NARES: a model of inflammation caused by activated eosinophils?

Twenty patients were selected on the basis of perennial rhinitis, the absence of allergy and with an eosinophil count higher than 20% of total leucocytes in nasal secretions (NARES). Nasal endoscopy with biopsies from the middle turbinate and sinus CT were performed. Biopsies were processed for histological examination and for immunofluorescence. The clinical progress during treatment was scrutinized. An acute congestive aspect of the nasal mucosa was noted in 4 cases, and micropolyposis in 9 cases. Sinus CT showed opacity of the ethmoidal cells in 87% of cases (maxillary sinuses: 75%; frontal sinus: 46%; sphenoidal sinus: 31%). An eosinophilic infiltrate of the nasal mucosa was constituted in 9 cases: In 6 cases, the cells expressed the Fc epsilon RII receptor, recognized by the monoclonal antibody Bb10. Anti-H1 drugs usually failed to result in a clinical improvement and local eosinophilia was not changed. Local corticoids were more effective but not sufficient in some cases, so that oral corticotherapy was needed. Ethmoidectomy was performed in three cases. NARES seems to evolve in three stages: (1) migration of eosinophils from the vessels to the secretions; (2) retention of eosinophils in the mucosa which might be linked to activation of unknown origin; (3) nasal polyposis. Numerous interactions between irritation of the epithelium, release of substance P, and eosinophils, lead to the hypothesis of a neurogenic origin of NARES.

[Diplomyelia and diastematomyelia. Case reports]

Diplomyelia and diastematomyelia. Case report. Three cases of diplomyelia [1] and diastematomyelia [2] were studied and treated between 1980 and 1990 years. All patients had symptomatic onset in adulthood. Pathological features were caused by localization on the lesion in cervical, thoracic and lumbar segment of the spinal cord. Plain X-rays showed a variety of osseous malformations associated with spinal dysraphism. The most usefull radiographic examination was computerized tomography (CT). Indications to surgical treatment are discussed.

Behçet's syndrome in Scotland

We present the clinical details and HLA typing of 15 Celtic Caucasian patients (four male, 11 female) with Behçet's syndrome (International Study Group criteria). The males affected were younger than the affected females, and three of these males had severe uveal involvement. Two of the 15 patients had the A2 Bw6 Dr4 haplotype but this did not confer family penetrance. Eight had gastrointestinal involvement: two females required ileostomy, two females had chronic diarrhoea, one female had severe ileitis and oesophageal lesions, two males had peptic ulcers, and one female had a peptic ulcer and primary biliary cirrhosis. All of those who developed gastrointestinal symptoms had either the Dr4 or the Dr7 antigens. This study is the largest HLA survey of Celtic Caucasians with Behçet's syndrome. The clinical features and HLA haplotypes are markedly different from 'Arab' and 'Japanese' varieties of Behçet's syndrome. The expression of the Dr4 and Dr7 antigens in those with gastrointestinal involvement possibly implicates class II antigens (Dr) in the pathogenesis of the manifestations of Behçet's disease in the bowel.

[The management of subarachnoid hemorrhage in pregnancy]

Subarachnoid haemorrhage (SAH) from an intracranial aneurysm or arteriovenous malformation is a grave complication of pregnancy. Authors critically analyzed 12 cases of verified SAH during pregnancy from an 11 identified and 1 unidentified cerebral vascular malformation. Aneurysms were responsible for SAH in 7, and arteriovenous malformations in 4 patients. Subarachnoid haemorrhage occurred during I trimester in 2, II trimester in 3, III trimester in 6 patients and after cesarean delivery in 1 case. We conclude that the decision to operate after SAH during pregnancy should be based upon neurosurgical principles, whereas the cesarean delivery should be done in every pregnant patient with SAH.

Drug assay in ground tissues: example of ketoprofen diffusion into tonsillar tissue

Ketoprofen was assayed in tissues of surgical patients after mechanical grinding of the tissue in liquid nitrogen; the fine powder obtained allowed the drug to be determined by HPLC in the same way as for liquid samples. The method was applied to the study of ketoprofen diffusion into the tonsillar tissue of 15 patients after a single intramuscular injection of ketoprofen (100 mg). A correction was made for blood contamination after hemoglobin determination.

