Inflammatory Fluid Research Articles

Use of Pavo cristatus feather extract for the better management of snakebites: Neutralization of inflammatory reactions

In Indian traditional medicine, peacock feather in the form of ash (Bhasma) or water extract are used against snakebite and to treat various problems associated with lungs. This study was aimed to evaluate the water extract of peacock feather (PCF) against the local tissue damage caused due to snakebite. PCF water extract showed inhibition towards phospholipase A 2 enzyme activity from snake venom ( Naja naja and Vipera russelii), inflammatory fluids (synovial, pleural, ascites) and normal serum in a dose-dependent manner. Hyaluronidase and proteases are other major enzymes in snake venoms responsible for local tissue damage. PCF water extract inhibited hyaluronidase and proteolytic enzyme activities from Vipera russelii, Naja naja and Trimeresurus malabaricus venom. The active principle is a hydrophilic molecule easily extractable in water or polar solvents. PCF water extract gave positive results for the presence of protein and secondary metabolites like carotenoids and steroids. Analysis of metal ions revealed that iron is the major ion (>20-fold). Other metal ions detected in smaller amount are copper, chromium, zinc and nickel. The least amount of ion detected is gold. Co-injection of PCF water extract with snake venom and inflammatory PLA 2 enzymes neutralize the edema inducing activity of all the PLA 2 enzymes studied. Since it inhibits hyaluronidase and proteases enzyme activity from snake venom PCF water extract is a powerful neutralizing agent, which has therapeutic application against venom toxicity.

Ovarian carcinoma cells and IL-1β-activated human peritoneal mesothelial cells are possible sources of vascular endothelial growth factor in inflammatory and malignant peritoneal effusions

Objective Inflammatory or malignant peritoneal diseases are associated with high levels of ascitic vascular endothelial growth factor (VEGF). We compared the VEGF secretion by human peritoneal mesothelial cells (HPMC) and ovarian carcinoma (OVCA) cells and its regulation by pro-inflammatory cytokines. Materials and methods VEGF secretion in cultured HPMC, established human OVCA cell lines, and inflammatory or OVCA-associated ascites was determined by enzyme linked immunosorbent assay. Results HPMC constitutively produced VEGF at median levels of 43 ± 7 pg/10 5 cells. Treatment of HPMC with 1 ng/ml IL-1β (567 ± 213 pg/10 5 cells) or TNF-α (89 ± 1 pg/10 5 cells) resulted in a 13-fold ( P < 0.01) or 2-fold ( P < 0.05) elevation of the VEGF secretion. In OVCA, the constitutive VEGF expression was 8-fold higher than VEGF levels in HPMC (364 ± 185 pg/10 5 cells; P < 0.001). VEGF secretion in OVCA cells was also increased by IL-1β (514 ± 105 pg/10 5 cells; P < 0.01) or TNF-α (458 ± 168 pg/10 5 cells; P < 0.01) reaching similar levels as in IL-1β-activated HPMC. Median VEGF levels in malignant ascites (2761 ± 1549 pg/ml) were 11-fold higher compared with levels in inflammatory fluids (244 ± 170 pg/ml; P < 0.01). VEGF levels in both inflammatory- and OVCA-associated fluids correlated with ascitic IL-1β levels ( P < 0.05). Conclusion We identified ovarian cancer cells and/or IL-1β-activated peritoneal mesothelial cells as important sources of ascitic VEGF. The present data indicate that IL-1β-triggered VEGF production by neoplastic and normal cells is a common pathomechanism for ascites formation in both inflammatory and malignant conditions.

