Presence Of Chronic Infection Research Articles

Peculiarities of laboratory parameters dynamics during helicobacter pylori eradication in patients with rheumatoid arthritis

Helicobacter pylori (H. pylori) is able to participate in the pathogenesis of a number of autoimmune diseases, actively maintains chronic inflammation and stimulates the systemic immune response. The virulence factor of H. pylori is cytotoxin-associated gene A (CagA) is associated with more severe inflammatory reactions, increased risk of poor clinical outcomes and is able to influence the efficacy of infection eradication in patients with rheumatoid arthritis (RA).Purpose of the study. To evaluate laboratory parameters of H. pylori eradication efficacy in RA patients with chronic infection with the strain encoding cytotoxin-associated gene A.Materials and methods. Forty women with RA and confirmed chronic H. pylori infection were included in the study (mean age 55.5±8.7 years; mean disease duration 13.9±9.1 years; DAS-28–3.96±0.56). CagA-IgG associated H. pylori infection was diagnosed in 22 (group I, CagA+) and not diagnosed in 18 (group II, CagA-) patients. All RA patients underwent a course of H. pylori eradication therapy.Results. The process of H. pylori eradication had the most significant effect on laboratory parameters of CagA-negative RA patients (group II). In this group the levels of rheumatoid factor (p=0,028), C-reactive protein (CRP, p=0.001), interleukin-6 (IL-6, p=0.002), tumor necrosis factor alpha (p=0,023), angiopoietinlike protein type 3 (p=0.026) and antibodies to cyclic citrullinated peptide (ACCP, p=0,016) decreased significantly. In patients from group I (CagA+) most parameters remained practically unchanged (p>0.05), except for CRP (p=0.01) and IL-6 (p=0.011). In the short term, the success of eradication in CagA+ patients was significantly lower than in CagA- patients (p=0.033). Moreover, confirmation of successful eradication of H. pylori within the established period of time was extremely rare (p=0.009) in the combination of CagA+ and high titers of ACCP and antibodies to modified citrullinated vimentin.Conclusions. The effectiveness of H. pylori eradication in RA patients depends on the presence of chronic infection with the strain encoding the cytotoxin-associated gene A and the level of antibodies to citrullinated proteins, which should be taken into account when choosing the therapeutic effect on H. pylori in this group.

Peculiarities of immunological manifestations in patients with rheumatoid arthritis in the presence of chronic infection with <i>Helicobacter pylori</i> variant encoding cytotoxin-associated gene A

The study aimed to evaluate the association between cyclic citrullinated peptide antibody seropositivity and chronic Helicobacter pylori (H. pylori) infection in patients with rheumatoid arthritis (RA). We examined 92 women with moderate RA activity. Serum antibodies to cyclic citrullinated peptide (antiCCP), antibodies to H. pylori (anti-H. pylori-IgG), and total antibodies to H. pylori CagA antigen (antiCagA) were determined by enzyme immunoassay; the presence of anti-CagA-IgG positivity was confirmed by immunoblot. 68.5% of RA patients were positive for anti-H. pylori-IgG, and 44.4% of patients in this group were positive for anti-CagA-IgG. All the study participants were divided into three groups: I – H. pylori seronegative (H. pylori- ); II – H. pylori positive, CagA negative (H. pylori+/CagA- ); III – H. pylori positive and CagA positive (CagA+). The anti-CCP values in RA patients with CagA+ (group III) were significantly higher not only in comparison with patients seronegative for H. pylori (p < 0.001), but also in comparison with patients from group II (H. pylori+/CagA- ) (p = 0.041). A study of the influence of the RA activity, the presence of RF and H. pylori on anti-CCP content demonstrated a small proportion of anti-CCP variability (R2 = 0.09), with a high contribution of H. pylori (beta = 0.25). The addition of the CagA(+) index (beta = 0.503) to the presented model allowed us to describe the variability of anti-CCP in almost 30% of cases (R2 = 0.29). In the group of RA patients with anti-CCP values exceeding the established threshold value of 20 U/mL (normal index), there was an increase in the proportion of patients infected with H. pylori (p < 0.001), but not the proportion of CagA-positive patients (p = 0.06). When the threshold level was increased to 60 U/mL (three times the upper limit of normal) in patients with significantly high anti-CCP, the association with positivity for CagA became significant (p = 0.005). CagA is highly immunogenic and is capable of inducing an inflammatory response in the host that goes beyond the effect of H. pylori itself. Additional experimental studies are needed to investigate possible clinical and laboratory associations that may influence the treatment tactics of CagA+ patients with RA who are seropositive for anti-citrullinated antibodies, as well as to evaluate the possible effects of therapeutic intervention aimed at the eradication of H. pylori in this group.

