[The treatment of allergic vasomotor rhinitis: diagnostic problems and local immunotherapy]

Treatment of allergic vasomotor rhinitis is to be regarded with the factors that modify the symptomatology. In fact must be considered the morphological changes (septum deviation, adenoids, turbinates hypertrophy, polyps) infections (bacteria, chlamydiae, micetes) and specific allergens. Identification of allergens and sensitization threshold is to be studied; then specific hyposensitization will be assessed. In the present study, 68 subjects having nasal reactivity have been observed and underwent to different ways of treatment: 18 with permanent stenosis identified by rhinomanometry and not modified with vasoconstrictors were operated; 25 of the 50 patients with normal nasal cavities showed contemporary infections: after a specific antimicrobic or antimycotic treatment, a clear improvement was obtained documented by rhinomanometry before and after nasal stimulations. The 50 patients with normal morphology underwent a local hyposensitization against the allergens. As a matter of fact: a) in all cases a clear improvement was obtained in phase of increasing; b) after one year of maintainance just 13 over 50 (26%) returned to previous conditions. The Authors remark how local immunotherapy by the nasal way give good possibilities in a high percentage of cases in the following conditions: correct clinical evaluation, especially concerning the identification of factors determining vasomotor rhinitis; employment of precise techniques for diagnosis; observation of clinical data and results turning out from instrumental investigations, especially concerning the nasal provocation test evaluated by rhinomanometry.

Regional localization of the human EGF-like growth factor CRIPTO gene (TDGF-1) to chromosome 3p21

The CRIPTO gene encodes a novel human growth factor structurally related to epidermal growth factor. We localized the CRIPTO gene to chromosome 3p21 by fluorescence in situ hybridization with a cosmid clone containing 40 kb of the CRIPTO genomic region (TDGF-1). To suppress hybridization to CRIPTO-related sequences, present in multiple copies in the human genome, hybridization was carried out in the presence of unlabeled CRIPTO cDNA in excess over the probe. Our finding confirms the provisional mapping of the CRIPTO gene to chromosome 3, and assigns it precisely to a chromosomal region involved in several rearrangements occurring in malignancy.

Genetic characterization of general transcription factors TFIIF and TFIIB of Homo sapiens sapiens

Analysis of loci GTF2F1 and GTF2B, encoding Rap 74 (a subunit of TFIIF) and TFIIB, respectively, showed that they are present in a single copy in the human genome and are localized at 19p13.3 and 1p22, respectively. By using as probe a cDNA for Rap 30 (the other subunit of TFIIF), we localized the GTF2F2 locus to 13q14; the same probe also detected a cross-hybridizing sequence at 4q31 whose functional importance remains to be elucidated. These data and those previously published by our group demonstrate that genes coding for class II general transcription factors with reported sequence similarity to bacterial sigma proteins are scattered in different regions of the human genome, with no evidence of clustering. This dispersion and the identification of homologs of both TBP and TFIIB in Archaea suggest an early evolutionary origin of the general transcription apparatus of contemporary eukaryotes.

Evaluation of cytogenetic effects of a naturally occurring non-ice-nucleation Pseudomonas fluorescens strain in Chinese hamster ovary (CHO) cells

One of the main methods for eliminating ice-nucleation-active (INA+) bacteria the micro-organisms responsible for frost injuries to plants at mild freezing temperatures, is the use, as competitors, of other naturally occurring non-nucleating strains (non-INA). In the present article we investigated the cytogenetic effects of a naturally occurring non-INA strain of Pseudomonas fluorescens (MS 1640 R3), evaluating the induction of chromosomal aberrations and sister chromatid exchanges (SCEs) in Chinese hamster ovary (CHO) cells in the absence and presence of rat S9 metabolism. The results obtained did not show any increase in either chromosomal aberrations or SCEs, both in the absence and presence of rat S9 metabolism when used as i) intact bacteria cells, ii) sonicated bacteria (i.e., potential endotoxins), or iii) metabolic bacterial products (i.e., potential exotoxins) released in the growth medium.

