Neonatal Leukemoid Reaction with Fetal Inflammatory Response Syndrome Is Associated with Elevated Serum Granulocyte Colony Stimulating Factor and Interleukin-6.

Leukemoid reaction (LR) is a reactive disease that exhibits abnormal blood values similar to leukemia, but not due to leukemia. One report showed that neonatal LR (NLR) was associated with elevated serum granulocyte colony stimulating factor (G-CSF) in only 30% of the study neonates. NLR is not always associated with the elevation of serum G-CSF. NLR was defined as a white blood cell count of ≥ 40 × 103/µL and/or blast cell concentration of > 2%. We have focused on NLR with fetal inflammatory response syndrome (FIRS), defined as a fetal systemic inflammatory reaction triggered by intrauterine infection. FIRS was diagnosed based on a cord serum interleukin-6 (IL-6) concentration ≥ 17.5 pg/mL and histopathological chorioamnionitis. Because NLR is highly associated with FIRS, we have hypothesized that NLR is associated with the elevation of both G-CSF and IL-6. This is the first report to measure multiple cytokines in NLR at the same time. The study comprised 19 preterm infants with FIRS: 8 with NLR (study group) and 11 without NLR (control group). Serum G-CSF and IL-6 concentrations were significantly higher in the study group than the control group. There was a positive correlation between G-CSF and IL-6 levels in the study group but not in the control group. These results suggest that elevated serum G-CSF and IL-6 may underlie NLR. Thus, G-CSF and IL-6 concentrations may be predictive of the onset of NLR. Measuring these cytokines is useful for judging the prognosis of preterm infants and for their post-natal clinical management.

DOWN'S SYNDROME WITH NEONATAL ALLOIMMUNE THROMBOCYTOPENIA DUE TO HLA-A2 ANTIBODY.

Anti-HLA antibodies reportedly exist in the one third of pregnant women. But few occurrences of neonatal alloimmune thrombocytopenia (NAIT) caused by anti-HLA antibodies have been reported. Here a male baby, who was admitted for low birth weight with Down syndrome (DS), was suffered from thrombocytopenia without transient myeloproliferative disorder (TMD). Positive reactions of HLA-specific antibodies were detected in maternal serum. Cross-matching tests between maternal serum and paternal platelets and lymphocytes were strongly positive. It is most conceivable that the previous pregnancy of the mother induced the production of anti-HLA-A2 antibody, which crossed the placenta and subsequently caused an NAIT in the case presented. This is the first case of DS with NAIT due to anti-HLA antibodies.

High incidence of ischemic necrosis of the gluteal muscle after transcatheter angiographic embolization for severe pelvic fracture.

BACKGROUND: After transcatheter angiographic embolization (TAE), massive gluteal muscle necrosis was found in patients during open reduction and internal fixation for pelvic fracture. METHODS: In our six patients, magnetic resonance imaging (MRI) scans obtained 1 and 4 weeks after TAE demonstrated ischemic damage of the gluteal muscle. RESULTS: Total reopening of the embolized artery was confirmed in only one case on the second angiogram obtained 1 month after TAE. In five patients, massive muscle necrosis, previously confirmed on MRI, was macroscopically found during open reduction and internal fixation or debridement surgery. In two patients, severe complications developed, such as soft tissue infection caused by necrosis, skin necrosis accompanied by subcutaneous infection, and sepsis. CONCLUSION: MRI revealed that TAE more frequently causes profound ischemic damage or necrosis than has been thought. This will be a warning to those who use TAE. Before definitive stabilization, external fixation may be recommended as a first-choice procedure for resuscitation and, then, unilateral selective TAE.

[Pathophysiologic changes in trauma patients and indications of damage control surgery].

Damage control surgery has become an inevitable strategy in the treatment of severely traumatized patients. Rationale for the DCS is the fact that the mortality in surgical patients who developed hypothermia, acidosis, and coagulopathy (lethal triad) is extremely high unless patients' physiologic stability was reestablished. DCS is usually indicated when patient shows signs of lethal triad during surgical operation. As most of patients who subsequently needed DCS could be judged as having most severe injuries during resuscitative phase, it may be more wise to select candidates for DCS during this phase than to indicate DCS during operation.