Current trends in candidate selection, contraindications, and indications for lung transplantation.

Lung transplantation is an established treatment option that can improve quality of life and prolong survival for select patients diagnosed with end-stage lung disease. Given the gaps in organ donation and failures to make effective use of available organs, careful selection of candidates for lung transplant remains one of the most important considerations of the transplant community. Toward this end, we briefly reviewed recent trends in pretransplant evaluation, candidate selection, organ allocation, and organ preservation techniques. Since the latest consensus statement regarding appropriate selection of lung transplant candidates, many advances in the science and practice of lung transplantation have emerged and influenced our perspective of ‘contraindications’ to transplant. These advances have made it increasingly possible to pursue lung transplant in patients with risk factors for decreased survival—namely, older recipient age, increased body mass index, previous chest surgery, poorer nutritional status, and presence of chronic infection, cardiovascular disease, or extrapulmonary comorbid conditions. Therefore, we reviewed the updated evidence demonstrating the prognostic impact of these risk factors in lung transplant recipients. Lastly, we reviewed the salient evidence for current trends in disease-specific indications for lung transplantation, such as chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis, emphysema due to alpha-1 antitrypsin deficiency, and pulmonary arterial hypertension, among other less common end-stage diseases. Overall, lung transplant remains an exciting field with considerable hope for patients as they experience remarkable improvements in quality of life and survival in the modern era.

Correlation between oral health and severity of respiratory coronavirus infection COVID-19

Aim. To establish the association between the presence of chronic infection in oral cavity and the severity of SARSCoV-2 infection.Materials and methods. The study was conducted among 30 people aged between18 and 22 who had had coronavirus infection from mild to severe cases. The assessment of oral health was carried out with main and additional examination methods, CFE index, PMA index, Greene, Wermillion oral hygiene index.Results. In group 1, the average value of CFE index was 4.2, in the second group – CFE index was twice higher at 7.8. PMA index in patients of group 2 was significantly higher (p> 0.01) and was at the level of 41.5%. In group 1, the PMA index was 13.3%. It was found that 17% of the respondents in the control group and 70% patients in the experimental group had an episodic exacerbation of dental diseases during COVID-19.Conclusions. The data obtained indicates a correlation between oral diseases and the severity of COVID-19. It is necessary to consider that chronic infection in the oral cavity as well as poor oral hygiene can act as a risk of complications of viral infections, in particular, of COVID-19.

Subjective Visual Vertical Testing in Patients With Chronic Suppurative Otitis Media.

To analyze the results of the subjective visual vertical test using the "bucket method" in patients with chronic suppurative otitis media (CSOM). Cross-sectional, controlled study. Outpatient otology clinic in a tertiary care hospital. Patients had CSOM, defined as the presence of chronic infection or inflammation of the middle ear cleft, associated with a perforation of the tympanic membrane, frequent or intractable middle ear suppuration, with or without cholesteatoma. Controls were selected using a nonprobability, purposive sampling method. We excluded patients with neurologic or metabolic diseases, cognitive deficits, otosclerosis, vestibular migraine, Ménière's disease, past use of ototoxic medication, or head and neck cancer. The volunteers were subjected to the subjective visual vertical test using the "bucket method." The results obtained in our study and control groups were analyzed using nonparametric tests. Our study comprised 51 patients with CSOM and 50 controls. In the CSOM group, we observed that 72.5% of the patients had vestibular symptoms in the past year, and 70.5% had abnormalities identified in at least 1 vestibular function test. The subjective visual vertical test revealed that patients with CSOM (with and without cholesteatoma) had significantly higher deviations of the true vertical as compared with controls (CSOM, 3.66°; controls, 0.76°; P < .001). Our results revealed that CSOM was associated with high rates of vestibular symptoms, abnormal vestibular function tests, and abnormal subjective vertical visual results.