Immunoactivity of pidotimod against episodes of recurrent tonsillitis in childhood

The therapeutic efficacy of the synthetic immunostimulant pidotimod ((R)-3-[(S)-(5-oxo-2-pyrrolidinyl) carbonyl]-thiazolidine-4-carboxylic acid, PGT/1A, CAS 121808-62-6) was evaluated in a double-blind placebo-controlled study in parallel groups in the management of recurrences in 235 children with recurrent tonsillitis. The ambulant study provided for 15 days of treatment with two oral vials of pidotimod 400 mg or placebo daily, in accordance with a randomisation list, 60 days of treatment with one oral vial of pidotimod 400 mg or placebo daily, and a 90-day follow-up period. The total trial period was 165 days. In addition to evaluating the number of tonsillitis recurrences which occurred during the 75 days of treatment and the 90-day follow-up period, the number of days on which the principal symptoms of the illness were present and on which drugs such as antibiotics or anti-inflammatory agents were used concomitantly, as well as the number of days' absence from school, were analyzed. The findings showed that, taking the treatment phase and the three-month follow-up period together, pidotimod significantly reduces the incidence of inflammatory upper airways episodes. The very low incidence of adverse effects, which was the same as that in the placebo group, confirmed the excellent safety of the product.

Localization of the human genes encoding the two subunits of general transcription factor TFIIE

TFIIE is a general transcription factor for class II genes composed of two types of subunits, a large one of 56 kDa and a small of 34 kDa. By Southern analysis at high and at low stringency of a panel of mouse/human hybrid cell lines and by in situ chromosomal hybridization, we have demonstrated that both polypeptides are encoded by genes that are single copy in the human genome and are localized at 3q13-q21 and at 8p12, respectively. A TaqI RFLP (heterozygosity index of 0.07) was detected at the locus for the 56-kDa subunit.

Physical mapping at 6q27 of the locus for the TATA box-binding protein, the DNA-binding subunit of TFIID and a component of SL1 and TFIIIB, strongly suggests that it is single copy in the human genome

The TATA box-binding protein (TBP) has a fundamental role in eukaryotic cell metabolism, since it is necessary for transcription of class I, class II, and class III genes; in fact, TBP is the DNA-binding subunit of TFIID and a component of SL1 and TFIIIB. Contrary to the previously hypothesized existence of a family of genes coding for DNA-binding proteins highly related to TBP, our experiments show that the segment coding for the evolutionarily well-conserved carboxyl-terminal domain, involved in DNA binding, is unique; accordingly, we conclude that the TBP locus itself, which we have localized to 6q27, is single copy in the human genome. On the other hand, a cDNA fragment coding for the evolutionarily variable amino-terminal domain detects multiple cross-hybridizing sequences in the genome of higher eukaryotes. We suggest that the common motif is represented by the long string of glutamine codons, which characterizes the amino-terminal segment of human TBP: in fact, other proteins involved in transcription, such as TAF II 110, Sp1, and some homeobox proteins, are known to contain glutamine-rich segments.

Abnormality of water barrier function in psoriasis. Role of ceramide fractions

BACKGROUND AND DESIGN

In psoriasis the formation of the cornified layer is deranged and water flux is reportedly increased. We investigated three different forms of psoriasis: transepidermal water loss was measured on uninvolved skin and psoriatic plaques; lipids from plaques were extracted; and ceramide distribution in scale vs normal stratum corneum was compared. Moreover, the lipid biochemical results were compared with transepidermal water loss rates in the same lesions. To assess potential alteration in ceramide distribution, lipids from both psoriatic scale and normal stratum corneum were extracted by the Bligh-Dyer method, separated on high performance thin layer chromatography plates, and quantified by computerized densitometry. Water flux was measured as transepidermal water loss using an evaporimeter; results between uninvolved and involved psoriatic skin and age-matched control skin were statistically evaluated.

RESULTS

In comparison with normal stratum corneum, psoriatic plaque ceramides showed a different distribution; in particular, ceramide 1 was significantly decreased. The increased transepidermal water loss values of psoriatic plaques vs control skin and between psoriatic involved vs uninvolved skin were significant.

CONCLUSION

Our findings indicate that in psoriasis the altered ceramide distribution can be linked specifically to the defect in keratinocyte differentiation; the defect in skin barrier function may be attributed largely or in part to ceramide 1 reduction.

Interlamellar lipid differences between normal and psoriatic stratum corneum

Intercellular lipids of the stratum corneum are involved in permeability barrier integrity and function. In psoriasis, desquamation and permeability barrier homeostasis are modified; these observations are consistent with an alteration in stratum corneum lipid production. Therefore, in the present study, we determined and compared the total content of the three main intercellular lipids in psoriatic scales and normal human stratum corneum. Our results showed that the relative free fatty acid content decreased remarkably (46%) in psoriatic scales, compared with normal human stratum corneum. This decrease may reflect a general state of emergency of keratinocytes, in which free fatty acids can be employed.

