bluuebunny/crossref_metadata_2025 huggingface dataset:
New perspectives for asthma treatment: Anti‐leukotriene drugs
Authors: Garcia‐Marcos L. , Schuster A.
Published: March 2003

Leukotrienes are synthesized by different cells, including eosinophils, neutrophils, basophils, lymphocytes, macrophages, and mast cells. Cysteinyl leukotrienes (LTC4, LTD4, and LTE4) are the most important leukotrienes in the pathogenesis of asthma. Pharmacologically, there are two different ways of blocking the action of leukotrienes: inhibiting their production by blocking 5‐lipoxygenase or its activating protein, 5‐lipoxygenase‐activating protein (FLAP), (inhibitors) or by blocking their receptors (antagonists). The available antagonists are, for the moment, directed against the one receptor demonstrated to play a role in asthma symptoms, CysLT1, and they act in a competitive way. The only marketed 5‐lipoxygenase inhibitor is zileuton (Zyflo™). CysLT1 antagonists, currently on the pharmaceutical market in some countries, are zafirlukast (Accolate™), pranlukast (Ultair™, Onon™), and montelukast (Singulair™). Undoubtedly, drugs acting on leukotrienes constitute a new pharmacologic class in the therapeutic armamentarium for the management of asthma. From the pediatric point of view, montelukast is currently the most interesting drug of the group to date because of published trials in patients as young as 6 yr of age. At present, zafirlukast is only approved for use in patients 12 yr of age and older, although we understand that applications are likely to extend the age range into childhood shortly. However, more experience is necessary to establish a definite place for montelukast in the step‐by‐step asthma treatment. New comparative studies (with sodium cromoglycate and inhaled steroids), which will probably be published in the near future, as well as studies on the use of montelukast in the treatment of children under 6 yr of age will add crucial information to our knowledge, and help to identify an appropriate use in the therapeutic algorithm. Montelukast will not be a substitute for inhaled corticosteroids or β‐agonists, although it may act as a ‘sparing drug’ (which might help tapering of steroids in some instances). Its role in exercise‐induced asthma seems promising. Although its more widespread use could highlight low‐frequency adverse effects, its apparent excellent tolerability is an additional advantage for the drug. Patients’ preference for a twice‐daily dosage over the inhaled medication, resulting in a better compliance, is relatively well established, at least for zafirlukast in adults, and these findings can probably be extended to montelukast, which only requires once‐daily dosing in children.
Latex type I sensitization and allergy in children with atopic dermatitis. Evaluation of cross‐reactivity to some foods
Authors: Tücke J. , Posch A. , Baur X. , Rieger C. , Raulf‐Heimsoth M.
Published: March 2003

Recent studies have demonstrated that allergy to natural rubber latex (NRL) is associated with cross‐reactivity to certain foods. The aim of this study was to investigate the prevalence of NRL sensitization and allergy in children with atopic dermatitis (n=74). We also examined cross‐reactions between latex and foods, and compared the frequency of suspected latex cross‐reacting fruits in children with and without NRL‐specific immunoglobulin E (IgE). Twelve of the 74 atopic children studied (16.2%; 95% confidence interval (CI), 8.7–26.6%) had circulating IgE antibodies to latex. These NRL‐sensitized children were older and they showed significantly higher total IgE values (p<0.003) when compared with the group of children without NRL sensitization. Of the specific food IgE evaluations, 18.4% (93 out of 505) were positive, and 69.9% were observed in the group of children with latex‐specific IgE, most frequently to potato, tomato, sweet pepper, and avocado. An isolated latex‐specific IgE response without food‐specific IgE was never observed. Exclusively in the latex‐positive group, conformity with the report of allergic symptoms after ingestion of food and increased food‐specific IgE was found. Twenty children without proven latex sensitization showed increased food‐specific IgE, most frequently to potato, banana, and chestnut. Avocado‐specific IgE was never determined in this patient group. No significant differences were detected concerning the sensitization to potato, banana, and kiwi between NRL‐sensitized children and the group of 20 children without latex‐specific IgE. The competitive CAP inhibition using sera from children with specific IgE to both latex and food showed different cross‐reactivities between latex and the specific food. A close relationship existed between latex and avocado (median inhibition: 100%), whereas sensitization to latex and kiwi seemed to be independent in our study group (inhibition: <25%). In particular, for potato, cross‐reactivity and co‐sensitization existed. Our study demonstrated that children with atopic dermatitis are a high‐risk group for latex sensitization. Increasing age, additional sensitization to ubiquitous inhaled allergens, and enhanced total serum IgE values seemed to be important variables for latex sensitization and further sensitization to the latex‐associated foods. Cross‐reactivity and, in some cases, co‐sensitization to specific fruits and vegetables, were observed.
Helicobacter pyloriseropositivity in children with atopic dermatitis as sole manifestation of food allergy
Authors: Corrado Giovanni , Luzzi Ida , Pacchiarotti Claudia , Lucarelli Sandra , Frediani Tullio , Cavaliere Marisa , Rea Patrizia , Cardi Ettore
Published: March 2003

