Adverse drugs reactions associated with glaucoma medications

We undertook a non-concurrent prospective study of 191 Puerto Rican patients from August 1993 to April 1994. All patients had open angle glaucoma (OAG) (age ranged from 50 to 80 yrs; mean = 65 yrs). Patient's symptomatology associated to side effects of their glaucoma medicadons was reviewed. Incidence percent of ocular and/or systemic side effects per medication were: levobunolol 45.0%; betaxolol 42.0%; timolol 27.3%; pilocarpine 100%; dipivefrin 14.0%; and acetazolamide 250 mg 64.1%. Incidence percent of ocular and/or systemic side effects of topical beta-blockers used with concomittant medications were determined. Ocular side effects were more frequent in patients using levobunolol 44.2% than in those patients using betaxolol 42.0%, 8.5% of patients using levobunolol did report systemic side effects. No systemic side effects were reported by patients using betaxolol. Ocular side effects in patients using pilocarpine were frequent (100%); whereas the frequency of systemic side effects was low (6.1%). Systemic side effects were common in patients using carbonic anhydrase inhibitors. These results suggest that non-selective and cardio-selective topical Beta-blockers, differ in their ocular or systemic side effects.

Elevated Th1 cytokine mRNA in skin biopsies and peripheral circulation in patients with erythema nodosum

It is generally believed that erythema nodosum is the result of an immunologic attack centered within the subcutaneous fat. This belief, however, is based on indirect evidence. The aim of this study was to analyze whether erythema nodosum could represent an example of a polarized Th1 or Th2 immune response. We have studied herein, by semiquantitative coupled reverse transcription-polymerase chain reaction the Th1 (IL-2, IFN-gamma) and Th2 (IL-4, IL-10) cytokine gene expression in skin biopsies and peripheral blood from eleven patients with erythema nodosum. As controls, we studied skin and peripheral blood from nine healthy subjects. We found expression of Th1 cytokines in most erythema nodosum skin lesions as well as in their peripheral blood. Both Th1 and Th2 cytokine gene expressions were scarcely or not detected in the skin and peripheral blood of control subjects. These results directly demonstrate that a polarized Th1 immune response occurs in the skin lesions of erythema nodosum patients regardless of the wide variety of provoking agents.

Primary non-Hodgkin's lymphoma of the intestine: high prevalence of Epstein-Barr virus in Mexican lymphomas as compared with European cases

Recent studies in Western European populations have shown that peripheral T-cell non-Hodgkin's lymphomas (T-NHLs) are associated with Epstein-Barr virus (EBV) in a higher percentage than sporadic B-cell NHL (B-NHLs), and that the frequency of EBV-positivity might be influenced by the primary site of the tumor. Because of the geographic differences in EBV expression in Burkitt's lymphoma (BL) and Hodgkin's disease (HD), and the lack of studies of sporadic NHL from developing countries, we decided to survey the presence of EBV in a series of primary intestinal lymphomas from patients in Mexico and in Western Europe, and to analyze whether EBV status is influenced by tumor phenotype, and geographic or ethnic determinants. Paraffin-embedded tissue from 43 primary intestinal NHLs (19 cases from Mexico and 24 from Western Europe) were examined, including 17 high grade B-NHLs, 9 low grade B-NHLs, and 17 T-NHLs; 6 of which were enteropathy associated T-cell lymphomas. The distribution of histologic subtypes was similar in both groups. The presence of EBV was investigated with a combined approach using a nested polymerase chain reaction technique as well as immunohistochemistry for latent membrane protein-1 and in situ hybridization for EBV early RNA transcripts (EBER 1/2) RNAs. The median age of the Mexican patients was significantly lower than the median age of the European patients (32 v 62 years). This difference was most pronounced in patients with T-cell lymphoma (24 v 63 years). EBER-positive tumor cells were detected in 13 of the 43 (30%) cases of primary intestinal lymphoma, including 5 of 26 sporadic B-NHL (3 high grade and 2 low grade), and 8 of 17 T-NHL, all of which were classified as pleomorphic, medium and large cell. The rates of EBV-positivity were markedly different for European and Mexican cases. Whereas 7 of 7 (100%) T-NHL and 5 of 12 (42%) sporadic B-NHL of Mexican origin were EBER-positive, only 1 of 10 T-NHL and 0 of 14 sporadic B-NHL from Europe showed EBER expression in tumor cells. Latent membrane protein was positive in only 2 of 43 cases, 1 of which was an EBER-negative high grade B-NHL from Mexico that showed intact total mRNA in control hybridization. CD30 expression was found in 4 of 8 EBV-positive T-NHL and in none of the EBV-positive B-NHL. In contrast to European cases, intestinal NHLs from Mexico show a very high frequency of EBV-positivity, which is not limited to T-NHL, but includes a significant proportion of B-NHL. This study strongly suggests that similar to HD and probably BL, there are important epidemiologic differences in EBV association in intestinal T-cell NHL between European and Mexican populations. These differences might be the result of environmental factors, for example, earlier contact with childhood viruses on intestinal lymphomagenesis.

