Clinical significance of intraoperative cultures of aneurysm walls and contents in elective abdominal aortic aneurysmectomy

To investigate the clinical significance of intraoperative cultures in elective abdominal aortic aneurysmectomy, we cultured the aneurysmal wall and contents in 90 patients undergoing vascular graft surgery. Prosthetic graft infection was documented in 1 out of 62 patients with negative cultures and in none of 28 patients with positive cultures (chi 2 = 0.4, p greater than 0.1). Bacterial growth was seen in neither of 2 inflammatory aneurysms, 3 of 14 atherosclerotic aneurysms and 2 of 5 aneurysms without specific features. A retrospective analysis of patients' charts aimed at finding possible risk factors failed to identify any correlation between results of cultures and length of hospitalization before surgery, time interval between angiography and surgery, route of angiography procedure or minutes of surgery before sample collection. We conclude that positive cultures may not imply clinical infection at the time of surgery and that prolonged post-operative organism-specific antibiotic therapy does not appear necessary to prevent graft contamination in patients undergoing elective abdominal aortic aneurysmectomy.

Immunoglobulin light chain patterns in the cerebrospinal fluid. A study with special reference to the occurrence of free light chains in cerebrospinal fluid with and without oligoclonal immunoglobulin G

The immunoglobulin light chain patterns were studied in paired cerebrospinal fluid (CSF) and serum samples from 30 controls, 70 multiple sclerosis (MS) patients, 18 subjects with other inflammatory neurological diseases and 17 patients with other non-inflammatory neurological disorders. In MS, all CSF samples examined by two-dimensional gel electrophoresis exhibited clonally restricted light chain components. Isoelectric focusing and immunoblotting detected free light chains in around 90% of CSF samples from patients with MS or other inflammatory diseases. These components were clonally restricted, appeared in both mono- and dimeric forms and occurred in CSF samples with as well as without oligoclonal immunoglobulin G bands. Generally, the positive CSF samples contained kappa as well as lambda free lights chains. Such components were not detected in the sera, nor in the CSF samples from controls or patients with non-inflammatory diseases.

Experimental allergic encephalomyelitis in the monkey: humoral immunity and blood-brain barrier function

Acute monophasic experimental autoimmune encephalomyelitis (AMEAE) was induced in 5 Macacus cynomolgus monkeys. Serum and cerebrospinal fluid (CSF) paired samples were collected before and four weeks after immunization, time of complete development of AMEAE clinical picture. After immunization the CSF/serum albumin ratio and the IgG index were markedly increased. Agarose isoelectric focusing (AIEF) followed by immunofixation revealed faint IgG oligoclonal bands in both serum and CSF of all monkeys, which became more evident after Kappa and Lambda assessment. Intrathecal synthesis of IgG oligoclonal bands was detected in only one CSF. Affinity-driven immunoblotting failed to detect anti-myelin basic protein (MBP) oligoclonal IgG. No free light chain (FLC) patterns or IgA and IgM oligoclonal bands were detected.

[Influence of chronically-administered enalapril on isotonic and isometric exercise in patients with moderate grade hypertension]

We studied 11 patients affected by mild essential hypertension during chronic therapy with enalapril (E). After a pharmacological wash-out the patients were treated with E once a day (10-20 mg) for 4 weeks. Before and after the treatment period the patients were studied by means of the isotonic exercise stress test on the cycloergometer with increments of 25 W every 2 min and by means of the Sustained Handgrip test (SHG) at 70% of maximal capacity for 1 min. During the study period E reduced the blood pressure at rest in all patients without untoward effects. During the isotonic test and particularly during SHG, E reduced systolic and diastolic blood pressure (BP) and the product systolic BP x heart rate. The treatment did not influence the time length of the isotonic exercise stress test. Our results suggest that E does not increase the MVO2 at rest and during different types of exercise: this can be very important because many patients affected by hypertension suffer from ischemic heart disease. E is utilized also in patients with heart failure, some of whom have an hypertensive or ischemic cardiomyopathy.

