Letters to the Editor
Granulocytes in Spontaneous
trophil functions with cirrhosis. Res Med Sci. 1987;5:403-406.
Bacterial Peritonitis Associated with Chronic Liver Disease To The Editor: I have read with interest Leggiadro and Lazar’s article entitled &dquo;Spontaneous Bacterial Peritonitis Due to Neisseria meningitidis Serogroup Z in an Infant with Liver Failure&dquo; (Clinical Pediatr. 1991;30: 350-352). For the pathogenesis of spontaneous bacterial peritonitis (SBP) in chronic liver diseases, the authors mentioned complement deficiency, but they did not bring up defective neutrophil chemotaxis, depressed hexose monophosphate shunt stimulation, decreased bactericidal capacity, and nitroblue tetrazolium reduction~~>2 Some of these granulocyte functions could be corrected by giving zinc/ which we have shown to be decreased in liver tissue in chronic liver disorders.’ In addition, it should be mentioned that granulocyte bone marrow reserve is decreased’ in chronic liver disorders as are the granulocyte-macrophage progenitorS5 and impaired monocyte6 and accessory cell functions.’’ I believe all these factors should also be taken into account in the pathogenesis of SBP. Sinasi Ozsolu, M.D. Professor of Pediatrics and Hematology
Hacettepe University Faculty of Medicine Department of Pediatrics Hematology Unit and Hacettepe Children’s Hospital Ankara, Turkey 1.
Ozsolu S, Akgun N. Defective neutrophil motility. Am J Dis Child. 1985; 139:10.
2.
190
Ozsolu S, Akgun N, Yetgin S et al.
Neu-
3.
4.
Turk J
Goksu N, Ozsoylu S. Hepatic and serum level of zinc, copper, and magnesium in childhood cirrhosis. J Pediatr Gastroenterol Nutr. 1986;5:459-462.
Cambiaghi G, Paina S. Defect in bone granulocyte reserve in liver cir-
marrow
rhosis evaluated with etiocholcholnolone. Acta Haematol. 1978; 60:291-295. 5.
Ponassi A, Morra L, Caristo G, et al. Blood granulocyte macrophage progenitor cell concentrations and differentiation in vitro in patients with hepatic cirrhosis. Acta Haematol.
6.
Hassner
1984;72:388-394. A, Kletter Y, Jedvab M, et al. Impaired monocyte function in liver cirrhosis. Lancet. 1979;1:329-330. 7. Rimola A, Soto R, Bory F, et al. Reticuloendothelial system phagocytic activity in cirrhosis and its relation to bacterial infection and prognosis. Hepatology.
1984;4:53-58. The authors reply: We appreciate Dr. Ozsolu’s comments on additional potential host defense mechanisms relevant to spontaneous bacterial peritonitis. In the case of the meningococcus, however, substantial evidence exists to support the unique role of complement-dependent serum bactericidal activity in prevention of disease caused by this pathogen.~1 Bactericidal activity against meningococci is also dependent on a specific antibody response, although the role of this antibody in the opsonophagocytosis of this organism is less clearly defined. Robert J. Leggiadro, M.D. Linda F. Lazar, M.D. University of Tennessee Health Science Center Memphis, Tennessee 1.
Densen P. Infectious disassociated with complement deficiencies. Clin Microbiol Rev. 1991; 4:359-395.
Figueroa JE, eases
Downloaded from cpj.sagepub.com at The University of Iowa Libraries on May 28, 2015
The Cost-Benefit Threshold To The Editor: The current climate of managing health-care costs has increased physicians’ awareness of cost-benefit analysis. In the expensive area of caring for very-low-birth-weight infants, a new parameter is introduced below, the cost-benefit threshold, or CBT. The CBT occurs on a variable day after birth when the cost of medical care has compounded to exceed a calculated amount as a function of increasing body weight and the relative worth of a standardized tangible asset. For example, the information provided by Shaffer et all allows an approximate prediction of weight on any subsequent day of life for low-birth-weight infants. Using five days of age as the nadir of weight loss, the lowest weight can be calculated:
WtDay5 = (0.033 BW + 0.83)
x
BW
where BW is the birth weight in kilograms. After five days, the weight on the day of CBT (Day CBT) can be estimated by adding 15 g/kg/day of subsequent linear growth to this lowest weight: Wt Day CBT BW x
WtDay 5 + 0.015 x (Day CBT - 5)
=
Furthermore, the total accumulat-
ing
cost
mated
of
care can
by using
be
approxi-
average cost per for neonatal intensive day (CPD) care. At tertiary-care centers in this region, the cost per day is approximately $1,500 for ventilated premature infants. Similarly, Hack and Fanaroff found that extremely-low-birthweight survivors from 1982 to 1985 had mean hospital stays of 137 an
Granulocytes in Spontaneous
trophil functions with cirrhosis. Res Med Sci. 1987;5:403-406.
