Complications of frontal sinusitis and their management.

Because of the anatomic location and venous drainage pattern of the frontal sinus, complications commonly involve intracranial structures but can involve the orbit and adjacent bony and soft tissue structures also. Evaluation of patients by a thorough history and physical examination, culture of purulent discharge or infected bone, and axial and coronal CT scanning with contrast is important for diagnosis and treatment planning. Treatment of complications uniformly involves the use of intravenous antibiotics and appropriate drainage procedures to arrest the infection and allow for resolution of the inflammatory complication. Significant morbidity and mortality from complications can occur despite aggressive medical and surgical treatment.

[Vertical transmission causing hepatitis C in a newborn infant]. / Verticalis transmissio okozta hepatitis C vírus fertözés újszülöttkorban.

There is a case report of an intrauterine growth retarded infant who was suffering of sepsis caused by Klebsiella pneumoniae. An exchange transfusion was carried out because of hyperbilirubinaemia on the 5th day of life. 10 days later high bilirubin concentration was observed again parallel to the liver enzyme abnormalities. HCV-related antibodies were detectable in the sera of the newborn and his mother as well. The results of analysis of HCV RNA with the polymerase chain reaction in the infant and his mother suggest vertical transmission of HCV infection. This is the first case of HCV infection in the newborn caused by vertical transmission in Hungary.

D-penicillamine inhibits the action of reactive oxygen species in the pig pulmonary circulation.

Oxygen radicals produced by the hypoxanthine-xanthine oxidase (Hyp-XO) system potently constrict the pulmonary circulation of pigs. D-penicillamine (DPA) is thought to be a free radical scavenger. In the present work we have studied if DPA may influence the vasoactive action of Hyp-XO in pig lungs. Further, we have measured how this drug influences the output of cyclooxygenase and lipoxygenase products from the left atrium in pigs infused with XO into the pulmonary circulation. Twelve young pigs were divided into two groups. Group 1, the XO group, was infused 1 U/kg XO into right atrium. Group 2, the DPA group, was pretreated with DPA, 100 mg/kg intravenously before XO infusion as in group 1. Pulmonary artery pressure, left atrial pressure, pulmonary artery blood flow and systemic blood flow and pressure were recorded continuously. Plasma tromboxane B2 and prostaglandin (6-keto-PGF1 alpha) were determined with a radioimmunoassay method. Cysteinyl containing leukotrienes LTC4, LTD4, and LTE4, were measured together by RIA analyses of plasma samples, using a monoclonal antibody. There was a significant parallel decrease in paO2 and saO2 during the 130 minutes duration of the experiments in both groups without differences between the groups. Pulmonary vascular pressure and resistance increased sharply with a peak found after 25 minutes in the XO group. DPA attenuated the hemodynamic response. DPA inhibited the XO induced pulmonary blood pressure changes with 80% and inhibited the increase in pulmonary vascular resistance 68%. Plasma TXB2 increased two folds in the XO group reaching a maximum after 40 minutes, this effect was completely inhibited by DPA (92% inhibition). DPA also inhibited the XO induced increase in 6-keto-PGF1 alpha, however, not as efficient as with TXB2 (40% inhibition). Plasma cysteinyl leukotrienes increased after XO infusion reaching a peak at 20 minutes. DPA completely abolished this effect (100% inhibition). The study demonstrates that DPA attenuates or even abolishes the hemodynamic effects of XO on the pulmonary circulation in pigs. It seems that DPA inhibits the production of both lipoxygenase and cyclooxygenase products per se, and it is tempting to speculate that the observed DPA effect is caused by its action as an oxygen radical scavenger. It is further speculated that the vasoconstricting effect of XO is due to the fact that oxygen radicals may inactivate nitric oxide (NO), and that DPA stabilizes NO so it more efficiently possess its vasorelaxant activity. We conclude that DPA is an extremely potent inhibitor of XO induced pulmonary vascular effects. The mechanism of action is not fully understood, although its action as an oxygen radical scavenger may explain part of it.

[D-penicillamine: old drug, new indication? D-penicillamine reduced pulmonary hypertension induced by free radicals]. / D-penicillamin: régi gyógyszer, új indikáció? A D-penicillamin csökkenti a szabad gyök indukálta kísérletes pulmonalis hypertensiót.

Pulmonary hypertension is one of the major problems in the neonatal period. Free oxygen radicals play important role in the activation of pulmonary vasoconstriction. Since D-penicillamine has proved to be a strong antioxidant in newborns it was of interest to investigate the effect of the drug in the oxygen radical induced pulmonary hypertension. According to our animal experiments D-penicillamine inhibits the xanthine oxidase induced pulmonary hypertension in piglets. The same inhibitory effect was observed in the prostanoid metabolism. Could D-penicillamine be used in the treatment of pulmonary hypertension in the newborn?

[Hemorrhagic shock and encephalopathy]. / Haemorrhagiás shock és encephalopathia syndroma.

Levin et al. described a new syndrome called haemorrhagic shock and encephalopathy in 1983. The authors present a case report and give an overview about the disease. They summarize the informations published recently.

Ultrastructural investigations in late infantile type of ceroid lipofuscinosis (Jansky-Bielschowsky).

Ultrastructural findings of biopsy materials of four gipsy first cousin infants suffering from late infantile type of ceroid lipofuscinosis (Jansky-Bielschowsky) were investigated. The diagnostic significance of the conjunctival biopsy is emphasized. The pericytes and the vascular smooth muscle cells of the arterioles proved to be the main inclusion storing cells.

