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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effects of acute vs. chronic glucocorticosteroid administration on established cellular immune responses were studied in guinea pigs previously sensitized to tuberculin. A greater than 50% reduction in circulating lymphocytes was observed 4 hr after injection of soluble hydrocortisone and 24 hr after daily subcutaneous injections of depot cortisone acetate. After a single dose of hydrocortisone, peripheral lymphocyte migration inhibitory factor (MIF) production and antigen and mitogen-induced proliferation were unchanged. However, the peripheral lymphocytes remaining in the circulation after chronic cortisone treatment showed a marked decrease in both antigen-induced MIF and proliferation, although mitogen responses remained normal. Although similar levels of lymphocytopenia were induced by acute and chronic glucocorticosteroid administration, only chronic treatment was associated with depression of certain cell-mediated lymphocyte functions. The available evidence suggests that these changes may depend on GCS-induced selective alterations in the circulation patterns of certain subpopulations of lymphocytes.
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PMID:Immunosuppressive effects of glucocorticosteroids: differential effects of acute vs chronic administration on cell-mediated immunity. 80 35

The molecular mechanisms which govern the biosynthesis and secretion of the various T cell-derived lymphokines are poorly understood at this time, in spite of their tremendous importance to the control of the mammalian immune system. Here we provide compelling evidence that production of the murine T cell growth factors interleukin (IL) 2 and IL4 are differentially regulated by glucocorticoid (GCS) hormones. Under conditions where IL2 production is reduced by GCS hormones, IL4 production is increased. In vivo, this effect on T cell production of growth factors is manifest at low GCS concentrations that are well within physiologic ranges. In vitro, splenocytes isolated from antigen-stimulated donors, as well as antigen-specific cloned T cell lines, undergo alterations in their capacity to secrete T cell growth factors when stimulated with antigens in the presence of GCS. Responses normally dominated by IL2 are dramatically shifted to a condition where IL4 represents the major species of T cell growth factor produced. Similar changes in the pattern of T cell growth factor production are observed following short pulses with low-dose GCS in vitro, and the steroid-induced depression in IL2 production can be reversed and/or inhibited by treatment with the potent steroid antagonist RU486. Our results imply that GCS hormones, presumably through their capacity to activate a specified family of ligand-dependent transcriptional regulatory proteins (steroid hormone receptors), function to control the pattern of lymphokines produced by activated T cells. Steroid-mediated regulation of lymphokine gene expression could serve to dictate the types of immune effector mechanisms which can be initiated subsequent to antigen exposure.
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PMID:Contrasting effects of glucocorticoids on the capacity of T cells to produce the growth factors interleukin 2 and interleukin 4. 260 41

Little is known about the degree of disability and quality of life of patients after major trauma. We conducted a prospective study to examine the incidence and predictors of functional limitation (FL). Between January 1, 1990 and March 30, 1990, 61 eligible trauma patients were enrolled in the study (admission GCS score > or = 12, LOS > 24 hours). Functional limitation after trauma was measured at discharge and 3 months after discharge using the Quality of Well-being (QWB) scale, a more sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Functional limitation was also measured using a standard ADL scale (range, 17 = full function to 41 = maximum dysfunction). Risk factors measured were injury severity, body region, depression (CES-D) scale, and social support. Follow-up was achieved in 42 patients (70%). The mean age was 30 years, 74% were male, 52% white, 41% hispanic, and 3% other. The mean ISS was 15, with 69% blunt injuries and a mean LOS of 12 days. The QWB scores improved between discharge and follow-up; discharge mean = 0.457 (+/- 0.048), follow-up mean = 0.613 (+/- 0.118), but the mean QWB score at follow-up still reflected a significant degree of functional limitation. The mean percentage of change in QWB scores was 34.5% (+/- 25.5%) with a range of -6.34% to 103.8%. The discharge mean FDS was 29 (+/- 6.2) while the follow-up FDS mean was 17 (+/- 3.8), reflecting that most patients at follow-up reported near-perfect ADL functioning.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Functional limitation after major trauma: a more sensitive assessment using the Quality of Well-being scale--the trauma recovery pilot project. 829 53

Non-protein thiols (NP-SH) and the activities of the glutathione status-regulating enzymes gamma-glutamylcysteine synthetase (G-GCS), gamma-glutamyl transpeptidase (G-GT) and glutathione reductase (GR) were assessed in perfused rabbit hearts subjected to severe (60 min) or mild (7 min) total ischemia and 30 min reperfusion. Severe ischemia significantly decreased NP-SH, which were further depressed on reperfusion together with a significant decline in G-GCS activity; G-GT and GR activities were unchanged. Specific analytes were unaffected by mild ischemia-reperfusion. Thus, impaired enzymatic biosynthesis of GSH is operative in the reperfused rabbit myocardium after 60 min ischemia. This phenomenon may favour myocardial GSH depression and oxidative reperfusion injury after severe ischemia.
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PMID:Impaired glutathione biosynthesis in the ischemic-reperfused rabbit myocardium. 870 34