A positive association betweenHelicobacter pyloriantibodies and food allergy presenting with gastrointestinal symptoms has recently been reported. A subset of aH. pyloristrain possesses an antigen, CagA, as a virulence factor. Anti‐H. pyloriand anti‐CagA IgG titre have been determined in children with atopic dermatitis (AD) as the sole clinical manifestation of food allergy. In this study, thirty patients with AD as the sole clinical manifestation of food allergy were examined (group A). For comparative purposes, 30 patients affected by food allergy with gastrointestinal symptoms (group B) and 30 affected by atopic asthma (group C) were studied. Anti‐H. pyloriand anti‐CagA immunoglobulin G (IgG) were determined in all individuals by means of the enzyme‐linked immunosorbent assay. The anti‐H. pyloriIgG titre was significantly higher in group A and group B vs. group C (p < 0.05); no significant difference was detected between group A and group B (p > 0.05). No significant difference in anti‐CagA titre was found between the groups. These data demonstrate a positive association betweenH. pyloriantibodies and AD as the sole manifestation of food allergy. Further investigations are needed to evaluate the cause–effect relationship betweenH. pyloriseropositivity and AD.
Allergic diseases in farmers' children
Authors: Braun‐Fahrländer CH.
Published: March 2003

Several studies have reported lower rates of allergic sensitization and allergies in children living in rural as compared to urban communities. This has been attributed to the lower levels of air pollution in rural areas. The question arises whether other factors in the rural environment could explain the lower prevalence rates of allergic sensitization and hay fever. A first report from rural South Bavaria in Germany demonstrated that children living in a home where coal and wood were used for heating had a significantly lower risk of suffering from hay fever (odds ratio 0.57 (0.34–0.98)), of being sensitized to common allergens (OR 0.67 (0.49–0.93)) and of having bronchial hyperresponsiveness (OR 0.55 (0.34–0.90)) than their peers living in homes with other heating systems. Subsequently, the Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution (SCARPOL) tested the hypothesis that farming as parental occupation was associated with a lower risk of hay fever and atopy. A total of 1620 (86.0%) 6–15‐year‐old schoolchildren living in three rural communities of Switzerland were examined using a standardized questionnaire completed by the parents and IgE antibodies against six common aeroallergens in serum samples of 404 (69.3.0%) of the 13–15‐year‐olds. Farming as parental occupation was significantly associated with lower rates of reported hay fever symptoms and allergic sensitization. Comparing children from farming with those from non‐farming environments, the adjusted OR was 0.34 (95% CI: 0.12–0.89) for sneezing attacks during the pollen season, and 0.31 (95% CI: 0.13–0.73) for a sensitization to allergens. These results have recently been confirmed in a new and much larger survey in rural South Bavaria. Several alternative explanations have to be considered when interpreting these findings, namely, selection bias, the development of tolerance, increased microbial stimulation and a more traditional lifestyle (diet and housing conditions). Based on present knowledge, the underlying environmental factor explaining the protective effect of the farming environment has not yet been identified.
A similar high level of immunoglobulin A and immunoglobulin G class milk antibodies and increment of local lymphoid tissue on the duodenal mucosa in subjects with cow's milk allergy and recurrent abdominal pains
Authors: Kokkonen Jorma , Tikkanen Sami , Karttunen Tuomo J. , Savilahti Erkki
Published: March 2003

In previous studies, we have reported endoscopic and histological alterations locally on the gastrointestinal (GI) tract associated with a gastrointestinal type of cow's milk allergy. In this study, we sought to further characterize endoscopic, and immunological findings in these children. We also hypothesized that the same type of immune responses might also be found in children with unexplained and recurrent abdominal pains. We did a gastroduodenoscopy for persistent GI symptoms, examined the mucosal histology of the small intestine and measured the antibodies to whole cow's milk and its fractions with an enzyme‐linked immunosorbent assay (ELISA) in a consecutive series of 22 subjects with untreated and 14 with treated cow's milk allergy (CMA) and 44 with recurrent abdominal pains (RAP). The immunological findings of the study subjects were compared with 54 controls. Lymphonodular hyperplasia (LNH) of the duodenum was the main endoscopic finding in 11 subjects (50%) with untreated and 5 (36%) with treated CMA. It was also found in 6 of 44 subjects with RAP. Compared with the controls, the patients with CMA showed significantly higher levels of IgA class antibodies to whole milk (p = 0.003) and βLG (p < 0.0001). Of the IgG class antibodies to βLG (p = 0.032), BSA (p < 0.0001) and αCAS (p < 0.0001) were significantly higher. The patients with LNH of the duodenal bulb as the main endoscopic finding showed significantly higher values of IgG class antibodies to βLG (p = 0.01) and αCAS (p = 0.005). Interestingly, the patients examined for RAP showed a similar increment in the pattern of whole milk and specific milk protein antibodies as the CMA children. In conclusion this study showed that gastrointestinal CMA beyond infancy is significantly associated with high levels of IgG and IgA class antibodies to milk and its fractions. As high levels of these antibodies and LNH of the duodenal bulb were also found in subjects with RAP, the study further suggests that gastrointestinal CMA might be one major reason for RAP.
The combination of nebulized sodium cromoglycate and salbutamol in the treatment of moderate‐to‐severe asthma in children
Authors: Furusho Kenshi , Nishikawa Kiyoshi , Sasaki Sei , Akasaka Toru , Arita Masahiko , Edwards Alan
Published: March 2003