The mouse chemerin receptor gene, m cmklr1, utilizes alternative promoters for transcription and is regulated by all- trans retinoic acid

CMKLR1 (chemoattractant-like receptor 1) is a G-protein-coupled receptor implicated in cartilage and bone development and is expressed in organs like the parathyroid gland, brain, and lung. The receptor is also expressed in dendritic cells and in macrophages where it acts as a co-receptor for entry of HIV/SIV isolates into human CD4 + cells. Recently, a protein named “chemerin” (also known as TIG2) was isolated from human inflammatory fluids and hemofiltrate and found to be the endogenous ligand for CMKLR1. We have previously described the genomic organization of the cmklr1 gene and characterized its promoter in mouse neuroblastoma NB4 1A3 cells. In the present study we identify a second transcript, cmklr1b, in mouse microglia BV2 cells. Cmklr1b is transcribed from an alternative promoter with a transcription start site located 6780 bp downstream of the previously identified exon 1 ( cmklr1a). The cmklr1b promoter lacks a TATA box but contains two CCAAT boxes in opposite directions. 5′ Deletion analysis of the promoter region in BV2 cells using a luciferase reporter gene assay indicates two regions, between 623–755 bp and 56–125 bp upstream of transcription start site, to be important for promoter function. The proximal promoter region includes both CCAAT boxes, and site-directed mutagenesis separately within these elements revealed that only the forward CCAAT element was important for transcription. Although the forward CCAAT element is essential for transcription electrophoretic mobility shift and super-shift assays demonstrated that both CCAAT elements actually bind nuclear proteins from BV2 cells and identified the binding factor as NFY. Real-time reverse transcriptase-PCR experiments of cmklr1b expression in all- trans retinoic acid (ATRA)- stimulated BV2 cells showed strong up-regulation of receptor transcript. Luciferase reporter gene assay of the promoter in ATRA-stimulated BV2 cells confirmed that transcriptional activity of the cmklr1b promoter is increased by ATRA. However, deletion analysis could not identify an ATRA-responsive element within the promoter region suggesting that gene activation is likely to occur through alternative mechanisms. The results emphasise a possible role of cmklr1 in bone modelling.

Inflammatory cerebrospinal fluid analysis in cats: clinical diagnosis and outcome

The medical records of 62 cats with clinical signs of central nervous system disease and accompanying inflammatory cerebrospinal fluid (CSF) analysis were examined retrospectively to determine if signalment, clinical signs, CSF analysis and ancillary testing could accurately predict the type of central nervous system disease that was present. An inflammatory CSF was defined as one in which a total nucleated cell count was greater than 5 cells/μl or one in which the total nucleated cell count was normal but the nucleated cell differential count was abnormal. Sex, degree of CSF inflammation, neuroanatomical location and systemic signs provided little contributory information to the final diagnosis. In 63% of the cases a presumptive diagnosis could be made based on a combination of clinical signs, clinicopathological data and ancillary diagnostic tests. CSF analysis alone was useful only in the diagnosis of cats with feline infectious peritonitis, Cryptococcus species infection, lymphoma and trauma. Overall, despite extensive diagnostic evaluation, a specific diagnosis could not be made in 37% of cats. The prognosis for cats with inflammatory CSF was poor with 77% of cats surviving less than 1 year.

ASGE guideline: the role of endoscopy in the diagnosis and the management of cystic lesions and inflammatory fluid collections of the pancreas

Cystic lesions and fluid collections of the pancreas often present a diagnostic and therapeutic challenge. Their pathology ranges from pseudocysts and pancreatic necrosis to benign and malignant neoplasms. Pancreatic cystic lesions may be encountered during the evaluation of a patient with pancreatitis or abdominal pain; but often these lesions are found incidentally during abdominal imaging performed for unrelated reasons. Because of their radiographic appearance, pancreatic cystic neoplasms frequently are misclassified as pseudocysts. 1 Martin I. Hammond P. Scott J. Redhead D. Carter D.C. Garden O.J. Cystic tumours of the pancreas. Br J Surg. 1998; 85: 1484-1486 Crossref PubMed Scopus (56) Google Scholar , 2 Fernandez-del Castillo C. Targarona J. Thayer S.P. Rattner D.W. Brugge W.R. Warshaw A.L. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg. 2003; 138: 427-434 Crossref PubMed Scopus (528) Google Scholar , 3 Le Borgne J. de Calan L. Partensky C. Cystadenomas and cystadenocarcinomas of the pancreas: a multi-institutional retrospective study of 398 cases. Ann Surg. 1999; 230: 152-161 Crossref PubMed Scopus (427) Google Scholar Inflammatory pancreatic fluid collections (PFC), such as pseudocysts and pancreatic abscesses, arise as a complication of acute and chronic pancreatitis or pancreatic trauma, and may be amenable to endoscopic therapy. This guideline will discuss the role of EUS and ERCP in the evaluation and the management of cystic lesions and fluid collections of the pancreas.

