C1-esterase inhibitor transfusions in patients with hereditary angioedema

BACKGROUND

Hereditary angioedema results from the deficiency of C1-esterase inhibitor (C1-INH), and C1-INH replacement would represent definitive treatment for angioedema attacks. In Canada, C1-INH is available only on a compassionate basis at select medical facilities. Our objective is to assess the efficacy of C1-INH transfusions during angioedema attacks at a single Canadian institution.

METHODS

A retrospective chart review of transfusion data between January 1, 1995 and June 30, 1996 was performed. Phone interviews with patients elicited their opinions of the treatment. Data collected included the number and duration of angioedema attacks, dose of transfused C1-INH, and side effects of treatment.

RESULTS

Of a cohort of 13 patients with hereditary angioedema, seven received transfusions with C1-INH. Attacks totaled 87, and more than 100,000 units of the product were transfused. The mean time for abatement of an attack after initiation of transfusion was 50 +/- 8 minutes (1 SD). There were no reports of adverse effects. Although patients were satisfied with the treatment, they raised concerns regarding long-term safety and availability.

CONCLUSIONS

C1-INH transfusion is a satisfactory means of treating angioedema attacks.

Variations of prostaglandin E2 receptors in hamster's ovary and endometrium during estrous cycle

The purpose of this study was to determine concurrent ovarian and endometrial prostaglandin E2 (PGE2) receptor concentrations throughout the hamster estrous cycle. The effect of progesterone (P4) on PGE2 receptor in these two tissues was also investigated during in vitro culture. Estrous cycles of mature female hamsters were monitored according to the appearance of the vaginal discharge on cycle day 1 (D1). Ovaries and uteri were removed from cyclic hamsters at 10:00 a.m. on each day of the cycle and at 6:00 p.m. on D4 (proestrus). Ovarian and endometrial cell membranes were collected and assayed for the specific PGE2 binding by Scatchard plot analysis, using seven different concentrations of 3H-PGE2 (0.72-9.1 nM) with or without the presence of unlabelled PGE2 (9.1 microM). Ovarian and endometrial tissues of the cyclic hamsters were shown to contain a saturable, specific binding site with KD=4.69+/-0.55, and 5.7+/-0.4 nM for ovary and endometrium, respectively. Relative binding activity of PGE1 for the PGE2 binding site was about 28%. PGF2alpha and PGA1 did not compete for the PGE2 binding site. In ovaries, the PGE2 receptor levels started to increase sharply in the evening of D4 and reached maximum in the morning of D1. A precipitous drop of PGE2 receptor was observed on D2 followed by gradual decreases on D3 and D4. The PGE2 receptor concentrations in endometrium were the lowest in the morning of D4, and increased thereafter until a maximal level was reached on D2. Progesterone (10 nM) augmented PGE2 receptors in ovarian but not in endometrial tissue during 24-h in vitro incubation.

Anesthetic management in parturients with uterine rupture preoperatively--report of two cases

Uterine rupture is a rare obstetric emergency, and the diagnosis of rupture is not always obvious. High surgical delivery rate today which tends to increase the incidence of the disaster urged us to present this report. Two cases of spontaneous rupture of uterus are described. Case 1 concerns spontaneous rupture of a previously intact uterus; case 2 is a rupture due to placenta percreta. A review relevant to its incidence, risk factors, clinical characteristics, and anesthetic managements is given.

Prognostic significance of proliferating cell nuclear antigen expression in transitional cell carcinoma of the upper urinary tract

BACKGROUND

Haphazard cell proliferation is a fundamental biologic defect in cancer. Thus, assessment of the growth fraction provides a valuable index of biological property for human neoplasm. Proliferating cell nuclear antigen (PCNA) expression has been used to estimate the growth fraction of human cancer, and its prognostic value. Information in transitional cell carcinoma (TCC) of the upper urinary tract, however, is very few.

MATERIALS AND METHODS

A total of 73 patients with TCC of the upper urinary tract was collected between July 1988 and December 1995 for this study. The labeling index of PCNA immunostaining was correlated with clinicopathologic factors and compared for its prognostic value with a median follow-up of 54 months.

RESULTS

The PCNA index was positively associated with histological grading, tumor stage and patient prognosis (P = 0.00, respectively). Multivariate analysis demonstrated that significant factors in relation to patient survival were tumor stage (P = 0.01), followed by PCNA index (P = 0.04) and gender of patients (P = 0.04). Multiple comparison revealed that PCNA index set at 0.30 had prognostic value in terms of patient survival (P = 0.00), and the risk of metachronous bladder recurrence (P = 0.02).