The aim of this multi‐centre prospective study was to evaluate the efficacy, tolerability, and safety of the combination of sodium cromoglycate (SCG) and salbutamol (administered as a nebulized solution), compared to SCG alone and salbutamol alone, in the management of severe, intractable asthma in childhood. The study was an open, randomized, cross‐over trial of 12 weeks' duration in children with moderate‐to‐severe intractable asthma. All treatments were administered twice daily by powered nebulizer. The primary outcome measure was the change in asthma severity, as measured by the mean asthma score during the last 2 weeks of a baseline period and the last 2 weeks of each treatment. Secondary outcome measure was the patient's opinion of the effectiveness of treatment. The change in asthma scores from baseline values were significantly greater with the combination treatment compared to each component administered separately. The mean difference in asthma score between the combination and salbutamol was: −7.5; 95% CI, −11.70 to −3.29 (p < 0.0001). The mean difference between the combination and SCG was: −8.53; 95% CI, −14.03 to −3.25 (p < 0.0001). Patients were also significantly in favor of combination treatment (p < 0.001 vs. salbutamol; p < 0.01 vs. SCG). Two patients reported adverse effects. We concluded that regular twice‐daily inhalation of a combination of SCG and salbutamol gave better control of symptoms than previous treatments in patients with severe, intractable asthma. Few adverse effects with this therapy suggest that it is extremely useful, safe, and effective.
Environmental risk factors for allergy and socioeconomic status in a birth cohort (BAMSE)
Authors: Lannerö E. , Kull I. , Wickman M. , Pershagen G. , Nordvall S. L.
Published: March 2003

Associations between parental educational level and possible risk factors for atopic disease during the first months of life were explored in a cohort of 4089 neonate children born 1994–96 in Stockholm, Sweden. Reports concerning a number of life style factors during pregnancy and after the baby was born were obtained by questionnaire. There was a strong negative association between duration of education and maternal smoking during pregnancy, parental smoking after the baby was born and keeping of cat and dog (p‐trend < 0.001), respectively. For example, smoking during pregnancy was reported by 6.7% (95% CI 5.5–7.9) of mothers with college or university degree and by 22.2% (95% CI 20.1–24.5) of those with the shortest education. Indicators of dampness and poor ventilation were also more common in homes of those with the shortest education. The results show that the educational level has an influence on risk factors for development of atopic disease in childhood and indicates a need of deeper understanding of life style in different socioeconomic groups. The data also indicate that various possible confounding factors need to be thoroughly investigated when analysing studies of risk factors for allergic disease in childhood.
Serum immunoglobulin E levels in human immunodeficiency virus‐infected children with pneumonia
Authors: Zar Heather J. , Latief Zeino , Hughes Jane , Hussey Gregory
Published: March 2003

Elevated serum immunoglobulin E (IgE) levels have been reported in association with human immunodeficiency virus (HIV) infection in adults, but there is little information in children. The aim of the present study was to compare serum IgE levels in HIV‐positive and ‐negative children hospitalized with pneumonia in South Africa and to investigate whether IgE may be useful as a marker of specific infections or prognosis in HIV‐infected children. History, examination, blood tests, and induced sputum or bronchoalveolar lavage were carried out. Of 122 children [45% female, median age 8 months (3–20 months)], 81 were infected with HIV. A history of allergy or asthma was present in three children (two of whom were HIV positive). Serum IgE was higher in HIV‐infected children [83 (33–147) vs. 29 (6–113) IU/l; p = 0.011] as was immunoglobulin G (IgG) [49 (37–63) vs. 27.5 (23–34) g/l; p < 0.001]. CD4 lymphocytes [600 (330–1210) vs. 1900 (1500–3030) cells/µl], percentage CD4 cells [13.6 (9.4–20.3) vs. 40.1 (31.1–44.9)] and CD4 : CD8 ratio [0.3 (0.2–0.4) vs. 2 (1.4–2.8)] were lower in HIV‐positive children (p < 0.001 for all). Bacteremia occurred in 12 (10%) children; other specific pathogens identified included Mycobacterium tuberculosis in eight (7%) and Pneumocystis carinii in nine (7%). There was no correlation with CD4 count, CD4 : CD8 ratio, or the presence of specific pathogens, and IgE level. In‐hospital mortality (11%) did not correlate with IgE levels. HIV‐infected children with pneumonia have higher serum IgE compared with seronegative patients. In HIV‐positive children, IgE levels did not correlate with the degree of immunosuppression or with outcome.
Pathological evaluation of steroid withdrawal in pediatric renal transplant recipients
Authors: Aikawa A , Miyagi M , Motoyama O , Shigetomi Y , Ohara T , Hirayama N , Kawamura S , Hasegawa A
Published: March 2003

Abstract:Protocol biopsies were performed to detect and treat sub‐clinical rejection in eight living related pediatric renal transplant recipients who had been withdrawn from steroids. Low‐grade tubulitis (t1) and mononuclear cell interstitial inflammation (i1), typical of borderline rejection and low‐grade interstitial fibrosis (ci1), and tubular atrophy (ct1), characteristic of chronic rejection, appeared frequently in protocol biopsies more than 3 yr after steroid withdrawal. In contrast, early‐type glomerulitis (g), allograft glomerulopathy (cg), arteriolar hyaline thickening (ah), intimal arteritis (v), and fibrous intimal thickening (cv) were not observed in protocol biopsies after steroid withdrawal. Low‐dose pulse therapy (methylprednisolone (MP) 250 or 500 mg/d for 3 d) was administered to five patients for borderline and/or acute grade 1a rejection, as determined by protocol biopsies in the absence of clinical rejection. No oral steroids were administered. Renal function in all patients remained satisfactory, without proteinuria, in follow‐up periods ranging from 22 to 68 months after steroid withdrawal. Of the eight patients, three grew to almost normal height (>mean – 2SD) and four exhibited catch‐up growth. Thus, steroid withdrawal can be safe and improves growth in pediatric renal transplant recipients if undertaken with careful clinical follow‐up, including protocol biopsies.
A comparative analysis of the use of mycophenolate mofetil in pediatric vs. adult renal allograft recipients
Authors: Roberti Isabel , Reisman Lewis
Published: March 2003

