RESUMEN
We examined the in vivo cell-mediated immune response in infants with respiratory syncytial virus (RSV) infection in order to gain information about the pathogenesis of severe RSV disease in infancy. Semiquantitative reverse transcription-polymerase chain reaction and three-color flow cytometry were used to determine the levels of messenger RNA (mRNA) for interferon (IFN)-gamma in peripheral blood mononuclear cells, and the distribution of lymphocyte subsets in infants with acute RSV infection. The findings were correlated with the severity of the patients' illness and the production of RSV-specific IgE antibodies (RSV-IgE). Significantly lower IFN-gamma levels and T-lymphocyte counts in the acute phase of illness were observed in infants with severe RSV disease than in those with a milder clinical course of illness. The induction of RSV-IgE was not related to IFN-gamma levels in the acute phase of illness, but rather correlated with IFN-gamma expression during convalescence. The data indicate that reduced IFN-gamma expression may be an important factor in the pathogenesis of severe RSV disease in infancy.
Asunto(s)
Interferón gamma/metabolismo , Leucocitos Mononucleares/metabolismo , Infecciones por Virus Sincitial Respiratorio/inmunología , Infecciones del Sistema Respiratorio/inmunología , Anticuerpos Antivirales/análisis , Relación CD4-CD8 , Citometría de Flujo , Humanos , Inmunoglobulina E/análisis , Lactante , Interferón gamma/genética , Subgrupos Linfocitarios , Reacción en Cadena de la Polimerasa , ARN Mensajero/análisis , Infecciones por Virus Sincitial Respiratorio/metabolismo , Virus Sincitiales Respiratorios/inmunología , Infecciones del Sistema Respiratorio/metabolismo , Transcripción GenéticaRESUMEN
We report on an 18.5-year-old woman with osteosarcoma and delayed methotrexate (MTX) elimination due to renal failure after high-dose MTX, in whom rescue with high doses of folinic acid caused intolerable side effects. In this life-threatening clinical situation, the patients was rescued by the administration of recombinant carboxypeptidase G2, a bacterial enzyme that rapidly hydrolyzes MTX into inactive metabolites. This is the first report on the successful clinical use of this alternative catabolic route for the elimination of MTX.
Asunto(s)
Antimetabolitos Antineoplásicos/farmacocinética , Metotrexato/farmacocinética , Insuficiencia Renal/metabolismo , gamma-Glutamil Hidrolasa/farmacología , Adolescente , Femenino , Humanos , Osteosarcoma/tratamiento farmacológico , Proteínas Recombinantes/farmacologíaRESUMEN
A 4-year-old girl suffering from acute lymphatic leukemia (ALL) was treated with cortisone and chemotherapy. During treatment a blister developed on the dorsum of her right hand, followed by a subsequent necrosis of the underlying tissue and of the first metacarpal bone. Recurrent suppression of bone marrow prevented an immediate single step reconstruction with a microvascular metatarsal bone transfer. Instead, the soft tissue defect was first covered with a pedicled groin flap and the skeleton of the thumb was supported with an external fixator. Then, a free fibular bone graft was transferred. During a complete remission of ALL, a microvascular transfer of the metatarsal bone and joint was finally performed. Two years after reconstruction the right hand is still the dominant one and both thumbs grow proportionately.