Frecuencia de signos y síntomas neuropsiquiátricos en pacientes con encefalitis viral

Acute viral encephalitis (AVE) is a frequent condition that usually courses with psychiatric alterations but few systematic studies have been conducted to investigate it. To determine the frequency and the progression of the neuropsychiatric symptoms in patients with AVE. A retrospective study was carried out. AVE was defined as an acute and progressively coursing condition in previously healthy subjects, with clinical signs of diffuse alteration of the central nervous system, abnormal electroencephalogram and/or inflammatory cerebrospinal fluid (CSF). We excluded patients who previously had epilepsy, a positive serodiagnosis for human immunodeficiency virus (HIV), and cases compatible with herpes simplex encephalitis from electroencephalographic or imaging data with focalisation towards temporal, frontal, regions or a positive DNA test for herpes in CSF. Finally, 83 patients were included. The psychiatric signs and symptoms that were produced were recorded during the acute phase and one year after discharge from hospital (sequelae). The psychiatric disorders in the acute phase were psychomotor agitation (67%), drowsiness (55%), disorientation (47%), visual hallucinations (43%) and aggressiveness (34%). One year after hospitalisation, in a sample of 70 patients in a clinical control, we found memory disorders (16%), aggressiveness (9%), aphasia (8%), visual hallucinations (8%), and auditory hallucinations (7%). The mortality rate was 6%. Neuropsychiatric disorders are very frequent during the acute phase of viral encephalitis, which is relevant for the differential diagnosis in patients who visit emergency departments with behavioural disorders. One year after hospital discharge, the main sequelae are of a neuropsychiatric nature and cognitive impairment is predominant.

MAGNETIC RESONANCE IMAGING FINDINGS IN 25 DOGS WITH INFLAMMATORY CEREBROSPINAL FLUID

To describe the signs that may be associated with intracranial inflammatory conditions, magnetic resonance (MR) images of 25 dogs that had inflammatory cerebrospinal fluid (CSF) were mixed with those of a control group of 40 dogs that had CSF negative for inflammatory disease and reviewed without knowledge of the clinical signs or diagnosis. CSF was considered inflammatory if the protein level was > 0.25 g/l and the white cell count was > 5 mm(-3). Abnormalities were found by MR imaging in 19 (76%) dogs with inflammatory CSF. Two dogs had focal lesions, 10 had multifocal lesions, and seven had diffuse lesions. Lesions affected all divisions of the brain. Mass effect was identified in seven (28%) dogs, including one that had a choroid plexus carcinoma. Lesions were hyperintense in T2-weighted images in 18 dogs and hypointense in T1-weighted images in six dogs. Multifocal or diffuse intraaxial lesions that were hyperintense in T2-weighted images were observed in 17 (68%) dogs with inflammatory CSF. Administration of gadolinium resulted in enhancement of intraaxial lesions in nine (36%) dogs and enhancement of meninges in seven (28%) dogs. Six (24%) dogs with inflammatory CSF had images interpreted as normal.