Abstract: Mycophenolate mofetil (MMF) is a new immunosuppressive drug used in combination with cyclosporin A (CsA) or tacrolimus and prednisone to prevent rejection of renal allografts in both adult and pediatric recipients. It has been shown in several large studies that MMF significantly decreases the incidence of acute rejection in adults and has acceptable adverse effects. In this retrospective study, we compare the incidence of adverse events between pediatric and adult renal allograft recipients. Twenty‐two children and 37 adult renal allograft recipients were included in the study. The initial dose of MMF was 1.5 g b.i.d. for the adult patients and ranged from 15 to 30 mg/kg/d for the pediatric patients. All patients received p.o. acyclovir as prophylaxis for cytomegalovirus (CMV). The two groups were similar regarding gender distribution and graft source. Acute rejections occurred in 10 of the 22 pediatric patients (45%) and in nine of the 37 adults (24%), p = NS. The incidence of infections was similar in both groups except for the occurrence of CMV (n = 5), which was seen only in adults. The incidence of GI symptoms was significantly higher in the pediatric population (54.5% vs. 21.6%; p = 0.02). Significant weight loss was seen more often in the smaller pediatric patients (weight ≤ 15 kg) compared to the larger pediatric patients, 60% vs. 11.7%, p = 0.05. Among the patients who had significant GI symptoms 50% of the adults and 75% of the pediatric recipients required either dose reduction or, most commonly, discontinuation of the MMF. The need to discontinue MMF was significantly higher in the pediatric patients, especially in those that weighed less than 15 kg. We suggest the possibility that the optimum dose, dosing interval or preparation of MMF has not yet been established for pediatric patients. One should therefore monitor pediatric patients closely, especially the small ones, to avoid significant nutritional problems and other adverse GI events.
Evaluation of anti‐human leukocyte antigen allo‐immunization in pediatric cadaveric kidney transplantation
Authors: Emonds M. ‐P. , Herman J. , Dendievel J. , Waer M. , Van Damme‐lombaerts R.
Published: March 2003

Abstract:Forty‐eight pediatric cadaveric renal transplantations, performed between May 1986 and February 1997, were retrospectively screened, pre‐ and post‐transplant, for antibodies to human leukocyte antigen (anti‐HLA) using complement‐dependent cytotoxicity (CDC) assay and enzyme immunoassay (EIA). The correlation between anti‐HLA immunization and graft outcome was investigated. The combined analysis of CDC and EIA enabled the differentiation between complement‐fixing and non‐complement‐fixing, anti‐HLA class I and anti‐HLA class II antibodies. The median post‐transplant follow‐up for all patients with a functioning graft was 86 months (range 10–138 months). In the whole population, 16 grafts were lost: six following a non‐immunologic complication; and 10 as a result of rejection. Of these 10 grafts lost, eight were in patients with pre‐ and/or post‐transplant donor antigen specific (DAS) anti‐HLA class I or class I + II antibodies; and two were in patients with DAS anti‐HLA class II antibodies only. Three of these grafts were lost in patients with weak pre‐existing DAS anti‐HLA class I antibodies. Immunological graft loss appeared at a median post‐transplant time of 38 months (range 2–68 months). All patients without DAS anti‐HLA antibodies had a good graft outcome. The presence of pre‐ and post‐transplant DAS anti‐HLA antibodies, especially if directed against HLA class I, were associated with a poor graft outcome. A systematic search for, and identification of, anti‐HLA antibodies should therefore be part of a pretransplant evaluation to allow the identification of ‘unacceptable’ donor HLA antigens, following which the impact of the HLA‐cross‐match on graft outcome will improve. Screening for DAS anti‐HLA antibodies post‐transplant could be helpful for detecting patients with an increased risk for graft loss following rejection episodes.
Pediatric renal transplantations in the Netherlands
Authors: Cransberg Karlien , Van Gool Jan D. , Davin Jean Claude , De Jong Maria C.J.W. , Darby Muriel , Boendermaker Marjolijn E. , De Meester Johan M.J. , Stijnen Theo , Wolff Eric D. , Nauta Jeroen
Published: March 2003

Abstract:In the Netherlands, pediatric kidney transplantation programs are available in four centers. We retrospectively analyzed the results obtained over the past decade. Between 1985 and 1995, 231 patients (139 boys) received 269 transplants, including 61 repeat. The recipients were aged 1.9–21.8 yrs (mean 10.9), the donors 0.3–63.3 yrs (median 11.4, mean 19.7). Immunosuppression consisted of corticosteroids, cyclosporin A and azathioprine, in various combinations and dosages. The patient survival during follow‐up was 97%. The overall graft survival was 73% at 1 yr and 60% at 5 yrs after transplantation. Major causes of graft loss were acute rejection (21%), thrombosis (12%) and chronic rejection (28%). Acute rejection episodes were noted in 74% of all grafts. First acute rejection episodes had a moderate predictive value for graft loss (relative risk (RR), compared to rejection‐free grafts, 5.9). First rejection episodes occurring later than 3 months after transplantation were considerably more predictive (RR 18.3) than early ones. Grafts from living related donors (n = 35) yielded a superior 5‐yr graft survival (77%) and remained free of rejection more often than grafts from adult cadaveric donors(43% vs. 25%). The results of pre‐emptive transplants were excellent (n = 13, 5‐yr survival 100%). Repeat transplants had the same results as primary transplants. Recipients younger than 4 yrs showed a poor 5‐yr graft survival of 38% (n = 13). Single kidney grafts from donors younger than 4 yrs (n = 35) had a 5‐yr graft survival of 44%. In contrast, kidneys from these young donors did well if transplanteden bloc(n = 10, 5‐yr graft survival 89%). These overall results are in line with those of others. The results may be improved by expansion of immunosuppressive therapy in the first year and by thrombosis prophylaxis in high‐risk patient–donor combinations. Better results may be expected from more extensive use of living related donations, pre‐emptive transplantation anden bloctransplantation instead of single kidneys of young donors.
Complete necrosis of the renal pelvis and ureter after cadaveric renal transplantation
Authors: Hidalgo G. , Vyas S. , Hong J. , Singh A. , Baqi N.
Published: March 2003

