Sgm Meuwissen

In vitro production of TNFα, IL-6 and sil-2R in Chinese patients with ulcerative colitis

AIM To determine the tumor necrosis factor alpha (TNFα), interleukin 6 (IL-6) and soluble interleukin 2 receptor (sIL-2r) from peripheral blood mononuclear cells (PBMC) in 25 Chinese patients with ulcerative colitis and 20 healthy controls. METHODS PBMC were isolated by density gradient centrifugation of heparinized blood and cultures for 24 or 48 hours by stimulation with LPS or PHA. TNFα and sIL-2r were measured by ELISA method and IL-6 measured by biossay. RESULTS TNFα production stimulated by LPS and sIL-2r production by PHA in ulcerative colitis were significantly lower than in healthy controls (TNFα 509(46-7244)ng/L vs 1995(117-18 950)ng/ L, P 0.05; sIL-2r 264U/ ml±115U/ml vs 236U/ml±139U/ml, P>0.05). IL-6 production by spontaneous release from PBMC in ulcerative colitis group was 109U/ml±94U/ml vs 44U/ml±39U/ml for those in healthy controls, P <0.01. IL-6 stimulated by LPS in ulcerative colitis group was (261U/ml±80U/ml) higher than in healthy controls (102U/ml±54U/ml, P<0.01). No correlation of TNFα , IL-6, sIL-2r production was found to disease activity, disease location and medication. CONCLUSION Cytokine production from PBMC was also disturbed in Chinese patients with ulcerative colitis.

Omeprazole: Therapy of choice in institutionalized intellectually-disabled children

We examined 157 patients aged from 1 day to 17 years (92 males and 65 females). Main indications were: caustic (73 pts) or foreign body (FB) ingestion (42 pts) and gastrointestinal bleeding (GIB) (40 pts). 2 patients were examined for severe and intractable hemesis. 73.8% of examinations were performed under general anaesthesia, 6.2 % with conscious sedation and 20 % with no sedation nor anaesthesia. 27.3% of patients had an endoscopic treatment. All caustic ingestions but four were accidental. 56.1% of these patients showed different degree lesions, evaluated on the basis of Niguarda 90 classification (Acta Endoscopica, 22 (4)~ 413-418, 1992). We retrieved as soon as possible any object lodged in the oesophagus. Those located in the stomach were removed in emergencY only if they could be dangerous because of their size, sharpness or possible toxicity; otherwise they were removed after 48-72 hours if they didnt cross the pylorus. Since we observed one case of mucosal lesion due to corrosive leakage from a disk-battery which Stayed in the stomach for almost 48 hours, we planned to retrieve them from the gastric cavity within 24 hours. 35 (87.5%) of all FB were successfully removed. In 5 patients (11.9%) FB had already reached the jejunum at the moment of endoscopy and couldnt be retrieved. In 2 patients FB couldnt be endoscopically localized because of the presence of food. Emergency gastrointestinal endoscopy led to a correct diagnosis of the source of bleeding in 33/40 patients (82.5%). Perinatal acute esophagitis (9 pts) and hemorrage from esophageal varices (8 pts), were, in our series, the most common cause of acute GIB. Other sources of bleeding were: acute hemorragic gastritis (5 pts), duodenal ulcer (6 pts) gastric ulcer (2 pts), esophageal ulcer (1 pt) and rectal polyps (2 pts). In 7 patients emergency endoscopy couldnt demonstrate any relevant lesion. Emergency sclerotherapy of esophageal varices as well as hemostasis of bleeding lesions were successful in all cases. We recorded 1 case (0.6%) ofab ingestis pneumonia. Our experience outlines that not only pediatrician or surgeon, but also endoscopist has a crucial role in the management of paediatric gastrointestinal emergencies, in fact 68.7% of our procedures showed some pathological feature, while only 31.2% were normal. Moreover in patients with gastrointestinal bleeding or foreign body ingestion, therapeutic endoscopy proved to be highly effective and safe.