Sudden psychotic episode probably due to meningoencephalitis and Chlamydia pneumoniae acute infection

BackgroundSince 9% to 20% of all cases of acute psychosis presenting to an Emergency Department (ED) are due to a general medical condition, cautious medical workup should be mandatory in such patients. Differential diagnosis must consider conditions as diverse as renal failure or CNS infection.Acute Chlamydia pneumoniae infection usually causes a self-limited respiratory syndrome. Rarely, acute neurological complications occur, with acute meningoencephalitis most frequently reported. Diagnosis requires a high level of suspicion and is difficult to confirm.Case reportWe describe a 22 year-old female Caucasian who, three days after a mild pharingitis, developed an acute psychosis with exuberant symptoms interspersed with periods of lucidity, in a background of normal consciousness and orientation.Initial medical and imagiological workup were inconclusive. After 20 days of unsuccessful treatment with antipsychotics she developed a high fever and was re-evaluated medically. Lumbar puncture revealed an inflammatory cerebrospinal fluid. MRI showed irregular thickening and nodularity of the lateral ventricles' lining. An anti-Chlamydia pneumoniae IgM antibody titter of 85 IU/ml was detected. All symptoms cleared after treatment with antibiotics and corticosteroids.ConclusionThis is, to our knowledge, the first reported case of acute CP-associated meningoencephalitis manifesting as an acute psychotic episode. It illustrates the principle that non-organic psychiatric syndromes must remain a diagnosis of exclusion in first-time acute psychosis.

Pacemaker infection due to Aspergillus: report of two cases and literature review

Aspergillus infections of pacing systems are extremely uncommon, and most cases reported are characterized by an aggressive behavior that may lead to death of the patient. The study was undertaken to assess the incidence of pacemaker infection due to Aspergillus in a defined population. A retrospective review of the case histories of all patients who underwent pacemaker implantation in the reference center for a defined population over a 13-year period was undertaken. A literature review of pacemaker infections due to Aspergillus was conducted. Of the 1,321 patients who required pacemaker implantation at Hospital Xeral-Calde in the Lugo region of northwestern Spain, 38 suffered a pacemaker infection. A pacemaker pocket infection due to Aspergillus fumigatus was found in two patients. Both patients had a previous history of diabetes mellitus. Cultures from pacemaker pocket inflammatory fluid yielded positive results. Following pacemaker explantation and antifungal therapy, clinical improvement was achieved. A literature review showed another five cases of pacemaker infection due to Aspergillus. However, two peculiarities were found in our patients: In both cases an etiological diagnosis was achieved prior to surgery and, to the best of our knowledge, they also constitute the first cases of pacemaker pocket infection due to Aspergillus. Although pacemaker infections due to Aspergillus species are uncommon, they should be considered in immunocompromised patients.

Rupture of Baker's Cyst Producing Pseudothrombophlebitis in a Patient with Reiter's Syndrome

This is an unusual case of pseudothrombophlebitis resulting from rupture of Baker's cyst in a patient with Reiter's syndrome. The patient presented with a swollen, painful left calf and persistent itching on the skin of the calf. Ultrasonography showed a ruptured popliteal cyst with minimal hemorrhage and fluid collection within the fascial compartments and gastrocnemius muscle. Color Doppler ultrasound showed a patent popliteal vein and artery and duplex Doppler scans revealed a normal flow pattern. In conclusion, the clinical picture of deep vein thrombosis and that of pseudothrombophlebitis are difficult to distinguish by clinical examination and necessitate detailed examination by imaging techniques. Persistent pruritus on calf skin resulting from irritation of inflammatory synovial fluid may be an important clinical feature.

The Innate Immunity: Roles for New Antifungal and Antibacterial Peptides Secreted by Chromaffin Granules from the Adrenal Medulla