Vasculitis in systemic lupus erythematosus

We studied the frequency, location, clinical and histopathological features, associated manifestations, and prognosis of vasculitides in a cohort of 667 SLE patients. Exclusion of patients with previous vasculitis or insufficient information left 540 patients, 194 of whom has vasculitis (incidence density: 0.053 new cases/person/year, cumulative incidence of 0.051 at one year, 0.232 at 5 years and 0.411 at 10 years). Vasculitis was confirmed by biopsy in 46 cases, by arteriography in five, and by both in three. A single episode of vasculitis occurred in 119 and two or more in 75 patients. Vasculitis was cutaneous in 160, visceral in 24, both in 10. In the first episode of cutaneous vasculitides, 111 had punctuate lesions, 32 palpable purpura, 6 urticaria, 6 ulcers, 8 papules, 5 erythematous plaques or macules confirmed with biopsy, 2 erythema with necrosis, and 1 panniculitis (plus small vessel vasculitis). Of 29 with visceral vasculitis in the first episode, 19 had mononeuritis multiplex, 5 digital necrosis, 3 large artery vasculitis of limbs, one mesenteric, and one coronary, more than one type could appear simultaneously or in subsequent episodes. Patients with vasculitis had longer disease duration and followup, younger age of onset of SLE, and were more frequently males than those without. Lupus manifestations associated with vasculitis in univariate logistic regression included myocarditis, psychosis, Raynaud's phenomenon, serositis, leukopenia, lymphopenia and pleuritis. Vasculitis also associated with the antiphospholipid syndrome. The strength of this association increased when patients with vasculitis confirmed by biopsy and/or arteriography were considered separately. Visceral vasculitis associated with increased mortality when controlled for age of onset and nephropathy.

T lymphocytes infiltrating the bladder wall of patients with carcinoma of urinary bladder are in vivo activated

OBJECTIVES

This paper studies the phenotypical characteristics of the lymphocytes present in mononuclear cell (MNC) preparations from peripheral blood (PBMNC), lymph nodes (LNMNC), tumor bladder (TBMNC), and tumor-free bladder (TFBMNC) from patients with infiltrated transitional cell carcinoma (TCC) of the bladder and PBMNC of healthy controls.

METHODS

Eight patients diagnosed with TCC of the bladder, according to UICC criteria, and 10 healthy controls were studied. For immunofluorescence staining, T lymphocytes were incubated with combinations of fluorescein (FITC, green)- and phycoerytrin (PE, red)-labelled monoclonal antibodies.

