Immune recovery in children undergoing allogeneic stem cell transplantation: absolute CD8+ CD3+ count reconstitution is associated with survival.

To evaluate the correlation between kinetics of immune reconstitution and survival, we prospectively evaluated lymphocyte subsets in 32 paediatric patients undergoing allogeneic stem cell transplantation (SCT) for haematological malignancies. Four-colour flow cytometric analysis was performed at short intervals with a median follow-up of 4 years post SCT. A total of 50% of patients reached age-matched 5th percentile of natural killer, cytotoxic T, B and helper T cells 4, 9, 20 and 28 weeks after SCT, respectively, which increased to more than 80% within 1 year after SCT. Transplantation of peripheral blood stem cells (PBSC) seemed to elicit the fastest reconstitution of CD3+, CD4+ CD3+, CD8+ CD3+ and naïve T cells compared to bone marrow (BM) or CD34-selected PBSC, which did not differ. Most importantly, we observed a significantly higher number of survivors among patients whose CD8+ CD3+ absolute counts rose above the 5th percentile of age-matched normal levels during the first year post SCT compared to patients who never reached these levels (19/25 vs 0/7, P<0.001). This was still present in both subgroups, BM- and CD34-selected grafts (P=0.03, 0.02). These results from a small patient sample underline the importance of particular lymphocyte subsets for the outcome of children undergoing SCT. A larger study with detailed subset analysis is underway.

A prospective evaluation of the timing of postoperative radiotherapy for preventing heterotopic ossification following traumatic acetabular fractures.

PURPOSE: Preoperative and immediate postoperative irradiation of traumatic acetabular fractures (TAF), although known to reduce heterotopic ossification (HO), can cause significant organizational and logistic difficulties. We sought to determine an acceptable time interval between surgery and radiation without compromising control, as well as to update our large experience and to further validate our treatment philosophy. METHODS AND MATERIALS: Beginning in June 1995, we began a prospective study, irradiating 152 patients on postoperative days 1, 2, or 3. There were also 17 patients delayed further secondary to medical difficulties. RESULTS: All patients treated since June 1995 received 700 cGy/1 fx. Fifty-eight patients received radiation within 24 hours of surgery, 41 within 2 days, 53 within 3 days, 13 within 4 days, and 4 were delayed further. Delaying irradiation for up to 4 days postoperatively caused no statistical increase in HO (p = 0.625). Of 263 patients in our retrospective cohort, HO occurred in 5.3% of patients who received irradiation versus 60% of patients who did not. CONCLUSION: In our prospective study, we noted no perceptible increase in HO with up to a 3-day interval between surgery and radiotherapy. This allows a more structured treatment schedule and allows the patient more time to heal and recover. Updated results from our overall series continue to demonstrate that adjuvant radiation decreases the incidence and severity of HO after TAF.

Effects of maternal infections on fetal adrenal steroid production.

We sought to determine the effect of maternal infections on the fetal hypothalamic-pituitary-adrenal axis. Umbilical cord blood was collected at vaginal delivery after labor (24-44 wk. gestation) from 361 infants of women having normal pregnancy ( apart from preterm delivery in some) and 110 infants of women diagnosed with infections: 86% of these women had amnionitis. Infants exposed to antenatal corticosteroids, being growth retarded, or having developmental abnormalities that would be expected to alter function of the hypothalamic-pituitary unit were excluded. Umbilical cord serum was assayed for dehydroepiandrosterone sulfate (DS) and for cortisol. The data were analyzed by use of SAS. The gestational age of the infants of normal women (35.8+/-0.2 wk., Mean +/- SE) was greater than that of the infants of women having infections (34.3+/-0.4 wk., P = 0.003). Umbilical cord serum levels of DS and cortisol rose as a function of gestational age in both groups of infants (P<0.01). Despite being, on average, 1 wk. younger than the normal infants are, the infants of women having infections during pregnancy had higher serum levels of cortisol and DS than did those infants of the normal women. These data are consistent with activation of the fetal hypothalamic-pituitary-adrenal axis in pregnancies complicated by maternal infections. Such a fetal response could be the consequence of transplacental passage of products of the activated maternal immune system.

[Deafness in a sociological context]. / Døvhet i et sosiologisk perspektiv.

This article presents deafness in a social context and problems that deaf people have to establish a social network. Deaf people "grow into" the deaf community. We discuss the relationship between this deaf society and the surrounding community of hearing people and the influence of the latter upon the deaf community. The deaf society also function as a "therapy" in general for deaf people.

[Deaf persons' communication possibilities in relation to auditory and visual symbols]. / Døves kommunikasjonsmuligheter i relasjon til auditive og visuelle symboler.

This article presents deaf people's possibilities of communication. There is a difference in communication skills between deaf people who were born hearing--and have learned a spoken language before the loss of hearing--and those who were born deaf. The later deafness is acquired, the better the individual's ability to communicate in a hearing society. Deaf people are far more dependent upon visual language symbols than are hearing people.

New developments for upper rate response in DDD pacing.

Although widely accepted as an effective method of dealing with rapid atrial rates in a DDD pacemaker, Wenckebach-type and multiblock-type upper rate behaviors may exacerbate pacemaker-mediated tachycardia through AV dissociation. In addition, pathologic atrial rates (e.g., atrial fibrillation, atrial flutter, automatic atrial tachycardia, etc.) frequently result in ventricular pacing at inappropriately high rates. New, more sophisticated algorithms available in today's microprocessor-based DDD pacing systems provide the capability to discriminate successfully a normal atrial rate response to exercise from a pathologic atrial rate. These and other improved capabilities allow the clinician to provide safe rate-responsive pacing to patients in whom rate-responsive pacing was previously contraindicated.

Bipolar versus unipolar issues in DDD pacing.

The relative merits of unipolar and bipolar systems are reviewed in the context of DDD pacing. In order to allow reliable atrial sensing in the presence of myopotentials and exogenous noise, bipolar atrial sensing is desirable. Bipolar ventricular sensing will reduce the incidence of myopotential sensing and may reduce susceptibility to cross-talk. Unipolar systems, however, generally offer better stimulation characteristics. Considerations have led to the development of a new DDD pacemaker with bipolar sensing and unipolar pacing characteristics. The bipolar-sense/unipolar-pace pulse generator is simple to implement based upon a unipolar design and retains the simplicity, convenience, and reliability inherent in that mode.