In our search of a function for the chromogranin-derived peptides present within secretory granules of chromaffin cells we observed that a large number of them displayed potent antibacterial and antifungal activities. These peptides are released by exocytosis into the circulation together with catecholamines and are also found in inflammatory fluids together with a variety of other antimicrobial peptides such as defensins. Vasostatin I, the natural N-terminal domain of chromogranin A (1-76), and the vasostatin-derived peptide chromofungin (chromogranin A47-66) are, in addition to fragments of proenkephalin (enkelytin) and ubiquitin (ubifungin), potent antimicrobial peptides of adrenomedullary origin. These peptides interact with the cell wall of fungi and yeast cells and may within minutes penetrate and accumulate within the cells. Once inside, the peptides may target to enzymes that are crucial for the growth of the microorganisms, inhibiting their activities and thus causing the rapid death of the affected species. These properties lead us to propose that these peptides participate in a primary and early line of host defence, acting as a shield against invading microorganisms during stress and infection, linking the neuroendocrine and nervous tissues to the immune system. On the basis of structure, absence of a specific receptor, ability to cross membranes and to inhibit the calmodulin-dependent enzyme calcineurin in vitro, we propose that the vasostatin-derived chromofungin should be recognised as a cell penetrating peptide.

Troubles psychiatriques itératifs révélateurs d’un lupus érythémateux disséminé

There is a wide range of non-specific symptoms that can reveal neurolupus, sometimes making diagnosis difficult. A 29-year-old man presented, from 1996 to 2002, three episodes of mood disorders with hetero-aggression, preceded by seizures, which resolved completely. Repeated investigations were negative except for lymphopenia, an inflammatory cerebrospinal fluid and some rare non-specific areas of high intensity signals in the white matter on the brain MRI. After a six-year course, the patient was considered to have a severe mood disorder related to a schizoid personality. A new dot-blot search for antinuclear antibodies detected anti-Sm antibodies was positive, leading to the diagnosis of neuropsychiatric lupus since the patient's symptoms fulfilling four of the American Rheumatism Association criteria (neuropsychiatric events, lymphopenia, antinuclear and anti-Sm antibodies). The patient was given monthly pulses of cyclophosphamide and remained symptom free one year after the last flare up. Lupus can rarely be revealed by long-standing isolated psychiatric disorders. Search for auto-antibodies, using highly specialized techniques (western blot, dot blot) should be a routine practice since antibody titres fluctuate during the course of the disease; elevated titres may correlate with exacerbations. Considering the prominence and severity of these behavior disorders, systemic diseases may often be misdiagnosed.

Approaches to the drainage of pancreatic pseudocysts

Review the current methods for the drainage of pancreatic pseudocysts, focusing on the recent developments in the new methods of endoscopic drainage. Pancreatic pseudocysts are collections of inflammatory fluid associated with acute and chronic pancreatitis. A leak in the pancreatic ductal system is most commonly the source of the fluid accumulation in these inflammatory cavities adjacent to the pancreas. Although most pseudocysts are not symptomatic and many resolve spontaneously over time, drainage of pseudocysts is occasionally required. There are several different approaches to the drainage: surgical, radiologic, and endoscopic. Surgical drainage is accomplished using the creation of a large anastomosis between the gastrointestinal tract and the pseudocyst cavity. Radiologically, pseudocysts are drained externally using a percutaneous, transabdominal drainage catheter. Endoscopy has offered the most recent advance, using the placement of transgastric or transduodenal stents. Most recently, therapeutic endoscopic ultrasound scopes have been used to introduce large stents that provide drainage into the upper gastrointestinal tract. Of the three methods for the drainage of a pancreatic pseudocyst, only the endoscopic approach can provide minimally invasive internal drainage.

Differential effect of calcium phosphate and calcium pyrophosphate on binding of matrix metalloproteinases to fibrin: comparison to a fibrin-binding protease from inflammatory joint fluids.

