We compared the immunogenicity of two vaccination schedules with either a systemic or a mucosal booster, both following a mucosal primary vaccination with a recombinant outer membrane fusion protein of Pseudomonas aeruginosa (OprF-I) in 12 healthy volunteers. The systemic booster induced higher levels of OprF-I-specific serum antibodies of IgG isotype, with a mean+/-S.E.M. of 32.6+/-7.8x10(7) enzyme-linked immunosorbent assay (ELISA) units (EU) as compared to the nasal booster with 14.6+/-2.1x10(7) EU (P=0.05). Specific serum IgA antibodies and antibodies in saliva did not differ between the two vaccination groups. We conclude that a combined mucosal/systemic vaccination with the OprF-I vaccine may offer an enhanced systemic immunogenicity. Further studies on the long-term immunogenicity and induction of antibodies on the respiratory airway surface are warranted.
Both HES 130/0.4 and human albumin 5% were effective for haemodynamic stabilization in non-cardiac surgery of young infants with no adverse impact on coagulation or other safety parameters in our study population.
No abstract
Studies on head injury-induced pituitary dysfunction are limited in number and conflicting results have been reported. To further clarify this issue, 29 consecutive patients (24 males), with severe (n = 21) or moderate (n = 8) head trauma, having a mean age of 37 ± 17 years were investigated in the immediate post-trauma period. All patients required mechanical ventilatory support for 8-55 days and were enrolled in the study within a few days before ICU discharge. Basal hormonal assessment included measurement of cortisol, corticotropin, free thyroxine (fT4), thyrotropin (TSH), testosterone (T) in men, estradiol (E2) in women, prolactin (PRL), and growth hormone (GH). Cortisol and GH levels were measured also after stimulation with 100 µg human corticotropin releasing hormone (hCRH) and 100 µg growth hormone releasing hormone (GHRH), respectively. Cortisol hyporesponsiveness was considered when peak cortisol concentration was less than 20 µg/dl following hCRH. TSH deficiency was diagnosed when a subnormal serum fT4 level was associated with a normal or low TSH. Hypogonadism was considered when T (males) or E2 (women) were below the local reference ranges, in the presence of normal PRL levels. Severe or partial GH deficiencies were defined as a peak GH below 3 µg/l or between 3 and 5 µg/l, respectively, after stimulation with GHRH. Twenty-one subnormal responses were found in 15 of the 29 patients (52%) tested; seven (24%) had hypogonadism, seven (24%) had cortisol hyporesponsiveness, five (17%) had hypothyroidism, and two patients (7%) had partial GH deficiency. These preliminary results suggest that a certain degree of hypopituitarism occurs in more than 50% of patients with moderate or severe head injury in the immediate post-trauma period, with cortisol hyporesponsiveness and hypogonadism being most common. Further studies are required to elucidate the pathogenesis of these abnormalities and to investigate whether they affect long-term morbidity. P2 Cortisol reserve in head trauma victims: evaluation with the low-dose (1 µ µg) corticotropin (ACTH) stimulation test
ZusammenfassungBei der nasalen Provokation liegen lediglich für die anteriore Rhinomanometrie (aRM) definierte Kriterien für den positiven Ausfall vor. Zwischenzeitlich sind weitere Untersuchungsgeräte zur nasalen Provokation in Gebrauch, welche in dieser Studie mit der etablierten aRM verglichen wurden. Untersucht wurden 14 Patienten mit perennialer Rhinitis und im Hauttest und RAST nachgewiesener Sensibilisierung gegen die Hausstaubmilbe. Als Kontrolle dienten 13 Atopiker mit Pollenallergie sowie 20 Nichtatopiker. Alle Probanden wurden mit D. pteronyssinus nasal provoziert. Aufgrund verschiedener Messtechniken erfolgten am Tag 1 einseitige Messungen mit der aRM, mit der Oszilloresistometrie (ORM), mit dem Peak Nasal Inspiratory Flowmeter (PNIF) und mit der Akustischen Rhinometrie (Rhinoklack) und am Tag 2 zweiseitige Messungen mit der ORM und dem PNIF. Bei allen Geräten wurde die relative ¾nderung des Messwertes nach Applikation des Allergens im Vergleich zur Kontrollmessung berechnet. Nach Festlegung der optimalen Grenzen für die Trennung von positiven und negativen nasalen Provokationtests für ORM, PNIF und Rhinoklack wurden Sensitivität und Spezifität berechnet. Die Sensitivität der verschiedenen Methoden erwies sich bei einseitiger Messung als vergleichbar gut. Die zweiseitige Messung ergab beim PNIF und bei der ORM eine bessere Sensitivität als die einseitige. In der Spezifität, die bei der aRM, der ORM und dem PNIF hervorragend war, erwies sich der Rhinoklack als unterlegen. Als Schlussfolgerung lässt sich feststellen, dass der PNIF den anderen Messmethoden nicht unterlegen ist, der Rhinoklack aber weniger spezifisch als die anderen Messmethoden ist. AbstractDefined criteria for nasal provocation exist only for the anterior Rhinomanometrie (aRM). During the last years there are other techniques for nasal provocation in use. In this study the new instruments were compared with the established aRM. We examined 14 patients with perennial rhinitis. All showed positiv skin test and RAST against D. pteronyssinus. The controls were 13 atopic patients sensitized against pollen but not against D. pteronyssinus and 20 healthy volunteers. All subjects underwent nasal provocation with D. pteronyssinus. On the first day the provocation was unilateral. The instruments were the aRM, the Oscilloresistometry (ORM), the Peak Nasal Inspiratory Flowmeter (PNIF) and the Acustic Rhinometry (Rhinoklack). On the second day the provocation was bilateral with ORM and PNIF. First we determined the limits for separation between a positive and negative nasal provocation test for the different instruments. Then we calculated the sensitivity and specifity for the instruments. By unilateral provocation there was a good sensitivity for all devices. The specifity was very good with the aRM, ORM and PNIF. In conclusion the PNIF is as good as the other instruments, but the Rhinoklack was less specific than the others.
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