RESULTS

The percentage of NK cells in the LNMNC and TFBMNC was significantly decreased in comparison to that found in the PBMNC from these patients (p < 0.05). A significant enhancement of the expression of class II molecules of the major histocompatibility complex (MHC) by CD3+ T lymphocytes from TBMNC and TFBMNC specimens from bladder walls was found with respect to those quantified in CD3+ T lymphocytes from PBMNC (p < 0.05). In addition, the percentage of CD3+CD25+ T lymphocytes was significantly higher in PBMNC in TCC patients than in healthy controls (p < 0.05).

CONCLUSIONS

Our data clearly demonstrate that the presence of infiltrative TCC of the bladder is associated to an infiltration of in vivo activated T lymphocytes of the urinary bladder wall. This in vivo T lymphocyte activation has been considered an expression of the immune response against the tumor cells.

Prophylactic intracavitary treatment with interferon alpha increases interferon gamma production by peripheral blood mononuclear cells in patients with superficial transitional cell carcinoma of the bladder

The immunomodulatory effect of prophylactic intravesical instillations of interferon alpha 2b (IFN-alpha-2b) on interferon gamma (IFN-gamma) and interleukin 4 (IL-4) production by peripheral blood mononuclear cells (PBMCs) from patients with superficial transitional cell carcinoma (STCC) of the bladder has been analysed. There were no significant differences in the production of IFN-gamma and IL-4 by PBMCs from untreated patients and healthy control subjects after 24 h of phytohaemagglutinin (PHA) stimulation. However, between 3 and 6 months after finishing the prophylactic intracavitary treatment with IFN-alpha-2b, PHA-stimulated PBMCs from patients with STCC of the bladder showed a significantly enhanced production of IFN-gamma and a significantly decreased production of IL-4. Both IFN-gamma and IL-4 returned to pretreatment levels 1 year after ending the treatment. In conclusion, prophylactic intravesical instillations of IFN-alpha-2b in patients with STCC of the bladder have an immunoregulatory effect on the production of IFN-gamma and IL-4 by PBMCs.

Effects of buthionine sulfoximine on the outcome of the in utero administration of alcohol on fetal development

The adverse effects of the maternal consumption of alcohol on the fetus have been recognized for centuries. Fetal alcohol syndrome is characterized by pre- and postnatal growth retardation, mental retardation, behavioral deficits, and facial deformities. Despite numerous animal studies, the biochemical mechanism(s) by which alcohol produces teratogenic effects on the developing fetus are not well understood. Several studies have shown that administration of alcohol to adult rats produces a decrease in hepatic levels of glutathione (GSH). In utero administration of alcohol has also been shown to produce a decrease in GSH levels, as well as prenatal growth retardation and intrauterine death. In an effort to determine if GSH may have a vital role in protecting the fetus against the teratogenic effects of alcohol, buthionine (SR)-sulfoximine (BSO) was used to deplete GSH levels in the mother and fetus. Timed pregnant Sprague-Dawley rats were placed on a liquid BioServ diet containing either 0%, 11%, 23%, 29%, 31%, 33%, or 35% ethanol-derived calories, with or without BSO (888 mg/kg/24 hr), starting on day 1 of pregnancy. Another set of mothers were fed lab chow and water as a control group for the liquid diet. The mothers were maintained on the diet until gestation day 21 when they were anesthetized with sodium pentobarbital and the pups delivered by cesarean section. The offspring were counted, weighed, killed, and the brain and liver weighed. The effects of BSO on the alcohol dose-response curves (body weights, brain weights, and litter number) were then determined to ascertain if a depletion in GSH potentiated the effects of alcohol. In utero administration of BSO, aside from the depletion of GSH in the liver and brain in the developing fetus, produced a shift to the left in the alcohol dose-response curve.

