Wound-related complications in the surgical treatment of vertebral metastatic disease – A case series analysis / Complicaciones relacionadas con la herida en el tratamiento quirúrgico de la enfermedad metastásica vertebral: análisis de una serie de casos

Introduction and objectives: Spinal metastases (SM) account for 5–30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. Materials and methods: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC – surgical site infection, hematoma, and/or dehiscence – at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. Results: 198 patients (121 males and 77 females) with an average age of 65 years (range 54–73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37–45.35, p=0.021), prostate cancer as primary tumor (6.73, 1.14–39.65, p=0.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02–5.22, p=0.044). There was no difference between groups on 90 days survival rate (p=0.714). Conclusions: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.(AU)

Introducción y objetivos: Las metástasis espinales (MV) pueden ocurrir en el 5-30% de los pacientes con cáncer, provocando dolor, deformidad y/o déficit neurológico. Las complicaciones postoperatorias son un motivo de preocupación y las complicaciones relacionadas con la herida (CRH) pueden retrasar el inicio del tratamiento adyuvante. El objetivo de este estudio fue analizar la incidencia de CRH en pacientes con MV sometidos a tratamiento quirúrgico y evaluar los posibles factores de riesgo relacionados con estas complicaciones. Materiales y métodos: Se analizaron pacientes operados por MV entre 2011 y 2021. Se analizaron características demográficas, tumor primario, estado general y neurológico, score de Tokuhashi, tipo de tratamiento quirúrgico, duración de la cirugía, albúmina sérica y hemoglobina preoperatorias, tratamiento adyuvante pre- y postoperatorio. Se evaluó la incidencia y los factores de riesgo de la CRH (infección del sitio quirúrgico, hematoma y/o dehiscencia) a los 90 días. Los pacientes se clasificaron en dos grupos según la ausencia/presencia de CRH. Resultados: Se analizaron 198 pacientes (121 hombres y 77 mujeres) con una edad promedio de 65 años (rango 54-73 años). Se observaron CRH en 44 pacientes (22%). En el análisis multivariado, los predictores significativos para el desarrollo de CRH fueron un score de Tokuhashi bajo (OR=7,89; IC del 95%=1,37-45,35; p=0,021), cáncer de próstata como tumor primario (OR=6,73; IC del 95%=1,14-39,65; p=0,035) y albúmina sérica preoperatoria≤3,5g/dL (OR=2.31; IC del 95%=1,02-5,22; p=0,044). No hubo diferencias entre los grupos en la supervivencia a los 90 días (p=0,714). Conclusiones: En nuestra serie, la incidencia de CRH fue del 22%, los principales factores de riesgo para su aparición fueron el score de Tokuhashi bajo, la albúmina sérica preoperatoria más baja y el cáncer de próstata. Finalmente, la tasa de supervivencia a corto plazo no se vio afectada por la ocurrencia de CRH.(AU)

[Artículo traducido] Complicaciones relacionadas con la herida en el tratamiento quirúrgico de la enfermedad metastásica vertebral: análisis de una serie de casos / Wound-related complications in the surgical treatment of vertebral metastatic disease - A case series analysis

Introduction and objectives: Spinal metastases (SM) account for 5–30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. Materials and methods: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC – surgical site infection, hematoma, and/or dehiscence – at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. Results: 198 patients (121 males and 77 females) with an average age of 65 years (range 54–73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37–45.35, p=0.021), prostate cancer as primary tumor (6.73, 1.14–39.65, p=0.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02–5.22, p=0.044). There was no difference between groups on 90 days survival rate (p=0.714). Conclusions: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.(AU)

