The phenotype and function of peripheral blood monocytes change after trauma and during sepsis. The aim of the study was to evaluate monocyte expression of human leucocyte antigen (HLA)-DR and Fc receptor III (FcR III) (CD16) in neonates and small children with high risk of sepsis (hospitalized at the intensive care unit). The reduced proportion of CD14 HLA-DR monocytes was observed in all patients at the intensive care unit, while the increase of CD16 expression on monocytes was observed in the course of sepsis. The measurement of CD16 expression on monocytes also proved to be more useful for monitoring patient. The proportion of both CD14 dim CD16 and CD14 high CD16 monocytes increased during sepsis; however, monocytes showed reduced ability to phagocytose Escherichia coli, compromised ability to cooperate with T cells and reduced CD86 expression in parallel to HLA-DR depression. The reduced interleukin (IL)-1 but rather increased IL-10 production was associated with sepsis. The differences between CD14 CD16 monocytes of healthy donors and patients with sepsis are discussed.

ABSTRACT:The aim of this study was to evaluate the B-cell compartment in the peripheral blood of children with different types of hipogammaglobulinemia: common variable immunodeficiency (CVID), transient hypogammaglobulinemia of infancy (THI), and selective IgA deficiency (SIgAD). We analyzed by flow cytometry the changes in the B-cell subsets with age and showed that children with an early-onset CVID develop similar pattern of B-cell subsets as adult patients with CVID with age, as the levels of memory B cells (CD19 ϩ /CD27 ϩ ) and class-switched memory B cells (, in contrast to age-matched control group, did not increase with age. Children with SIgAD displayed similar changes as patients with CVID only within the class-switched memory B-cell subpopulation. No significant differences in the level of memory B cells and class-switched memory B cells in children with THI in comparison to age-matched control group were observed. There were no differences in the percentage of immature B cells (CD19 ϩ /CD21 low ) among all studied groups. As B-cell subsets in children with THI were normal during entire period of hypogammaglobulinemia, the persistence of low levels of memory B-cell subsets in some children may facilitate the diagnosis of CVID. (5), or primary B-cell defects (6,7) have been reported. In some patients with CVID, defects in B-cell receptors signaling and B cell development have been described, especially mutations in CD19 (8), B-cell activating factor of the tumor necrosis factor family receptor (BAFF-R) (9), inducible costimulator of activated T cells (ICOS) (10), and transmembrane activator and CAML interactor (TACI) (11-14), which are required for maturation of B cells and generation of antibody diversity. Disease is usually diagnosed in the second or third decade of life after a history of recurrent pyogenic sinopulmonary infections (15), but some cases of CVID are diagnosed in the childhood as an early-onset CVID.Selective IgA deficiency (SIgAD) is the most prevalent primary humoral immunodeficiency. The clinical picture of SIgAD may vary from absence of clinical manifestations to fully symptomatic form (16). A variety of pathologic mechanisms of SIgAD have been postulated, which include the occurrence of IgA-specific T suppressor cells, inadequate T helper (Th) cell function, an intrinsic B-cell defects (17), or decreased expression of CD40 on monocytes (18). In most cases, the molecular defect is unknown, although in some patients with SIgAD, mutations in TACI gene have been identified (11,12). SIgAD is considered to be genetically linked with CVID, as the latter may develop from SIgAD (19 -21) and occasionally vice versa (22). Familial studies have implicated the existence of an allelic relationship between SIgAD and CVID, indicating that these disorders have the same molecular defect (23).Transient hypogammaglobulinemia of infancy (THI) is defined by decreased level of IgG (below 2 SD for the agematched healthy children) and in some cases low level of IgA and intact cell-mediated immunity. Prod...

Torticollis may be a herald sign of the tumor of the cervical spinal cord or the posterior fossa. Those pathologies should be considered in the differential diagnosis of the torticollis, particularly if accompanied by other symptoms of the focal pathology of central nervous system. Awareness of this fact may shorten the time to establish the proper diagnosis. Torticollis necessitates exclusion of the posterior fossa and spinal cord tumor.

Background Introducing the principles of multimodal analgesic therapy is necessary to provide appropriate comfort for the patient after surgery. The main objective of the study was evaluating the influence of perioperative intravenous (i.v.) lidocaine infusion on postoperative morphine requirements during the first 48 h postoperatively in children undergoing major spine surgery. Materials and methods Prospective, randomized, double-blind study: 41 children, qualified to multilevel spine surgery, were randomly divided into two treatment groups: lidocaine and placebo (control). The lidocaine group received lidocaine as a bolus of 1.5 mg/kg over 30 minutes, followed by a continuous infusion at 1 mg/kg/h to 6 hours after surgery. The protocol of perioperative management was identical for all patients. Measurements: morphine demand, intensity of postoperative pain (the Numerical Rating Scale), oral feeding initiation time, first attempts at assuming erect position, postoperative quality of life (the Acute Short-form /SF-12/ health survey). Results Patient data did not differ demographically. Compared to the control group, lidocaine treatment reduced the demand for morphine during the first 24h [95% CI 0.13 (0.11-0.28) mg/kg, p = 0.0122], 48h [95% CI 0.46 (0.22-0.52) mg/kg, p = 0.0299] after surgery and entire hospitalization [95% CI 0.58 (0.19-0.78) mg/kg, p = 0.04]; postoperative pain intensity; nutritional withdrawal period [introduction of liquid diet (p = 0.024) and solid diet (p = 0.012)], and accelerated the adoption of an upright position [sitting (p = 0.048); walking (p = 0.049)]. The SF-12 generic health survey did not differ between groups before operation, 2 months and 4 years after surgery. Conclusions Perioperative lidocaine administration, as a part of the applied analgesic therapy regimen, may decrease postoperative opioid demand and accelerates convalescence of children undergoing major surgery.