The complement-mediated opsonic activity (CMOA) in intra-abdominal exudates collected during laparotomy from peritonitis patients was examined by an in vitro phagocytic bactericidal assay. It was found that infected intra-abdominal exudates barely promoted detectable killing of Escherichia coli 01 by polymorphonuclear leukocytes. Only the minority of bacteria recovered by differential centrifugation from the infected exudates had C3 on their surfaces. Such bacteria were not optimally opsonized in vivo, whereas they became fully coated with C3 during a brief incubation in vitro in normal human serum. The low level of CMOA in the peritoneal fluid paralleled a depletion of complement in the peripheral blood. Thus, in cases complicated by sepsis with gram-negative bacteria, the CMOA in the blood was extremely low. These data suggest that the high susceptibility of the peritoneum to infection by gut flora, despite the normal phagocytic response, may be partly explained by the low local level of functional complement which is inadequate for optimal opsonization of the bacteria.

Adult↗

PubMedDate not supplied

Open approach in pancreatic and infected pancreatic necrosis: laparostomies and preplanned revisions.

One hundred and two patients with acute necrotizing pancreatitis were treated in accordance with a combined regimen of necrosectomy, open drainage by laparostomies, and repeated re-explorations. The severity of pancreatitis was assessed by the APACHE II score (median 15 on admission). Eighty-seven (85%) patients were classified as having infected pancreatic necrosis and only 15 (15%) as having pancreatic necrosis. Overall, 36 (35%) patients died, most of multiple organ failure. Survival was significantly impaired by bacterial contamination of pancreatic necrosis (p = 0.008), bacteremia (p = 0.0001) and infected bronchial secretions (p = 0.05). The mortality rate was reduced from 53% to 28% by changing the regimen of re-explorations from on demand to regular 48 hour intervals. Despite the fact that open packing was associated with a high frequency of gastrointestinal fistulas (30%), this concept seems to be a successful and recommendable approach in the therapy of pancreatic and infected pancreatic necrosis.

Acute Disease↗

PubMedDate not supplied

Evidence of gestational heroin exposure by comparative analysis of fetal and maternal body fluids, tissues, and hair in a heroin-related death.

In order to determine the fetal-maternal distribution of heroin and its main metabolites (6-monoacetylmorphine and morphine) the drug concentrations were measured in autopsy material. The heroin-related death of a pregnant drug abuser (approximately the 32nd week of gestation) provided the fetal and maternal material. Fetal and maternal hair was analyzed in order to obtain long-term information on the transplacental opiate transfer. Morphine and 6-monoacetylmorphine were detected in toxic concentrations in maternal as well as in fetal tissues and body fluids. The drug concentrations in the fetal blood were significantly lower than in the maternal blood. The ratio of fetal-to-maternal (F/M) blood morphine concentration was found to be 0.39, whereas the F/M ratio of 6-monoacetylmorphine in blood was 0.15. In fetal hair analysis, morphine, heroin, and, for the first time, 6-monoacetylmorphine were measured. The resulting F/M ratios were 0.49, 0.36, and 0.6, respectively.

Adult↗