Brain tumors: detection of B-cell stimulatory factor-2/interleukin-6 in the absence of oligoclonal bands of immunoglobulins

24 patients with neoplasia of the central nervous system (CNS-N) were investigated for the presence of B-cell stimulatory factor-2/interleukin-6 (IL-6) in the cerebrospinal fluid (CSF). Whereas IL-6 was detected in 21 (88%) of these CSF samples, only 6% of CSF from non-inflammatory brain diseases and 12% of the samples from multiple sclerosis patients were positive. IL-6 was found in both primary and secondary CNS-N. The presence of IL-6, a cytokine which activates B-lymphocytes to produce high-rate immunoglobulin (Ig) synthesis, is in contrast to the ineffective intrathecal B-cell activation as suggested by the failure to detect oligoclonal bands of Igs in CNS-N.

The role of indium-111 antimyosin (Fab) imaging as a noninvasive surveillance method of human heart transplant rejection

The identification of rejection after heart transplantation in patients receiving cyclosporine immunosuppressive therapy requires the endomyocardial biopsy, an invasive method associated with a finite morbidity. To evaluate the role of indium-111 antimyosin (Fab) scintigraphy as a noninvasive surveillance method of heart transplant rejection, the Fab fragment of murine monoclonal antimyosin antibodies labeled with indium-111 was administered intravenously in 30 scintigraphic studies to 10 consecutive heart transplant recipients. Endomyocardial biopsy specimens were obtained 72 hours after each scintigraphic study. Nineteen scintigraphic studies had negative findings; no false negative finding was obtained. Eleven antimyosin scintigraphic studies had positive findings, and in these studies endomyocardial biopsy revealed mild rejection in two cases, moderate acute rejection with myocyte necrosis in two cases, myocyte necrosis as a consequence of ischemic injury in six cases, and possibly cytotoxic damage in one case. Antimyosin scintigraphy may represent a reliable screening method for the surveillance of heart transplant patients. In the presence of a negative finding from antimyosin scintigraphy, it may be possible to avoid endomyocardial biopsy. Conversely, in patients who have a positive finding from antimyosin scintigraphy, the endomyocardial biopsy is mandatory to establish the definitive diagnosis by histologic examination of the myocardium.

Tumour necrosis factor-alpha in infectious meningitis

During a one year period tumour necrosis factor-alpha (TNF-alpha) was prospectively determined in the cerebrospinal fluid of 49 patients with infectious meningitis. TNF-alpha was found in the cerebrospinal fluid of 15 of 18 patients with bacterial meningitis. In 11 patients who had cerebrospinal fluid positive for TNF-alpha it was detected in only one serum (in low concentration). There was no significant correlation between the concentration of TNF-alpha in cerebrospinal fluid and the patient's age, duration of illness and fever, body temperature, and serum C reactive protein. However, cerebrospinal fluid protein concentrations of greater than or equal to 2 g/l and leucocyte values of greater than or equal to 2.5 X 10(9)/l were more often associated with high TNF-alpha concentrations (greater than or equal to 500 pg/ml). In contrast with bacterial meningitis, none of the 31 samples of cerebrospinal fluid from patients with viral meningitis was positive for TNF-alpha. Thus this investigation supports the conclusion, drawn from animal studies on TNF-alpha in the cerebrospinal fluid, that the presence of TNF-alpha is indicative of bacterial meningitis. Absence of TNF-alpha cerebrospinal fluid, however, was found here not to exclude a bacterial aetiology of the infection.

Immune activation in multiple sclerosis: study of IL-2, sIL-2R, and gamma-IFN levels in serum and cerebrospinal fluid

Serum and cerebrospinal fluid (CSF) levels of interleukin-2 (IL-2), soluble IL-2 receptor (sIL-2R), and gamma-interferon (gamma-IFN) were measured in multiple sclerosis (MS) patients, human immunodeficiency virus type 1 (HIV-1)-infected patients and normal controls (NC). Increased levels of both IL-2 and sIL-2R were found in MS serum. Moreover, 11 of 50 MS patients showed detectable levels of IL-2 in the CSF. HIV-1-infected patients had increased levels of sIL-2R in serum and, less frequently, in the CSF. gamma-IFN was never detected in serum and CSF of all the patients studied. These findings confirm preliminary reports, further stress a systemic T-cell activation in MS, and support the hypothesis that an immunologic disorder exists in such patients.