Local and systemic specific antibody response of different chicken lines after ocular vaccination against infectious bronchitis

The specific lacrimal fluid IgA levels and the specific serum IgG levels of broiler chicks (meat type hybrids (MT)), brown-egg layer chicks (heavy layer (HL)), and white leghorn chicks (light layer (LL)) were compared after infectious bronchitis virus (IBV) ocular vaccination at 1 day of age. All birds were maintained as a mixed population throughout the experiment of 45 days. The class specific antibody levels were determined at regular intervals by enzyme-linked immunosorbent assays. All birds responded to the vaccination stimulus as shown by a significant increase of antibody levels in both serum and lacrimal fluid. When comparing the IgG response of the chicken lines tested, LL chicks showed higher serum IBV-IgG values at the time of maximal response at days 5 and 9 post-vaccination (pv). This bird group also showed a more homogeneous (lowest coefficient of variation of values) serum IgG response. On day 13 pv and until the last serum sampling day (day 41 pv) all three chicken types showed statistically identical serum IBV-IgG levels. The local IgA response detected in lacrimal fluids showed differences between the chicks at the time of maximal levels (days 5 to 14 pv), the response of LL chicks being the highest. LL chicks maintained higher specific IgA levels than MT and HL chicks almost throughout the experimental period. According to the coefficient of variation of the absorbance values (36%), the IgA response shown by LL chicks was the most homogeneous.

Phenotypical expression in XX males correlates with testicular response to exogenous choriogonadotropin in early infancy: does a variable degree of testicular failure determine the degree of genital ambiguity?

The 46,XX male syndrome is characterized by the presence of testicular development in subjects who lack a Y chromosome. The majority of patients have male external genitalia without ambiguity; however, 10-15% show diverse degrees of hypospadias. Testicular function is normal at birth but deteriorates thereafter. However, it has not been clarified why some cases exhibit genital ambiguity. This study examined 10 affected patients, including 4 prepubertal (< 1 year old) with hypospadias (1 glandular, 1 penile, and 2 penoscrotal). In all subjects, testicular function was evaluated by performing a stimulation with choriogonadotropin. In the postpubertal individuals, basal and poststimuli testosterone were below the reference values. Prepubertal patients had age-appropriate basal test-osterone concentrations. All responded to the choriogonadotropin challenge; however, the most significant response was observed in the patient with the glandular hypospadias, the second highest response was presented by the patient with the penile hypospadias, while both patients with the penoscrotal hypospadias had the poorest responses. These results suggest that the degree of genital ambiguity is correlated with the impairment in testosterone response to choriogonadotropin in early infancy, indicating a defect in testosterone production in XX males with genital ambiguity.

Increased production of interleukin-6 by T lymphocytes from patients with multiple myeloma

Alterations in T lymphocyte functions may affect other cellular components of the immune system. Several lymphokines produced by T cells are involved in the proliferation and differentiation of human B lymphocytes. Alterations in the secretion of these molecules may be implicated in the development of B cell lymphoproliferative diseases. We have investigated the production of interleukin-2 (IL-2) and interleukin-6 (IL-6) by T lymphocytes from 14 patients with multiple myeloma (MM) and 16 healthy controls. The phenotypical and functional characteristics of these T lymphocytes were also studied. The proliferative response to vegetal lectin phytohemagglutinin (PHA) stimulation was decreased in T lymphocytes from MM patients (p < 0.01). This defective proliferative response cannot be ascribed to either defective IL-2 production or diminished receptor expression, since neither of these parameters showed a significant difference between MM patients and healthy controls (p < 0.05). However, the defective proliferative response of T lymphocytes from MM patients was reverted by the addition of saturating amounts of exogenous IL-2 (p > 0.05) but not by exogenous IL-6 (p < 0.05). The IL-6 production by PHA-stimulated T lymphocytes from the MM patients was significantly higher than in healthy controls (p < 0.01). We conclude that T lymphocytes from MM patients show a functional alteration with a defective proliferative response to PHA that is reverted by exogenous addition of IL-2. After lectin stimulation, the production of IL-2 by T lymphocytes from those patients was normal, while IL-6 secretion was increased.

