Cytokines and chemokines multiplex analysis in patients with low disease activity rheumatoid arthritis.

Rheumatoid arthritis is a severe chronic autoimmune disorder that results from pathological activation of immune cells and altered cytokine/chemokine network. The aim of our study was to evaluate concentrations of chosen cytokines and chemokines in blood sera and synovial fluid samples isolated from low disease activity rheumatoid arthritis (RA) patients and osteoarthritis (OA) sufferers. Blood sera and synovial fluid samples have been obtained from 24 OA and 14 RA patients. Cytokines/chemokines levels have been determined using a Milliplex® Map 38-plex human cytokine/chemokine magnetic bead-based panel (Merck Millipore, Germany) and Luminex® MAGPIX® platform (Luminex USA). Low disease activity RA patients showed altered concentration of numerous cytokine/chemokine when compared to OA controls-they were characterized by, inter alia, increased: eotaxin/CCL11 (p = 0.037), GRO/CXCL1 (p = 0.037), IL-2 (p = 0.013), IL-4 (p = 0.017), IL-7 (p = 0.003), IL-8 (p = 0.0007) and GM-CSF (p = 0.037) serum levels, whilst MDC/CCL22 concentration was decreased in this group (p = 0.034). Eotaxin/CCL11 (p = 0.001), GRO/CXCL1 (p = 0.041), IL-10 (p = 0.003), GM-CSF (p = 0.01), IL-1RA (p = 0.0005) and VEGF (p = 0.01) concentrations in synovial fluid of RA females were also increased. Even with low disease activity score, RA patients exhibited increased concentrations of cytokines with pro- and anti-inflammatory activities, as well as numerous chemokines, growth factors and regulators of angiogenesis. Surprisingly, RA subjects also shown decreased concentration of CCL22 chemokine. The attempt to restore cytokine balance and tolerogenic environment is ineffective in RA sufferers even with good disease management. Distinguished factors could serve as possible indicators of disease progression even in low disease activity patients.

Analysis of selected pro- and anti-inflammatory cytokines in patients with multiple injuries in the early period after trauma.

INTRODUCTION: Severe trauma causes damage to the protective barriers of the organism, and thus activates immunological reaction. Among substances secreted during this process pro-inflammatory cytokines are of high importance. THE AIM OF THE STUDY: Severe trauma causing multiple injuries is more likely to lead to particularly intensive inflammatory reaction, which can sometimes lead to serious complications, even life-threatening. The aim of the study is to determine those parameters which may serve as predictors of infectious complications and to enable estimation of the patient's immunological status before the decision to introduce elective procedures. MATERIAL AND METHODS: The study population included patients with multiple trauma treated in the Department of Trauma Surgery of the Medical University of Gdansk. The severity of injuries was evaluated with commonly used numerical scales (Revised Trauma Score - RTS, Injury Severity Score - ISS, Glasgow Coma Scale - GCS). Blood samples were collected on the first, second, and fifth day after injury. Evaluated parameters: C-reactive protein (CRP), the level of cytokines: IL-8, IL-1ß, IL-6, TNF, IL-12p70, and IL-10. Control population: individuals without injury. RESULTS: Evaluation of IL-6, IL-8, and CRP levels in patients with multiple trauma in the early period after injury (2-3 days) could be considered as a predictor of delayed infection (5-10 days). CRP level, being cheap and commonly accessible, can be used in clinical practice enabling identification of patients at higher risk of infectious complications and introduction of appropriate treatment and prevention. The analysis of the mentioned parameters may contribute to choosing an appropriate management strategy, including "timing" depending on the patient's biological status.

Unusual simultaneous multifocal rupture of oesophagus, stomach and diaphragm after blunt trauma.

An unusual case of simultaneous multifocal rupture of the oesophagus, stomach and diaphragm after blunt trauma is described. The characteristic computed tomography scans (with intraluminal contrast application) of the ruptured oesophagus are shown, and successful management is presented.

Mucormycosis complicating lower limb crash injury in a multiple traumatised patient: an unusual case.

Necrotising skin and soft tissues infections are most commonly bacterial in origin. However, saprophytic fungi of the class Zygomycetes, family Mucoraceae, can cause highly aggressive infections (mucormycoses) mainly in immunocompromised patients. Severe trauma is one of the major risk factors for mucormycosis. Fungal traumatic wound infection is an unusual complication associated with crash limb injury. This report describes a case of serious necrotising soft tissue infection caused by Mucor sp following primary fungal environmental wound contamination in a multiply injured patient. Despite undelayed diagnosis and proper treatment (surgical debridement and limb amputation, amphotericin B therapy) the patient presented a fatal outcome.

Mixed hydroblast and missile injury with abdominal eventeration: case report.

Gunshot injuries are quite common nowadays. Increasing numbers of high-pressure injection injuries are also being observed with a good correlation with industrial progress. High-pressure devices produce pressures and velocities of fluid streams similar to those generated in firearms. However, no missile plays a part in high-pressure injection injuries. We present the unusual case of mixed missile and hydroblast injury, which has not yet been reported. Physical characteristics, typical patterns of injury and the possibility of infectious complications are shown. The importance of educating workers about safety precautions is emphasised.

[Shotgun injuries--epidemiological and clinical aspects]. / Obrazenia ciala w nastepstwie postrzalów--aspekty epidemiologiczne i kliniczne.

Shotgun injuries constitute an increasing surgical problem as they frequently lead to severe trauma disease and even to death. These injuries are mainly diagnosed in young people and are localized in limbs. Human life is in danger in case of shotgun injuries of the head (CNS), abdominal and thoracic cavities. Prognosis is worse in multiple shotgun lesions. The dominating cause of death in shotgun victims is hemorrhagic shock. Patient's life is potentially in a real danger and necessitates precise diagnostic and therapeutic management in the early stages following shotgun trauma, in the operating room and in the postoperative phase.

Various clinical aspects of alcohol consumption in trauma patients.

The aim of the study was the evaluation of alcohol consumption pattern, clinical outcome of alcohol misuse patients admitted to traumatology ward as well as estimation of usage of brief intervention strategy. The analyzed group consisted of 137 patients (49 females and 88 males) aged from 17 to 95 (mean 47.8 +/- 21.3) years hospitalized in 2004. All the patients were asked to complete the AUDIT and CAGE tests and were divided into groups according to alcohol consumption. There were analyzed alcohol consumption patterns, patient's medical history and also diagnosis of alcohol misuse. Almost half of the men (45.5%) hospitalized in the traumatology ward had been drinking in hazardous pattern in comparison with 4.1% of women. The most numerous population in this cohort were patients < 35-year-old (38.1%). Both, the group of patients with hazardous alcohol consumption (HAC) (>7 pts. according to AUDIT) and the group of alcohol addicted patients (>1 pts according to CAGE) were mainly represented by males. The anamnesis concerning the alcohol consumption was conducted by the surgeons in only 1 (0.7%) case, but without using any tests. Brief intervention was not used even among those patients who were drunk on admission. There were 45.5% of hazardous drinking males and 4.1% of females among patients admitted to the traumatology ward. None of the surgeons used the screening test to evaluate the drinking misuse of the patients. The brief intervention was not used by the medical staff despite its low cost and high effectiveness.