Depressed skull fractures (DSFs) account for 7-10% of children admitted to hospital with a head injury and 15-25% of children with skull fractures. We reviewed the records of 530 patients operated on for DSF from January 1, 1973, to December 31, 1993. This group was made up of 357 boys (67%) and 173 girls (33%) whose ages ranged from 1 day to 16 years (mean age 6.1 years). Fall was the most common cause of injury. Of the 530 patients with DSF, 66% had compound fractures. The incidence of compound fractures increased with age. Compound fractures caused more brain lacerations (29%) than simple fractures (15.5%) did. We also classified DSFs radiologically as true, flat, or ping-pong ball fractures. Associated intracranial lesions were found to be a bad prognostic factor. There were 13 deaths (2.5%) in this series. Satisfactory results were achieved in over 95% of the patients. Compound fractures are associated with a worse outcome and a higher incidence of intracranial lesions and cortical laceration. Unilateral pupillary dilatation and an admission GCS score of 8 or less are ominous signs in regard to mortality. We also found that the deeper the depressed bone, the higher the risk of both dural tear and cortical laceration and the worse the prognosis. A conservative approach should be followed in cases of simple DSF without associated intracranial hematoma and in cases in which the bone depression is not deeper than 1 cm.
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PMID:Pediatric depressed skull fractures: analysis of 530 cases. 881 97

The number of parameters (i.e., EEG or ICP-intracranial pressure) routinely monitored under clinical situations is limited. The brain function analyzer described in this paper enables simultaneous, continuous on-line monitoring of cerebral blood flow (CBF) and volume (CBV), intramitochondrial NADH redox state, extracellular K+ concentrations, DC potential, electrocorticography and ICP from the cerebral cortex. Brain function of 14 patients with severe head injury (GCS < or = 8), who were hospitalized in the neurosurgical or general intensive care unit was monitored using this analyzer. Leao cortical spreading depression (SD) has been reported in many experimental animals but not in the human cerebral cortex. In one of the patients monitored, spreading depression was observed. This is the first time that spontaneous repetitive cortical SD cycles have been recorded from the cerebral cortex of a patient suffering from severe head injury. Typical SD cycles appeared 4-5 h after the beginning of monitoring this patient. During the first 3-4 cycles the responses of this patient were very similar to the responses to SD recorded in normoxic experimental animals. Electrocorticography was depressed whereas extracellular K+ levels increased. The metabolic response to spreading depression was characterized by oxidation of intramitochondrial NADH concomitant to a large increase in CBF. During brain death, an ischemic depolarization, characterized by decrease in CBF and an irreversible increase in extracellular K+, was recorded.
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PMID:Cortical spreading depression recorded from the human brain using a multiparametric monitoring system. 897 24

The effects of water-immersion restraint (WIR) stress on lipid peroxide, glutathione (GSH), glutathione peroxidase (GSH-Px), gamma-glutamylcysteine synthetase (gamma-GCS) and gamma-glutamyltranspeptidase (gamma-GT) activities in several tissues of rats were investigated. Hepatic and intestinal lipid peroxide levels were increased significantly in the WIR stress group. In both tissues, GSH levels were significantly decreased and gamma-GCS activity was significantly increased. In addition, gamma-GT activities remained unchanged in both tissues following WIR stress. However, lipid peroxide and GSH levels did not change in the stomach and brain in the WIR stress group compared to the control group. These results suggest that lipid peroxidation, but not the depression of GSH synthesis and/or the increase of GSH breakdown may be a factor in hepatic and intestinal GSH reduction following WIR stress.
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PMID:Lipid peroxides, glutathione, gamma-glutamylcysteine synthetase and gamma-glutamyltranspeptidase activities in several tissues of rats following water-immersion stress. 905 11

Intracranial pressure (ICP) is currently the main parameter monitored following severe head injury or during the post operative period in neurosurgical patients. The normal cerebral cortex depends upon a continuous supply of O2, and direct coupling exists between adequate cerebral blood flow (O2 supply) and ion homeostasis as well as electrical activities. We have developed a new "Brain Function Analyzer-BFA" which enabled monitoring of the following parameters continuously in real time from the surface of the cortex: ICP; tissue blood flow & volume; intramitochondrial NADH redox state; DC steady potential; electrocorticography; tissue temperature. The probes were assembled in a Brain Function Multiprobe (BFM) which was connected to the brain via the burr hole procedure used for ICP monitoring. Measurements were performed in 18 comatose patients after severe head injury (GCS < or = 8) who were monitored in the ICU for 48-72 hours. The basic concept of the multiparametric monitoring approach was proven to be practical in neurosurgical patients. Clear correlations were recorded between hemodynamic, metabolic, ionic and electrical activities under various treatments administered to the patients or after pathological events. Responses similar to cortical spreading depression and ischemic depolarization were recorded from a severely head injured patient.
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PMID:Real-time multiparametric monitoring of the injured human cerebral cortex--a new approach. 977 50