Avian infectious bronchitis: viral persistence in the harderian gland and histological changes after eyedrop vaccination

The histological changes in the harderian gland (HG) induced by the attenuated H-120 infectious bronchitis virus (IBV) vaccine strain and the persistence of this virus in the stroma of the gland was evaluated in chickens after eyedrop vaccination. Virus replication induced an increase in IBV-specific enzyme-linked immunosorbent assay antibody levels from marginal levels at vaccination (26 days of age) to significantly higher levels 10 days after exposure. IBV antigen was detected in the HG by both immunofluorescence using a monoclonal antibody and virus reisolation in embryonated chickens eggs until day 14 postvaccination. Lymphocytic, heterophilic, erythrocytic, and plasma cell infiltration as well as epithelial cell integrity in collecting tubules and acini were evaluated in the HG throughout the experimental period. IBV vaccination with the attenuated vaccine strain H-120 resulted in partial damage to the HG, as demonstrated by both the presence of plasma cells showing Russell bodies and by tubule epithelial cell exfoliation that occurs simultaneously with the presence of detectable IBV. The increase in plasma cell number and the enlargement of lymphoid foci appear to be expressions of the immunocompetence of this paraocular gland.

[Hypersensitivity syndrome caused by allopurinol. A case of massive hepatic necrosis]

Adverse drug reactions have a wide variety of clinical manifestations mainly related to the affected organ. The skin is one of the most common organs involved due to the visibility of the lesions to the observer. These untoward drug cutaneous responses may mimic any known dermatosis, and may be a clue to a serious systemic disease. We present the case of a 72 year-old woman with erythema multiforme, liver and renal failure due to a unknown dosage of allopurinol self-medication for two weeks. The clinical course was characterized by a Stevens-Johnson syndrome and severe drug-induced liver disease with massive hepatic necrosis corroborated by a transjugular liver biopsy; finally she died of gastrointestinal bleeding. Consent for a postmortem study was not obtained. The clinical course as well as the cutaneous, renal and hepatic drug-related complications corresponds to an allopurinol hypersensitivity syndrome. The relevance of this case was the extension of the liver damage apparently due to the allopurinol, which is an infrequent hepatotoxic complication. In some cases, like the present case, it can be a serious and fatal complication.

Evaluation of a pressure sore model using monoplegic pigs

This study evaluated a newly developed swine monoplegic pressure sore model by testing the uniformity of the initial wound size. The natural healing also was evaluated. Nine minipigs were used. The hindlimb was denervated by transecting the unilateral nerve roots L1 through S2. At 5 to 14 days, 800 mmHg of pressure was applied to the denervated skin over the trochanteric area with a 3-cm-diameter disk compressing the skin and subcutaneous tissue against the underlying bone for 48 hours. The wound was then debrided of devascularized tissue. Wound surface areas were calculated from photographs. Wound volumes were obtained by measuring the volume of saline needed to fill the wound defect. Full-thickness sores of uniform size developed in all pigs without mortality or complications. Wound surface area and volume increased initially, peaked, and then decreased in an exponential fashion. This model provides a new tool for direct comparison of pressure sore treatment modalities for short- and long-term studies.

Abnormal gamma IFN and alpha TNF secretion in purified CD2+ cells from autoimmune thrombocytopenic purpura (ATP) patients: their implication in the clinical course of the disease