Effects of chronic cocaine abuse on memory and learning

Sixteen chronic (M = 5 years) weekly cocaine users who were at least 10 days (M = 20 days) abstinent were compared to age, education, race, and gender matched controls on the California Verbal Learning Test, Wechsler Adult Intelligence Scale-Revised (WAIS-R) Vocabulary, and Block Design. Subjects with developmental disorder, neurological, psychiatric, or other substance abuse history were excluded. Cocaine subjects learned and recalled fewer words than controls, but did not differ on IQ. Results suggested significant residual impairment in verbal learning efficiency subsequent to chronic cocaine use that results from memory storage difficulties rather than attentional impairment or general intellectual reduction. A dose-response relationship is suggested.

Ceramide composition of the psoriatic scale

This paper investigates the ceramide composition of the psoriatic scale compared with that of normal human SC. A method was optimalized, based on TLC separation followed by densitometry, allowing the provision of good resolution and quantification of ceramide fractions from both normal and pathological specimens. Seven ceramide fractions were isolated and submitted to compositional analysis. The obtained results suggested a revisitation of previous ceramide designation. Therefore a simple classification is suggested, based on grouping ceramides carrying structural similarities under common codes. According to these rules, ceramides were grouped into five classes designated as: (1) Cer[EOS], which contains ester-linked fatty acids, omega-OH fatty acids and sphingosines; (2) Cer[NS], which contains non-OH fatty acids and sphingosines; (3) Cer[NP], which contains non-OH fatty acids and phytosphingosines; (4) Cer[AS], which contains alpha-OH fatty acids and sphingosines; (5) Cer[AP], which contains alpha-OH fatty acids and phytosphingosines. Analysis of ceramides from the psoriatic scale, compared to those from normal human SC, resulted in an impairment of the Cer[EOS] content as well as of the ceramides containing phytosphingosine, with concurrent increase in ceramides containing sphingosine, being the total amount maintained identical. Since one of the suggested pathways for phytosphingosine biosynthesis involves the water addition to the corresponding sphingosine double bond, we can speculate that the observed alteration is due to a deranged water bioavailability, associated with psoriasis.

Allergic rhinoconjunctivitis: diagnostic and clinical assessment

In allergic rhinoconjunctivitis not only the nasal mucosa but also the conjunctiva and, in severe cases, the cornea are affected by reactive phenomena. This pathological process is often encountered in clinical practice, its incidence ranging from 10% to 30% of the whole population, as reported by many authors. Up to now, the pathogenetic mechanisms of allergic reactivity are not completely understood. In our opinion this is due to insufficient standardization of the diagnostic procedures; even the clinical picture of such a pathological process seems to be insufficient, especially with regard to the analogies between the nasal and conjunctival pathologies. To a great extent this depends on the different clinical pictures both in otorhinolaryngology and ophthalmology. Our study has been carried out on 98 patients suffering from rhinoconjunctivitis, and presents an accurate documentation with regard to the existence of analogies in reactivity at the immunoallergic level, in both the nose and conjunctiva. These are evident when we refer not only to specific routine allergological tests but, mainly, to local examinations. The evaluation of the selected data enables us to formulate a single classification of allergic rhinoconjunctivitis, taking into account the common reactive phenomena.

[Adenotonsillectomy: the evaluation of the long-term results after more than 7 years from the intervention]

A study was carried out on 110 patients with various diseases related to chronic inflammation of the tonsils and to hypertrophic adenoids. Sixty-two of these patients underwent adenotonsillectomy, while the others were followed clinically and, where necessary, given medical treatment. At the first observation the patients were between the ages of 2 and 12 (mean age 6.1 years). At the start of the present study the patients ages ranged from 10 to 22 (mean age 17 years). Clinical follow-up was carried out on the patients 2 and 7 years after the first observation and/or adenotonsillectomy. The patients were divided into homogeneous groups according to the severity of symptoms. The A.A. evaluated changes of the following clinical parameters: annual frequency of inflammatory pharyngotonsillar episodes, nasal respiratory obstruction, sore throat, otologic pathology. Evaluations were carried out statistically in each group. After more than 7 years from surgery, the significant reduction of various diseases related to chronic inflammation of the tonsils and to hypertrophic adenoids, in accordance with the findings after 2 years from surgery, underline the effectiveness of adenotonsillectomy in correctly selected candidates.

