According to the American-European Consensus Conference and the Lung Injury Severity Score definitions, ARDS is common in the adult burn population and has a delayed onset compared to most critical care populations. We found age to be a major predisposing factor for ARDS.

The aim of the investigation was to assess the prevalence of ovarian adrenal rest tumours and polycystic ovaries in female patients with congenital adrenal hyperplasia (CAH). Thirteen female CAH patients (median age 19.8 years, range 14.8-23.5 years) underwent transvaginal (n=6) or transabdominal (n=7) ultrasonography by a gynaecologist and MR imaging (n=13) of the ovaries (pre and post contrast-enhanced T1- and T2-weighted images). Ovarian adrenal rest tumours were defined as small hypoechoic and multifocal nodules on ultrasound and isointense lesions on T1- and hypointense on T2-weighted MR images (derived from characteristics of testicular adrenal rest tumours). Polycystic ovaries were defined as the presence of > or = 10 follicles arranged peripherally around or scattered throughout increased stroma. No ovarian adrenal rest tumours were found either on ultrasound, or by MR imaging. Polycystic ovaries were found in 2 of the 13 patients (15.4%), both with ultrasound and MR. No ovarian adrenal rest tumours were detected in these female CAH patients, which suggests that ovarian adrenal rest tumours in CAH females are rare. The prevalence of polycystic ovaries corresponded to that in the general population. From these results, we would suggest that routine ovarian imaging in CAH females is not indicated. However, when ovarian dysfunction is present, ovarian imaging is advised, first by ultrasonography, to detect ovarian adrenal rest tumours or polycystic ovaries.

No abstract

Liposomal encapsulation of antimicrobial agents has been used to improve drug delivery, particularly against intracellular pathogens. The effect of unilamellar liposomes on macrophage activation in response to Escherichia coli lipopolysaccharide was examined. Liposomes caused a dose-and time-dependent inhibition of tumor necrosis factor release by lipopolysaccharide-treated cells. The accumulation of tumor necrosis factor mRNA transcripts was unaffected, suggesting a posttranscriptional mechanism for this effect. However, induction of macrophage procoagulant activity was unaffected by liposomes, indicating a selective rather than a global inhibition. These data suggest that liposomes used for drug delivery may modulate the host response to infection.Standard therapy for the management of secondary bacterial peritonitis includes fluid resuscitation to restore normal hemodynamics, surgical intervention to deal with the underlying pathological process and to reduce the bacterial inoculum, and the use of antimicrobial agents to treat local and systemic infections. Despite modem therapeutic approaches, clinical failures occur, some of which are attributed to antibiotic failure. The reasons for the lack of efficacy of various antimicrobial regimens include bacterial resistance, inadequate antibiotic levels, the failure of antibiotics to penetrate into sites of residual infection, and the reduced levels of antibiotic activity within the abnormal microenvironment of infection. Various novel approaches have been used to overcome some of these deficiencies. Liposome-encapsulated antibiotics have been shown to have improved penetration into phagocytic cells and have been advocated for use against intracellular microbes (1,22). Indeed, this carrier system augmented the efficacy of various antimicrobial agents against a wide range of microorganisms that survive within macrophages (1, 6, 9, 25). Our laboratory -has previously reported that the use of cefoxitin encapsulated within unilamellar liposomes (95% dipalmitoylphosphatidylcholine, 5% phosphatidylserine) significantly reduced the mortality rate compared with that with the use of free cefoxitin in an intra-abdominal infection model in the rat (5). Improved survival correlated with a reduction in residual bacterial numbers in the peritoneal cavity and the liver, suggesting that the beneficial effect of liposome-encapsulated cefoxitin was mediated via the improved microbicidal activity.Experimental intra-abdominal infection has been shown to initiate the release of numerous cytokines by cells of the monocyte/macrophage lineage (11). Among these, tumor necrosis factor (TNF) appears to play a central role in the host response to infection, including the lethality associated with endotoxemia (3,13,17,26,27 595-9486. ment with anti-TNF antibodies prevents the hemodynamic and pathological alterations as well as the lethal effects of endotoxin administration. On the basis of the importance of TNF in the development of the host response to intra-abdominal infection, we hypoth...

No abstract