ES Patients Research Articles

Functional analysis of monocyte activity through synthesis patterns of proinflammatory cytokines and neopterin in patients in surgical intensive care.

This study was designed to further differentiate monocyte behavior in critically ill patients with operative or accidental trauma. The patient population studied consisted of 39 patients (17 patients undergoing elective surgery [ES], seven patients with major multiple injuries [MI], and 15 patients in an acute septic state [S]). Immunologic parameters assessed included monocyte phenotyping with the monoclonal antibody LeuM3, measurement of the cytokines interleukin (IL)-1, IL-6, and IL-8 in lipopolysaccharide-stimulated in vitro cultures of mononuclear leukocytes (PBMCs), and determination of neopterin in gamma-interferon-stimulated in vitro cultures and corresponding serum samples. Serum neopterin levels were very high in S patients (89.0 nmol/L; p less than 0.05) compared with control values (4.6 nmol/L), with a rise to 16.4 nmol/L in ES patients on day 7 and 13.4 nmol/L in MI patients on day 7. The concentrations of gamma-interferon-induced neopterin in the supernatants of the PBMC cultures were elevated in all patient groups. Severe impairment of IL-1 synthesis was seen in MI and S patients. IL-8 synthesis (818 +/- 150 units/ml, control value) was also suppressed (p less than 0.05) in MI patients; the values were 135 +/- 65 units/ml on day 1,231 +/- 110 units/ml on day 3,347 +/- 131 units/ml on day 7, and 355 +/- 107 units/ml in S patients. The kinetic patterns of synthesis were comparable for IL-1 and IL-8 in all patient groups. Lipopolysaccharide-induced IL-6 synthesis (9.4 +/- 1.5 x 10(3) units/ml, control value) was significantly elevated in the PBMC cultures of all patient groups, with the exception of the early phase after accidental trauma. Maximum amounts of IL-6 synthesis after surgery were 19.6 +/- 7 x 10(3) units/ml in S patients and 19.0 +/- 2.2 x 10(3) units/ml in ES patients. These results demonstrate (1) the impairment of the functional capacity of circulating monocytes and (2) that the degree of functional impairment is proportional to the severity of the injury.

The use of comic cartoons for the study of social comprehension in schizophrenia.

A method of analyzing responses to comic cartoons is presented as a means of studying social comprehension. The method was applied to 4 groups of patients: chronic schizophrenic, early schizophrenic, depressive, and neurotic. No group showed impairment in simple description of the environment depicted in the cartoons. Proceeding through the categories of Speakers, Action, Social Roles, Motivation, and Humor, decreasing adequacy of response was apparent for all groups. The CS group showed impairment in all these categories relative to the other 3 groups. For the ES patients there was a suggestion of deficit in Action, Motivation, and Humor; but these patients were clearly better than the CS group. The Dp and Nt groups did not differ from each other. The schizophrenic patient has difficulty in understanding social interactions, even in the simple situations depicted in the cartoons used here. Since the ES patients tended to have difficulty in the more complex categories, it is suggested that the ability to interpret these more complex aspects of interpersonal situations is impaired early in the course of schizophrenia. This method helps to clarify the nature of the schizophrenic difficulty in social interactions. Further development of the method may permit greater clarification of the psychopathology of interpersonal relations in various diagnostic groups.