[Serum cortisol and ceruloplasmin determination in neonates with intrauterine growth retardation]. / Szérum cortisol és coeruloplasmin meghatározások intrauterin retardált újszülöttekben.

The authors have shown recently that coeruloplasmin deficiency was associated with severe respiratory distress in premature neonates. In the present study they measured the serum cortisol and coeruloplasmin levels in 58 intrauterine growth retarded infants. The results were compared to the data of 44 appropriate for gestational age neonates. Both parameters showed association with the fetal distress in term babies (cortisol: 17.2 vs 12.3 ug/100 ml, coeruloplasmin: 29.7 vs 11.9 U/l). Coeruloplasmin activity was also higher in growth retarded prematures (48.5 vs 16.5 U/l), while cortisol concentration increased irrespective of intrauterine malnutrition. There was a significant positive correlation between serum cortisol and coeruloplasmin in dysmaturity. This is the first report suggesting a possible role for coeruloplasmin, an important extracellular antioxidant enzyme in the precocious development of intrauterine growth retarded infants.

[Prenatal lead blood levels in a city heavily exposed to lead]. / Perinatalis vér-ólomszint fokozott ólomexpozíciójú városban.

The blood lead concentrations were measured in 38 pregnant women and their newborn babies in a high exposure area. The lead content of human milk was also determined on the 5th day after delivery. The blood lead concentrations were higher than 12 micrograms/100 ml in more than 80 per cent of the samples. The lead content of breast milk was also greater than those of published recently. We found a strong correlation between the blood lead levels of the mothers and the newborns. There was a moderate correlation between the lead concentrations in the blood and the breast milk.

One year longitudinal follow-up of premature infants treated with D-penicillamine in the neonatal period.

A prospective controlled trial has recently been reported to show the effectiveness of D-penicillamine (DPA) in the prevention of retinopathy of prematurity (ROP) among infants less than 2000 g birth-weight. The present paper is a comprehensive overview of a cohort of 204 prematures enrolled in the above study, with respect to mortality and outcome. Survival rate in the DPA treated group was the same as of those receiving conventional therapy. When the outcome of the DPA treated and the control infants was compared in terms of both major and minor impairments, the frequency of disabled and handicapped infants was higher in the control group. The same was observed with respect to the number of repeated hospital treatments, which was significantly higher among the control babies. The results suggest that DPA effectively prevents ROP among very-low-birth-weight infants, and also that the drug has no adverse effect on either mortality or late development.

The pharmacokinetics of D-penicillamine in neonates.

The pharmacokinetics of D-penicillamine in premature babies was studied. The metabolism of the drug was characterized by a long half-life (115 min) with a low plasma clearance (2.84 ml/min/kg body weight) in contrast to adults. The mean volume of distribution (649/ml/kg body weight) was similar to that of adults.

Antenatal corticosteroid increases serum ceruloplasmin activity in premature neonates.

Serum ceruloplasmin activity in full term and premature neonates was measured on the first day of life. Preterm newborns were born more than 24 hours after antenatal corticosteroid treatment, had enzyme activity equivalent to that of the full term babies. Little or no ceruloplasmin activity was found in those prematures who were born without steroid prophylaxis. Highly significant correlation was observed between the initial ceruloplasmin activity and the morbidity and mortality of respiratory distress syndrome.

Effects of various thiols on paraquat toxicity.

It was demonstrated that cysteine and D-penicillamine are able to replace reduced glutathione to some extent in the glutathione peroxidase reaction. An in vivo study was made of the role played by--SH compounds in the antioxidant enzyme system involved in the detoxication of the LD50 of paraquat (PQ), and hence of their role in the detoxication of PQ. The effectiveness was D-PA greater than GSH greater then Cys in the liver and GSH greater than Cys greater than D-PA in the lung.

Controlled trial of D-penicillamine to prevent retinopathy of prematurity.

204 infants with birthweights between 751 and 2000 g and 26-35 weeks gestational age (100 treated and 104 control subjects) were enrolled in a prospective controlled trial of the effectiveness of D-penicillamine (DPA) in the prevention of retinopathy of prematurity (ROP). The two groups did not differ significantly in gestational age, birth weight, Apgar scores, the time of exposure to oxygen and in the incidence of PDA or in the number of exchange transfusions and RBTs. Of the treated infants 29, and of the control infants 34 died before the tenth week of life. These cases were not included in further analysis. Patients were subsequently examined and assessed by two ophthalmologists independently, who did not know which babies were receiving DPA. Six of the 70 surviving control infants and none of the 71 surviving treated infants had ROP stage II or graver. The results suggested that ROP may effectively be prevented with DPA in very low-birth-weight-infants, and that the drug has no serious adverse effects during the neonatal period.

D-penicillamine decreases the H2O2 and phenylhydrazine induced lipid peroxidation in the erythrocyte membrane.

The protecting effect of D-penicillamine against hydrogen peroxide and phenylhydrazine induced haemolysis and lipid peroxidation is discussed. It might represent a possible way of action of the drug in some neonatal disorders like hyperbilirubinaemia and retrolental fibroplasia.

Heme oxygenase activity is decreased by D-penicillamine in neonates.

A 3-day D-penicillamine treatment of neonatal rats caused a significant decrease in heme oxygenase activity. This change was not observed in adult rats. The data indicate age-related differences in the effects of D-penicillamine.