Zinc is an essential trace element, and constituent of many metallo-enzymes required for normal metabolism. Age may be associated with altered metallothionein metabolism related to changes in zinc metabolism. The objectives of this study were: (i) to assess the prevalence of zinc deficiency among hospitalised elderly patients; (ii) to define the social, functional, pathological and nutritional characteristics of zinc deficient elderly hospitalised patients; and (iii) to assess the relationship between the zinc status and humoral immune function among hospitalised elderly patients. Fifty consecutive patients underwent comprehensive geriatric assessments included evaluations of the medical (index of the severity of the disease(s)), psychiatric (Geriatric depression scale (GDS)), therapeutic, social, functional (Katz's scale), and nutritional problems (Mini Nutritional Assessment (MNA) and biochemical markers (zinc, albumin, prealbumin (PAB), cholesterol) before their discharge. Fourteen patients (28%) presented a zinc concentrations lower than 10.7 micromol/l, this value is usually considered as the cut-off level below which a zinc deficient status is possible. Higher proportions of respiratory infections, cardiac failure, and depression were observed among zinc deficient patients as compared with the group of patients with normal zinc status. The other parameters of comprehensive geriatric assessment did not allow to discriminate the zinc deficient patients. The only slight differences (which remained unsignificant) concerned the prealbumin levels which tended to be higher in the group of patients presenting normal zinc status than in the group with poor zinc status (0.208+/-0.062 versus 0.171+/-0.068 g/l respectively, P=0.06), and the IgG2 levels which tended to be lower in the group of patients with normal zinc status than in the group presenting poor zinc status (2.77+/-1.91 versus 4.06+/-2.56, respectively, P=0.057). A negative correlation was observed between the Zn concentrations and the IgG2 levels (Spearman R=-0.311, P=0.028). To the best of our knowledge, this is the first study presenting zinc status according to a comprehensive geriatric assessment among European hospitalised geriatric patients. We decided to perform this study to known whom of our patients needed to be supplemented with zinc administration. Considering the low energy intake of hospitalised patients (confirmed here in regards of the nutritional assessment), and the insufficient trace element density in European foods, the relevance of providing medical supplements or enriched foods to this population has to be evaluated. Although most of the current diseases may be relevant to long-term interactions between nutrition and ageing, certain states observed in the elderly, like impaired immune and cognitive functions, could still benefit from an appropriate nutritional supplementation.

Journal Article↗

PubMedDate not supplied

Ischaemic colitis after endovascular repair of an infrarenal abdominal aortic aneurysm: a case report.

INTRODUCTION: Endovascular repair of abdominal aortic aneurysms (EVAR) has proven to be an attractive and successful alternative to traditional open surgery in properly selected patients. As in open surgery, ischaemic colitis remains a feared complication, but the incidence and causes are not properly documented. OBJECTIVE: To present a case of endovascular aneurysm repair complicated by postoperative unilateral graft limb occlusion and ischaemic colitis. CASE REPORT: A 76-year-old woman presented with diffuse abdominal pain in the presence of an infrarenal abdominal aorta aneurysm of 5.5 cm. Based on CT and calibrated angiography, the patient was selected for endovascular repair which was performed with an Excluder bifurcation graft (W. L. Gore & Associates Inc., Newark USA). The endograft was placed successfully, but completion angiography showed a kinking of the left graft limb at the level of the aortic bifurcation. The patient developed acute ischaemia of the left limb 3 days postoperatively. Treatment consisted of femorofemoral cross-over graft. One week postoperatively she developed diarrhoea. A sigmoidoscopy was performed, showing ischaemic colitis grade I. In spite of the initial good result of conservative therapy, she had to undergo a left hemicolectomy with manual colorectal anastomosis and protective ileostomy 25 days later. Despite this intervention, the patient developed multiple organ failure and died after 2 months. CONCLUSION: Postoperative ischaemic colitis has been described in extenso after open aneurysm repair. The incidence after endovascular repair is not well described. From 1998 to 2005, we performed 52 endovascular procedures with a bifurcation endoprosthesis in the treatment of an infrarenal abdominal aortic aneurysm. We report one patient out of this series, who developed an ischaemic colitis after the procedure. Possible causes include cholesterol embolization and peroperative exclusion of the inferior mesenteric artery of which the consequences might be aggravated in our patient by subsequent thrombosis of the left graft limb.

Aged↗

PubMedDate not supplied

Suppressor T-lymphocytes in pregnancy.