Introducción y objetivos: Las metástasis espinales (MV) pueden ocurrir en el 5-30% de los pacientes con cáncer, provocando dolor, deformidad y/o déficit neurológico. Las complicaciones postoperatorias son un motivo de preocupación y las complicaciones relacionadas con la herida (CRH) pueden retrasar el inicio del tratamiento adyuvante. El objetivo de este estudio fue analizar la incidencia de CRH en pacientes con MV sometidos a tratamiento quirúrgico y evaluar los posibles factores de riesgo relacionados con estas complicaciones. Materiales y métodos: Se analizaron pacientes operados por MV entre 2011 y 2021. Se analizaron características demográficas, tumor primario, estado general y neurológico, score de Tokuhashi, tipo de tratamiento quirúrgico, duración de la cirugía, albúmina sérica y hemoglobina preoperatorias, tratamiento adyuvante pre- y postoperatorio. Se evaluó la incidencia y los factores de riesgo de la CRH (infección del sitio quirúrgico, hematoma y/o dehiscencia) a los 90 días. Los pacientes se clasificaron en dos grupos según la ausencia/presencia de CRH. Resultados: Se analizaron 198 pacientes (121 hombres y 77 mujeres) con una edad promedio de 65 años (rango 54-73 años). Se observaron CRH en 44 pacientes (22%). En el análisis multivariado, los predictores significativos para el desarrollo de CRH fueron un score de Tokuhashi bajo (OR=7,89; IC del 95%=1,37-45,35; p=0,021), cáncer de próstata como tumor primario (OR=6,73; IC del 95%=1,14-39,65; p=0,035) y albúmina sérica preoperatoria≤3,5g/dL (OR=2.31; IC del 95%=1,02-5,22; p=0,044). No hubo diferencias entre los grupos en la supervivencia a los 90 días (p=0,714). Conclusiones: En nuestra serie, la incidencia de CRH fue del 22%, los principales factores de riesgo para su aparición fueron el score de Tokuhashi bajo, la albúmina sérica preoperatoria más baja y el cáncer de próstata. Finalmente, la tasa de supervivencia a corto plazo no se vio afectada por la ocurrencia de CRH.(AU)

Wound-related complications in the surgical treatment of vertebral metastatic disease - A case series analysis. / [Artículo traducido] Complicaciones relacionadas con la herida en el tratamiento quirúrgico de la enfermedad metastásica vertebral: análisis de una serie de casos.

INTRODUCTION AND OBJECTIVES: Spinal metastases (SM) account for 5-30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. MATERIALS AND METHODS: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC -surgical site infection, hematoma, and/or dehiscence- at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. RESULTS: 198 patients (121 males and 77 females) with an average age of 65 years (range 54-73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37-45.35, p=.021), prostate cancer as primary tumor (6.73, 1.14-39.65, p=.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02-5.22, p=.044). There was no difference between groups on 90 days survival rate (p=.714). CONCLUSIONS: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.

Wound-related complications in the surgical treatment of vertebral metastatic disease - A case series analysis.

INTRODUCTION AND OBJECTIVES: Spinal metastases (SM) account for 5-30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. MATERIALS AND METHODS: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC - surgical site infection, hematoma, and/or dehiscence - at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. RESULTS: 198 patients (121 males and 77 females) with an average age of 65 years (range 54-73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37-45.35, p=0.021), prostate cancer as primary tumor (6.73, 1.14-39.65, p=0.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02-5.22, p=0.044). There was no difference between groups on 90 days survival rate (p=0.714). CONCLUSIONS: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.

Potentially mobile of heavy metals on the surface sediments in tropical hyper-saline and positive estuaries.

Estuarine sediments represent important pools of trace metals, released from both anthropogenic and natural sources. Fluctuations in the water column physicochemical conditions, on the other hand, may transfer metals from solid to liquid compartment and resulting in contamination of the surrounding environment. The present research was carried out to evaluate the weakly bounded heavy metal levels in tropical hyper-saline and positive estuaries, in order to quantify its potentially availability. The monitoring includes five metals (Cd, Cr, Cu, Pb, Zn) and cover nine estuaries in Rio Grande do Norte state/Brazil, including four hypersaline and five true estuaries. 50 surface sediment samples were collected in each estuary. At the same time, organic matter concentrations were evaluated in order to help explaining possible local variations in heavy metal levels. Organic matter results (0.7% - 7.3%) suggest the positive Potengi estuary as the most critical environmental quality situation. On the other hand, according to heavy metals levels, both Conchas and Potengi estuaries registered the higher concentrations of Cr. The highest concentrations were observed in the hyper-saline estuaries, with the exception of the Zn. The present study revealed that the watershed occupation has significantly influenced the heavy metal concentrations in the estuaries.