An ideal analgesic for patients after craniotomy should neither cause respiratory depression, nor affect intracranial pressure (ICP) and cerebral perfusion pressure (CPP). The aim of the study was to evaluate the effect of Tramadol (T) on ICP and CPP, as well as to determine its analgetic efficacy in patients (pts) after craniotomy. Thirty five pts aged 16 divided by 78 years (mean 46) entered the study. Twelve had GCS (Glasgow Coma Scale) scores < or = 8 and 23 pts had scores > or = 12. Fourteen pts were mechanically ventilated and 21 pts were breathing spontaneously (BS). Tramadol was injected i.v. at a dose of 0.75 mg/kg over 3 minutes in 11 pts (Group 1), 1.0 mg/kg over 5 minutes in 13 pts (Group 2) and 1.0 mg/kg over 10 minutes in 11 pts (Group 3) PaCO2 was measured before T in all pts and at 8 minute after injection in 21 BS pts. Heart rate (HR), mean arterial blood pressure (MBP), ICP, CPP and respiratory frequency (f) were registered before and in the 1st, 3rd, 8th, and 15th minute after T. Analgetic effect was evaluated in 22 conscious pts by comparing the pain intensity before and 30 minutes after T using a five-point verbal response scale. Mean control ICP was 17 mmHg. ICP over 15 mmHg was diagnosed in 15 pts (mean ICP equal 26 mmHg). Mean CPP for all 35 pts was 85 mmHg. There were no statistically significant changes in HR, MBP, ICP, and CPP after T in any particular group, nor were there changes in ICP in subgroups with normal and elevated ICP. No significant changes in PaCO2 and f were found in BS pts. Satisfactory analgesia was obtained in 50% of pts of Group 1, and in 88% of pts of Groups 2 and 3. We conclude that tramadol in doses of 0.75 mg/kg and 1.0 mg/kg i.v. does not affect ICP and CPP in adult postcraniotomy patients and seems to be a safe and effective analgesic at a dose of 1.0 mg/kg for postcraniotomy pain control.
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PMID:Tramadol for postoperative analgesia in intracranial surgery. Its effect on ICP and CPP. 1145 59

We report the survival of a multiply injured patient with exanguinating haemorrhage and an arterial pH of 6.5, following a road vehicle crash. The previously healthy 38 years old male driver veered off the motorway and collided with a tree. The ambulance arrived at the scene 9 min after being called by an eyewitness and, following rapid extrication from the wreckage; the patient arrived in hospital 27 min later (with a GCS of 6), and was immediately intubated. The patient had suffered near-complete amputation of the left leg at upper femoral shaft level, along with multiple distal fractures and open wounds. He also sustained a head injury and closed displaced fractures of left radius and ulna. The patient received 2 l of crystalloids in the pre-hospital phase. Once in hospital the haemorrhage was controlled with a pressure dressing and intra-venous fluids were kept to a minimum until he was taken promptly to theatre. His initial arterial blood sample revealed a pH of 6.57, pCo(2) of 9.18 kPa, a pO(2) of 70.11 kPa and a base excess of -27.5 mmol l(-1). The co-oximeter Hb was 5.8 g dl(-1). Haemorrhage was controlled in theatre where he was transfused a total of 30 U of blood, 1 pack of platelets, 12 U of fresh frozen plasma, 3.5 l of crystalloids and 1.5 l of colloid. Sodium bicarbonate was administered three times. He subsequently remained ventilated in intensive care unit (ICU). Over the following week he survived sepsis, disseminated intravascular coagulation and myoglobinuria (with transient renal failure) attributable to rhabdomyolysis secondary to muscle necrosis. He later underwent diversion colostomy and disarticulating amputation of the left femur after several debridements. After 6 weeks on ICU he made an excellent recovery will full return of his mental abilities. In this case, the serial arterial blood samples obtained were reliable. The lactic acidosis observed was the result of profound tissue hypo-perfusion and its rate of clearance seems to have greater prognostic value than its peak or initial value. Several factors may have contributed to the patient's survival: rapid retrieval from the scene; early intubation with excellent subsequent oxygenation (thus avoiding the dangerous combination of hypoxia and acidosis with synergistic influence on cardiac depression) and limited initial fluid resuscitation in the emergency department with prompt surgical intervention and vigorous restoration of organ perfusion after surgical haemostasis. Immediate operative haemostasis, coupled with restricted fluid administration beforehand and vigorous restoration of organ perfusion afterwards is now replacing the old resuscitation paradigm. Perhaps this shift in practice has helped this patient to survive.
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PMID:Survival with an arterial pH of 6.57 following major trauma with exsanguinating haemorrhage associated with traumatic amputation. 1200 26


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