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PubMed1992

An autopsy case of Kawasaki disease with reference to occurrence of acute coronary thrombosis in the convalescent stage.

A one-year, four month-old boy who had suffered from Kawasaki disease died suddenly during convalescence despite intensive gamma-globulin treatment. Autopsy revealed a) sausage-like aneurysms of the left and right coronary arteries and fresh thrombosis in the right coronary aneurysm, b) fresh transmural myocardial necrosis in the whole wall of the left ventricle and the anterior part of the wall of the right ventricle, and c) swelling of the cervical lymph nodes and thymus (60 g). Histologically, fibrocellular thickening of the intima and destruction of the media and internal elastic lamina were conspicuous in the area of the aneurysm, but those of the intima and media in the areas adjacent to the aneurysm were mild. Abrupt narrowing of the lumen at the border between the aneurysm and periphery of the right coronary artery was detected, and this may have been responsible for formation of the thrombus in the right coronary aneurysm. In the systemic arteries, perivascular fibrosis was very noticeable despite less severe injury to the intima and media. These findings suggest that severe inflammation of the periarterial regions was present in the acute phase. The lymph system still showed inflammation, supporting the infectious or toxic nature of Kawasaki disease.

Acute Disease↗
PubMed1995

Effect of standard rest periods on convalescent preterm infants.

OBJECTIVE: To examine the effects of standardized rest periods on the sleep-wake states of preterm infants who were convalescing. DESIGN: A randomized experimental study conducted from time of infants' entry into intermediate care until their discharge from the hospital. Because subjects' time in this study varied, data were analyzed cross-sectionally using the observation made between 5-11 days of the study and longitudinally over 3 weeks using a subset of subjects. SETTING: The intermediate care nursery of a tertiary care hospital. SUBJECTS: Forty-six preterm infants (23 matched pairs). A subset of 12 pairs, in which infants in the experimental and the control groups were in the study for 3 weeks, was analyzed longitudinally. INTERVENTIONS: Four standardized rest periods each day. MAIN OUTCOME MEASURES: Infants were observed once a week between noon and 8 p.m. Three sleep-wake states--quiet awake, active, and sleep--were measured as percentages of the naps and total observation. RESULTS: Within 5 days, infants in the experimental group exhibited more sleep (F[1,44] = 2.37, p < 0.05) and less active states (F[1,44] = 3.06, p < 0.01) during nap time. Infants receiving the intervention for 3 weeks had more sleep (F[1,22] = 4.63, p < 0.05) and less quiet waking states (F[1,22] = 13.85, p < 0.01) during naps. State patterns over the entire observation did not differ between the groups at 5 days, but by 3 weeks, infants in the experimental group had less quiet waking (F[1,22] = 17.44, p < 0.001) and longer uninterrupted sleep bouts (F[1,22] = 5.19, p < 0.05). CONCLUSIONS: A simple modification of nursing care had an impact on the sleeping and waking states of preterm infants.

Activity Cycles↗
PubMed2005

[Autopsy case of pulmonary aspergillosis soon after convalescence from pulmonary tuberculosis].

A 70-year-old man with liver cirrhosis and previous gastrectomy admitted for fever, coughing, and bloody sputum soon after convalescing from pulmonary tuberculosis had a peripheral white blood cell count of 9,900/microL, C-reactive protein of 14.1mg/dL, serum albumin of 2.0g/dL, and serum positive for antiaspergillus and beta-D glucan antibodies. Chest radiography showed thickening of the walls of the large residual cavities with previous tuberculosis lesions and infiltrates around them. On day 2 of hospitalization, Aspergillus fumigatus without other bacillus was detected in sputum culture taken on admission. Despite immediate treatment with intravenous micafungin and oral itraconazole and improved brief initial improvement, his general condition abruptly deteriorated into frequent massive hemoptysis and he developed of shock, respiratory failure, and severe malnutrition, dying 30 days later. Autopsy findings showed pulmonary aspergillosis in and around the large cavities and on the other side of the lungs. Pulmonary aspergillosis without hematological malignanciy and immunosuppression can thus be abruptly severe and fatal due to malnourishment stemming from pre-existing conditions such as chronic hepatitis despite prompt, ordinarily adequate medical treatment.