Experience with tretinoin therapy in temperate regions

In a previously reported study on the anti-photoageing effects of topical tretinoin, the following regimen produced good patient compliance: 0.01% for 1 month, 0.025% for 1 month; and 0.05% for 4 months. The majority of patients (60/89) enrolled in the initial study continued to apply the cream to the face, and a further 140 patients were enrolled for a long-term study (mean duration 2 years). The prolonged study showed that 91.4% of patients used tretinoin in an attempt to slow down skin aging, and 8.6% sought subjective skin benefits. Of the 163 patients who completed the study, 58.8% sought an improvement of wrinkles, 30.1% skin trophism and 14.7% reduced pigmentation. The product was used throughout the year by 66.9% of patients, but 8.0% stopped using it during the summer. A daytime moisturizing cream was required by 77.9% of patients, and 82.8% used a sunscreen in the summer. Tretinoin was applied to other areas of the body by 63.8% of patients.

[Phonatory rehabilitation via esophageal voice and the laryngophone]

Esophageal voice obtained through logopedic treatment and speech produced by electronic prostheses is the principal means of verbal communication of laryngectomized patients. Several factors condition the success of logopedic rehabilitation: entity of hypopharyngeal surgical exeresis and scar repairing modalities; rehabilitation technique employed; patient's skill in controlling pharyngo-esophageal tract and articulation organs; patient motivation. A previous study executed by our School reported that only the 20% of the patients who did not practise logopedic therapy employed the laryngophone. Reduced use of electronic prosthesis depends on three factors: acoustic products of poor quality; evidence of anatomic and functional impairment pointed out by laryngophone use; limitation of manual activity during phonation. Electronic prostheses have a precise indication in the following cases: immediately after surgery; in case of logopedic treatment failure and when tracheo-esophageal prosthesis are contraindicated; when the esophageal voice has an insufficient volume or in noisy environments. Finally indicative criteria to introduce patients to the most suitable rehabilitation modality are reported.

[Diagnosis of sensorineural hearing loss by ipsilateral masking of brain stem auditory evoked potentials]

The Authors show their original technique for the differential diagnosis of cochlear and retrocochlear hearing loss which employs ipsilateral masking of the A.B.R. in order to define the difference in V wave latency between a standard technique (clicks at 21 pps without noise) and a sensitized technique (clicks at 21 pps with noise at S/N of +40). This difference in latency has been named Sensitizing Latency Difference (SLD). Sixty normal subjects, 85 patients with cochlear hearing loss and 6 with retrocochlear hearing loss, were studied. The obtained data showed a SLD value: in normal hearing of: a) 0.31 msec. (+/- 0.14 SD) from 18 to 40 years old; b) 0.36 msec. (+/- 0.26 SD) from 41 to 60 years old; c) 0.48 msec. (+/- 0.21 SD) over 60 years old; in patients with cochlear hearing loss 0.12 msec. (+/- 0.14 SD) in 2 subjects affected by retrocochlear hearing loss a value superior to 1.5 msec. in the other 4 cases the V waves disappeared during recording of the sensitized test. A differential value of 1 msec. between cochlear and retrocochlear hearing loss was established by the Authors who with this value correctly identified all the patients with retrocochlear hearing loss and 97.8% of the subjects with cochlear hearing loss. An incorrect diagnosis of the hearing loss origin (false positives) was made in 2.2% of the patients with cochlear hearing loss. In conclusion, the Authors feel that the SLD evaluation, in consideration of its large clinical utility and of the high reliability of obtained data, is a particularly useful test in making a differential diagnosis between cochlear and retrocochlear hearing loss.

[Use of CO2 laser in conservative surgery of glottic tumors]

The present work evaluates the results obtained in a group of 360 patients with laryngeal-glottic tumors (classification T1/T2-N0-M0) who, in the last 10 years, have undergone direct microlaryngoscopy surgery employing a CO2 Laser. In the T1 glottic carcinomas the neoplasm was limited to the vocal cord on one side or it involved the anterior commissure and, most likely, the vocal cord on the opposite side; in T2 glottic tumors the extension reached the hypoglottic region and/or the Morgagni ventricle and the false vocal cords on one or both sides but without compromising laryngeal motility. The five year healing rate for the T1 tumors proved to be 84.7% while it was 74% for the T2 forms. In 36 cases complications were found which can be broken down as follows: - limited local recurrences (13 patients) requiring subsequent direct microlaryngoscopy; - regional lymph node metastases (6 patients) without reproduction of the primary neoplasm; in general (5 of the 6 cases) these patients underwent lateral neck dissection; - spreading of the neoplastic process (17 cases) which made total laryngectomy with lateral neck dissection necessary; this procedure was performed in 15 cases. When these subsequent surgical procedures are also taken into account the percentage healing rises to 94.3% for T1 glottic tumors and to 84.9% for T2. Detailed analysis of the case study, comparison with the data found in the relative literature regarding patients treated with traditional techniques, a series of observations on the advantages and disadvantages inherent to the techniques employed have all led to the conclusion that the use of a CO2 laser in the treatment of laryngeal tumors gives excellent results in terms of prognosis. Moreover, this technique offers significant advantages over the traditional methods and constitutes a reliable technique for partial laryngectomies as long as the indications are accurately applied and the proper techniques used.