Evaluation of Hematocrit Level, Red Blood Cells and White Blood Cells Counts in Blood from Patients with Different Severities of Periodontal Diseases

Background: Anemia of chronic disease (ACD) occurs in the presence of chronic infection, inflammatory conditions or neoplastic conditions despite of adequate iron and vitamins storage. Gingivitis is the inflammation of the gingiva, periodontitis is the inflammation in the periodontium that extend deeper with loss of connective tissue attachment and supporting bone. The main pathogenesis of periodontal diseases and ACD is immune activation. Aims of study: Determine and compare the clinical periodontal parameters (plaque index (PLI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD) and clinical attachment level (CAL)). Evaluate the hematocrit (Hct) level, red blood cells (RBCs) count and white blood cells (WBCs) count. Assess the correlations between the clinical periodontal parameters and hematological parameters at patients had gingivitis, chronic periodontitis (CP) with different severities (mild, moderate and severe) with healthy periodontium subjects. Materials and Methods: 35-50 years old, 150 male subjects were included in this study. They were divided into three study groups: group of 30 patients with gingivitis, group of 90 patients with CP which subdivided into (Mild CP=30 patients, Moderate CP =30 patients, Severe CP =30 patients) and control group 30 subjects with clinically healthy periodontium. Blood samples were collected then by automated blood analyzer the Hct, RBCs and WBCs were evaluated. Results: Comparisons among groups and subgroups revealed significant differences in Hct and WBCs, while RBCs was non-significant. Means values of RBCs count showed reduction in mild and severe CP subgroups. while, the Hct and WBCs mean values increased in patients with periodontal disease. The correlations between the clinical periodontal parameters with WBCs and RBCs were almost non-significant but, with Hct was mostly significant negative correlations. Conclusion: Inflammatory and immune responses in periodontal diseases caused change in different hematologic parameters which could contribute to the development of anemia of chronic disease.

Therapeutic administration of IL-10 and amphiregulin alleviates chronic skeletal muscle inflammation and damage induced by infection.

Maintenance of tissue integrity in skeletal muscle requires the immunomodulatory and regenerative functions of muscle-resident regulatory T cells (Tregs). Chronic skeletal muscle infections, such as with Toxoplasma gondii disrupt normal immuno-regulatory networks and lead to pathogenic changes in Treg function. Specifically, Tregs during chronic T. gondii infection reinforce an inflammatory macrophage bias that exacerbates injury in skeletal muscle. In this study, we investigated whether the aberrations in skeletal muscle Treg function during chronic infection could be overcome by treatment with Treg-related factors associated with enhanced muscle regeneration during sterile injury. We show treatment of chronically infected mice with the Treg promoting therapies, interleukin-2 complexed with anti-IL-2 antibody or interleukin-33 (IL-33), did not restore macrophage dynamics or muscle function, respectively, in vivo. However supplementation of known Treg-derived factors, interleukin-10 (IL-10) and amphiregulin (Areg) improved muscle function and skewed macrophages toward a restorative phenotype in the presence of chronic infection. These shifts in macrophage phenotype are coupled with enhanced physiologic parameters of regeneration. Together, these data suggest that while Treg-mediated immuno-regulation is compromised during chronic skeletal muscle infection, supplementation of canonical Treg-derived factors such as IL-10 and Areg can restore immunologic balance and enhance muscle repair.