Gamma inferferon (gamma IFN), alpha tumor necrosis factor (alpha TNF), and interleukin 6 (IL-60) are cytokines produced by a wide variety of cells, including T lymphocytes and NK cells. These cytokines affect B-cell proliferation and differentiation into immunoglobulin secreting cells. In addition, gamma IFN and alpha TNF also enhance the function of macrophages, upregulating the expression of their IgG receptors. Abnormalities in the production of these cytokines may be involved in the clinical course of autoimmune thrombocytopenic purpura (ATP). This paper describes the production of these cytokines in PHA-stimulated peripheral blood CD2+ cells from ATP patients. Both gamma IFN and alpha TNF were significantly increased in PHA-stimulated CD2+ cells from therapy-dependent ATP patients (platelet counts < 50,000/microliter), as compared to ATP patients with stable disease (sustained platelet counts < 50,000/microliter without need treatment) (P < 0.05). No significant differences were found in gamma IFN production by PHA-stimulated CD2+ cells between therapy-dependent ATP patients and healthy controls (P < 0.05). However, the production of alpha TNF by PHA-stimulated CD2+ cells from therapy-dependent ATP patients was significantly higher compared to that found in healthy controls (P < 0.05). There were no significant differences in IL-6 production by PHA-stimulated CD2+ cells from ATP patients and healthy controls (P < 0.05). These findings demonstrate abnormal gamma IFN and alpha TNF secretion in purified CD2 cells from ATP patients. The clinical severity of the disease is associated with the altered secretion of these lymphokines by CD2 cells.

[Anorexigenic drugs in the treatment of obesity]

Obesity is highly prevalent and has several adverse effects on health. Its treatment is thus warranted and must aim to modify dietary and physical activity habits. The opinion of this association is that anorexigenic drugs with cathecolaminergic action (diethylpropion, phentermine, mazindol and phenylpropanolamine) or serotoninergic action (fenfluoramine and fluoxetine) may be used in moderate or severe obesity (BMI > 30 kg/m2) after a complete clinical assessment and in the context of an integral medical treatment. This association recommends a close surveillance of the use of these drugs, specially when formulated as non-proprietary prescriptions.

The effect of in utero administration of buthionine sulfoximine on rat development

Glutathione (GSH) is a tripeptide that is thought to be an essential cell component playing an important role as a cellular antioxidant and scavenger of free radicals. GSH depletion has been shown to render cells more sensitive to various insults. GSH has a protective effect. GSH levels can be decreased by inhibition of its synthesis with buthionine sulfoximine (BSO), which inhibits gamma-glutamylcysteine synthetase. Several studies have shown that treatment with BSO enhances the toxicity of some drugs and radiation. A previous study indicated that the effects of BSO on the developing embryo were short lived and did not persist to birth. In the above-mentioned study, mothers were treated with BSO only on days 10 and 11 of gestation. The objective of the present study was to determine the effects of BSO administration on GSH depletion throughout pregnancy on the developing rat. Timed pregnant Sprague-Dawley rats were placed on a liquid BioServ diet containing BSO starting on day 1 of pregnancy. The mothers received a daily dose of BSO ranging from 2 to 6 mmol/kg/24 h. The mothers were maintained on the diet until gestation day 21 when they were anesthetized with sodium pentobarbital and the pups delivered by Cesarean section. GSH levels were measured in brain and liver, and various parameters relating to development were assessed. A dose-response curve showed that a maximum depletion (86%) of GSH in the mother's liver was produced by the 6 mmol/kg dose of BSO. However, no change was seen in brain GSH levels of the mothers.(ABSTRACT TRUNCATED AT 250 WORDS)

Persistent lymphocytosis of natural killer cells in autoimmune thrombocytopenic purpura (ATP) patients after splenectomy

We report three patients with primary autoimmune thrombocytopenic purpura (ATP) who developed an absolute lymphocytosis (lymphocyte count > 5 x 10(9)/l) after splenectomy and with a lymphocyte count between 5.4 and 8.9 x 10(9)/l. An immunophenotype study showed that the peripheral blood lymphocytosis was a persistent NK cell expansion (CD2+, CD56+, CD3-), and was characterized by a typical large granular lymphocytes (LGL) morphology. Two of these three ATP patients were refractory to splenectomy.

