S Taniguchi

Tumor necrosis factor-α and tumor necrosis factor receptor I, II levels in patients with severe burns

Abstract Tumor necrosis factor α (TNF-α) and tumor necrosis factor receptor I and II (TNFRI and TNFRII) were studied in 24 burn patients who had a total burn surface area (TBSA) of 50.2±20.4%. Immediately after the injury, both the TNFRI and TNFRII levels correlated significantly with TBSA ( r =0.7344, P r =0.6074, P =0.0012). The TNFRI and TNFRII levels immediately after the injury were significantly higher in the 11 patients who later died of their burns than in the 13 patients who survived (0.8±0.4 ng/ml vs. 1.8±0.7 ng/ml, P =0.0002; 2.3±1.1 ng/ml vs. 4.5±1.6 ng/ml, P =0.0009). The TNF-α levels immediately after the injury did not differ significantly between the group that survived and the group that died. The TNFRI and TNFRII values for the entire follow-up period also correlated significantly with TBSA. Peak TNFRI and TNFRII levels were significantly higher in the group that died than in the group that survived (6.0±4.7 ng/ml vs. 14.1±7.8 ng/ml, P =0.0009; 7.0±5.1 ng/ml vs. 16.7±5.2 ng/ml, P =0.0003). The TNF-α levels correlated significantly with both the TNFRI and the TNFRII levels. The TNFRI and TNFRII levels thus closely reflected the severity of the burns in both the acute postburn period and the subsequent follow-up period. In other words, these parameters well reflected the severity and outcome of the burns, irrespective of the presence or absence of accompanying infection.

Plasma levels of type II phospholipase A2 and nitrite/nitrate in patients with burns

Type II phospholipase A2 (type II PLA2), nitrite/nitrate (NOx), tumor necrosis factor-alpha (TNF-alpha) and endotoxin were studied in burn patients. Type II PLA2 values and NOx values were both significantly higher in the group that died, the group with shock as a complication and the group with multiple organ dysfunction syndrome (MODS) as a complication, than in the group that survived, the group without shock as a complication and the group without MODS as a complication, respectively. The results suggested that type II PLA2 and nitric oxide (NO) may play a major role in the pathology of burn patients. Significant correlations were found between TNF-alpha and type II PLA2 values and between type II PLA2 and NOx values, suggesting the possibility of involvement in each others production.

Nuclear matrix protein levels in burn patients with multiple organ dysfunction syndrome

In this study, we investigated multiple organ dysfunction syndrome (MODS) and nuclear matrix protein (NMP), which is an indicator for apoptosis, in burn patients. The subjects were 17 patients with a total burn surface area (TBSA) of 26% or more. Eight of them had MODS, and nine did not. Seven patients died, and 10 survived. The NMP value in the group with MODS (610 +/- 318 units/ml) was significantly higher than in the group without MODS (82 +/- 31 units/ml). The NMP values of the patients who died (645 +/- 326 units/ml) were significantly higher than in the group who survived (111 +/- 95 units/ml), and they rose significantly as the number of impaired organs increased. Our findings suggested that the NMP level in burn cases associated with MODS was higher when apoptosis developed and larger numbers of organs were impaired.

Are nitrite/nitrate (NOx) levels elevated by inhalation injury?

The relationship between airway burn and nitric oxide (NO) levels in the early burn stage was investigated by quantifying nitrite/nitrate (NOx), which are the final metabolites of NO, in 22 burn patients. Although total body surface area (TBSA) and burn index (BI) were significantly higher in patients with airway-burn than in patients without airway burn (P=0.0347 and 0.0422, respectively), no significant difference in NOx levels was observed between the two groups (P=0.6196). The NOx levels were found to correlate significantly with TBSA (r=0.4775, P=0.0246). A significant correlation was also noted between the NOx levels and BI (r=0.4391, P=0.0409). These results suggest that NO reflects the intensity of inflammation in the early burn stage, but that excessive NO formation is unlikely to be induced by stress, such as that caused by airway burn.