The risk factors of cardiovascular disorders in children with chronic bronchopulmonary diseases

The purpose was to determine the features of cardiovascular system morphofunctional state and the risk factors for cardiovascular disorders formation in children with chronic bronchopulmonary diseases.Materials and methods. We examined 144 patients aged 3–16 years (mean age was 11.3 ± 1.2 years) with chronic bronchopulmonary pathology (60 patients with cystic fibrosis with pancreatic insufficiency and 84 patients with heavily treated or partially treated persistent bronchial asthma) and 68 conditionally healthy children who made up the control group. A complex of functional methods for cardiovascular system studying in patients with chronic bronchopulmonary diseases included: echodopplercardiography with determination of left ventricular myocardium geometry, Holter monitoring of cardiac activity, duplex scanning of the common carotid artery by intima-media thickness measuring of the common carotid artery wall and examining the index of endothelial stress shift. To determine the risk factors for cardiovascular disorders development in children with chronic bronchopulmonary diseases, a method E. N. Shigan was used to normalize intensive indicators, based on the Bayesian probabilistic method. A prognostic model of cardiovascular disorders development was obtained using the exponential regression equation for patients with chronic bronchopulmonary diseases.Results. According to results of the study it has been found that there is a structural and functional restructuring of the left ventricular myocardium on the background of the cardiac activity vegetative regulation violation and vascular remodeling in children with chronic bronchopulmonary diseases. The definition of risk factors for cardiovascular complications development in children with bronchial asthma has showed the followings: the presence of chronic infection (OR = 8.4), the age of child from 3 to 6 years (OR = 4.9), the disease duration more than 3 years (OR = 2.3), the circadian index value less than 1,2 units (OR = 3.1) and QTc interval prolongation more than 420 ms (OR = 2.1). The main risk factors for cardiovascular disorders formation in the group of children with cystic fibrosis were the age of the child from 3 to 6 years (OR = 4.0), contamination of the respiratory tract by Pseudomonas aeruginosa (OR = 4.0), severe course of the disease (OR = 3.3), the presence of chronic infection (OR = 6.0), the body mass index less than P50 (OR = 4.2) and the QTc interval duration more than 420 ms (OR = 1.4). The risk of cardiovascular complications was increased with the presence of 3 or more risk factors that confirmed by the equation of exponential regression in the group of patients with chronic bronchopulmonary diseases.Conclusions. The development of cardiovascular complications is caused by a combination of many factors in children with chronic bronchopulmonary diseases. It is necessary to include into the algorithm for examination heart echodopplerography, Holter heart rate monitoring, duplex scanning of the common carotid artery with determination of the endothelial stress index shift and intima-media thickness at least twice a year for the purpose of cardiovascular disorders early diagnosis in children with chronic bronchopulmonary diseases, having 3 or more risk factors for cardiovascular complications. Timely detection of a risk group for cardiovascular disorders development will allow the full implementation of preventive measures and medications for cardiovascular disorders correcting in children with chronic bronchopulmonary diseases.

Dynamical analysis on a chronic hepatitis C virus infection model with immune response.

A mathematical model for HCV infection is established, in which the effect of dendritic cells (DC) and cytotoxic T lymphocytes (CTL) on HCV infection is considered. The basic reproduction numbers of chronic HCV infection and immune control are found. The obtained results show that the infection dies out finally as the basic reproduction number of HCV infection is less than unity, and the infection becomes chronic as it is greater than unity. In the presence of chronic infection, the existence of immune control equilibrium is discussed completely, which illustrates that the backward bifurcation may occur under certain conditions, and that the two quantities, the sizes of the activated DC and the removed CTL during their average life-terms, play a critical role in controlling chronic HCV infection and immune response. The occurrence of backward bifurcation implies that there may be bistability for the model, i.e., the outcome of infection depends on the initial situation. By choosing the activated rate of non-activated DC or the cross-representation rate of activated DC as bifurcation number, Hopf bifurcation for certain condition shows the existence of periodic solution of the model. Again, numerical simulations suggest the dynamical complexity of the model including the instability of immune control equilibrium and the existence of stable periodic solution.

