BB rats and nonobese diabetic (NOD) mice spontaneously develop autoimmune insulin dependent diabetes and serve as models for human type I diabetes. During progression of the disease the cytokine pattern elaborated by islet infiltrating immune cells shifts from a Th2 or Th0 toward Th1 type. Only the latter is associated with "destructive" insulitis. We discuss here attempts to modulate disease progression by targeting the gut immune system with bacterial immunostimulants. Oral dosing of diabetes prone BB rats with lipopolysaccharide (LPS) or the Escherichia coli extract OM-89 lead to a Th2-shift of pancreatic mRNA expression. In vitro studies showed that repeated exposure toward LPS or OM-89 lead to downregulation of proinflammatory macrophage responses. In the NOD mouse, repeated oral dosing of OM-89 caused a Th2 shift in the gut cytokine gene expression, probably because of desensitization of macrophages and other antigen presenting cells. Concomitantly, diabetes prevention by oral insulin was improved. In conclusion, oral dosing with bacterial immunostimulants dampens Th1 type immune reactivities of the gut immune system and thereby promotes oral tolerance mechanisms. Downregulation of proinflammatory immune reactivities by repeated exposure to bacterial stimulants requires intact desensitization mechanisms in macrophages or other antigen presenting cells.

Adjuvants, Immunologic↗

PubMedDate not supplied

[An algorithm for reconstruction of soft tissue defects of the distal lower leg, ankle and heel].

AIM: The purpose of the study was to establish an algorithm for the reconstruction of soft tissue defects of the distal lower leg, ankle and heel. METHOD: 81 patients presenting with soft tissue defects in these regions underwent flap coverage. The average age was 44.1 years. Small defects (up to 4 x 4 cm) were covered by local flaps. The neurovascular sural flap was the predominant flap procedure for medium size defects (up to 10 x 15 cm). Free flaps were used for larger defects or in cases of stenosis or occlusion of the peroneal artery. Femoro-crural bypasses were performed in three cases to improve peripheral arterial perfusion. RESULTS: The reconstructive goals were achieved in 95% of the cases by performing reconstruction according to the established algorithm. Minor complications occurred in 29.6% of the cases. CONCLUSION: The results appear to be very good considering a patient population with complex and predominantly contaminated wounds. A preoperative angiography represents an important part of the algorithm for flap reconstruction to detect abnormal arterial vascular conditions and thus to plan vascular reconstruction prior to or simultaneously with free flap coverage. Additionally, a non-patency of the peroneal artery represents a contraindication for sural flaps.

Adolescent↗

PubMedDate not supplied

Advanced maternal age is not only associated with newborn somatometrics but also with the mode of delivery.

BACKGROUND: At both extremes of reproductive phase, female cycles are characterized by a high rate of anovulation, and pregnancies at these phases of reproductive span are considered as risky for obstetric complications, poor pregnancy outcome and increased maternal and newborn morbidity and mortality. AIM: To analyse if this high rate of anovulation may be interpreted as an adaptation to poor pregnancy outcome. Therefore the association patterns between maternal age and newborn somatometric characteristics and the mode of delivery were tested. SUBJECTS AND METHODS: The associations between the age as well as somatic characteristics such as pre-pregnancy weight, stature, pelvic dimensions and pregnancy weight gain of 10 765 women aged between 12 and 49 years (mean = 25.3, SD = 5.7) and newborn body dimensions and the mode of delivery were analysed. RESULTS: With increasing maternal age, maternal and newborn body dimensions increased significantly. Although extremely young mothers were significantly shorter and lighter and exhibited the significantly lowest pre-pregnancy weight status and the narrowest pelvic dimensions, they showed the lowest rates of caesarean sections (13.1%) and, unexpectedly, not the highest rate of low weight newborns (<2,500 g). In contrast, for mothers older than 35 years the highest rate of low weight newborns (3.7%) and the highest rate of macrosom newborns (<4,000 g) were found. Furthermore, mothers older than 40 years experienced the significantly highest rate of caesarean section (31.3%). CONCLUSIONS: Special risks were found for mothers older than 35 years, so the lower rates of ovulatory cycles during this phase of life may be interpreted as an adaptation to increased risks for complications and poor pregnancy outcome.

Adolescent↗

PubMedDate not supplied

Anthropometric characteristics and pulsatile growth hormone secretion patterns in premenopausal and postmenopausal women from Austria.

The intercorrelations between 18 anthropometric variables, describing amount and distribution of subcutaneous fat tissue, and 12 growth hormone (GH) levels which had been obtained at intervals of 2 hours over a period of 24 hours, were tested in 25 premenopausal and 23 postmenopausal women from Austria. The 12 GH levels were included in the analyses because the GH shows typical pulsatile secretion patterns with peak values about midnight. Initially, premenopausal and postmenopausal women showed significantly different secretion patterns of GH; furthermore it became evident that the GH constantly correlated positively, however insignificantly, with stature height, but significantly negatively with all those measures describing amount and distribution of subcutaneous fat tissue. Beyond that the present paper indicates that age and menopausal status have a marked influence on GH secretion patterns. It became evident that, independent of menopausal status, typical association patterns between frequency of GH pulses per 24 hours, as well as the amplitude of the individual bursts and the amount of subcutaneous fat tissue, occur.