INTERLEUKIN 11 LEVELS IN PATIENTS WITH DISSEMINATED INTRAVASCULAR COAGULATION.: 20

We assessed the blood interleukin 11 (IL-11) levels in patients with disseminated intravascular coagulation (DIC). The IL-11 level exceeded the detection limit, i.e., IL-11 was positive, in 14 of the 21 patients in the group with DIC complicated by sepsis, with a mean value of 20.4 pg/ml. In the group with DIC uncomplicated by infection, IL-11 levels were above the detection limit in 8 of the 17 patients, and the average level was 10.6 pg/ml. The difference between the IL-11-positive rate in the two groups was not significant. Although IL-11 levels tended to be higher in the group with sepsis as a complication, the difference was not significant. The elevated IL-11 levels observed in patients with DIC, with or without complication by infection, seem quite appropriate as a biological response to increased platelets.

171 BLOOD CYTOKINE AND COMPLEMENT LEVELS IN PATIENTS WITH SEPSIS

We measured serum levels of endotoxin, cytokines, and eicosanoids and investigated their relationship to serum complement levels in patients with sepsis. Serum endotoxin (Et) levels (5.3 +/- 2.4 pg/ml) were within the normal range, but levels of tumor necrosis factor-alpha (TNF-alpha, 114 +/- 104.94 pg/ml), interleukin 6 (IL-6, 86.7 +/- 50.9 pg/ml), interleukin 8 (IL-8, 86.8 +/- 49.7 pg/ml), type-II phospholipase A2 (type II PLA2, 211.3 +/- 193.9 ng/ml), leukotriene B4 (LTB4, 88.7 +/- 27.2 pg/ml), thromboxane B2 (TXB2, 58.7 +/- 50.9 pg/ml) and 6-keto-prostaglandin F1 alpha (PGF1 alpha, 21.0 +/- 11.0 pg/ml) levels were above normal. Levels of C3a (1088.4 +/- 83.8.7 ng/ml) and C4a (1951.5 +/- 1697.8 ng/ml) were also above normal; C3 (66.0 +/- 25.6 mg/dl) and C4 (23.6 +/- 5.3 mg/dl) were within the normal range, and C5a was lower than the detectable limit in all but one of the subjects. Serum TNF-alpha was significantly correlated with C3a (p < 0.001). Serum IL-6 had a significant negative correlation with C3 (p = 0.002) and C4 (p = 0.010). Type II PLA2 was significantly correlated with C3a (p < 0.001). There were no significant correlations between serum Et or IL-8 and serum C3, C4, C3a or C4a. Our findings suggest that increased levels of TNF-alpha, IL-6, and Type II PLA/ in patients with sepsis contribute to activation of the complement system.

184 PAF ACETYLHYDROLASE AND ARACHIDONIC ACID METABOLITE LEVELS IN PATIENTS WITH SEPSIS

To examine the relationship between arachidonic acid metabolism and sepsis, we determined the blood concentration of platelet-activating factor acetylhydrolase (PAFAH) and of arachidonic acid cascade substances, leukotriene B4 (LTB4), thromboxane B2 (TXB2), and 6-keto-prostaglandin Fla (PGF1a), in patients with clinical sepsis. Blood concentrations of PAFAH, LTB4, TXB2 and PGF1a at the time of the initial diagnosis of sepsis were 23.9 +/- 9.7 nmol/min/mL, 90.4 +/- 31.5 pg/mL, 55.3 +/- 44.1 pg/mL and 22.3 +/- 11.9 pg/mL, respectively. There was a significant correlation between the blood PAFAH and LTB4 concentration (r = 0.520, p = 0.0033) and the diagnosis of sepsis. There also was a significant correlation between the blood PAFAH and TXB2 concentration (r = 0.460, p = 0.0311). There was no correlation between the blood PAFAH and PGF1a concentrations. Elevated LTB4 and TXB2 concentrations showed a significant correlation with the PAFAH concentration in patients with sepsis, suggesting a direct relationship between these substances.

Clostridial gas gangrene associated with congenital generalized lipodystrophy: Report of a case

Congenital generalized lipodystrophy (CGL) is a rare disease, the main symptoms of which are a reduction of systemic subcutaneous fat, characteristic facial features, hypertrichosis, and insulin-resistant diabetes. We report herein the unusual case of a 25-year-old man with CGL in whom gas gangrene developed, an association which has never before been encountered.

Electron Microscopic Findings of the Kidney of Congenital Nephrogenic Diabetes Insipidus — Case Report —

Ultrastructural changes were noticed in the epithelia of the proximal tubule by electron microscopy of the biopsy specimen. Decrease of the basal infoldings was observed. Some epithelia showed degenerative changes, especially in mitochondria, and also the increased electron density of matrix of cytoplasma. These changes seem to explain the disturbance of reabsorption of water in the kidney.