargyline than clorgyline. After pargyline administration the monoamine oxidase activity of insulinoma returns faster than activity of islets. This may occur because both synthesis of new MAO in pre-existing cells and formation of new cells occurs in the insulinoma.