Human immunodeficiency virus type 1 (HIV-1) infection of the central nervous system: an evaluation of cytokines in cerebrospinal fluid

Cytokines play an important role not only for initiation of immune reactivity but also for development of tissue injury. Of 38 patients infected with human immunodeficiency virus type 1 (HIV-1) interleukin-1 beta (IL-1 beta) and interleukin-6 (IL-6) were identified in cerebrospinal fluid (CSF) of 22 (58%) and 16 (42%) patients, respectively. Among the IL-1 beta- and IL-6-positive CSF were eight of 15 HIV-1 patients with no clinical signs of central nervous system involvement and four of five patients with acquired immunodeficiency syndrome (AIDS) dementia complex. The presence of IL-6 was often associated with IL-1 beta and soluble interleukin-2 receptor in CSF as well as with intrathecal IgG synthesis. In none of the CSF samples tumor necrosis factor-alpha or interleukin-2 was detected.

[Acute viral myocarditis: new aspects of an old disease]

The causes of acute myocarditis include infections (viral, bacterial, protozoal), toxins, drugs, hypersensitivity, chemical and physical agents. One of the most interesting and not completely understood of these conditions is the viral myocarditis. This diagnosis is often invoked to explain non-specific chest pain in the absence of coronary artery disease, spontaneous onset of arhythmias associated or not to congestive heart failure of unidentified origin. In most instances, there is little evidence that myocarditis is the underlying pathology. The challenge for physicians is not only to recognize and treat myocarditis, but also to identify which patient might be at risk for progression to dilated cardiomyopathy. Although in most cases myocarditis is limited and does not progress to chronic left ventricular dysfunction, nevertheless a casual relationship exists between viral myocarditis and dilated cardiomyopathy. This association was initially supported by observation during epidemics of Coxsackie B infection since as many as 12% of infected patients manifested clinical sign of cardiac involvement and few of these developed subsequently a dilated cardiomyopathy. Experimentally, in animals affected by acute viral myocarditis, the T lymphocytes appear to mediate continued myocyte necrosis in the apparent absence of virus. In addition, cellular infiltration and myocardial necrosis are minimal in the athymic mouse where T lymphocytes are depleted: thus T lymphocytes may play some role in the subsequent development of chronic congestive cardiomyopathy. However, until the application of endomyocardial biopsy, arguments for and against this relationship were based primary on circumstantial evidence from clinical, serologic, epidemiologic findings. recent studies using endomyocardial biopsy have demonstrated that myocarditis is associated to dilated cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Determinants of end-stage idiopathic dilated cardiomyopathy: a multivariate analysis of 104 patients

Our purpose in this study was to investigate the correlation of clinical, electrocardiographic, hemodynamic, and histopathologic features at diagnosis with the long-term prognosis in 104 patients with idiopathic dilated cardiomyopathy to determine which factors are the independent determinants of the end-stage disease. During a mean follow-up of 3.8 +/- 3.5 years, 35 patients (33%) died, 14 (13%) suddenly and 21 (20%) from congestive heart failure. Univariate analysis of survival curves disclosed that clinical and electrocardiographic variables at diagnosis were similar in survivors and non-survivors. On the contrary, patients who subsequently died had higher mean right atrial pressure (p = 0.0001), right ventricular end-diastolic pressure (p = 0.0061), mean pulmonary artery pressure (p = 0.0001), and left ventricular systolic (p = 0.0049) and end-diastolic (p = 0.0021) pressure than survivors. They also exhibited larger left ventricular end-diastolic (p = 0.0046) and end-systolic (p = 0.0027) volumes, lower ejection fraction (p = 0.0001), and a greater proportion had severe mitral regurgitation (p = 0.0095). Univariate analysis of histologic findings collected in a subgroup of patients referred since 1984 revealed a mild degree of myocellular hypertrophy to be associated with a poor prognosis (p = 0.0217). Multivariate analysis selected only mean right atrial pressure (p = 0.0022), ejection fraction (p = 0.0089), and end-systolic volume (p = 0.0265) as independent determinants of cardiac death. Our results suggest that cardiac catheterization is mandatory for risk stratification of patients with idiopathic dilated cardiomyopathy, since it allows the assessment of hemodynamic, angiographic, and histopathologic features helpful in identifying patients with a poor prognosis.