Aged↗
PubMed1995

Recombinant vaccinia viruses expressing hepatitis A virus structural polypeptides: detection of an anti-VP0 response in convalescent-phase sera.

We have generated a number of recombinant vaccinia viruses which expressed the hepatitis A virus (HAV) structural polypeptides VP1, VP2, VP3, and VP4, either alone or in combination. The relevant sequences encoding these polypeptides were amplified from cloned cDNA by PCR and then cloned into the insertion vector pGS62. The presence of the HAV structural polypeptide-encoding sequences in the recombinant viruses was confirmed by Southern blot analysis, whilst their transcription and translation were demonstrated by Northern (RNA) blot analysis and immunodetection, respectively. Immunoprecipitation studies using these constructs have detected the presence of an anti-VP0 response in human convalescent sera following HAV infection. The significance of this finding and the usefulness of these constructs in studying cell-mediated immunity during recovery from HAV infection are discussed.

Antibodies, Viral↗
PubMed1976

Mechanisms of immunity in typhus infections. V. Demonstration of Rickettsia mooseri-specific antibodies in convalescent mouse and human serum cytophilic for mouse peritoneal macrophages.

Antibodies in both mouse and human Rickettsia mooseri (Rickettsia typhi) convalescent serum that were cytophilic for mouse macrophages were demonstrated by the rosette technique. Mouse peritoneal macrophages, passively sensitized with early and late serum from mice with a sublethal infection of R. mooseri, were washed and exposed to rickettsiae. Rosettes of rickettsiae were found around macrophages, maintained at 4 degrees C, which had been sensitized with immune serum (direct sensitization of macrophages), but no rosettes were found around macrophages sensitized with serum from normal mice. When the macrophages were maintained at 34 degrees C after addition of the rickettsiae, phagocytosis of rickettsiae occurred, indicating one probable role for cytophilic antibodies in typhus infections. If the rickettsiae were mixed with serum from infected mice, washed, and then added to macrophages (indirect sensitization of macrophages), more rosettes were found around the macrophages than around directly sensitized macrophages. The presence of mouse immunoglobulin G on the macrophage surface was also shown by staining living sensitized macrophages with rabbit fluroescein-conjugated anti-mouse immunoglobulin G.

Animals↗
PubMed1986

Immune responses to the lipopolysaccharides and capsular polysaccharides of Haemophilus pleuropneumoniae in convalescent and immunized pigs.

The immunologic responses to a smooth-type lipopolysaccharide (LPS) (HpS-LPS), a rough-type LPS (HpR-LPS), and a capsular-enriched polysaccharide preparation (HpC-PS) purified from Haemophilus pleuropneumoniae were determined in pigs immunized with a commercial H. pleuropneumoniae cellular vaccine, in pigs experimentally infected with H. pleuropneumoniae, in control pigs, and in immunized rabbits. The ability of the preparations to induce lymphocyte blastogenesis and B-cell activation was determined in the pigs and compared with the responses induced by the LPS of Escherichia coli O111:B4 and the LPS of Salmonella minnesota Re595. All the LPS preparations acted to induce proliferation of peripheral blood lymphocytes (PBL) from all pigs. The blastogenic response of PBL from H. pleuropneumoniae-infected pigs to HpS-LPS and HpR-LPS was significantly (P less than 0.05) greater than that of PBL from immunized and control pigs. HpC-PS did not induce a blastogenic response in the PBL of control pigs but did in PBL from H. pleuropneumoniae-infected pigs and to a greater degree in immunized pigs. An increase in the response of PBL to the S. minnesota LPS occurred only in the H. pleuropneumoniae-infected pigs. Significantly more (P less than 0.05) immunoglobulin-secreting cells (ISC) were induced in a reverse hemolytic plaque assay by stimulation with HpS-LPS and HpC-PS of PBL isolated from pigs infected with H. pleuropneumoniae than of PBL from immunized pigs. Increasing the number of T cells increased the number of ISC induced by HpS-LPS in control and immunized pigs, but not in convalescent pigs. The presence of macrophages reduced activation of ISC by HpS-LPS in control pigs and to a lesser degree in immunized pigs, whereas in H. pleuropneumoniae-infected pigs macrophages enhanced the induction of ISC by HpS-LPS. In immunized pigs, macrophages acted to inhibit the ability of HpC-PS to induce ISC. Serologic studies indicate that HpC-PS contains strain- and serotype-specific antigens; that HpS-LPS has both serotype-specific and cross-reacting species-specific antigens; and that HpR-LPS does not contain detectable serotype-specific antigens but does have both non species- and species-specific antigens. These studies show that the serotype-specific protection provided by immunization of pigs with an H. pleuropneumoniae cellular vaccine is principally the result of immunity to capsular antigens and that a weak cellular immune response occurs as compared with that induced by infection with H. pleuropneumoniae.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1995