Primiparous and multiparous healthy pregnant women were tested at the end of the gestation period, or immediately after delivery, for their lymphocyte reactivity to paternal or neonatal cells in mixed lymphocyte culture and in cell-mediate cytotoxicity assays. Freshly isolated maternal lymphocytes had no spontaneous cytotoxic activity against PHA-activated neonatal or paternal lymphocytes. In conventional 6-day mixed lymphocyte cultures and in cytotoxicity assays, maternal lymphocytes displayed a response similar to that of paternal or third party lymphocytes when stimulated with neonatal, paternal, or third party lymphocytes. By contrast, in 3-day mixed lymphocyte cultures maternal cells had a selectively lower response to paternal antigens (expressed either on cord blood cells or on paternal lymphocytes), than to unrelated alloantigens. Removal of T-lymphocytes with IgG receptors (T gamma), or of T-lymphocytes reacting with OKT8 monoclonal antibody, corrected the depressed response of maternal cells in these 3-day cultures. It is suggested that circulating maternal lymphocytes contain antigen-specific suppressor cells characterized by their membrane receptors for IgG and the T8 antigen.

Adolescent↗

PubMedDate not supplied

Further improvement of quality of life by cetirizine in perennial allergic rhinitis as a function of treatment duration.

The SF-36 Health Status Questionnaire is a generic quality of life questionnaire based on 36 questions selected to represent nine health concepts. Perennial allergic rhinitis is a disease which causes variable restrictions on the physical, psychological and social aspects of patients' lives. According to the SF-36 questionnaire assessment, quality of life is impaired in these patients. Cetirizine, a potent, reliable histamine H1-receptor antagonist, has already been found to induce significant improvement in the quality of life of patients with chronic rhinitis, as assessed by the same SF-36 questionnaire after 1 and 6 weeks of treatment. This paper further investigates the extent to which cetirizine continues to improve quality of life after a long-term treatment (6 weeks) compared to a shorter treatment (1 week). The analyses show that, despite the significant improvement found after 1 week of treatment with cetirizine compared to placebo, a further 5-week course of therapy not only maintains this improvement but continues to enhance quality of life significantly above and beyond this.

Adolescent↗

PubMedDate not supplied

[Lymphocyte impairment in aging].

In vitro stimulation of peripheral blood lymphocytes by T mitogens and in MLC is reduced in aging. As the number of T lymphocytes and their antigenic power are in the normal range, a functional T-cell defect is anticipated in high age.

Adult↗

PubMedDate not supplied

Intermediate and long-acting insulin preparations without protamine sulphate are complement activators in vitro.

Recently, we have documented an abnormal in vivo complement metabolism in Type 1 diabetic children treated with monocomponent porcine insulin Monotard MC and its correction after switch-over to human insulin Protaphane HM. This prompted us to investigate the ability of different kinds of insulin preparations to induce complement activation in vitro. Freshly collected serum samples from healthy blood donors were incubated with commercial rapid and intermediate or long-acting (by protamine sulphate (PS) or zinc) insulin preparations for 2 hours at 37 degrees C. The C3d content of the supernatants was measured by turbidimetry as a marker of C3 complement fraction consumption. Only long-acting preparations of insulins without protamine sulphate were associated with highly significant increased levels of C3d, whatever the source of insulin, animal or human. Moreover, addition of exogenous protamine sulphate was able to inhibit the C3 conversion. This effect was dose-dependent and peaked at the concentration of commercial NPH insulin preparations. The mechanism by which protamine sulphate inhibits complement activation in vitro could be related to its ability to interfere with the physical nature of the solid surfaces presented by the insulin crystals. Indeed, insulin crystals were rapidly cleared (< 5 min) in the incubated serum when small doses of protamine sulphate were added. The complement activating capacity of long-acting insulin without protamine was dose dependent, equivalent to the known complement activator Zymosan, and abolished in the presence of EDTA. In conclusion, the present study has documented the ability of some protracted insulin preparations to activate the complement system in vitro if they are devoided of protamine sulphate. On the other hand, short-acting and NPH insulins are not complement activators.

Animals↗

PubMedDate not supplied

Modulation of class II histocompatibility antigen expression by maternal serum.

Human maternal serum has been shown to down-regulate the expression of MHC class II antigen in three distinct circumstances. Cord blood mononuclear cells, incubated in the mother's own serum, showed significant modulation of class II antigen expression. This was also the case for unrelated donor lymphocytes, incubated in pooled maternal serum. One neoplastic line (Daudi) was further shown to down-regulate class II antigen expression. In this last case, the down-regulating effect persisted over a 10-day period during which maternal serum was renewed regularly. Retroplacental serum was more MHC class II-inhibiting than peripheral serum. This down-regulating effect does not apply to maternal lymphocytes. The inhibitory effect is thought to be due to a factor, yet to be defined, included in the maternal IgG fraction. Regular assays made throughout pregnancy showed that the class II inhibiting component appears early (5th week), reaches its peak value at the 12th week, and disappears 2 or 3 weeks after delivery.

Antigen-Antibody Complex↗

PubMedDate not supplied

Effects of selenium supplementation on immune parameters in gut failure patients on home parenteral nutrition.