Clinical Outbreaks of Bacterial Kidney Disease (BKD) in Hatchery-Raised Brook Trout (Salvelinus fontinalis) (Mitchill, 1814): Lessons Learned

A number of clinical Bacterial Kidney Disease (BKD) outbreaks caused by Renibacterium salmoninarum infection among the hatchery reared brook (BKT) trout lots were presented during 2002-2004 to the Aquatic Animal Health Laboratory, Michigan State University, MI, USA. Diagnosis of these mortality episodes was performed thorough clinical examination, quantitative enzyme-linked immunosorbant assay (Q-ELISA), nested polymerase chain reaction (nPCR), culture, histopathology and immunohistochemistry (IHC). The possible causes that lead to the initiation and progression of such outbreaks have been investigated. Although Q-ELISA, nPCR and culture results for all of the examined cases indicated a heavy infection with R. salmoninarum, inconsistent results were obtained by histopathology and immunohistochemical examination of the paraffin embedded blocks of the formalin fixed kidney tissues. This study also included assessment of R. salmoninarum infection status in a subsample of BKT broodstocks of the same hatchery. Results indicated the presence of chronic infection in the broodstock with BKDpathognomonic granulomas occupying fairly large portions of the kidney tissues.

AB0440 What effect does the presence of bronchiectasis have on CCP antibody levels in patients with rheumatoid arthritis?

BackgroundIt is well established that anti cyclic citrullinated peptide (CCP) antibodies are a marker of rheumatoid arthritis (RA) and are associated with greater articular damage [1]. There is increasing evidence...

Mandibular Osteomyelitis and Fracture in a Patient With Pyknodysostosis

Pyknodysostosis is a rare, recessive, hereditary, autosomal disease belonging to the group of bone dysplasias. Complications such as osteomyelitis and fractures of the mandible are not uncommon and appear in the most varied forms. We report a case of chronic osteomyelitis with subsequent mandible fracture, which was successfully treated with the use of a reconstruction plate and antibiotic therapy. This article outlines the clinical and radiographic characteristics of this condition based on the clinical case described and proposes an approach regarding the best form of treatment. Considering the risks of fracture subsequent to removal of the graft from long bones as well as the presence of chronic infection, difficult-to-defeat infection, and bone contact on the compression band, the best choice is a more conservative treatment.

Fatal Outcome of Recombinant Factor VIIa in Heart Transplantation With Extracorporeal Membrane Oxygenation

Recombinant activated factor VII (rFVIIa) has been approved for treatment of bleeding episodes in patients with hemophilia and in nonhemophilia patients with acquired antibodies against factor VIII or IX. The application of rFVIIa in nonapproved settings, as in cardiac surgery, has not been established. It raises concerns regarding its safety. We used rFVIIa in a patient with excessive nonsurgical bleeding on extracorporeal membrane oxygenation, which was established for early graft failure after heart transplantation and after 3 months of biventricular assist device support. After rFVIIa administration, cardiac thrombosis developed and caused the patient's death.