The ability of calcium phosphate (CaP) and calcium pyrophosphate (CaPPi) to mediate matrix metalloproteinase-2 and -9 (MMP-2 and MMP-9) binding to fibrin was evaluated. Substrate gel electrophoresis (gelatin zymography) revealed that CaP bound MMP-2 and MMP-9, forming a high molecular weight aggregate with lowered electrophoretic mobility. Formation of the CaP : MMP aggregate was necessary for fibrin binding. In contrast, CaPPi did not aggregate MMPs and did not promote uptake of MMPs into fibrin. Scatchard analysis (Ca/P ratio) revealed that CaPPi (1.96) was chemically similar to calcium pyrophosphate dihydrate (2.00) compared to amorphous CaP (1.50) or crystalline CaP, hydroxyapatite (1.66). MMP : CaP interaction appeared to be electrostatic in nature as high salt concentration (NaCl > 150 mm) reduced binding. In contrast, two non-ionic detergents (Brij-35 and Tween-20) did not prevent MMP : CaP binding. MMP : CaP interaction did not involve the C-terminal MMP region because the specific tissue inhibitor of metalloproteinases (TIMPs) also did not block MMP : CaP interaction and fibrin binding. Although MMP : CaP binding could be decreased with albumin, this effect appeared non-specific due to the high albumin concentration required. High albumin concentration could also partially dissociate preformed MMP : CaP complexes. Interestingly, type I and type IV collagen substantially increased MMP : fibrin-binding activity, whereas denatured collagen, gelatin, did not. Inflammatory joint fluid from five patients also demonstrated similar MMP fibrin-binding activity consistent with CaP mediation. The relevance of these findings to CaP and CaPPi in the pathogenesis of crystal arthropathies such as basic calcium phosphate (BCP) and calcium pyrophosphate dihydrate crystal disease (CPPD) is discussed.

?Fu�kribbeln?, Vergesslichkeit und progrediente Wesensver�nderung bei einer 63-j�hrigen Patientin

A 63-year-old female was admitted to the hospital with leg and forearm paresthesias. We found progressive ataxia, dementia, and psychosocial deterioration. The clinical symptoms, the neurologic and psychiatric abnormalities together with the inflammatory cerebrospinal fluid alteration and the cerebral magnetic resonance imaging changes suggested a paraneoplastic etiology. It was confirmed by paraneoplastic antineuronal antibodies in the patient's serum and the histological diagnosis of a small cell bronchial carcinoma. The prognosis of patients with paraneoplastic symptoms is the better the earlier a diagnosis is established and antitumor therapy is initiated.

Tissue kinetics of telithromycin, the first ketolide antibacterial.

The potential efficacy of an antibacterial depends not only on its spectrum of activity but also on its concentration at the site of infection. The tissue kinetics of telithromycin-the first ketolide antibacterial-are reviewed here. Telithromycin accumulates rapidly in white blood cells, inflammatory fluid, and cells and tissues of the upper and lower respiratory tract, with mean concentrations above the MICs of key respiratory pathogens. Tissue kinetics of telithromycin support facilitated delivery to the site of infection, good efficacy against intracellular respiratory pathogens and respiratory pathogens at extracellular sites in the airways, and effectiveness in the treatment of upper and lower respiratory tract infections (RTIs). The tissue kinetics profile of telithromycin, together with its microbiological profile, makes it a promising new antibacterial for the treatment of community-acquired RTIs.

Characterization of plasmacytoid dendritic cells in inflammatory arthritis synovial fluid.

To examine the phenotype of dendritic cell subsets in synovial fluid and peripheral blood from patients with rheumatoid arthritis (RA) or spondyloarthropathy (SpA). Multiparameter flow cytometry was used to identify and characterize dendritic cells in mononuclear cell populations isolated from synovial fluid and peripheral blood. Synovial fluid contained two subsets of dendritic cells (DC), myeloid and plasmacytoid. These subsets could also be identified in peripheral blood, but there were lower numbers of DC in peripheral blood compared with synovial fluid. Plasmacytoid DC were distinguished from the myeloid subset by high expression of CD123 and lack of expression of CD11c. In comparison with myeloid dendritic cells, the plasmacytoid subset were less mature, similar to those in peripheral blood. They failed to express CD83 and DC-LAMP, and had relatively low levels of CD40 and CD86. Comparison of dendritic cells in synovial fluid from RA and SpA patients showed increased numbers of the plasmacytoid subset in SpA. This is the first demonstration of the plasmacytoid subset of dendritic cells in synovial fluid. Since these cells are major producers of type I interferons, their increased numbers in SpA might be relevant to pathogenesis, but the immature phenotype in SpA synovial fluid may also indicate that conditions for maturation of this subset do not pertain in SpA synovium.