Adipose Tissue↗

PubMedDate not supplied

Menopause-associated differences in female fat patterning estimated by dual-energy X-ray absorptiometry.

The aim of the present study was to describe and quantify the typical changes in fat patterning from premenopause to postmenopause. The absolute and relative fat and lean body mass were estimated using dual-energy X-ray absorptiometry in 461 healthy non-obese females between the ages of 18 and 64 years (x = 43.2). Significant differences (p < 0.001) in absolute and relative fat mass, body weight and body mass index between pre-, peri- and postmenopausal females were observed. Postmenopausal women were significantly heavier (BMI, x = 26.8) than perimenopausal (BMI, x = 24.4) and younger and older premenopausal women (BMI, x = 22.8) and showed significantly higher fat percentages (fat% x = 38.1) in comparison to perimenopausal (x = 36.8) and premenopausal females (x = 31.4). Three indices, upper body composition index, lower body composition index and fat distribution index were calculated. Typical differences in fat distribution patterns between females of differential menopausal status were found. During the premenopausal phase a more gynoid type of fat distribution prevailed, during the postmenopausal phase a more android kind of fat distribution occurred predominantly. The fat distribution during the perimenopause can be interpreted as less gynoid than during the premenopause.

Absorptiometry, Photon↗

PubMedDate not supplied

Maternal prepregnancy weight status and pregnancy weight gain as major determinants for newborn weight and size.

The impact of maternal anthropometric characteristics, above all prepregnancy weight status and pregnancy weight gain, on newborn size was tested using 10,240 single births in the University Hospital of Vienna, Austria. Highly significant relations between maternal prepregnancy weight status and newborn size were observed. With higher maternal prepregnancy body mass index, higher birthweight, length, head circumference, acromial circumference and fronto occipitalis diameter occurred. Furthermore the incidence of low weight newborns (< 2500 g) was significantly higher in underweight women than in normal weight, overweight and obese women. Although the pregnancy weight gain was significantly higher in underweight women than in normal weight, this higher pregnancy weight gain was not able to compensate for the negative impact of poor weight status before pregnancy. These results indicate that even in a highly developed country such as Austria, where starvation is a nearly unknown problem and the medical and social system are well developed, a poor maternal weight status is a risk factor for growth retarded and low weight births.

Birth Weight↗

PubMedDate not supplied

Association between maternal age at menarche and newborn size.

The impact of maternal age at menarche on newborn size was tested using data from 4,996 single births taking place at Vienna, Austria, between 1985 and 1995--so-called teenager pregnancies were excluded from the present analyses. All women experienced pregnancies between the ages of 19 to 42 years. Maturational time was related significantly to infant weight and length independent of maternal age and behavioral variables such as smoking. Early maturation, i.e., age at menarche before the 12th birthday, was significantly associated with decreased newborn weight and size. The incidence of low-weight newborns was significantly higher in early-maturing mothers. The more favorable nutritional status of women whose menarche occurred relatively early was not able to compensate for the negative effects of early maturation on intrauterine growth. Higher circulating estrogen levels in early maturers preserved into adulthood are discussed as possible reasons for intrauterine growth retardation of the offspring of early-maturing mothers.

Adolescent↗

PubMedDate not supplied

Cellular immune functions, endorphins, and alcohol consumption in males.

The effects of alcohol abuse on cellular immune functions were measured by various levels of alcohol use in adult men. Total lifelong abstainers were used as controls. Previous abusers, current abusers, and patients with alcoholic cirrhosis or pancreatitis were age-matched to controls. T-lymphocyte mitogenesis stimulated by phytohemagglutinin and concanavalin A was generally reduced in peripheral blood lymphocytes of current and previous alcohol consumers, although the decrease was not statistically significant. B-cell mitogenesis stimulated by pokeweed mitogen was not changed by previous alcohol consumption. The number of T-cells was not changed by either previous or current alcohol abuse. T-helper cells were significantly increased and T-suppressor cells increased only in the patients with alcoholic cirrhosis or pancreatitis. The percentage of T-lymphocytes with T-suppressor characteristics in controls was 27% while in alcoholic cirrhosis or pancreatitis subjects it was 16%. Plasma corticosteroid levels were significantly increased in people currently consuming alcohol (12.1 +/- 1.1 mg/dl) compared to controls (7.7 +/- 1.1). The corticosteroid levels were also higher in previous alcohol abusers although not statistically significant. Plasma endorphin levels were increased by severe alcohol abuse in the patients with cirrhosis or pancreatitis to 25.03 +/- 6.74 from 11.85 +/- 2.48 pg/ml in controls.

Adult↗

PubMedDate not supplied

Immunohistochemical diagnosis of a totally necrotic retinoblastoma: a clinicopathologic case.

An 8-month-old girl underwent enucleation of her right eye because of a calcified retrolental white mass filling the entire vitreous cavity. The conventional histological examination revealed a totally necrotic unidentifiable tumor, with scattered foci of calcification. In addition, we found two islands of viable small round cells, suspected to be retinoblastoma cells, which were located in the optic nerve behind the lamina cribrosa. These cells stained positively for neuron-specific enolase (NSE), but not for glial-fibrillary-acidic-protein (GFAP), supporting the diagnosis of retinoblastoma. Because one of the latter foci of viable tumor cells was located at the cut end of the optic nerve, the baby was treated by external beam irradiation.

Eye Neoplasms↗