SOME BIOLOGICAL HEALTH HAZARDS AMONG SEWAGE WORKERS

Objectives: The current work aimed at assessment of biological hazards among workers of sewer networks.Subjects: The work was conducted on 34 male workers involved in the maintenance of the sewerage system network and a matched unexposed control group (n= 35).Methods: (A) All workers were interviewed using a special questionnaire including occupational history ; and full clinical examination was performed. (B) Detection of HAV and HBV (C) Detection of leptospira spirochete antibodies in serum sample using monoclonal antibody technique. (D) Detection of leptospira spirochete in stool by polymerase chain reaction (PCR). (E) Detection of Helicobacter Pylori in blood sampleby Ig G.Results: We found that there were statistically significant differences between the exposed and the control groups as regards the presence of chronic infection with HAV and Helicobacter and of leptospira spirochete and the presence of abdominal pain and body aches. There was no statistically significant difference between sewage workers 20 years as regards HAV, HBV, Helicobacter and a statistically significant difference between both groups as regards leptospira spirocheteinfection.Conclusion: There were statistically significant differences between the exposed and the control groups as regards the presence of chronic infection with HAV and Helicobacter and of leptospira spirochete and the presence of abdominal pain and body aches.Recommendation: Biological hazards could be prevented through engineering, medical and legislative measures. The medical measures will help in early detection of the effects of these exposures. This can be partly achieved by developing an effectiveoccupational health service for the workers. Regular awareness programs should be conducted to impart knowledge regarding safer work procedures, the use of personal protective devices and to avoid direct contact with raw sewage. For pipeline or other inspections, remote-controlled robotic cameras can minimize human exposure.

Endovascular PTFE-Covered Stent for Treatment of an External Iliac Artery Pseudoaneurysm in the Presence of Chronic Infection

A 75-year-old woman with an external iliac artery pseudoaneurysm, thought to have resulted from a chronic loosening and infection of a total hip replacement, was successfully treated by placement of a covered endoluminal stent.

Reconstruction of skull base and dura using rectus abdominis muscle combined with a vascularised fascial perforator flap

The goal of reconstruction of the skull base is to repair dural defects with a watertight seal and separate it from the nasopharynx and the exterior environment with well vascularised tissue. This prevents cerebro-spinal fluid leakage and secondary contamination leading to the potentially life threatening complications of meningitis or extradural abscess. Following large composite resections, traditional techniques to repair the dura involve the use of an autologous fascial graft or a pericranial flap, whilst a regional pedicled or free muscle flap is used to close the dead space defect. We describe a technique performed in two cases, whereby a single flap, the rectus abdominis muscle free flap, can be used to provide vascularised reconstruction both of the dura and the skull base. The anterior rectus sheath, islanded on a single perforator vessel, is used as a vascularised layer to reconstruct dura, whilst the supporting rectus abdominis muscle provides bulk to obliterate dead space. We show that this flap is suitable for reconstruction even in the presence of chronic infection. Advantages of a vascularised reconstruction are the rapid healing of the wound, even after radiotherapy, the delivery of systemic antibiotics to the site of the operation, and that it may allow early postoperative radiotherapy to be planned.

Innate immunity in human bone

Bone has exceptional regenerative properties. Oral bone appears to be particularly resistant to infection despite exposure to oral flora, even in circumstances such as oral surgery where the thin mucosal layer covering the bone is disrupted. The goal of this study was to determine whether the innate immune system of antimicrobial peptides exists inside bone. Biopsies of non-infected and chronically infected mandibular bone were harvested from patients during maxillofacial surgical procedures. Bone biopsies from the iliac crest and fibula served as controls. Immunohistochemical staining was performed, directed against the human beta-defensin antimicrobial peptides (hBD) -1, -2 and -3. In addition, cultures of osteoblast-like cells were examined for the presence of each of the three beta-defensins and their mRNA transcripts. All three human beta-defensins were detected within the mineralized bone matrix of chronically infected mandibular bone in the vicinity of the endosteum and osteocytes. hBD-1, -2 and -3 were also found in the cytoplasm of osteocytes. Expression of all three beta-defensins was detected in each of the non-infected bone types including the controls, however, to a lesser degree than that found in the chronically infected mandibular bone. This may reflect upregulation of antimicrobial peptide expression in the presence of chronic infection. Cultures of non-infected osteoblast-like cells were found to express mRNA for each of hBD-1, -2 and -3. Immunohistochemical staining of the cultures was positive for hBD-1 and -2, but not for hBD-3. We provide the first evidence of a previously unrecognized innate immunological function of bone through the demonstration of the presence of the human beta-defensins hBD-1, -2 and -3 in bone.

