Procalcitonin Concentration Measured Within the First Days of Cardiac Surgery Is Predictive of Postoperative Infections in Neonates: A Case-Control Study.

Increased procalcitonin concentration (PCT) is known to be reliable for the identification of infections even in the presence of the non-specific systemic inflammatory response seen after cardiopulmonary bypass (CPB), whereas increased C-reactive protein concentration (CRP) is not. The present work explored the ability of neonate PCT measured early after cardiac surgery to identify postoperative infections. This was a retrospective case-control study, where PCT was matched between patients with and without infections according to the patient's age, the CPB length, the use of deep hypothermic circulatory arrest (DHCA), and the postoperative day (POD). The accuracy in the prediction of infections was ascertained and cutoff thresholds were identified. 144 neonates were eligible, and 89 pairs of measurements from 94 patients were analyzed. PCT was a good predictor of infections within POD4, and was a better predictor when compared with CRP at POD1 and POD2. The sum of PCT (pg mL-1) and CRP (mg L-1) > 33 on POD1 or POD2 predicted infections with a 0.68 sensitivity and a 0.82 specificity, and a sum > 49.36 on POD3 or POD4 predicted infections with a 0.82 sensitivity and a 0.93 specificity. In patients with DHCA, PCT was higher than in those without DHCA, and was not predictive of infections. The accuracy of PCT to identify infections after neonatal cardiac surgery is better than that of CRP when measured within 48 h of surgery. The sum of the two markers measured early after surgery is an excellent predictor of postoperative infections.

[A new case of systemic contact eczema to nickel in a peripheral venous catheter]. / Eczéma de contact systémique au nickel d'un cathéter périphérique : un nouveau cas.

BACKGROUND: Nickel-elicited systemic contact dermatitis is a rare event seen in previously skin sensitized patients. We report a case of systemic contact dermatitis due to nickel released into the bloodstream from a metal section of a catheter during infusion. CASE REPORT: A 39-year-old woman presented papular and vesicular flexural dermatitis and pompholyx 72h after cervical spine surgery. She received numerous treatments during the perioperative period. A challenge test with one of the suspected treatments, cefazolin, was performed by intravenous infusion over a six-hour period using the same Optiva) peripheral catheter (Johnson & Johnson, USA). Six hours after withdrawal of the catheter, an eruption occurred. A further cefazolin challenge test performed later under identical conditions but using a different type of catheter (nickel-free) was negative. Nickel-elicited systemic contact dermatitis due to nickel release from a catheter was diagnosed. The patient's medical history was notable for contact dermatitis with jewellery. Patch tests confirmed marked nickel sensitization. DISCUSSION: A little-known way of systemic nickel absorption is through insertion of a venous catheter with a metal section containing nickel and a metallic eyelet containing nickel can in fact remain in place after catheter placement. Nickel can thus be released into the circulation during infusion and an eruption may occur during the postoperative period. This diagnosis is noteworthy as such eruptions can easily be mistakenly diagnosed as cutaneous drug eruptions.

Low serum selenium concentrations in French patients with measles.

OBJECTIVE: Selenium deficiency adversely affects the clinical outcome of measles in the tropics. In developed countries, serum selenium level has never been investigated during acute measles. The aim of this study was to determine serum selenium concentrations in French patients with acute measles and to seek correlations with clinical and virological findings. PATIENTS AND METHODS: We studied serum selenium concentrations in 94 French patients with acute measles and in 99 healthy controls matched for age and sex. RESULTS: The mean of selenium concentration was significantly lower in the patients than in the controls (46.4±14.1µg/L versus 86.5±13.9µg/L, P<0.0001). In the patients, selenium concentrations were not associated with age, sex, vaccination status, clinical signs or specific antibody responses. Selenium levels did not differ significantly between patients with uncomplicated measles (45.8±14.2µg/L) and patients with complications (52.7±13.2µg/L) (P=0.15). CONCLUSION: Acute measles is associated with significant reduction of selenium level that did not seem to negatively affect the course of the disease suggesting compensating mechanisms in patients from developed countries against the disease.

Evidence for the involvement of (Cu-ATP)2- in the inhibition of human erythrocyte (Ca2+ + Mg2+)-ATPase by copper.