Tumor necrosis factor alpha (TNF alpha) and neurological diseases. Failure in detecting TNF alpha in the cerebrospinal fluid from patients with multiple sclerosis, AIDS dementia complex, and brain tumours

The presence of tumor necrosis factor alpha (TNF alpha)/cachectin was investigated in 180 paired cerebrospinal fluid (CSF) and serum samples from patients with neurological diseases, and in five paired CSF and serum samples of Macaca cynomolgus monkeys with acute monophasic experimental autoimmune encephalomyelitis (AMEAE). TNF alpha was never detected in human CSF, even when an extensive demyelination was documented (active multiple sclerosis, acquired immunodeficiency syndrome (AIDS) dementia complex). Only one Macaca with AMEAE had detectable levels of TNF alpha in CSF but not in serum, suggesting an intrathecal synthesis of this cytokine in AMEAE.

[A case of unilateral multiple agenesis]

A case of monolateral multiple congenitally missing permanent teeth orthrodonticallq treated in the first Dept. of Orthodontics, Dental Hospital, Univ. of Turin is presented.

Identification of Neisseria gonorrhoeae with the ORTHOProbe DNA probe test

We evaluated and compared the ORTHOProbe DNA hybridization test (Ortho Diagnostic Systems, Inc., Raritan, NJ) with conventional carbohydrate fermentation and commercial rapid tests for identifying gonococci (GC). The ORTHOProbe system employs a biotinylated DNA probe that hybridizes specifically with chromosomal target sequences of GC. Hybridization is detectable visually following the addition of a streptavidin-peroxidase conjugate in a rapid 10-min. assay. A total of 200 clinical isolates resembling Neisseria (gram-negative, oxidase-positive diplococci) cultured from various sites were tested. The ORTHOProbe test reacted strongly with all GC (94) and not with nongonococcal organisms (106), yielding a sensitivity and specificity of 100%. The ORTHOProbe system provides a convenient and reliable test for identifying Neisseria gonorrhoeae.

[Predictive value of myocellular hypertrophy in idiopathic dilated cardiomyopathy]

The role of endomyocardial biopsy (EMB) in assessing of idiopathic dilated cardiomyopathy (IDCM) is a well-recognised one. On the contrary, the value of correlating histological features, such as myocellular hypertrophy, with functional evaluation and outcome is still controversial. It was the purpose of the present study to appraise the correlation with hemodynamic data and the predictive role of histological features in 32 consecutive patients affected by IDCM who underwent left ventricular EMB between January 1984 and December 1986. Light microscopy findings were graded by means of a semiquantitative score system. In comparison with the 19 patients with mild myocellular hypertrophy, the 13 patients with marked hypertrophy showed significantly lower right ventricular end-diastolic pressure (10.4 +/- 5.8 vs 6.6 +/- 3.6 mmHg, p less than 0.05) and left ventricular end-diastolic pressure (26.9 +/- 9.0 vs 16.5 +/- 8.8 mmHg, p less than 0.01). On the contrary, different degrees of interstitial fibrosis, as well as of the other morphologic findings, could not identify patients with distinct hemodynamic patterns. However, there was a direct correlation between the amount of myocellular hypertrophy and interstitial fibrosis (p less than 0.01). During a mean follow-up period of 32 +/- 11 months (range: 12-48 months), 6 patients died and 3 further patients underwent heart transplantation. Univariate analysis of histological features (log-rank test) showed a mild degree of hypertrophy alone to be significantly related to a poor outcome (p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Interleukin-2 levels in serum and cerebrospinal fluid of multiple sclerosis patients

A sensitive enzyme-linked immunosorbent assay method was employed to measure interleukin-2 (IL-2) levels in cerebrospinal fluid (CSF) and sera from 30 patients with multiple sclerosis (MS) and 8 patients with other neurological diseases. Detectable levels of IL-2 were found in 6 sera and 9 CSF samples of 21 patients with acute relapse of MS. However, only 3 patients showed measurable IL-2 both in CSF and in serum. IL-2 was not detected in specimens from 9 patients with chronic-progressive MS, whereas high levels were found in 2 CSF samples from patients with aseptic meningitis. Our data suggest that systemic activation of a T-cell population is present in some MS patients; moreover, an active immune mechanism involving IL-2 production takes place within the central nervous system.