The functional outcome of lower-extremity fractures with vascular injury.

Salvage of lower-extremity Gustilo type IIIC fractures is difficult, time-consuming for the patients and physicians, and not universally successful because of poor functional outcomes. Even if successful with limb salvage, the functional result may be unsatisfactory because of mutilating injuries to muscle and nerve, bone loss, and the presence of chronic infection. From July 1991 until July 1994, revascularizations of open IIIC fractures were attempted for wounds with Mangled Extremity Severity Score (MESS) < or = 10. The functional results were evaluated at 2 years after injury. Thirty-six lower-extremity revascularizations were performed on 34 patients, including 1 patient with bilateral distal tibial IIIC fractures and a child with IIIC femoral fracture accompanied by ipsilateral distal tibial amputation. Excluded were patients with below-ankle IIIC fractures as well as patients who underwent immediate amputation at admission. After the revascularization, seven patients with IIIC fractures (7 of 36, 19.4%) underwent secondary amputation within 1 week. At the 2-year follow-up, the overall secondary amputation rate was 25% (9 of 36) and the salvage rate was 75% (27 of 36). Those were no deaths. Of the 29 salvaged limbs among these 27 patients, 23 limbs (23 of 29, 79.3%) required secondary coverage procedures that included 12 free flap transfers (12 of 29, 41.4%). Every patient needed subsequent reconstructive surgery to achieve an acceptable functional result. In this series, MESS was able to predict the secondary amputation rate and the functional result. Sixteen of the 17 limb-salvaged patients with MESS < or = 7 were able to achieve minimal functional requirements, whereas 3 of the 10 patients with MESS = 8 to 10 failed to achieve minimal functional requirements at the 2-year follow-up. Using statistical analysis, we found that the salvaged limbs with MESS < or = 9 exhibited a significant difference in achieving adequate function compared with limbs with MESS > 9. Using our protocol for treatment for IIIC fractures, the threshold for immediate amputation can be raised from MESS = 7 to MESS = 9. Our conclusions are (1) more severely injured limbs have poor functional results, (2) every patient needs subsequent reconstructive surgery, and (3) the MESS may be helpful in decision-making.

Amputation After Failed Total Knee Arthroplasty

From 1983 to 1992, nine above-knee amputations were performed in eight patients for complications after total knee arthroplasty. The mean time from the initial knee replacement to amputation was 9.7 years. The average age of the four men and four women was 72 years. Eight knees had chronic infection and one had intractable pain after four revision attempts for aseptic loosening. Most patients had two revision arthroplasties after the original implant. In this series, the common factors that lead to amputation were multiple revision attempts in the presence of chronic infection, severe bone loss, and intractable pain. Earlier consideration of arthrodesis rather than multiple revision attempts is recommended to avoid such a poor outcome.

Factors influencing the acute phase protein levels in patients with esophageal cancer

Based on the findings that the enhancement of serum alpha 2-macroglobulin (A2M) is associated with the occurrence of infectious complications following surgery in patients with esophageal cancer, we examined possible factors which could contribute to the alterations of serum acute phase protein levels in patients with this disease. A multiple linear regression analysis was made for 71 patients with esophageal cancer and 58 with gastric cancer. In patients with esophageal cancer, protein calorie malnutrition (PCM) and age factors more strongly contributed to the alteration of 6 acute phase protein levels than did the malignant tumor when compared to those with gastric acner. PCM was negatively associated with A2M levels while it was positively associated with alpha 1-acidglycoprotein (A1AG) and haptoglobin (Hp) levels. Age did not contribute to the A2M levels but did have a negative effect on the Hp, ceruloplasmin (Cp) and fibronectin (Fn) levels. On the other hand, the malignant tumor was positively related only to the A1AG levels. Since none of these factors contributed to the elevation of A2M levels, it is suggested that the presence of chronic infection might be a factor contributing to the A2M increase which was associated with the occurrence of postoperative infectious complications in patients with this disease.