Abstract:Urological complications of transplantation, in particular, necrosis of the transplanted ureter, are rare. We report on a 20‐yr‐old boy who received a well‐matched cadaveric kidney transplant that was complicated by poor graft function and subsequent exploratory laparotomy for complete necrosis of the renal pelvis and ureter.
Does treatment of bladder dysfunction prior to renal transplant improve outcome in patients with posterior urethral valves?
Authors: Lopez Pereira P , Jaureguizar E. , Martinez Urrutia M. J , Meseguer C , Navarro M
Published: March 2003

Abstract: Fourteen patients with posterior urethral valves and end‐stage renal failure were urodynamically evaluated in order to identify and correct any bladder dysfunction before renal transplant. Of the 14 patients, during filling, six had normal bladder function, two had an over‐distended bladder (one with instability), one had instability, four had poor compliance, and one had a very reduced bladder capacity. During the voiding phase, one had a myogenic failure and another had detrusor–sphincteric dyssynergia. Four patients underwent bladder augmentation. Three were managed with anticholinergic therapy and two required clean intermittent catheterization owing to post‐voiding residual urine. A renal transplant was performed in all of these patients at a mean age of 8.2 years. We compared outcome in these 14 patients with bladder dysfunction treated before transplantation with outcome in a matched control group of 14 transplant patients. Graft function and survival were similar in both groups. We believe that urodynamic studies must be included in the pretransplant evaluation of patients with posterior urethral valves in order to diagnose any bladder dysfunction and commence appropriate treatment to avoid any negative influence on graft function.
Endomyocardial biopsy in pediatric heart transplant recipients: A useful exercise? (Analysis of 1169 biopsies)
Authors: Wagner Kerstin , Oliver Mark C. , Boyle Gerard J. , Miller Susan A. , Law Yuk M. , Pigula Frank , Webber Steven A.
Published: March 2003

Abstract:The objective of this study was to define the diagnostic yield for endomyocardial biopsy (EMB) procedures performed for various indications in a large pediatric heart transplant population. Endomyocardial biopsy procedure has been employed as the ‘gold standard’ for rejection surveillance. Previous studies have questioned the value of surveillance EMB beyond the early post‐transplant period. We retrospectively reviewed data on 82 pediatric heart transplant recipients with serial EMB. A total of 1169 EMB were performed during a follow‐up period of 2–149 months (median 41 months). EMB were classified by age at transplantation, time from transplant, immunosuppressive regimen used [tacrolimus vs. cyclosporin A (CsA)] and indication, i.e. surveillance, follow‐up after rejection or lowering of immunosuppression, non‐specific clinical symptoms and graft dysfunction. During the first year after heart transplantation, surveillance EMB demonstrated significant rejection [International Society for Heart and Lung Transplantation (ISHLT) grade ≥ 3A] in 18% of biopsies with the yield being 14–43% for all other indications. Surveillance EMB 1–5 yr post‐transplantation were found to have a lower diagnostic yield in infants (4% vs. 13% in children) and in patients with favorable first‐year rejection history (9% vs. 17% in ‘frequent rejectors’). Tacrolimus‐based immunosuppression was associated with significantly less rejection, but only in the first year post‐transplantation (14% in tacrolimus vs. 24% in CsA surveillance EMB, p = 0.035). Surveillance EMB remains an important diagnostic tool for rejection surveillance during the first 5 years after pediatric heart transplantation. Endomyocardial biopsy is particularly warranted after reduction of immunosuppression and for monitoring for ongoing rejection after treatment of acute rejection episodes.
Pneumatosis intestinalis in an infant undergoing bone marrow transplantation for Wiskott–Aldrich syndrome
Authors: Uçkan Duygu , Çetin Mualla , Haliloðlu Mithat , Çiftçi Arbay O. , Tuncer Murat A. , Tezcan Ýlhan
Published: March 2003

Abstract: A 7‐month‐old patient with Wiskott–Aldrich syndrome (WAS) developed pneumatosis intestinalis (PI) in the immediate post‐transplant period after receiving paternal human leucocyte antigen (HLA) phenotypically matched bone marrow (BM). PI has been described in patients with congenital or acquired immunodeficiency states and after bone marrow transplantation (BMT). To our knowledge, the condition has not been described in WAS. The underlying bowel mucosa damage as a result of the history of massive rectal bleeding, the effects of the conditioning regimen, immunosuppression, neutropenia, and infection, may all have contributed to the development of PI. Although the condition resolved by conservative management alone, the patient developed Klebsiella pneumonia sepsis, interstitial pneumonitis, failed to engraft, and died on day +66 following a second infusion of stem cells mobilized from his father's peripheral blood.
Rotavirus infection as cause of tacrolimus elevation in solid‐organ‐transplanted children
Authors: Frühwirth M. , Fischer H. , Simma B. , Hochleitner B. , Königsrainer A. , Margreiter R. , Ellemunter H.
Published: March 2003