Convalescent pigs are protected completely against infection with a homologous Actinobacillus pleuropneumoniae strain but incompletely against a heterologous-serotype strain.

To study whether Actinobacillus pleuropneumoniae induces a species-specific immunity, we infected pigs in the left lung with serotype 3 or 9 and after 3 weeks we infected their right lungs with serotype 9. Convalescent pigs were protected against homologous strain reinfection, but after heterologous strain reinfection the degree of protection varied. Neutralizing antibodies were not essential for protection.

Actinobacillus Infections↗
PubMed1973

Differences in clinical and convalescent-phase antibodies of Rhesus monkeys infected with monkey pox, tanapox, and Yaba poxviruses.

Complement-fixing and complement-fixing inhibiting (CFI) antibodies were demonstrated in the clinical and convalescent stages, respectively, of rhesus monkeys infected with either monkey poxvirus, Tanapoxvirus, or Yaba poxvirus. Specificity of the CFI antibody was confirmed by its failure to cross-react with heterologous poxvirus antigens and by experiments demonstrating the CFI test as being antigen dependent. Serum containing CFI antibody neutralized homologous poxvirus but failed to agglutinate antigen-coated, tanned red blood cells. The application of CFI test as a seroepidemiologic tool for studies of poxvirus infection of man and simian monkeys and the biologic role of CFI antibody in pathogenesis were discussed.

Animals↗
PubMed1985

Cytomegalovirus early and late membrane antigens detected by antibodies in human convalescent sera.

Using indirect immunofluorescence and a panel of human convalescent-phase sera, we identified cytomegalovirus (CMV) early and late membrane antigens (CMV-EMA and CMV-LMA, respectively) as separate entities on the surfaces of viable CMV-infected fibroblasts starting at 6 to 12 and 36 to 48 h postinoculation, respectively. For expression of CMV-EMA and CMV-LMA, infectious virus and active protein synthesis were required, whereas the expression of CMV-LMA, in addition, required viral DNA synthesis. Our data suggest that CMV-EMA and CMV-LMA form an individual set of CMV antigens that are different from intracellular CMV antigens and possibly (partly) different from the viral envelope.

Antibodies, Viral↗
PubMed2006

Sleeping position, oxygen saturation and lung volume in convalescent, prematurely born infants.