The effects of copper on the activity of erythrocyte (Ca2+ + Mg2+)-ATPase have been tested on membranes stripped of endogenous calmodulin or recombined with purified calmodulin. The interactions of copper with Ca2+, calmodulin and (Mg-ATP)2- were determined by kinetic studies. The most striking result is the potent competitive inhibition exerted by (Cu-ATP)2- against (Mg-ATP)2- (Ki = 2.8 microM), while free copper gives no characteristic inhibition. Our results also demonstrate that copper does not compete with calcium either on the enzyme or on calmodulin. The fixation of calmodulin on the enzyme is not altered in the presence of copper as shown by the fact that the dissociation constant remains unaffected. It may be speculated that (Cu-ATP)2- is the active form of copper, which could plausibly be at the origin of some of the pathological features of erythrocytes observed in conditions associated with excess copper.

Effects of cyclic (nocturnal) total parenteral nutrition and continuous enteral nutrition on circadian rhythms of blood lipids, lipoproteins and apolipoproteins in humans.

The aim of the present study was to investigate the occurrence and characteristics (acrophase, amplitude) of circadian rhythms of serum total cholesterol, free-fatty acids (FFA), triglycerides, lipoproteins (HDL-, LDL-, and VLDL-cholesterol), apolipoproteins A and B, glucose and total proteins in hospitalized patients fed with 12 h nocturnal total parenteral nutrition (TPN) (from 8 PM to 8 AM) including lipids, patients fed with continuous enteral nutrition over 24 h daily spans, and patients eating 3 meals a day serving as controls. All the subjects were synchronized with diurnal activity and nocturnal rest in the hospital routine. The results showed the following: 1) circadian rhythms of total cholesterol, triglycerides, FFA, HDL-, LDL-cholesterol, apolipoprotein A and total proteins were detected in both TPN patients and controls, rhythms of apolipoprotein B and glucose in TPN patients only; in enteral nutrition patients, rhythms were detected for total proteins, glucose and triglycerides only; 2) a significant shift in triglyceride and FFA acrophases was observed in TPN patients, as compared with controls; 3) 24 h mean of both triglyceride and cholesterol concentrations remained unchanged after one month, in both TPN and enteral nutrition patients. The present approach, by extending results of previous investigations, leads one to conclude that, on both a metabolic and a chronobiological basis, cyclic nocturnal TPN is well-tolerated.

Ultrastructural study of rat hippocampus after chronic administration of aluminum L-glutamate: an acceleration of the aging process.

An ultrastructural study of rat hippocampus was performed on young (group 1) and old (group 4) rats receiving daily subcutaneous injections of aluminum L-glutamate and on old untreated rats (group 5). Young controls were treated with sodium L-glutamate (group 2) and physiological saline (group 3). Group 1 showed vacuolated astrocytes with numerous lipofuscin deposits, mitochondrial swelling, a thinning of the myelin sheath, and many multivesicular bodies invading the cytoplasm. Cellular structure did not appear to be affected in groups 2 and 3. Group 4 showed swollen mitochondria, a demyelination process in axonal regions, sizable perivascular oedema with vessel retraction and gliofilament bundles. In this group, lipofuscin deposits in astrocytes were associated with multivesicular bodies that thinned the myelin sheath to the breaking point; however, no excitotoxic glutamate-induced effects were observed. In group 5, extreme cytoplasmic vacuolation was observed, with massive mitochondrial swelling, considerable thinning of the myelin sheath (at times to the breaking point), sizable vacuolar degeneration and gliofilament bundles. These results indicate that ultrastructural alterations in the hippocampus, such as cell vacuolization, massive mitochondrial swelling and the demyelination process, occur with aging and independently of aluminum intoxication. Similar alterations were observed in aluminum L-glutamate-intoxicated young rats, but not in controls. These results are consistent with aluminum-induced acceleration of the aging process.

In vitro and in vivo effect of mercury, lead and cadmium on the generation of chemiluminescence by human whole blood.