Cardiovascular reactions to physiological stimuli in the elderly and the relationship with the autonomic nervous system

In order to evaluate age-related differences in autonomic nervous system control of the cardiovascular system, we studied two groups of healthy subjects of different ages by means of an autonomic function test, the posture test, applied before and after meals. Our results suggest that the reactions of the cardiovascular system to physiological stimuli such as meals or standing up, differ in elderly compared with young people, partly because age modifies the balance between the parasympathetic and the orthosympathetic nervous systems. In the elderly there is a progressive decline in parasympathetic function, which controls the initial heart rate response to standing up. Splanchnic blood pooling and possible hormonal secretions after meals may produce a drop in blood pressure due to cardiovascular modifications in the elderly. Other factors contributing to the different patterns found in the elderly may be reduced compliance of the vascular tree, a decreased baroreceptor response and decreased sympathetic activity.

[Physiopathology of alveolar bone]

Bone tissue is a dynamic system in which the net balance between resorption and apposition defines the final osseous form. This process occurs in minute asynchronous foci and results from a cascade of activations, cooperations and inhibitions of specialized cells (osteoblasts and osteoclasts). The alveolar bone resorption due to periodontal disease is a complex and dynamic chain reaction in which both osteoclasts and osteoblasts have a role in the hormonal interactions occurring during the course of the resorption activity. Both microbial and host factors as prostaglandins, endotoxins and lipoteic acid seems to be able in activating bone resorption. However bone resorption can be interchanged with repair formative episodes, more or less intense, which can delay the destructive process.

Production of B cell stimulatory factor-2 and interferon gamma in the central nervous system during viral meningitis and encephalitis. Evaluation in a murine model infection and in patients

Synthesis of B cell-stimulating factor-2 (BSF-2) and IFN-gamma was shown in cerebrospinal fluids (CSF) collected from mice with experimental viral meningitis. In the CSF, the level of BSF-2 started to increase 24 h after intracerebral infection with lymphocytic choriomeningitis virus (LCMV) with rapid increase after day 4. IFN-gamma was not detected in the CSF before day 5 or 6 after infection, but increased sharply thereafter. In athymic nude mice, LCMV infection did not result in meningitis, and both BSF-2 and IFN-gamma levels were only slightly and transiently elevated. These findings suggest that activated mature T cells are required for development of disease and production of both BSF-2 and IFN-gamma. As observed in mice, BSF-2 was also detected in 16 out of 19 CSF samples collected from patients with acute viral infections of the central nervous system (CNS). Intrathecal production of BSF-2 and IFN-gamma may be instrumental in local production of antiviral antibodies by B lymphocytes/plasma cells invading the CNS during viral CNS disease.

Central nervous system involvement in HIV infection

Central nervous system (CNS) involvement occurs frequently in patients with the acquired immunodeficiency syndrome (AIDS), but at present only a few reports have addressed the analysis of intrathecal IgG synthesis in human immunodeficiency virus (HIV)-seropositive patients with no signs of HIV-related neurologic syndromes. In this study, intrathecal IgG synthesis was investigated using several techniques in patients with different stages of HIV infection and then correlated with the state of the blood-brain barrier. Almost all patients had specific anti-HIV IgG synthesis within the CNS, suggesting the presence of HIV in the brain. These findings further stress that direct CNS infection occurs early in the course of systemic virus spread.

Cerebrospinal fluid lymphocytes from HIV-infected patients synthesize HIV-specific antibody in vitro

Cerebrospinal fluid lymphocytes from six human immunodeficiency virus (HIV)-infected and three seronegative patients were studied for in vitro synthesis of HIV-specific antibody by means of Western blot analysis of lymphocyte culture supernatants. All the HIV-positive subjects showed in vitro production of HIV-specific IgG, regardless of neurological involvement, while no specific antibody synthesis was detected in seronegative individuals. These data provide the first direct evidence that HIV-specific antibody in cerebrospinal fluid is due to intrathecal synthesis.