[Evaluation of acute cardiotoxicity from the combination cyclophosphamide-mitoxantrone-5-fluorouracil (CMF) with Holter ECG]

By making use of a twenty-four hour Holter monitoring, it as been possible to compute the acute cardiotoxicity of the cyclophosphamide + mitoxantrone + 5-fluorouracil (CNF) association in twenty oncologic patients (pts) each of whom being immune from organic cardiopathy emerging clinically and at their first cycle of chemotherapy. The following parameters have been computed: meaningful changes in the heart frequency; premature atrial and ventricular depolarizations, both as a first appearance and as a clear growth in the number; the ST dislocation entity; malignant ventricular arrhythmias. The administration of CNF at the doses of: 600 mg/m2 of cyclophosphamide, 12 mg/m2 of mitoxantrone and 600 mg/m2 of 5-fluorouracil , has caused a meaningful increase in the heart frequency on 6 pts (30%), an increase of premature atrial depolarization on 4 pts (20%) with an appearance ex novo on 2 pts (10%), an increase of premature ventricular depolarization, without any passing to superior Lown classes, on 2 pts (10%) with an appearance ex novo on 3 pts (15%). Although the results in the study point out a frequency percentage of simple hyperkinetic arrhythmias equal to the 55%, the lack of more serious hyperkinetic arrhythmias and of intense disorders of ventricular repolarization testified to a synergic effect as a determining factor on the acute cardiotoxicity of the previously discussed association, in our opinion.

The treatment of visible signs of senescence: the Italian experience

An open clinical study was undertaken to evaluate the anti-photoageing efficacy of topical tretinoin. A length of cream of approximately 1 cm was applied to the face daily in the evening for 6 months: during month 1 of therapy 0.01% tretinoin cream was administered; 0.025% was given during month 2; and 0.05% was given in months 3-6. The clinical symptoms of photoageing (coarse wrinkling, fine wrinkling, skin thinning, mottled hyperpigmentation, laxity and xerosis) were evaluated before and after therapy. A total of 19.1% of patients withdrew from the study; only 5.6% were for treatment-related reasons. At the end of the treatment period all the clinical parameters, except xerosis, were improved. The amount of improvement varied, but only 4.2% of patients failed to show any improvement. Tolerability was excellent in 51.4% of patients, good in 44.4% and fair in 4.2%, and compliance was excellent in 47.0% of patients, good in 48.5% and fair in 4.5%. Tolerability and compliance were improved by applying the same amount of cream each day but increasing the concentration of tretinoin over the 6-month period. Silicone skin replicas of the same area of skin taken before and after treatment, analysed by scanning electron microscopy, profilometry and computer image analysis, showed a decrease in the width of wrinkles, and an improvement in skin texture and follicle density.

[Current role of radical surgery in the treatment of breast tumors]

Though currently conservative surgical procedures have an ever-growing importance in breast cancer treatment, there is still place for radical surgery. The Authors describe radical techniques and their indications. The surgeon must know how to choose the proper radical technique, when it is not possible to perform a conservative surgical procedure.

Lymphocytes proliferation kinetics and SCE variation after rubella vaccination

The effect of anti-rubella vaccination on lymphocyte proliferation kinetics in vitro and on SCE frequency was studied in three young women. The studies were carried out by taking blood samples before vaccination (day 0) and subsequently on days 7, 14, 28 and 42. The mitotic index (MI) shows a decrease at day 14 and 28 followed at day 42 by an increase above day 0 levels. The average cell cycle (ACC) shows a decrease at day 14 followed by an increase at day 28. Complex variations were also found in the percentage distribution of cells in the various division classes. The SCE frequency showed variations inverse to the MI. The whole picture seems to indicate the existence of changes in the lymphocyte population which can be correlated with immune response.