Pulmonary accumulation of polymorphonuclear leukocytes in the adult respiratory distress syndrome.
ABSTRACT The polymorphonuclear leukocyte (PMN) plays an integral role in the development of permeability pulmonary edema associated with the adult respiratory distress syndrome (ARDS). This report describes 3 patients with ARDS secondary to systemic sepsis who demonstrated an abnormal diffuse accumulation of Indium (111In)-labeled PMNs in their lungs, without concomitant clinical or laboratory evidence of a primary chest infection. In one patient, the accumulation of the pulmonary activity during an initial pass suggested that this observation was related to diffuse leukoaggregation within the pulmonary microvasculature. A 4th patient with ARDS was on high-dose corticosteroids at the time of a similar study, and showed no pulmonary accumulation of PMNs, suggesting a possible reason for the reported beneficial effect of corticosteroids in human ARDS.
Article: Infection and inflammation.[Show abstract] [Hide abstract]
ABSTRACT: Seizures and epilepsy may occur secondarily to a wide range of infectious (parasites, bacteria, viruses, or fungi) and inflammatory diseases of the central nervous system, either as the primary manifestation or as part of a diffuse encephalopathy. The pathogenesis and clinical expression of the seizure disorder vary widely from one disease to another, and even across different types of infection with the same agent. While a myriad of infective agents invading the central nervous system may cause seizures, most frequent causes include cerebral malaria, neurocysticercosis, bacterial meningitis or encephalitis, bacterial abscesses, tuberculosis, viral encephalitis, and cryptococcosis. Seizures may also be associated with inflammatory, noninfectious disorders including Rasmussen encephalitis and neurosarcoidosis. Treatment of seizures associated with infection or inflammation usually involves symptomatic management, including antiepileptic drug therapy, and treatment for the underlying disorder. Recognition of infectious- or inflammatory-related acute or remote symptomatic seizures has important therapeutic and prognostic implications.Handbook of Clinical Neurology 01/2012; 108:601-20.
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ABSTRACT: The multiple organ failure syndrome (MOFS) is the leading cause of death in intensive care units. Although sepsis is an important cause of MOFS, it is clear that MOFS can occur in the absence of infection. The pathophysiology of MOFS is complex and multifactorial and includes derangements in oxygen delivery and consumption, the release of inflammatory and vasoactive mediators capable of inflicting tissue damage, and alterations in the barrier function of the intestinal mucosa. Although advances have been made in our understanding of MOFS, treatment remains nonspecific and largely supportive. Early and aggressive restoration of tissue perfusion, adequate treatment of infection, timely nutritional support, and support of individual failed organs remain the mainstay of therapy. Therapeutic agents directed against the various mediators associated with the pathophysiology of MOFS may prove useful in the future.Journal of Intensive Care Medicine - J INTENSIVE CARE MED. 01/1991; 6(6):279-294.
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ABSTRACT: Acute lung injury (ALI) induced by lipopolysaccharide (LPS) develops by the activation of leukocytes via various mediators. Leukotriene B 4 (LTB4) has a strong effect on activation and migration of leukocytes. We investigated the role of LTB 4 in the chain leading to the development of ALI induced by LPS, by observing how an LTB 4 receptor antagonist, ONO-4057, suppresses or mitigates leukocyte activation and migration. The 36 rabbits used in the experiment were divided into 3 groups: C group (control group of 12 rabbits treated with physiological saline solution only); L group (of 12 rabbits treated with 20 μg/kg LPS) and L-O group (of 12 rabbits treated with, first, 10 mg/kg ONO-4057, then LPS). Blood samples were taken before, 3 h after and 6 h after the injection of drugs; then the rabbits were exsanguinated. The right and left lungs were removed for wet/dry weight ratio and bronchoalveolar lavage fluid (BALF) measurements, respectively. We measured: the leukocyte counts in the peripheral blood, the chemiluminescence (CL) intensity to measure the amount of oxygen free radical species (active oxygen species) production, the LTB 4 concentration in the blood, the complement activity levels (CH50), the polymorphonuclear neutrophil elastase (PMN- E) and myeloperoxidase (MPO) levels in BALF, and the wet/dry weight ratio of the right lung. The leukocyte counts in L and L-O rabbits decreased significantly 3 h after LPS injection, then were regained by the 6th h. Regarding CL (with and without zymosan stimulation), there was no significant difference over time for C group. For L group, the zymosan-stimulated CL showed a significant increase at the 6th h, whereas the non-stimulated CL showed significant increases at the 3rd and 6th h. For L-O group, the zymosan-stimulated CL showed a significant increase at the 6th h, whereas the non-stimulated CL increased after 3 h, then slightly decreased after 6 h. The LTB 4 levels showed significant increases at the 6th h for both L and L-O groups. The CH 50 showed significant decreases at 6th h for both L and L-O groups. The MPO activity in the BALF was significantly high for both the L and L-O groups. There was a tendency for a high PMN-E level in the BALF for L group. The mean wet/dry weight ratio of the right lung was significantly high for L group, compared to both C and L-O groups. Although an inhibitory effect on LTB 4 receptors by ONO-4057 failed to prevent leukocyte migration, it successfully suppressed the activity of non-stimulated CL, MPO and PMN-E, and, as a result, prevented the wet/dry weight ratio from increasing.01/1998;