Potentially mobile of heavy metals on the surface sediments in tropical hyper-saline and positive estuaries

ABSTRACT Estuarine sediments represent important pools of trace metals, released from both anthropogenic and natural sources. Fluctuations in the water column physicochemical conditions, on the other hand, may transfer metals from solid to liquid compartment and resulting in contamination of the surrounding environment. The present research was carried out to evaluate the weakly bounded heavy metal levels in tropical hyper-saline and positive estuaries, in order to quantify its potentially availability. The monitoring includes five metals (Cd, Cr, Cu, Pb, Zn) and cover nine estuaries in Rio Grande do Norte state/Brazil, including four hypersaline and five true estuaries. 50 surface sediment samples were collected in each estuary. At the same time, organic matter concentrations were evaluated in order to help explaining possible local variations in heavy metal levels. Organic matter results (0.7% - 7.3%) suggest the positive Potengi estuary as the most critical environmental quality situation. On the other hand, according to heavy metals levels, both Conchas and Potengi estuaries registered the higher concentrations of Cr. The highest concentrations were observed in the hyper-saline estuaries, with the exception of the Zn. The present study revealed that the watershed occupation has significantly influenced the heavy metal concentrations in the estuaries.

The role of the humic substances in the fractioning of heavy metals in Rodrigo de Freitas lagoon, Rio de Janeiro--Brazil.

One of the main results of the processes related to urbanization is the contamination of the adjacent water bodies. Inserted in this context, the Rodrigo de Freitas lagoon is situated in the south zone of the city of Rio de Janeiro. This ecosystem receives several inputs containing all sorts of pollutants, including heavy metals. The present work aimed to study the partitioning of heavy metals in the sediments of Rodrigo de Freitas and the influence of organic matter in this fractionation dynamic. The results of these analyses presented the contents of organic matter as an important metal-capturing agent. Fractionation of organic matter resulted in a predominance of humine. Heavy metal partitioning showed that the metals bound by the water-soluble phase have no significant concentrations. Special features such as, reducing sediment, high levels of organic matter and fine grain size have transformed this ecosystem in an effective deposit of pollutants, where heavy metals are not available in easily reactive fractions.

Geochronology and heavy metal flux to Guanabara Bay, Rio de Janeiro state: a preliminary study.

Guanabara Bay, located in Rio de Janeiro state. It is surrounded by the second most important metropolitan area of the country. Over recent decades, land disturbance and urbanization in the surrounding area has significantly increased sediment input to the bay and had a negative effect on its overall environmental. This is especially related to high volumes of untreated sewage and industrial effluents. This study evaluates the history of this human impact through detailed examination of a sediment core taken from the northern portion of Guanabara Bay. A geochronology is established using ²¹°Pb dating and related to organic carbon and heavy metal fluxes to the sediments. This gave a calculated net average sedimentation rate for the core of 0.67 cm.year⁻¹. The organic carbon and heavy metals flux started to increase at the beginning of the last century and the highest values was observed in the top of the cores.

Study of heavy metal concentration and partitioning in the Estrela River: implications for the pollution in Guanabara Bay ­ SE Brazil.

In this study, the geochemical analysis of ten sediment samples collected along the fluvial system of the Estrela River, which flows into the northern portion of Guanabara Bay, shows the presence of anthropogenic impacts in this area. Concentrations of Fe, Mn, Zn, Cu, Pb, Cr and Ni obtained were slightly higher, when compared with values found in natural environments. The particle size and organic matter content in most of the analyzed stations showed features not conducive to the accumulation of pollutants due to the low organic matter content and the strong presence of sand fraction. There was also the fractionation of heavy metals in sediments and it was found the prominence of residual and reducible phase, besides the significant occurrence of organic fractions in some analyzed stations. These factors, thus, highlight the potential risks of contamination, where the metals associated with the organic phase can become bioavailable in processes of dissolution, provided by physico-chemical changes that can occur in this aquatic environment.

Study of heavy metal concentration and partitioning in the Estrela River: implications for the pollution in Guanabara Bay - SE Brazil

In this study, the geochemical analysis of ten sediment samples collected along the fluvial system of the Estrela River, which flows into the northern portion of Guanabara Bay, shows the presence of anthropogenic impacts in this area. Concentrations of Fe, Mn, Zn, Cu, Pb, Cr and Ni obtained were slightly higher, when compared with values found innatural environments. The particle size and organic matter content in most of the analyzed stations showed featuresnot conducive to the accumulation of pollutants due to the low organic matter content and the strong presence ofsand fraction. There was also the fractionation of heavy metals in sediments and it was found the prominence ofresidual and reducible phase, besides the significant occurrence of organic fractions in some analyzed stations. Thesefactors, thus, highlight the potential risks of contamination, where the metals associated with the organic phase canbecome bioavailable in processes of dissolution, provided by physico-chemical changes that can occur in this aquaticenvironment.