Bacterial Peritonitis Associated with Chronic Liver Disease To The Editor: I have read with interest Leggiadro and Lazar’s article entitled &dquo;Spontaneous Bacterial Peritonitis Due to Neisseria meningitidis Serogroup Z in an Infant with Liver Failure&dquo; (Clinical Pediatr. 1991;30: 350-352). For the pathogenesis of spontaneous bacterial peritonitis (SBP) in chronic liver diseases, the authors mentioned complement deficiency, but they did not bring up defective neutrophil chemotaxis, depressed hexose monophosphate shunt stimulation, decreased bactericidal capacity, and nitroblue tetrazolium reduction~~>2 Some of these granulocyte functions could be corrected by giving zinc/ which we have shown to be decreased in liver tissue in chronic liver disorders.’ In addition, it should be mentioned that granulocyte bone marrow reserve is decreased’ in chronic liver disorders as are the granulocyte-macrophage progenitorS5 and impaired monocyte6 and accessory cell functions.’’ I believe all these factors should also be taken into account in the pathogenesis of SBP. Sinasi Ozsolu, M.D. Professor of Pediatrics and Hematology
Hacettepe University Faculty of Medicine Department of Pediatrics Hematology Unit and Hacettepe Children’s Hospital Ankara, Turkey 1.
Ozsolu S, Akgun N. Defective neutrophil motility. Am J Dis Child. 1985; 139:10.
2.
190
Ozsolu S, Akgun N, Yetgin S et al.
Neu-
3.
4.
Turk J
Goksu N, Ozsoylu S. Hepatic and serum level of zinc, copper, and magnesium in childhood cirrhosis. J Pediatr Gastroenterol Nutr. 1986;5:459-462.
Cambiaghi G, Paina S. Defect in bone granulocyte reserve in liver cir-
marrow
rhosis evaluated with etiocholcholnolone. Acta Haematol. 1978; 60:291-295. 5.
Ponassi A, Morra L, Caristo G, et al. Blood granulocyte macrophage progenitor cell concentrations and differentiation in vitro in patients with hepatic cirrhosis. Acta Haematol.
6.
Hassner
1984;72:388-394. A, Kletter Y, Jedvab M, et al. Impaired monocyte function in liver cirrhosis. Lancet. 1979;1:329-330. 7. Rimola A, Soto R, Bory F, et al. Reticuloendothelial system phagocytic activity in cirrhosis and its relation to bacterial infection and prognosis. Hepatology.
1984;4:53-58. The authors reply: We appreciate Dr. Ozsolu’s comments on additional potential host defense mechanisms relevant to spontaneous bacterial peritonitis. In the case of the meningococcus, however, substantial evidence exists to support the unique role of complement-dependent serum bactericidal activity in prevention of disease caused by this pathogen.~1 Bactericidal activity against meningococci is also dependent on a specific antibody response, although the role of this antibody in the opsonophagocytosis of this organism is less clearly defined. Robert J. Leggiadro, M.D. Linda F. Lazar, M.D. University of Tennessee Health Science Center Memphis, Tennessee 1.
Densen P. Infectious disassociated with complement deficiencies. Clin Microbiol Rev. 1991; 4:359-395.
Figueroa JE, eases
Downloaded from cpj.sagepub.com at The University of Iowa Libraries on May 28, 2015
The Cost-Benefit Threshold To The Editor: The current climate of managing health-care costs has increased physicians’ awareness of cost-benefit analysis. In the expensive area of caring for very-low-birth-weight infants, a new parameter is introduced below, the cost-benefit threshold, or CBT. The CBT occurs on a variable day after birth when the cost of medical care has compounded to exceed a calculated amount as a function of increasing body weight and the relative worth of a standardized tangible asset. For example, the information provided by Shaffer et all allows an approximate prediction of weight on any subsequent day of life for low-birth-weight infants. Using five days of age as the nadir of weight loss, the lowest weight can be calculated:
WtDay5 = (0.033 BW + 0.83)
x
BW
where BW is the birth weight in kilograms. After five days, the weight on the day of CBT (Day CBT) can be estimated by adding 15 g/kg/day of subsequent linear growth to this lowest weight: Wt Day CBT BW x
WtDay 5 + 0.015 x (Day CBT - 5)
=
Furthermore, the total accumulat-
ing
cost
mated
of
care can
by using
be
approxi-
average cost per for neonatal intensive day (CPD) care. At tertiary-care centers in this region, the cost per day is approximately $1,500 for ventilated premature infants. Similarly, Hack and Fanaroff found that extremely-low-birthweight survivors from 1982 to 1985 had mean hospital stays of 137 an