The relationships between some parameters of the immune response and selenium were investigated in five patients receiving home parenteral nutrition for short-bowel syndrome. They were first submitted to a relative depletion by providing 20 micrograms selenium/day as L-selenomethionine for 1 mo. Then, daily selenium intake was raised to 200 micrograms for 2-4 mo. On entering the study, the patients presented a relatively good health status, and immunological parameters were at the lowest limit of the normal range. Four patients rapidly responded to the 200-micrograms supplementation by a continuous increase in their plasma selenium levels, whereas the fifth patient showed a moderate and late increase. At the end of the trial, there was an improvement in the lymphocyte response to pokeweed and phytohemagglutinin mitogens in four patients and to CD3 in three patients. The response to two of three antigens (Candidin, Varidase) tested was also enhanced in the same patients, but the response to the third antigen (tetanus toxoid) was uniformly low in all patients. The only patient showing essentially no immune improvement after selenium supplementation was the one with a low and delayed increase in plasma selenium. This study supports a role for selenium in the maintenance of an optimal immune response in humans.

Aged↗

PubMedDate not supplied

Transfer from purified porcine insulins to semisynthetic human insulins decreases insulin antibodies and circulating immune complexes in diabetic children and adolescents. A two-year follow-up.

In this long-term prospective study, including 45 diabetic children and adolescents under the age of 20 years, insulin antibodies and other immunological factors (circulating immune complexes, autoantibodies, etc.) were compared before and during a two-year follow-up after a switch-over from monocomponent porcine insulins to monocomponent semisynthetic human insulins. IgG insulin antibodies were detected in 21 children out of 45 (47%) at a mean level of 0.96 mU/ml (0.77-1.15). A significant and important decrease of both the number of patients having insulin antibodies and the level of insulin antibodies was observed 18 months after the switch-over. After 24 months, IgG insulin antibodies were only present in 5 patients (11%) at a mean level reduced by half (0.53 mU/ml; p less than 0.05). Four patients out of the five (80%) had HLA-DR3 DR4 antigens while this phenotype was only prevalent in 26% of the initial patient cohort. On the other hand, 3 months after the transfer, there was a significant and persistent decrease (by half) of non-specific immune complexes (39% of the patients with porcine insulins) which did not appear to correlate with the level of insulin antibodies. The prevalence of autoantibodies and of antinuclear factors showed no significant variations. The practical implication of these findings is that the use of semisynthetic human insulins could be of interest in patients previously treated by porcine insulins.

Adolescent↗

PubMedDate not supplied

Combined myocardial and cerebral revascularization. A ten year experience.

We report on the results of combined carotid endarterectomy and coronary artery bypass grafting in 82 patients. Vascular pathology was severe in these cases: 94% of patients had extensive multivessel coronary artery disease, 29% had unstable angina, 30% had severe left main stem stenosis and all patients had hemodynamically significant stenosis of at least one carotid artery, 13% had an additional occlusion of the contralateral internal or common carotid artery and 26% had severe bilateral carotid artery stenosis. The carotid lesion was asymptomatic in 64% of cases, 24% of the patients experienced previous transient cerebral ischemia and 12% of the patients had a history of completed stroke. Hospital mortality was 7.3%. Neurological deficit occurred in 7.3% but functional impairment was not permanent. Late results have been obtained for 76 survivors at a mean postoperative interval of 29 months. Five year life table survival rate was 86%. Follow-up showed that 3 patients (4%) have died and that 3 patients (4%) experienced a late neurologic event (one TIA; two strokes) but none of these events involved the cerebral cortex on the side of the carotid endarterectomy. The cumulative 5 year stroke free survival rate is 91%. We conclude that combined carotid endarterectomy and coronary artery bypass grafting can be done with an acceptable mortality rate in these critically ill patients and that the postoperative incidence of neurological events is low.

Adult↗

PubMedDate not supplied

[Screening in asthma].

One of the most important characteristics of asthma is its association with non specific bronchial hyperresponsiveness. This is diagnosed by histamine bronchial challenge tests. This latter is an easy procedure but requires a precise and standardized methodology. We have analysed, in a large group of bronchial challenge tests (n = 162) the clinical correlations with bronchial response to histamine. Our conclusions are in agreement with several recent literature, and may be summarised as follows: 1. more than 10% of patients, clinically considered as asthmatics do not show bronchial hyperresponsiveness and probably will not benefit from bronchodilators; 2. several aspecific respiratory symptoms (cough, chest tightness, blocked nose and sneezing, recurrent bronchitis, etc...) are frequently associated with bronchial hyperresponsiveness and should be considered as asthmatic manifestations. To conclude, we recommend to realise a histamine non specific challenge test in all cases of clinical suspicion of asthma (with normal lung function at basal state) and in all subjects presenting chest symptoms of uncertain etiology.

Asthma↗