OBJECTIVE: To determine whether the effects of sleeping position on lung volume and oxygenation are influenced by postmenstrual age (PMA) and oxygen dependency in convalescent prematurely born infants. DESIGN: Prospective study. SETTING: Tertiary neonatal unit. PATIENTS: 41 infants (21 oxygen dependent), median gestational age 28 weeks (range 24-31 weeks) and birth weight 1120 g (range 556-1780 g). INTERVENTION: Infants were studied both supine and prone at two-weekly intervals from 32 weeks' PMA until discharge. Each posture was maintained for 1 h. MAIN OUTCOME MEASURES: Pulse oximeter oxygen saturation (Spo(2)) was monitored continuously, and at the end of each hourly period functional residual capacity (FRC) was measured. RESULTS: Overall, lung volumes were higher in the prone position throughout the study period; there was no significant effect of PMA on lung volumes. Overall, Spo(2) was higher in the prone position (p = 0.02), and the effect was significant in the oxygen-dependent infants (p = 0.03) (mean difference in Spo(2) between prone and supine was 1.02%, 95% CI 0.11% to 1.92%), but not in the non-oxygen-dependent infants. There was no significant influence of PMA on Spo(2). CONCLUSION: In the present study, prone sleeping did not improve oxygenation in prematurely born infants, 32 weeks' PMA or older and with no ongoing respiratory problems. However, the infants were monitored in each position for an hour, thus it is recommended that oxygen saturation should continue to be monitored after 32 weeks' PMA to be certain that longer periods of supine sleeping are not associated with loss of lung volume and hypoxaemia.

Functional Residual Capacity↗
PubMed2001

Acute and convalescent changes in plasma homocysteine concentrations in acute coronary syndromes.

BACKGROUND: Raised plasma homocysteine is a risk factor for coronary artery disease. Patients with myocardial infarction or unstable angina show greater activation of coagulation, greater troponin release, and a worse outcome. OBJECTIVE: To examine variations in plasma homocysteine concentration in relation to C reactive protein (CRP) in patients presenting with acute coronary syndromes. METHODS: Consecutive patients presenting with acute myocardial infarction (22) and unstable angina pectoris (12) were studied. Plasma samples were obtained on admission (before clinical intervention), on days 2, 7, and 28, and again six months after admission. Plasma homocysteine, assayed by high performance liquid chromatography, and CRP were both determined at the same time points. Changes were assessed by analysis of variance. RESULTS: CRP concentrations showed a classical rise on day 2, followed by a gradual decline to normal values taken at six months from admission in both myocardial infarction (p < 0.0001) and unstable angina (p = 0.02). Homocysteine concentrations in myocardial infarction (median, 25th to 75th interquartile range) were: 11.9 (10.7 to 12.6), 11.5 (9.1 to 13.4), 12.1 (11.4 to 14.1), 12.4 (11.1 to 14.4), and 12.1 (11.2 to 14.0) micromol/l, for days 1, 2, 7, 28, and 180, respectively (p = 0.02). Significant differences were observed only between day 2 and day 7 (p < 0.05). The final homocysteine measurement was not different from the admission level. Homocysteine concentrations in unstable angina did not differ between admission and convalescence (12.5 (9.1 to 14.5) micromol/l and 12.3 (7.7 to 14.9) micromol/l, respectively). CONCLUSIONS: Plasma homocysteine concentrations are minimally influenced by acute phase variations with reliable measurements obtained on admission in patients with myocardial infarction and unstable angina.

Acute Disease↗
PubMed1980

Nuclear angiography in convalescent phase of myocardial infarction. Serial study of left ventricular performance.

Electrocardiograph-gated blood pool scans (anteroposterior and left anterior oblique projections) were recorded in 30 patients seven to 10 days after myocardial infarction. Left ventricular ejection fractions (mean 0.26 +/- 0.10) were lower on average than values previously obtained in 11 normal subjects (mean 0.52 +/- 0.06) and correlated broadly with the clinical assessment of left ventricular performance. Ejection fractions were lower in anterior (mean 0.21 +/- 0.09) than inferior (mean 0.32 +/- 0.08) infarcts. Abnormal wall motion was detected in 11 of 15 anterior infarcts and in six of 13 inferior infarcts: mean ejection fractions associated with global asynergy, segmental asynergy, and normal wall motion were 0.15, 0.26, and 0.36, respectively. Twenty-four patients were reinvestigated two months later. Though there was some change in the clinical status of eight patients, wall motion and ejection fraction were unchanged (mean difference -0.005 +/- 0.036). Twelve patients were reinvestigated six months after infarction. The ejection fraction for the group was significantly lower than the values obtained at 10 days and two months, and four individual changes were significant when compared with the first study. Changes in wall motion were observed in one patient. From this radionuclide study, we conclude that ejection fraction and wall motion do not improve after the early convalescent phase of myocardial infarction.