Neste estudo, analises geoquímicas de dez amostras de sedimentos coletadas ao longo do sistema fluvial do rio Estrela, que deságua na porção norte da Baía de Guanabara, evidenciam a presença de impactos antropogênicos nesta área. As concentrações de Fe, Mn, Zn, Cu, Pb, Cr e Ni obtidas foram ligeiramente elevadas, quando comparados com valores encontrados em ambientes naturais. A granulometria e o teor de matéria orgânica na maioria dos pontos analisados mostraram características não favoráveis à acumulação destes poluentes devido à baixa concentração de matéria orgânica e à forte presença de fração areia. Realizou-se também o fracionamento dos metais pesados nos sedimentos e constatou-se a preeminência da fase residual e redutível, além da ocorrência significativa da fração orgânica em alguns pontos analisados. Estes fatores evidenciam, portanto, riscos potenciais de contaminação, onde os metais associados à fase orgânica podem se tornar biodisponíveis em processos de solubilização, proporcionados por mudanças físico-químicas que podem ocorrer neste ambiente aquático.

Geochemical behavior of heavy metals in differents environments in Rodrigo de Freitas lagoon - RJ/Brazil.

The accelerated urbanisation without a planning, brought several environmental problems to Rio de Janeiro coastal zone, especially in areas such as Rodrigo de Freitas lagoon, which receives a great amount of untreated sewage every day. To assess the nature, potentially sources and extent of heavy metal pollution in the lagoon, sediments from the surrounding streets, from the entrance of the main canal that drains to the lagoon and from the bottom of the lagoon were collected and analysed by a modified selective extraction procedure in order to study the geochemical partitioning and bioavailability of Zn, Cu, Cr, Ni and Pb in these three compartments. The present study verified an increase in the Cu, Pb and Zn concentrations in the north of the Rodrigo de Freitas lagoon. Despite the different levels of oxidation between the sediments accumulated in the streets and in the bottom of the lagoon, the geochemical partitioning of the heavy metals did not show any pattern of variation for the metals, except for the element Cu. No concentrations were found in the soluble phase of samples collected in the surfacial sediments of the lagoon, suggesting no bioavailability of heavy metals.

Geochemical behavior of heavy metals in differents environments in Rodrigo de Freitas lagoon - RJ/Brazil

The accelerated urbanisation without a planning, brought several environmental problems to Rio de Janeiro coastal zone, especially in areas such as Rodrigo de Freitas lagoon, which receives a great amount of untreated sewage every day. To assess the nature, potentially sources and extent of heavy metal pollution in the lagoon, sediments from the surrounding streets, from the entrance of the main canal that drains to the lagoon and from the bottom of the lagoon were collected and analysed by a modified selective extraction procedure in order to study the geochemical partitioning and bioavailability of Zn, Cu, Cr, Ni and Pb in these three compartments. The present study verified an increase in the Cu, Pb and Zn concentrations in the north of the Rodrigo de Freitas lagoon. Despite the different levels of oxidation between the sediments accumulated in the streets and in the bottom of the lagoon, the geochemical partitioning of the heavy metals did not show any pattern of variation for the metals, except for the element Cu. No concentrations were found in the soluble phase of samples collected in the surfacial sediments of the lagoon, suggesting no bioavailability of heavy metals.

A urbanização acelerada, sem planejamento, resultou em uma série de problemas à zona costeira do Rio de Janeiro, especialmente em áreas como a Lagoa Rodrigo de Freitas, a qual recebe uma grande descarga de esgoto não tratado todos os dias. No intuito de avaliar a natureza, as fontes potenciais e a extensão da poluição por metais pesados na lagoa, sedimentos das ruas do entorno, das entradas do principal canal de drenagem e de superfície de fundo foram coletados. As análises se deram através de um método modificado de extração sequencial, com o objetivo de estudar o fracionamento geoquímico e a biodisponibilidade de Zn, Cu, Cr, Ni e Pb, nestes três compartimentos. O presente estudo verificou um aumento nas concentrações de Cu, Pb, e Zn no setor norte da Lagoa Rodrigo de Freitas. Apesar dos diferentes níveis de oxidação entre os sedimentos acumulados nas avenidas e no sedimento de fundo da lagoa, o fracionamento geoquímico dos metais pesados não apresentou nenhum padrão de variação, com exceção do Cu. Não foram observadas concentrações na fase solúvel, das amostras coletadas nos sedimentos superficiais na lagoa, sugerindo a não biodisponibilidade dos metais pesados.