Abstract:Rotavirus (RV) is the most common cause of diarrheal illness in children. We report three solid‐organ‐transplanted patients in whom RV infection caused increased trough levels of the immunosuppressive macrolide tacrolimus (TAC) by mechanisms that are still under investigation. The virus was detected for longer in the feces of these patients than in infants not receiving immunosuppressive therapy. In association with short‐term monitoring of blood trough levels of TAC, the dosage should be reduced early if symptoms of an acute gastroenteritis are present.
Does lung growth occur when mature lobes are transplanted into children?
Authors: Sritippayawan Suchada , Keens Thomas G. , Horn Monica V. , MacLaughlin Eithne F. , Barr Mark L. , Starnes Vaughn A. , Woo Marlyn S.
Published: March 2003

Abstract: Lung volume increases after living donor lobar lung transplantation (LD) in children. The mechanism responsible for this increase may be alveolarization (lung growth) or alveolar dilation. The diffusing capacity of the lung for carbon monoxide adjusted for lung volume (DLco/VA) should decrease if alveolar dilation occurs, but not if lung growth occurs. Pulmonary function tests were measured 1–12 months after transplant in 20 children receiving LD transplants and in 11 children receiving cadaveric whole lung transplantation (CL). One month after transplant there were no differences between LD and CL recipients in age, gender, or height. Compared to the first month after transplant, height increased at 6–12 months after LD (p < 0.05), and only at 12 months after CL (p = 0.02). Total lung capacity (TLC) showed an 11–22% increase at 3–12 months after LD , and an 11–14% increase at 6–12 months after CL. DLco/VA showed an 11–17% decrease at 3–12 months after LD. However, in recipients of CL, DLco/VA showed a transient decrease of 10% at 3–6 months post‐transplant, but was not significantly lower at 9–12 months. LD recipients had lower DLco/VA values than CL recipients at 6–12 months after transplant (p < 0.05). We conclude that following LD, lung volume increases, but DLco/VA decreases. We speculate that alveolar dilation, rather than alveolarization, is the primary mechanism of increased lung volume in children following LD.
Fulminant recurrence of atypical hemolytic uremic syndrome during a calcineurin inhibitor‐free immunosuppression regimen
Authors: Florman Sander , Benchimol Corinne , Lieberman Kenneth , Burrows Lewis , Bromberg Jonathan S.
Published: March 2003

Abstract: Recurrence of hemolytic uremic syndrome (HUS) after kidney transplantation is frequent, occurring almost exclusively in patients with atypical HUS, which is not caused by Escherichia coli gastroenteritis and in which diarrhea is absent. Calcineurin inhibitors are associated with recurrence of HUS. In two children who underwent living donor kidney transplantation for atypical HUS, we pre‐emptively employed sirolimus in a calcineurin inhibitor‐free immunosuppression regimen. Both children had excellent early graft function, yet both developed severe recurrent disease and subsequently lost their grafts. Avoidance of calcineurin inhibitors did not prevent recurrence of severe HUS and graft loss. Transplantation for severe atypical HUS remains problematic.
Normal and variant arterial supply of the liver and gallbladder
Authors: Molmenti Ernesto P. , Pinto Peter A. , Klein Jeffrey , Klein Andrew S.
Published: March 2003

Abstract: The vascular supply of the liver and gallbladder is characterized by a striking degree of polymorphism. The occurrence of variants that differ from the usual pattern is both surprisingly common and unpredictable. Knowledge of this variable anatomy is particularly important during surgical interventions in which preoperative imaging studies are not available, such as in organ procurements. In this report we consider various anatomical arterial configurations, and describe an unusual variant.
Stimulation of nodulation in field peas (Pisum sativum) by low concentrations of ammonium in hydroponic culture
Authors: Waterer John G. , Vessey J. Kevin , Raper, C. David
Published: March 2003

Although the inhibitory effects of high concentrations of mineral N (> 1.0 mM) on nodule development and function have often been studied, the effects of low, static concentrations of NH4+ (< 1.0 mM) on nodulation are unknown. In the present experiments we examine the effects of static concentrations of NH4+ at 0, 0.1 and 0.5 mM in flowing, hydroponic culture on nodule establishment and nitrogenase activity in field peas [Pisum sativum L. cv. Express (Svalöf AB)] for the initial 28 days after planting (DAP). Peas grown in the presence of low concentrations of NH4+ had significantly greater nodule numbers (up to 4‐fold) than plants grown without NH4+. Nodule dry weight per plant was significantly higher at 14, 21 and 28 DAP in plants grown in the presence of NH4+, but individual nodule mass was lower than in plants grown without NH4+. The nodulation pattern of the plants supplied with NH4+ was similar to that often reported for supernodulating mutants, however the plants did not express other growth habits associated with supernodulation. Estimates of N2 fixation indicate that the plus‐NH4+ peas fixed as much or more N2 than the plants supplied with minus‐NH4+ nutrient solution. There were no significant differences in nodule numbers, nodule mass or NH4+ uptake between the plants grown at the two concentrations of NH4+. Nodulation appeared to autoregulate by 14 DAP in the minus‐NH4+ treatment. Plant growth and N accumulation in the minus‐NH4+ plants lagged behind those of the plus‐NH4+ treatments prior to N2 fixation becoming well established in the final week of the experiment. The plus‐NH4+ treatments appeared not to elicit autoregulation and plants continued to initiate nodules throughout the experiment.
Multiple forms of phosphoenolpyruvate carboxylase in mesophyll, epidermal and guard cells of Vicia faba
Authors: Schulz Margot , Hunte Carola , Schnabl Heide
Published: March 2003