Adult↗
PubMed1986

Further evidence for the involvement of immunoregulatory processes in corneal alkali burns: effects of immunosuppression and convalescent serum.

Alkali burns were produced in one eye of a group of mice. Two, 3 and 4 weeks later the second eye of each mouse was similarly burned. The rate of perforation in the second-burned eyes was significantly higher than in the first eye. This effect was abolished by immunosuppressing the animals before the burning of the first eyes. This potentiation effect of an ocular burn on subsequent ones is transferable to other mice by intraperitoneal administration of convalescent serum prepared from mice that were previously burned. This evidence suggests that ocular alkali burns cause the appearance in the circulation of antigens not previously present there. The antibodies produced against these antigens exacerbate the subsequent burn lesion and perhaps also the condition of the original burn.

Alkalies↗
PubMed1978

Movement therapy with geriatric patients in a convalescent home.

After several weeks of orientation with staff, the author, a registered dance therapist, established a movement therapy group for long-term geriatric patients in a convalescent home. The purpose was to promote socialization and expression of feelings, partly by recognizing even the most minimal participation in the group. Many patients were severely depressed and disoriented; most were in wheel chairs. Three months later a second group, functioning at a higher level, was formed. During the first six months, patients showed increases in verbalization and spontaneous expression of feelings, in interaction, and in assertiveness.

Aged↗
PubMed2003

Following severe injury, hypocholesterolemia improves with convalescence but persists with organ failure or onset of infection.

INTRODUCTION: Our primary objective was to determine the impact of traumatic injury, onset of infection, organ/metabolic dysfunction, and mortality on serum cholesterol. METHODS: During 676 surgical intensive care unit (SICU) days, 28 ventilated trauma patients underwent daily measurement of white blood cell (WBC) count and differential, cholesterol, arterial oxygen tension/fractional inspired oxygen, bilirubin, glucose, creatinine, and bicarbonate. With the onset of infection, WBC response was considered positive if the WBC count was 16.0 or greater, immature neutrophils were 10% or greater, or WBC count increased by 20%. Cholesterol response was considered positive if cholesterol decreased or failed to increase by 10%. RESULTS: Injury Severity Score was 30.6 +/- 8.6 and there were 48 infections. Initial cholesterol was decreased (119 +/- 44 mg/dl) compared with expected values from a database (201 +/- 17 mg/dl; P < 0.0001). The 25 survivors had higher cholesterol at SICU discharge (143 +/- 35 mg/dl) relative to admission (112 +/- 37 mg/dl; P < 0.0001). In the three patients who died, the admission cholesterol was 175 +/- 62 mg/dl and the cholesterol at death was 117 +/- 27 mg/dl. The change in percentage of expected cholesterol (observed value divided by expected value) from admission to discharge was different for patients surviving (16 +/- 19%) and dying (-29 +/- 19%; P = 0.0005). With onset of infection, the WBC response was positive in 61% and cholesterol response was positive in 91% (P = 0.001). Percentage of expected cholesterol was decreased with each system dysfunction: arterial oxygen tension/fractional inspired oxygen < 350, creatinine > 2.0 mg/dl, glucose > 120 mg/dl, bilirubin > 2.5 mg/dl, and bicarbonate >/= 28 or </= 23 (P < 0.01). Percentage of expected cholesterol decreased as the number of dysfunctions increased (P = 0.0001). CONCLUSION: Hypocholesterolemia is seen following severe injury. Convalescing patients (ready for SICU discharge) have improved cholesterol levels, whereas dying patients appear to have progressive hypocholesterolemia. Decreasing or fixed cholesterol levels suggest the development of infection or organ/metabolic dysfunction. Cholesterol responses are more sensitive for the onset of infection than are WBC responses. Sequential cholesterol monitoring is recommended for patients with severe trauma.