A method based on the use of the luminogenic substance, luminol, was developed for measuring the respiratory burst induced by phorbolmyristate acetate in 4 microliters of human whole blood. In vitro, the three cations, Hg2+, Pb2+ and Cd2+, inhibit the peak luminescence response at concentrations higher than those usually found in blood of subjects exposed to these metals. Cadmium metallothionein, however, in a concentration range similar to that found in whole blood of workers exposed to cadmium strikingly reduces the respiratory oxidative burst. In workers exposed to inorganic lead or mercury vapour, no reduction of the chemiluminescence response of whole blood was observed while a slight but statistically significant reduction was found in whole blood from cadmium exposed workers. If a similar effect occurs in lung macrophages, it might decrease the respiratory tract resistance to infection.

An evaluation of the biological significance of aluminium in plasma and hair of patients on long-term hemodialysis.

In hemodialyzed patients, the risk of toxicity attributed to the body accumulation of aluminium (Al) justifies the need for monitoring Al in various human media. In this study, Al concentrations in the hair and plasma of 78 hemodialyzed patients with chronic renal failure and of 351 healthy volunteers were measured by electrothermal atomic absorption spectrometry with Zeeman effect. Plasma Al concentrations in patients were significantly higher than in the controls and positively correlated with time on dialysis. Hair Al levels were widely distributed with no significant distinction between patients and controls. On the subject of establishing correlation, the authors stress the importance of taking into account the kinetics of the elimination of minerals from hair. Even when this was done, in the patient group there was no statistical link between plasma and hair Al levels. Hair Al analysis is of no value as an indicator of body Al accumulation.

Congenital hypomagnesemia: alternatives to tissue biopsies for monitoring body magnesium status.

We have been monitoring a 12-year-old boy (his present age) suffering from selective magnesium (Mg) malabsorption. After ascertaining his Mg status, we attempted to maintain Mg balance through the use of oral supplements. Plasma and erythrocyte Mg concentrations were monitored at bimonthly intervals. However these measurements did not accurately reflect Mg status and we subsequently measured Mg in the following tissues: lymphocyte, tooth, and hair. Levels of Mg in stable tissues such as temporary teeth and lymphocytes, unfailingly revealed a marked deficit in Mg that was only two-thirds of the normal levels found in the control group. The use of these readily-accessible stable tissues can thus obviate the need for muscle or bone biopsy. Unfortunately the level in hair is higher than in healthy subjects, and thus does not constitute an adequate measure of Mg status.

Copper-induced lipid peroxidation and hemolysis in whole blood: evidence for a lack of correlation.

In order to establish a possible relationship between hemolytic and peroxidant activities of copper ions, lipid peroxidation was studied in plasma and whole blood incubated for 24 h with different concentrations of copper. The lipid peroxidation was investigated by the determination of thiobarbituric acid-reactive species, conjugated dienes and fluorescent lipid chromophores. The copper-induced lipoperoxidation was clearly demonstrated in plasma incubated with high concentrations of copper (12.10(-4) and 20.10(-4) M); in whole blood, all the lipoperoxidation products were increased in the plasma, while the fluorescent lipid chromophores remained unchanged in red cells. With a copper concentration similar to that found in acute copper intoxication (4.10(-4) M) no lipoperoxidation was observed and yet hemolysis occurred, reduced glutathione (GSH) decreased dramatically and methemoglobin (MetHb) increased. From these results, we assume that, despite its prooxidant activity and its capacity to produce lipoperoxidation, it has not been proven that copper ions at pathophysiological concentrations induce hemolysis by an oxidative mechanism.

Role of aluminium in skin reactions after diphtheria-tetanus-pertussis-poliomyelitis vaccination: an experimental study in rabbits.

The occurrence of subcutaneous nodules at the injection site is one of the complications of diphtheria-tetanus-pertussis-poliomyelitis vaccination, but the causes and mechanisms involved are still poorly understood. An experimental study in the New Zealand rabbit enabled us to determine the frequency of occurrence of these nodules, how long they persist and the histopathologic features of the cells involved. Aluminium (Al) assays by electrothermal atomic absorption spectrometry allowed us to study concentrations both in nodules and the organism (serum, normal skin). The results show an absence of Al diffusion outside nodules, a correlation between infiltrate intensity and Al concentration in nodules and modifications in the histological constituents of nodule cells. The histological picture indicates a foreign body reaction to Al. All these data underscore the role of Al in the formation of early postvaccinal nodules at the injection site.

Chronic administration of aluminium L-glutamate in young mature rats: effects on iron levels and lipid peroxidation in selected brain areas.