The liver in acquired immune deficiency syndrome: emphasis on patients with intravenous drug abuse

To assess the spectrum of hepatic abnormalities in acquired immune deficiency syndrome (AIDS), we reviewed clinical, biochemical, and pathological material in 32 patients with AIDS. Eight-four percent of AIDS cases had a history of intravenous drug abuse. Ninety percent of AIDS patients has some liver biochemical abnormality at the first presentation of illness. During the course of AIDS, significant (p less than 0.05, paired Student's t test) rises in alkaline phosphatase and bilirubin occurred, without rises in aminotransferases. Mean abnormalities were mild, reflecting approximately 2-fold increases over baseline. Liver failure was not believed to contribute to the death of any AIDS patient. Pathological findings in AIDS included specific infectious diagnosis in 26%, granulomas in 16%, hemosiderosis in 26%, nonspecific abnormalities in 39%, cirrhosis in 23%, and chronic active hepatitis in 3%. AIDS cases were also compared to 10 selected age, sex, and epidemiologically similar non-AIDS patients. Although granulomas or infections were not seen in our comparison group, only the incidence of chronic active hepatitis was significantly different between the groups. If only those with intravenous drug abuse were studied, then none of 24 AIDS patients versus four of eight non-AIDS cases (p less than 0.005) had chronic active hepatitis. AIDS patients with specific hepatic infections tended to have a higher alkaline phosphatase and aspartate aminotransferase (p less than 0.05) than noninfected cases. However, substantial overlap existed, and no difference in hepatomegaly was noted. Ninety percent of AIDS patients were ingesting at least one potentially hepatotoxic drug. We conclude that AIDS patients have a high incidence of underlying hepatic abnormalities. However, clinical and biochemical abnormalities are similar in our selected liver biopsy patients with intravenous drug abuse with or without AIDS. As expected, AIDS patients have a higher incidence of hepatic granulomas and infections, but these patients were not clearly distinguishable from other AIDS cases. Histological examination showed a wide array of changes by light microscopy, but no specific lesion of AIDS was noted. The low incidence of chronic active hepatitis in this AIDS population may imply that the altered T lymphocyte function in AIDS could influence the course of liver disease in these patients.

Gastrointestinal manifestations of the acquired immunodeficiency syndrome: a review of 22 cases

Patients with acquired immunodeficiency syndrome (AIDS) frequently have diarrhea and weight loss. We prospectively examined the upper and lower gastrointestinal tracts in 22 AIDS patients, although severe medical problems often precluded full evaluation. Ninety-six percent (21 of 22) lost weight, and 55% (12 of 22) had diarrhea. The mean (+/- SD) weight loss was 34 +/- 19 lb. Steatorrhea was found in 4 of 14 patients, and D-xylose tests were abnormal in 8 of 14 patients. Mean serum albumin was 3.3 +/- 0.8 g/dl. A significantly diminished plasma selenium level, which can influence immune function, was noted in these AIDS patients. Gastrointestinal infections were identified in 45% of patients. Although diarrhea and malabsorption were more common in the infected group, weight loss and albumin were similar in those with and without demonstrated infections. Flexible sigmoidoscopy showed that of 15 patients, there were two with Kaposi's sarcoma, 10 normals, and three with nonspecific endoscopic changes of colitis. Infection was documented in all patients with colitis. Panendoscopy of the upper gastrointestinal tract was positive for AIDS-related pathology in five of 10 patients, including two with Kaposi's sarcoma, one with Candida esophagitis, one with herpetic esophagitis, and one with gastroduodenitis (biopsy positive for cryptosporidia); five patients had a normal-appearing tract. Small bowel or colonic biopsies frequently showed nonspecific inflammatory changes, although pathogens were identified in six patients (27% of all biopsies). We conclude that a wide variety of gastrointestinal pathology, which includes infectious agents, neoplasms, and inflammatory changes, may occur in AIDS patients. Therefore, AIDS patients, particularly those with diarrhea or weight loss, deserve an intensive evaluation for remediable lesions of their gastrointestinal tracts.

Hereditary angioneurotic edema: clinical management and case report

Hereditary angioneurotic edema, although a rare clinical entity, can be fatal if diagnosis and appropriate therapy are not instituted before the performance of routine dental and oral surgical procedures. The pathophysiology, physical findings, and therapeutic treatment modalities have been reviewed, and a case involving both restorative and surgical dental intervention has been presented.

Cysticercosis presenting as a mass lesion at foramen of Monro

Cysticercosis is a parasitic infestation that commonly affects the central nervous system. This is a report of computed tomography findings in a patient with a noncalcified cyst causing asymmetric lateral ventricular obstruction at the foramen of Monro. The lesion was isodense and uniformly enhancing, an unusual finding possibly related to presentation early in the course of the disease. This disease should be considered in the differential diagnosis of the lesions at the foramen of Monro in patients with appropriate residence or travel history.

[Combined therapy of ovarian cancer (author's transl]

Following the introduction of massive triple drug therapy with high doses of Endoxan, Proresid and Methotrexat instead of the earlier long-term Endoxan treatment in addition of surgery, percutaneous irradiation and intraperitoneal radio-gold, 3 year survival of advanced stages IIb-IV of ovarian carcinoma rose from 19.6% to 42.6%. The 3 year survival of all malignant ovarian tumors (primary or secondary) rose from 38.3% to 51.0%. Further development led to targeted multiple drug therapy (ultrahigh Endoxan, Proresid/VM26, Methotrexat and Adriblastin) according to oncobiogram. The main side-effects, their control and experience with combined chemotherapy and irradiation are described.