In vitro-in vivo correlation and comparative bioavailablity of vincamine in prolonged-release preparations.

Developing an in vitro dissolution test that gives good correlation with in vivo data for a particular drug product is an important objective. Available dissolution data of vincamine prolonged-release preparations show different in vitro release behavior at different pH using the conventional dissolution techniques. This does not allow development of an in vitro-in vivo correlation (IVIVC). In the present work, the flow-through cell (FTC) dissolution system (USP apparatus 4) was utilized to compare the release rate of three marketed prolonged-release oral formulations of vincamine; namely, a brand innovator formulation used as the reference and two formulations from different manufacturers as test products. Both the open and closed systems of FTC were used at variable pH. A comparative bioavailability study was then conducted in 16 healthy volunteers for a test versus the reference product by administering a single dose of 60 mg in a crossover design. Vincamine plasma concentrations were analyzed by a sensitive high-performance liquid chromatography (HPLC) method. This was followed by assessment of IVIVC according to level A as specified by USP 23; the absorbed fraction of vincamine was determined using the Wagner-Nelson method. The results indicated that the pH of the medium affects the release rate pronouncedly. The relative bioavailability based on Cmax and AUC0-12 were found to be 83.15% and 84.15%, respectively. Good correlation was obtained between fraction absorbed in vivo and fraction dissolved in vitro by applying the open system of the FTC. This technique gave the most favorable results with regard to the percentage vincamine released and the IVIVC.

[Education of patients with rheumatoid arthritis. Assessment of a survey of interests]. / Educación en pacientes con artritis reumatoidea. Evaluación de una encuesta de intereses.

BACKGROUND: The congruence of interests between health care providers and clients is essential if subjects with chronic diseases will be educated. AIM: To assess, in patients with rheumatoid arthritis, those fields in which they would like to receive education. PATIENTS AND METHODS: Eighty eight patients with rheumatoid arthritis were surveyed about the topics in which they would like to be educated. The inquiry included medical aspects, handicap overcoming, social issues and labor aspects. RESULTS: Eighty two percent of patients were interested in medical aspects, 77% in social issues and 71% in handicap overcoming. Eighty three percent of patients with greater handicaps preferred handicap overcoming, 75% social aspects and 74% medical aspects. Younger patients had a greater interest in labor aspects, those with a recently diagnosed disease were interested in their legal rights and those with a prolonged disease wanted information about self help groups. CONCLUSIONS: The greater educational interests of patients with rheumatoid arthritis were on medical aspects. However, those impaired by the disease were interested in handicap overcoming. Age and duration of the disease also influenced the educational interests of patients. Thus, education in these patients must be individualized.

[Dihydrocyclosporin D--a new immunosuppressive?]. / Dihydrocyclosporin-D--ein neues Immunsuppressivum?

The first preliminary clinical results with a new Cyclosporin derivative (Dihydrocyclosporin-D) are reported. The compound has no obvious nephrotoxic effect; but it exhibits a hepatotoxic effect, and frequently leads to hypertension. The clinical efficiency cannot yet be judged with certainty.

[Liberation of the oxygen radical from peripheral human phagocytes (granulocytes and monocytes) in patients with chronic polyarthritis]. / Untersuchungen zur Sauerstoffradikalfreisetzung aus peripheren humanen Phagozyten (Granulozyten und Monozyten) bei Patienten mit Chronischer Polyarthritis.

Monocytes from patients with definite or classical rheumatoid arthritis show a significantly higher release of O2-radicals in the chemiluminescence assay (2925 X 10(3) cpm) than those of healthy volunteers (267 X 10(3) cpm) (p = 0.01). This difference does not appear in a similar test with granulocytes, which in both groups tested show a mean chemiluminescence of 2739 X 10(3) and 2547 X 10(3) cpm. The chemiluminescence of monocytes is clearly time-course dependent: in the morning we saw the least response, at noon the highest. Following our results, corticosteroids lower chemiluminescence significantly (p = 0.05), while non steroidal antirheumatic drugs and long-term therapy with gold compounds, etc., do not affect chemiluminescence.