Early time course of altered leukocyte response to lipopolysaccharide and peptidoglycan in porcine gunshot injury.

BACKGROUND: Penetrating injuries are frequently combined with polybacterial soiling. Clearance of the microorganisms depends on the ability to activate immune responses, but post-traumatic hyporeactivity of immune cells is almost universal. The aim of this study was to map the early time course of this altered leukocyte reactivity, and to compare the reactions to subsequent Gram-positive or Gram-negative challenges. METHODS: Twelve juvenile pigs sustained two standardized rounds, one through the right femur and one through the left upper abdomen. First aid treatment and acute surgery were started immediately. Blood samples were drawn before trauma and after 10, 30, 60, and 90 min, and thereafter stimulated in ex vivo whole blood for 3 h with lipopolysaccharide (LPS, 10 ng/ml), peptidoglycan (PepG, 1 microg/ml), or an equivalent amount of normal saline. The leukocyte response was evaluated by measurement of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, IL-6, IL-8, and IL-10 in the supernatant. RESULTS: In the post-traumatic in vivo serum, the concentration of TNF-alpha increased steadily (significant after 60 min). A reduced ex vivo reaction to LPS was evident after 10 min, and was statistically significant after 30 min. The lowest levels were reached after 90 min. The ex vivo synthesis of TNF-alpha after stimulation with PepG remained unaltered. A similar development was seen for IL-6. IL-1 beta levels did not change, while IL-8 increased significantly only after 60 and 90 min. CONCLUSIONS: Trauma almost instantaneously reprogrammed circulating leukocytes. As measured with TNF-alpha, a profound hyporeactivity to LPS, but not to PepG, was induced. In addition, no global down-regulation of leukocyte function was found after stimulation with LPS.

Capacity of glycine to modulate early inflammatory disturbances after serious gunshot injuries in the pig.

OBJECTIVE: Perturbation of immune homeostasis is an important determinant for organ dysfunction following multiple injuries. The aim of this study was to investigate the ability of glycine to influence the immediate post-traumatic inflammatory environment and altered reactivity of circulating leucocytes. MATERIAL AND METHODS: Twenty pigs were subjected to two standardized gunshots to the abdomen and thigh. Treatment was started immediately. The animals were randomized to receive either glycine 180 mg/kg i.v. over 30 min (n=10) or normal saline (n=10). Blood samples were drawn at baseline and 75 min after injury. In a follow-up study 12 pigs were exposed to an identical trauma. Blood was drawn at the same time-points and stimulated with lipopolysaccharide (LPS) or LPS plus glycine for 2 h in an ex vivo whole blood model. RESULTS: Selected physiologic variables and organ injury did not differ between groups 75 min after trauma. Reactive oxygen species decreased to 82.7+/-5.5 % of baseline (p<0.05) in the glycine group (unaltered in the controls). Liver glutathione concentrations decreased in parallel in both groups. In vivo production of TNF-alpha and IL-1-beta increased to the same extent regardless of treatment. Trauma induced a strong LPS tolerance. In whole blood challenged with LPS, glycine inhibited cytokine synthesis, but only in samples drawn at baseline. CONCLUSIONS: Post-traumatic infusion of glycine only modestly influenced the early post-traumatic inflammatory environment. Our ex vivo results confirm previous reports on the anti-inflammatory potential of glycine, but restricted to pre-trauma conditions.

Epidemic of louse-borne relapsing fever in Ethiopia.

During summer 1991 an outbreak of louse-borne relapsing fever occurred simultaneously in two transit camps established for prisoners of war being returned from Eritrea at the end of the Ethiopian civil war. Only antibiotic treatment was given at the Bahr Dar camp where the frequency of cases increased for 20 days. Vector control by delousing in addition to antibiotics was given at Mekele camp where the frequency of cases fell over a similar period. This difference was significant (p < 0.001). Furthermore, there was a significant correlation between the decreasing proportion of camp inhabitants that had not been deloused at Mekele camp each day and the numbers of patients with fever (r = 0.89, p < 0.001). Taken together, these results confirm that effective control of an epidemic of louse-borne relapsing fever is dependent on efficient vector control in addition to antibiotic treatment.

Subarachnoid anaesthesia: comparison of hyperbaric solutions of bupivacaine and amethocaine.

Hyperbaric solutions of 0.5% bupivacaine and 0.5% amethocaine (2 and 3 ml) were compared in a double-blind study of 40 patients receiving subarachnoid anaesthesia for urological surgery. The drugs produced similar and satisfactory analgesia in the tested concentrations and volumes. Motor blockade was more profound and longer lasting with amethocaine.

An unusual complication of lithotripsy.

The case described illustrates a most unusual course of events due to a perforation in the wall of the bladder during transurethral lithotripsy. Irrigation fluid forced its way retroperitoneally to the mediastinum. The differential diagnostic problems encountered are discussed.

Spinal analgesia with hyperbaric bupivacaine: effects of volume of solution.

The effects of 0.5% bupivacaine 1.5, 2 and 3 ml in 8% glucose was compared in a double-blind study involving 30 patients undergoing spinal analgesia. The time to the onset of maximum segmental spread of analgesia was approximately 15 min for all three volumes. Cephalad spread of analgesia was related to the volume used: 1.5 ml reached T10, 2 ml T8 and 3 ml T7. The duration of analgesia increased with increasing volume, 3 ml producing analgesia in T8-T12 for 1.5-2 h, and in the lumbar region for 2.5-3 h. Increasing the volume increased the extent of motor blockade and speeded up its onset. Significant decreases in arterial pressure were observed in the 2- and 3-ml groups. The changes in heart rate were moderate and not correlated with the amount of drug. Spinal headache occurred in two patients.