The distribution of phosphoenolpyruvate carboxylase (PEPCase, EC 4.1.1.31) in different leaf‐cell‐types and tissues of Vicia faba L. cv. 3‐fach Weiße was studied. The highest specific PEPCase activity was found in guard cell protoplasts (16.3 µmol mg−1 protein h−1) whereas for epidermal and mesophyll protoplasts remarkably lower specific activities were found (1.6 and 1.0 µmol mg−1 protein h−1, respectively). On chlorophyll and protoplast basis, a similar distribution of enzyme activity was observed. Compared with epidermal extracts, the specific PEPCase activity of mesophyll tissue was 17‐fold lower. Immunological studies with polyclonal antibodies to PEPCase indicated 3 immunoreactive proteins in epidermal tissue and guard cell protoplasts with molecular masses of 107 000, 110 000, and 112 000. Only the Mr 107 000 protein was found in extracts of mesophyll and epidermis protoplasts. Western immunoblots after native electrophoresis of epidermal and mesophyll proteins showed a significant difference in PEPCase mobility. It is assumed, that the immunostained proteins of Mr 110 000 and 112 000 represent isoforms or subunits of the PEPCase and that they are involved in stomatal movements.
Differential transport of Zn, Me and sucrose along the longitudinal axis of developing wheat grains
Authors: Pearson J. N. , Jenner C. F. , Rengel Z. , Graham R. D.
Published: March 2003

The hypothesis that Zn and Mn are transported within the grain in a similar manner to sucrose was investigated in the developing wheat grain. Detached ears were cultured in solution containing 65Zn, 54Mn and [14C]‐sucrose for 10 to 120 min at 18–22 days post‐anthesis. At different times the grain was cut transversely into 1‐mm sections and the radioactivity in each section determined The embryo region was damaged in some grains to investigate the effect of reduced accumulation rate on the transport of 65Za, 54Mn and [14C]‐sucrose to the embryo. The distribution of 65Zn. 54Mn and [14C]‐sucrose between the endosperm cavity sap. endosperm, embryo and pericarp in grains labelled for 2.5 and 6 h at 18–22 days post‐anthesis was also determined. [14C]‐su‐crose was initially high in the first, embryo‐containing section of the grain but decreased progressively to the distal end of the grain. The amount of 65Zn along the longitudinal axis of the grain was distributed evenly in each 1‐mm section, whilst 54Mn accumulated exponentially in the first proximal 1‐mm section of the grain and was distributed evenly in the remaining sections. Damaging the embryo had no effect on 65Zn and 54Mn transport to the section containing the embryo. The pericarp contained almost all of the grain 65Za and 54Mn, with small amounts found in the embryo, endosperm and endosperm cavity sap. Increasing amounts of [14C]‐sucrose were found in the endosperm as time progressed. The rate of accumulation of 65Zn, 54Mn and [14C]‐sucrose was much higher in the embiyo than the endosperm: the difference between the embryo and endosperm was especially large for 65Zn and 54Mn. It is suggested that 65Zn and 54Mn are not transported within the grain in the same way as [14C]‐sucrose. [14C]‐sucrose moves laterally out of the vascular system of the crease into the endosperm cavity and is subsequently taken up and stored in the endosperm. In contrast, 65Zn and 54Mn appear to be retained within the vascular system of the crease and may be transported more slowly to grain parts such as the embryo and pericarp tissue.
Acid‐induced elongation of Reynoutria stems requires tissue stresses
Authors: Hejnowicz Z. , Sievers A.
Published: March 2003

Measurements of the elongation rate of strips of outer tissue composed of epidermis and collenchyma, peeled from the elongating internodes of Reynoutria japonica Houtt. (Japanese knotweed) and stretched in buffer, showed that the rate depended on pH and the stretching force. At pH 6.8, elongation was barely perceptible in the force range studied, but the rate of elongation increased rapidly with the force at pH 5.0 (acid‐induced elongation). The yield threshold stress at pH 5.0 amounted to 1.8×106 N m−2. It was three times higher than the osmotic pressure in the outer tissue, but was lower than the average tensile tissue stress in this tissue in intact stems. We infer that tensile tissue stress in the outer tissue is required for the manifestation of acid‐induced elongation of this tissue in situ.
Expression and low pH increase the activity of an apoplastic acid phosphatase in growing tissues from Zea mays
Authors: Pfeiffer Wolfgang
Published: March 2003