Clinical and experimental studies have demonstrated the neurotoxicity of aluminium (Al), notably as a result of lipid peroxidation in vitro. We previously showed that Al is able to cross the blood-brain barrier as an L-glutamate complex and be deposited in rat brain. The present work in young mature rats investigated the in vivo effects of chronic Al-L-glutamate treatment on Al and iron movement in plasma and selected brain regions. Brain lipid peroxidation was determined by evaluating the production of thiobarbituric acid reactive substances (TBARS) and analysing polyunsaturated fatty acids (PUFAs) such as C20:4n-6 and C22:6n-3. Our results indicate that iron concentration was decreased in plasma and that Al accumulated especially in striatum where iron levels were decreased and in the hippocampus where TBARS were increased without PUFA modifications. These data show that Al administered chronically as an L-glutamate complex is neurotoxic in vivo and thus provides a good model for studying Al toxic mechanisms.

Comparative pharmacokinetics of [65Zn]zinc sulfate and [65Zn]zinc pantothenate injected intravenously in rabbits.

The pharmacokinetics of zinc sulfate were compared with those of a new zinc salt, pantothenate, in rabbits. Each salt was administered at a dosage of 3.3 microCi of zinc-65/kg of body weight. The measured pharmacokinetics of the two compounds responded to a two-compartment open model. The urinary elimination of the two salts was similar, as was their localization in the skin and fur, but zinc pantothenate was fixed by the liver to a lesser extent than was zinc sulfate.

Biological levels of aluminium after use of aluminium-containing bone cement in post-otoneurosurgery.

Use aluminium-containing biomaterials in otoneurosurgery for reconstitution of bone in contact with cerebrospinal fluid (CSF) also led to cases of encephalopathy and death. We report aluminium (Al) concentrations in the biological fluids of six French patients following use of Al-containing bone cement in otoneurosurgery. In five patients, the mean plasma Al levels (microgram/L) were: 1.20 +/- 0.05 (case 2), 9.20 +/- 0.10 (case 3), 1.00 +/- 0.05 (case 4), 2.80 +/- 0.05 (case 5) and 2.00 +/- 0.05 (case 6). In case 1, Al concentrations were 176 micrograms/L in the postauricular CSF accumulation, 34 micrograms/L in the pontocerebellar angle and 4 and 6 micrograms/L in the lumbar shunt. As a precautionary measure, in the first three cases the biomaterial was removed soon after the intervention, and no increase in plasma or CSF Al was observed. In the other cases, absence of neurobiological symptoms and normal concentrations of Al in plasma led neurosurgeons not to extract this biomaterial. Al assay thus may be considered to be a complementary and at times a decision-generating factor. Care is needed at all stages from sampling through analysis because Al is ubiquitous and factually high results may be clinically misleading. Herein, such considerations are discussed in conjunction with the neurotoxicity of this metal in man. In addition, the authors call for in-depth preliminary trials of these biomaterials in animals prior to introduction on the market.

Determination of total mercury in human hair samples by cold vapor atomic absorption spectrometry.

A procedure for the determination of mercury in human hair by cold-vapor atomic absorption spectrometry with a new reaction vessel was developed and evaluated. To eliminate the so-called matrix effect, calibration was carried out in an isomedium under identical operating conditions. Under these conditions, the recovery percentage of mercury from human hair digest samples using the peak height method, was 102 +/- 2.2%. The method has been used for measuring the mercury level in hair of different groups of people living in the Nantes, France area.

Modification of the blood-brain barrier through chronic intoxication by aluminum glutamate. Possible role in the etiology of Alzheimer's disease.

The authors have used an experimental rat model of chronic aluminum (Al) intoxication to reproduce pathological signs analogous to those observed in humans for Alzheimer's disease or dialysis encephalopathy. Preliminary chronic intoxication was achieved during 5 wk by daily subcutaneous injection of a suspension of glutamate and Al prior to intravenous (i.v.) administration of sodium L-glutamate and Al chloride. A significant increase in Al content was observed in different areas of the brain, such as the hippocampus, the occipito-parietal cortex, the cerebellum, and the striatum. Moreover, half of the animals subcutaneously treated with Al glutamate had neurological disturbances, such as trembling, equilibrium difficulties, and convulsions leading to death about 1 h after i.v. administration. A significant increase in glutamic acid at the level of the occipito-parietal cortex was found in comparison with controls, which received only sodium L-glutamate or saline solution. These results show that the Al-L-glutamate complex may well induce a modification of the blood-brain barrier.