Adult↗
PubMed1992

Effects of a protein-rich diet during convalescence from shigellosis on catch-up growth, serum proteins, and insulin-like growth factor-I.

Shigellosis in children can cause growth retardation, worsening of malnutrition, and hypoproteinemia. To assess the effects of ingestion of a protein-rich diet during convalescence, 22 children aged 2 to 4 y with culture-proven shigellosis were randomly assigned after 5 d of antibiotic treatment to 21-d feeding regimens of either a 150 kcal/kg/d high-protein diet with 15% of calories as protein or an isocaloric control diet with 6% of calories as protein. At the start and end of dietary treatment, weight, height, mid-arm circumference, skinfold thickness, serum protein concentrations, and serum IGF-I were measured. Means of weight gain and increases in mid-arm circumference were greater in children fed high-protein diets than those fed control diets (1.23 versus 0.76 kg; 1.40 versus 0.96 cm; p < 0.05). Mean increase in height in children fed high-protein diets (0.83 cm) was not significantly greater than with control diets (0.74 cm). Mean increases in serum concentrations of total protein, prealbumin, and retinol-binding protein were greater in the high-protein group than in controls (p < 0.05). Mean serum concentrations of IGF-I were low in both groups before treatment [4.2 +/- 2.6 nmol/L (31.9 +/- 19.6 ng/mL) in controls; 3.1 +/- 3.4 nmol/L (24.0 +/- 26.3 ng/mL) in the high-protein group] but increased more in the high-protein group [39.0 +/- 16.2 nmol/L (298 +/- 124 ng/mL)] than in the control group [16.7 +/- 9.2 nmol/L (128 +/- 70 ng/mL), p < 0.01].(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Proteins↗
PubMed1990

Management and evaluation of non-supervised home exercise program in a convalescent phase of acute myocardial infarction.

Out of 636 patients with acute myocardial infarction (AMI) admitted to our institution, 183 patients enrolled in our non-supervised home exercise program immediately after their discharge from the hospital. The first 40 patients were randomized to control and training group, while the remaining 143 patients were included in the training group. Before and after the trial, all patients underwent cardiopulmonary exercise testing; submaximal graded treadmill exercise test with the application of expiratory gas analysis. In the training group, patients performed 2 km walk-jog exercise everyday for 1 month, keeping their heart rate (HR) at 90-100% of that in the anaerobic threshold. HR during exercise was monitored by patients themselves, using HR-meter. The anaerobic threshold significantly increased in the training group; while control group had no significant changes. VO2 and HR significantly increased at the same Borg's indices. Psychological improvement was also obtained in the training group compared to control group. It is concluded that non-supervised home exercise program is effective and easily applicable in the convalescent phase of AMI.

Aged↗
PubMed1980

Antiarrhythmic efficacy, pharmacokinetics and clinical safety of tocainide in convalescent myocardial infarction patients.

The antiarrhythmic efficacy and pharmacokinetics of tocainide, an oral analog of lidocaine, was evaluated in 18 hospitalized convalescing myocardial infarction patients. Holter ECG tapes were recorded daily during two-day placebo therapy preceding and succeeding two days of tocainide treatment. Left ventricular function was characterized from prior or subsequent arteriographic studies (ten cases) or from radionuclide scanning (eight cases). Tocainide dosage was 17.7 +/- 4.9 SD mg/kg/day. Plasma half-time of elimination was 19.1 +/- 6.8 hours (r = 0.9). Tocainide had no significant effect on heart rate, pulse rate, or QTC intervals and did not worsen chronic heart failure, even in patients with ejection fraction < 30%. In seven of 18 patients, tocainide significantly reduced ventricular premature beat (VPB) frequency as compared to predrug and postdrug placebo periods. Drug responders averaged a 200 to 545% reduction in VPB frequency at tocainide blood levels of > 3.5 microgram/ml.

Adult↗