Inflammation: acute

Thl7 TGF-P IL-6 orlL-ip, anti-IL-4, anti-IL-12 RORC2 IL-17,IL-22, TNF-a Induction of G-CSE, IE-6, IL-8, neutrophilic inflammation (acute inflammation, arthritis, acute neutrophilic asthma)... 

Systemic inflammation Acute respiratory distress syndrome (sustained therapy with moderate dosage accelerates recovery and decreases mortality)... 

Lindhorst E, Young D, Bagshaw W, Hyland M, Kisilevsky R. Acute inflammation, acute phase serum amyloid A and cholesterol metabolism in the mouse. Biochim Biophys Acta 1997 1339 143-154. 

Acute inflammation Acute viral infections Kidney stones Preeclampsia Surgical trauma Transplant rejection Myocardial infarction CHF Pancreatitis Trauma... 

Chronic inflammation Acute coronary syndrome Crohn s disease Emphysema Hepatitis Inflammatory bowel disease Rheumatoid arthritis... 

Systemic disorders may also manifest with conjunctival inflammation. Acute or chronic conjunctivitis may present with any of five signs of conjunctival inflammation chemosis, hyperemia, discharge or exudate, follicles, and papillae (Table 25-1). Specific patterns of inflammation may be helpful in diagnosis of the underlying cause. 

Type IVc. T cells themselves can also act as effector cells. They migrate to the tissue and can kill tissue cells such as hepatocytes or keratinocytes in a perforin/ granzymeB- and FasL-dependent manner (Schnyder et al. 1998 Nassif et al. 2002, 2004 Kuechler et al. 2004). Such reactions occur in most drug-induced delayed hypersensitivity reactions, mostly together with other type IV reactions (monocyte, eosinophil, or neutrophil recruitment and activation). Cytotoxic T cells thus play an important role in maculopapular or bullous skin diseases as well as in conditions characterized by neutrophilic inflammation (acute generalized exanthematous pustulosis, AGEP), and in contact dermatitis. Type IVc reactions appear to be dominant in bullous skin reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), where activated CD8-t T cells kill keratinocytes (Schnyder et al. 1998 Nassif et al. 2002, 2004). They may also be the dominant cell type in hepatitis or interstitial nephritis. 

Pathological find- No inflammation Acute inflamma- Airway inflamma-... 

Toxicity. Many /V-nitrosamines are toxic to animals and cells in culture (4,6—8,88). /V-Nitrosodimethy1amine [62-75-9] (NDMA) is known to be acutely toxic to the Hver in humans, and exposure can result in death (89). Liver damage, diffuse bleeding, edema, and inflammation are toxic effects observed in humans as a result of acute and subacute exposure to NDMA. These effects closely resemble those observed in animals dosed with NDMA (89,90). 

These steioids aie capable of preventing or suppressing the development of the sweUing, redness, local heat, and tenderness which characterize inflammation. They inhibit not only the acute symptoms of the inflammatory process, such as edema, fibrin deposition, and capillary dilatation, but also the chronic manifestations. There is evidence that glucocorticoids induce the synthesis of a protein that inhibits phosphoHpase A 2 (60), diminishing the release of arachidonic acid from phosphoHpids (Fig. 2), thereby reducing chemotaxis and inflammation. 

Unfortunately steroids merely suppress the inflammation while the underlying cause of the disease remains. Another serious concern about steroids is that of toxicity. The abmpt withdrawal of glucocorticoid steroids results in acute adrenal insufficiency. Long term use may induce osteoporosis, peptidic ulcers, the retention of fluid, or an increased susceptibiUty to infections. Because of these problems, steroids are rarely the first line of treatment for any inflammatory condition, and their use in rheumatoid arthritis begins after more conservative therapies have failed. 

Skin. The skin may become contaminated accidentally or, in some cases, materials may be deHberately appHed. Skin is a principal route of exposure in the industrial environment. Local effects that are produced include acute or chronic inflammation, allergic reactions, and neoplasia. The skin may also act as a significant route for the absorption of systemicaHy toxic materials. Eactors influencing the amount of material absorbed include the site of contamination, integrity of the skin, temperature, formulation of the material, and physicochemical characteristics, including charge, molecular weight, and hydrophilic and lipophilic characteristics. Determinants of percutaneous absorption and toxicity have been reviewed (32—35,42,43,46—49). 

The likelihood that materials will produce local effects in the respiratory tract depends on their physical and chemical properties, solubiHty, reactivity with fluid-lining layers of the respiratory tract, reactivity with local tissue components, and (in the case of particulates) the site of deposition. Depending on the nature of the material, and the conditions of the exposure, the types of local response produced include acute inflammation and damage, chronic... 

Eye. Adverse effects may be produced by splashes of Hquids or soflds, and by materials dispersed in the atmosphere. The eye is particularly sensitive to peripheral sensory irritants in the atmosphere. Toxic effects that may be induced include transient acute inflammation, persistent damage, and, occasionally, sensitivity reactions. ToxicologicaHy significant amounts of material may be absorbed by the periocular blood vessels in cases of splash contamination of the eye with materials of high acute toxicity (58). 

Primary Irritancy Studies. These studies are employed to determine the potential of materials to cause local inflammatory effects in exposed body surfaces, notably skin and eye, following acute or short-term repeated exposure. In general, the approach involves applying the test material to the surface of the skin or eye, and observing for signs of inflammation, their duration, and resolution. Reviews have been written about the conduct of primary eye irritation (58,86,87) and primary skin irritation studies (88,89). 

Chinese Liver Fluke. The adult worm of the Chinese Hver fluke Clonorchis sinensis) can grow to be 2 cm long. Worms infect the bihary tree where they cause local inflammation, diarrhea, and hepatomegaly in the acute infection. Progressive biUary obstmction and cirrhosis can occur in the more advanced disease state. The presence of 20—200 worms is common, but they may number over 20,000. Infection is the consequence of eating raw fish that contain viable parasites. Untreated worms can Hve for up to 30 years. Treatment is with pra2iquantil (1). 

Commercially available electrotransport systems are bulky and limited to acute appHcations (96). One example, the Drionic system used for the treatment of hyperhidrosis (excessive perspiration), is presoaked in water for 30 min before each 20- to 30-min treatment. Another system, the Phoresor, approved for the deHvery of Hdocaine [137-58-6] for local anesthesia, and of dexamethasone [50-02-2] for treatment of local inflammation such as bursitis or tendinitis, is powered by a 9 V replaceable battery and features a disposable, fiHable dmg electrode. 

Gastroenteritis Gastroenteritis is an acute inflammation of the lining of the stomach and intestines. Symptoms include anorexia, nausea, diarrhea, abdominal pain and weakness. Gastroenteritis has many causes, such as bacteria (food poisoning), viruses, parasites, consumption of irritating food or drink, as well as stress. Treatment for the condition depends on the underlying cause. 

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