A study of chromium in human cataractous lenses and whole blood of diabetics, senile, and normal population.

Chromium (Cr) is of known biological importance, necessary for the maintenance of normal glucose metabolism. There is a lower level of blood Cr concentrations in cases of diabetes. Diabetes carries a risk of cataract development, so the potential effects of Cr on the eye may need to be studied in more depth. The presence of this trace element in both normal and cataractous human lenses has to our knowledge not been investigated so far. The concentration of total Cr in 61 human lenses and 38 blood samples was determined by electrothermal atomic absorption spectrometry with Zeeman effect (EAASZ). Analysis of the levels of Cr in human lenses shows a significant difference between normal and diabetic populations, and an absence of difference between senile and diabetic populations.

Aluminum transfer as glutamate complex through blood-brain barrier. Possible implication in dialysis encephalopathy.

In vitro distribution of aluminium between plasma and erythrocytes has been studied in the presence of variable amounts of sodium L-glutamate. With a red blood cell suspension in isotonic sodium chloride, aluminium remains confined in erythrocytes even when the sodium L-glutamate concentration increases in the medium. Aluminium initially present in plasma penetrates red blood cells when sodium L-glutamate increases in whole blood, showing that this metal is able in vitro to cross the erythrocyte membrane as glutamate complex. In vivo experiments with male Wistar rats prove that aluminium is also able to pass the blood--brain barrier as glutamate complex and deposit in the brain cortex.

Total chromium in the human lens. Determination with Zeeman electrothermal atomic absorption spectrometry following mineralization in a mini-autoclave.

A simple, quick procedure has been developed for preparation of human lenses for total chromium (Cr) analysis by electrothermal atomic absorption spectrometry (EAAS). This procedure involves wet ashing in a mini-autoclave with HNO3 and H2SO4. Recovery was 101.6%. This procedure is simple to carry out, does not generate corrosive fumes, and minimizes contaminations. Measurements obtained by this method give values similar to those found previously by more cumbersome methods. It can be conveniently used to prepare biological samples for ultratrace analysis. The mean Cr concentration in human lenses varied between 0.345 +/- 0.147 micrograms/g dry wt in the normal population and 0.205 +/- 0.160 micrograms/g dry wt in cataractous lenses.

Severe selective magnesium malabsorption: tests of tolerance of oral magnesium supplements.

Since his birth, we have been monitoring a 12-year-old boy suffering from selective severe magnesium malabsorption. Our essential problem is to prepare a form of galena with acceptable taste, tolerated by the digestive tract and well absorbed; also, the carrier compound must not cause short- or long-term side effects. An additional factor is the steadily increasing need for magnesium from 1 mmol/kg.d at 1 year to 14 mmol/kg.d at present age (345 mg/kg.d). The galena forms currently on sale were, with the exception of lactate and pyrollidone carboxylate, immediately rejected since they contain insufficient Mg2+. Following short trials resulting in diarrhoea, the other two preparations were also rejected. We then constituted - and also abandoned - our own galena compounds: aspartate (bitterness), aspartate + glycerophosphate (GLP) (bitterness), glutamate + GLP ('Chinese restaurant syndrome' and fear of the long term toxic effect of the glutamate), gluconate (excessive volume: 11/1 proportion with Mg2+). A recent test featuring GLP of Mg 40 g + cocoa butter 40 g + cocoa 10 g, brought about vomiting and diarrhoea, and was not adequately absorbed. The best tolerated formula is: Mg GLP 21.33 g; saccharose 6 g; aspartam 1 g; gelatin 0.5 g; citric acid, conserving agent, fruity aroma; water: qs 100 g. Such composition yields a caramel cream absorbed in five small portions, at a daily quantity of 375 g (80 g GLP Mg, 10 g Mg2+). Vitamin B6, which promotes intestinal absorption of magnesium, must be given separately in tablet form at a dose of 1 g/d, since it causes nausea if it is included in the Mg preparation.(ABSTRACT TRUNCATED AT 250 WORDS)