Auxin‐induced secretion of an acid phosphatase (EC 3.1.3.2) leads to the hypothesis that this enzyme may be involved in plant cell elongation growth (W. Pfeiffer. 1996. Physiol. Plant. 98: 773–779). Elongation growth can be characterized by the effects of pH, phosphate and citrate, and the correlation with a particular region of the root: the elongation region. Therefore, it was investigated whether these parameters may reveal further correlations between acid phosphatase and elongation growth. The following results were obtained. (1) An extracellular acid phosphatase with high substrate affinity was characterized (Michaelis‐Menten constant, 0.03 mM for 4‐methylumbelliferyl phosphate; pH optimum, 3.0). The pH dependence of the enzyme was similar to that of elongation growth of coleoptile segments after pretreatment with phosphate (U. Kutschera and P. Schopfer. 1985. Planta 163: 483–493). (2) Phosphate inhibited both the acid phosphatase and coleoptile growth. Phosphate was a competitive inhibitor of the acid phosphatase (inhibitor constant, 2.5 mM). (3) Citrate inhibited coleoptile growth and the acid phosphatase in a similar way (inhibitor constant, 21 mM). (4) The elongation region of maize roots contained more apoplastic acid phosphatase than adjacent regions (170%). The pH dependence of the enzyme suggests that the low pH reported for the elongation region would result in an additional increase of the enzymatic activity (pH optimum at 3.0).
Suppression of the osmoinduced proline response of rapeseed leaf discs by polyamines
Authors: Larher F. , Aziz A. , Deleu C. , Lemesle P. , Ghaffar A. , Bouchard F. , Plasman M.
Published: March 2003

Rapeseed leaf discs (RLD) subjected to upshock osmotic stress accumulate proline (Pro). Di‐ and polyamines (PA) supplied to the external medium suppressed Pro accumulation. These effects were dependent not only on diamine and PA concentrations but also on their cationic charge. The suppression of Pro accumulation required that diamine and PA be taken up and further accumulated in the leaf tissues. Glycine betaine (GB) also inhibited Pro accumulation, with the effects of GB and PA being additive. Experiments to elucidate the mechanism(s) responsible for the inhibitory effect of spermine (Spm) indicated that it could be simulated with methionine sulfoximine (MSO), a potent inhibitor of glutamine synthetase. The inhibitory effects of Spm and MSO were both alleviated by supplying glutamine to the RLD. In addition, Spm as well as MSO increased glutamate content, indicating that these compounds could inhibit the conversion of glutamate to proline. A comparison of the changes in chlorophyll and protein content of RLD osmotreated with or without added Spm indicates that this PA behaves as an antisenescent compound, preventing chlorophyll breakdown and proteolysis and hence the conversion of amino acids to Pro. Since the PA concentrations used in this work were much higher than the endogenous concentrations in RLD, the significance of PA under osmotic stress remains unclear. This study shows, however, that PA can suppress Pro accumulation.
Regulation of elongase activity by abscisic acid and temperature in microspore‐derived embryos of oilseed rape (Brassica napus)
Authors: Wilmer J. A. , Lessire R. , Helsper J. P. F. G. , Van Der Plas L. H. W.
Published: March 2003

Growth temperature and ABA both affect the level of erucic acid (22:1) in microspore‐derived embryos (MDEs) of oilseed rape. We have previously shown that these stimuli act independently. In the present study we investigated the effects of growth temperature (15 vs 25°C) and ABA (0 vs 5 µM) on the characteristics and activity of the elongase complex, the enzymes synthesising 22:1. Due to inhibition by the substrate oleoyl‐CoA at low concentrations (< 10 µM) it was not possible to determine values for Km and Vmax. Elongase activities from preparations extracted from MDEs grown under different conditions showed an optimum temperature higher than 30°C, with a Q10 value of about 3. We found considerable effects of temperature and exogenous ABA on total elongase activity in MDEs. Our results suggest that the accumulation of 22:1 is regulated by the amount of elongase enzyme and not by changes in the intrinsic characteristics of the enzyme. Elongase activity correlated closely with the absolute amount of 22:1 (µmol), whereas the correlation between elongase activity and the fraction of 22:1 (% of fatty acids) in oil was poorer. Including the total activity of acyltransferases did not improve the correlation. Acyltransferase activity itself correlated poorly with the total amount of oil formed.
A Nicotiana plumbaginifolia protein labeled with an azido cytokinin agonist is a glutathione S‐transferase
Authors: Gonneau Martine , Mornet René , Laloue Michel
Published: March 2003

The mechanisms of reception/transduction of cytokinins still remain largely unknown. We used 1‐(2‐azido‐6‐chloropyrid‐4‐yl)‐3‐(4‐[3H])phenylurea ([3H]azido‐CPPU), a new photoaffinity probe to search for cytokinin‐binding proteins. A soluble protein that binds phenylurea‐type cytokinins has been specifically photolabeled in Nicotiana plumbaginifolia (cv. Viviani line pbH1D) leaf extracts. The protein was purified to homogeneity by affinity chromatography. Its N‐terminal amino acid sequence, as well as four internal peptidic sequences are highly homologous with the theta class of the glutathione S‐transferase superfamily (GST, EC 2.5.1.18) including Hyoscyamus muticus and Arabidopsis GSTs identified as auxin‐binding proteins. The purified N. plumbaginifolia protein also possesses GST enzymatic activity. To test the possible involvement of this GST in the mechanism of action of cytokinin, we studied the binding of tritiated‐CPPU to the purified GST in the presence of various compounds, cytokinin agonists, cytokinin antagonists, or inactive molecules. Thidiazuron is a poor competitor, and neither zeatin nor the active optical isomer R‐MeBA is able to inhibit the binding of CPPU. There is no correlation between the cytokinin activity and the binding properties of the molecules tested. Our results confirmed that plant GSTs bind different compounds, especially plant hormones but probably have no specific role in the mode of action of cytokinins.