This study examined lipopolysaccharide (LPS) induced in vitro secretion of interleukin-1 (IL-1) by peripheral blood monocytes from pre-term infants with and without sepsis. Thirteen pre-term babies were tested; eight were completely healthy and five suffered from six episodes of sepsis. The latter group was tested both in the acute septic phase and in the convalescent period. IL-1 secretion by monocytes derived from septic pre-term infants was lower, but not significantly different from healthy pre-term infants (7.1 +/- 1.0 U/ml versus 8.1 +/- 0.9 U/ml, respectively). IL-1 secretion by monocytes of eight control full-term babies was in the same range (8.4 +/- 0.6 U/ml). In the convalescent period IL-1 secretion by monocytes from septic pre-term babies increased (9.0 +/- 0.3 U/ml) and was significantly higher than values measured during acute infection (p less than 0.05). Septic premature babies were also found to have higher absolute blood neutrophil concentration (p less than 0.001), but their body temperature did not increase along the infectious stage. The decreased secretion of IL-1 by monocytes from pre-term babies in the acute phase of infection compared to the convalescent period may have contributed to their inability to mount appropriate immunological as well as inflammatory responses. Sepsis promoting IL-1 production in vivo may have limited the monocytes' capacity for LPS stimulated IL-1 synthesis in vitro.

Acute Disease↗

PubMedDate not supplied

Functional reconstruction after facial paralysis: a survey.

The attempt to achieve symmetrical harmonious facial expression represents a complex surgical challenge, necessitating an individualized approach. Clinical investigations and laboratory experiments have demonstrated how to better reconstruct a "smile." In long-standing deformities, ipsilateral or crossfacial nerve grafting followed by functional muscle transfer in a 2-stage procedure seems to give the most acceptable results; however, hypoglossal-facial anastomosis and dynamic muscle techniques such as temporal muscle transposition and others can result in adequate functional reconstruction. The development of these techniques with special emphasis on those made during the last 10 years is discussed and compared with our own experiences.

Facial Expression↗

PubMedDate not supplied

Progress in limb and digital replantation: Part B.

Progress in micro- or macroreplantation has resulted in higher survival rates of formerly amputated parts. Progress has been made as a result of intensive laboratory training and considerable experience due to the popular application of microsurgical techniques. More amputated digits or limbs may survive because the time of ischemia can be exceeded in using cold storage or perfusion. Homo- or heterodigital vessel transposition, expanded indications for vein graft interposition, as well as heterotopic transplantation allow for extremity preservation even in crush injuries, and in disastrous multiple amputations combined with contusion or avulsion. Nowadays, microvascular digital replantation with vessel anastomosis distal to the distal interphalangeal joint in adults is technically feasible. Finger amputations in children are a prime indication for replantation. Maintenance of extremity length is possible in applying external fixation. Emergency free flaps or compound tissue transfer under the "Urgence differée" condition may provide reliable soft tissue coverage. Secondary reconstruction with regard to bone defects, tendon repair, and eventual nerve grafting have to be aspired, finally leading to an improvement of functional results in daily and leisure activities as well as in early professional readaptation.

Adolescent↗

PubMedDate not supplied

Advances in peripheral nerve repair in emergency surgery of the hand.

The development of microsurgical techniques has changed the surgical treatment of severe hand injuries over the last 25 years. Not only has the repair of vessels by microvascular surgery brought new possibilities of treatment, but the results in repair or peripheral nerves have been improved by the use of new microsurgical techniques, such as perineural suture and interfascicular nerve grafts. The use of vascularized nerve grafts in multiple digit amputations has been a further new idea in emergency hand surgery. The operative treatment of lesions of the brachial plexus has become possible. Nevertheless, the traditional secondary operations such as tendon and muscle transfers are necessary in order to reach an optimal functional reconstruction following nerve injuries.

Adolescent↗