Alcohol consumption: biochemical and personality correlates in a college student population

The frequency of alcohol use among a subject population of 28 male and 60 female college students was assessed using the Student Alcohol and Drug Use Survey (STADUS). Data were also collected on personality traits as measured by the Sensation Seeking Scale V (SSSV) and the Eysenck Personality Questionnaire (EPQ). Finally, three biochemical variables were assessed: monoamine oxidase (MAO) activity, dopamine beta hydroxylase (DBH) activity, and testosterone levels. Among males, high SSSV scores, high testosterone levels, and low MAO activity contributed to the variance in alcohol use, whereas among females, a significant proportion of the variability in alcohol use was accounted for by high SSSV scores, high DBH activity, and younger age.

Hippocampal involvement associated with human immunodeficiency virus encephalitis in Mexico

The objective of the present study was to review the alterations of the central nervous system (CNS) in a group of deceased Mexican patients with acquired immunodeficiency syndrome; autopsies were reviewed with a special emphasis on the damage to the hippocampal formation. Of these 19 deceased patients with acquired immunodeficiency syndrome, nine (47%) had opportunistic infections in the CNS that were accompanied by human immunodeficiency virus encephalitis (HIVE), three (16%) had evidence of opportunistic infections in the brain without HIVE, and two (11%) had HIVE alone. All of the patients who had presented with neurological and neurobehavioral alterations had evidence of HIVE and/or opportunistic infections in the CNS. Of these 19 patients, 11 (58%) had presented with evidence of HIVE (with or without opportunistic CNS infections), as evidenced by the presence of gp41-positive microglial cells in the basal ganglia, neocortex, and hippocampus. The subiculum was the region that displayed the most abundant infiltration by gp41-positive microglial cells. The percentage of cases of acquired immunodeficiency syndrome with HIVE and/or CNS opportunistic infections in our series was similar when compared with that of other series in which similar methods of detection of human immunodeficiency virus in the CNS were used. We conclude that evidence of human immunodeficiency virus-associated lesions in the hippocampal formation might in part explain the selective neuronal alterations in this limbic structure, and we suggest that damage to this circuitry might be in part involved in the cognitive alterations in HIVE.

Clinical, histopathological, immunological and fibroblast studies in 30 patients with subcutaneous injections of modelants including silicone and mineral oils

OBJECTIVE

To study patients with side effects secondary to the injection of modelants.

METHODS

We studied their clinical, serological, histopathological, radiographic, immunoregulatory and fibroblast culture features by standard methods. We studied thirty patients, 24 women, mean age: 38.2 years. Patients had received either mineral oil, guayacol, silicone or a mixture of these substances; some had received unknown material(s).

RESULTS

The mean time between the injection and the onset of symptoms was six years (range: 0.1-24 years). All patients had sclerodermatous skin changes, subcutaneous nodules, edema and/or hyperpigmentation at the site(s) of injection(s); five individuals also had skin changes at sites remote from the injection. Thirteen patients had clinical features of an autoimmune disease. Eleven patients gave a history of arthralgias including four that had symmetrical non-erosive polyarthritis. Twenty of 28 patients (71%) had positive anti-nuclear antibodies. We found intracellular spontaneous production of IL-1 (interleukin-1) by patients' macrophages which was almost absent in normal cells (p < 0.001). Silica-stimulated monocytes from patients also secreted more IL-1 than those from normal subjects (p < 0.001) in autologous mixed lymphocyte reaction. Twelve patients had an early proliferative response. At day seven, a decreased proliferative response was seen in 12/19 patients (p < 0.001). Skin fibroblasts from 3/3 patients synthesized 3-to-5-fold more 3H-hyaluronic acid than normal control cells (p < 0.001).

CONCLUSIONS

This report confirms the association between the injection of modelants and the development of autoimmune disease (human adjuvant disease, HAD). Our results implicate IL-1 in the amplification of the disease process. The similarities between primary scleroderma and human adjuvant disease now include immunological and connective tissue data. The study of these patients may help to understand the etiopathogenesis of some autoimmune diseases.