The Production Mechanism of TNF-α and IL-6 by Group IIA Phospholipase A2

Background: Secretory phospholipase () are a group of extracellular enzymes that release fatty acids at the sn-2 position of phospholipids. Group IIA (-IIA) has been detected in the inflammatory fluids, and its plasma level increases in the inflammatory disease. This study examined the effect of -IIA on mouse macropahges in order to investigate the potential mechanism of -induced inflammation. Materials and Methods: Wild type and mutant H48Q were purified from HEK293 cells transfected with the corresponding plasmids, and the activities were measured using 1-palmitoyl-2-[1-]linoleoyl-3-phosphatidylethanolamine as substrates. The TNF- and IL-6 released in the supernatants were determined by ELISA. In addition, the TNF- and IL-6 mRNA were analyzed by RT-PCR. Results: -IIA stimulated the production of TNF- and IL-6 in a dose- and time-dependent manner. In addition, the effect of -IIA on cytokine production from the macrophage was found to be associated with the accumulation of their specific mRNA. The mRNA levels of TNF- and IL-6 peaked at 2 and 6 hours in a time-dependent manner, respectively. Conclusion: In conclusion, the production of proinflammatory cytokine might be mediated by the binding of -IIA to the receptors.

Medical treatment of pulmonary hydatidosis: complications and surgical management.

Pulmonary hydatidosis is more frequently encountered in children than in adults. Chemotherapy with oral administration of particular antihelminthic agents (mebendazole and albendazole) has proved to be effective. This treatment, however, may be associated with serious complications that require surgical management. The aim of this study was to define the limitations of medical treatment, the subsequent complications, and their management. During a 16-year period (1985-2001), 36 children with pulmonary hydatidosis (Echinococcus cysticus) were medically treated. Oral antihelminthic agents (mebendazole until 1992 and albendazole thereafter) were given to all these patients. During this treatment, 11 patients developed complications requiring surgical intervention. In seven children, pleural empyema, or the presence of inflammatory residual fluid, was noted. The remaining four developed pulmonary abscess combined with fluid collection within the pleural cavity. In all complicated cases, the mean size of the cysts exceeded 6 cm in diameter at the beginning of medical treatment. At operation, suturing of communicating bronchi was insecure due to inflammation. Postoperatively, three patients had air leakage from the bronchial tree, requiring continuous suction and prolonged hospitalization. One patient presented with pneumothorax 4 months postoperatively and was operated on again. Overall, long-term results were good. We concluded that a) large pulmonary hydatid cysts should not be treated medically, b) incomplete expectoration of the cyst contents after the parasite death may lead to infection through bronchial communication, and c) patients surgically treated for complications following medical treatment are hospitalized twice as long as patients surgically treated in the first place.

Determination of the Role of Hypoxia-Inducible Factor 1 in Wound Healing

Publisher Summary This chapter analyzes the role of hypoxia-inducible factor 1 (HIF-1) in wound healing. Examination of cells isolated from polyvinyl alcohol (PVA) sponge wounds in rats demonstrate a dramatic accumulation of HIF-1α mRNA and protein in cells isolated 1 and 5 days after injury. These observations suggest a role for HIF-1 in the regulation of inducible Nitric Oxide Synthase (iNOS) expression in early wounds. This chapter focuses on the methodology for the study of HIF-1 expression during inflammation and wound healing. Surgical methods for the implantation of PVA sponges and the recovery of inflammatory cells and fluids suitable for the analysis of HIF-1 expression and content of proinflammatory mediators, respectively, are discussed. Additional methods include the application of pimonidazole hydrogen chloride (HCl) as a marker of hypoxia within the inflammatory site, and the use of immunoblotting and northern blotting to detect HIF-1 protein and the messenger RNA, respectively. Detection of pimonidazole HCl adducts and detection of HIF-1 by western blotting method are also described.