CONCLUSION

Our data suggested that assessment of PCNA index may be used as an adjuvant prognostic factor for patients with TCC of the upper urinary tract.

The monosodium glutamate symptom complex: assessment in a double-blind, placebo-controlled, randomized study

BACKGROUND

Considerable debate swirls about the validity of symptoms described by many people after ingestion of monosodium glutamate (MSG), and the question has remained unresolved largely because of a paucity of well-designed challenge studies.

METHODS

We conducted oral challenge studies in self-identified MSG-sensitive subjects to determine whether they had a statistically significant difference in the incidence of their specific symptoms after ingestion of MSG compared with placebo. First, 5 gm MSG or placebo was administered in random sequence in a double-blind fashion. Subjects who reacted only to a single test agent then underwent rechallenge in random sequence in a double-blind fashion with placebo and 1.25, 2.5, and 5 gm MSG. A positive response to challenge was defined as the reproduction of > of 2 of the specific symptoms in a subject ascertained on prechallenge interview.

RESULTS

Sixty-one subjects entered the study. On initial challenge, 18 (29.5%) responded to neither MSG nor placebo, 6 (9.8%) to both, 15 (24.6%) to placebo, and 22 (36.1%) to MSG (p = 0.324). Total and average severity of symptoms after ingestion of MSG (374 and 80) were greater than respective values after placebo ingestion (232 and 56; p = 0.026 and 0.018, respectively). Rechallenge revealed an apparent threshold dose for reactivity of 2.5 gm MSG. Headache (p < 0.023), muscle tightness (p < 0.004), numbness/tingling (p < 0.007), general weakness (p < 0.040), and flushing (p < 0.016) occurred more frequently after MSG than placebo ingestion.

CONCLUSIONS

Oral challenge with MSG reproduced symptoms in alleged sensitive persons. The mechanism of the reaction remains unknown, but symptom characteristics do not support an IgE-mediated mechanism. According to Food and Drug Administration recommendations, the symptoms, originally called the Chinese restaurant syndrome, are better referred to as the MSG symptom complex.

Cloning and characterization of rat Ku70: involvement of Ku autoantigen in the heat-shock response

To study the role of the Ku autoantigen in the heat-shock response, we have cloned the 70-kDa subunit (the DNA-binding component of Ku) from a rat cDNA library. The deduced amino acid sequence of rat Ku70 bears extensive homology with the human and murine counterpart (83 and 97% identity, respectively). Overexpression of Ku70 in rat fibroblasts results in the specific repression of hsp-70 upon heat shock. The inhibition of induction of hsp-70 was greatest in cells expressing the highest level of Ku70. Induction of other heat-shock proteins besides hsp-70 by hyperthermia appears normal, as does the activation of the heat-shock transcription factor, HSF-1. It is likely that other factors besides HSF-1 are involved in controlling heat-shock gene transcription. While the formation of the Ku70 and Ku80 complex is important for repair of DNA double-strand breaks our data suggest that the 70-kDa subunit of Ku plays a role in regulating hsp-70 expression.

Comparative effects of diverse vertebrate gonadotropins on estradiol-17 beta formation in vitro in an immature rat Sertoli cell bioassay

The biopotencies of pituitary gonadotropins (GTHs) from various vertebrate classes were examined in an in vitro rat Sertoli cell bioassay which was previously established for mammalian follicle-stimulating hormones (FSHs). Potencies of the gonadotropins were determined by incubation of Sertoli cells obtained from 10-day-old rats, with increasing doses of GTHs, which resulted in dose-related and parallel estradiol-17 beta formation converted from added 19-hydroxy-androstenedione. In general, mammalian (human and ovine) FSHs were most potent, avian (chicken, turkey, and ostrich) FSHs were intermediate, and reptilian (snapping turtle) and amphibian (bullfrog) FSHs were the least potent. By contrast, mammalian and bullfrog luteinizing hormones (LHs) were inactive or negligibly active in this assay; avian LHs possessed one-fifth to one-half of the potency of the FSH preparations of the same species. The data suggest that the assay is specific for FSHs from mammalian and amphibian species and is relatively specific for FSHs from avian species. Both snapping turtle FSH and LH exhibited low and similar potencies in this bioassay. Black silver carp GTH was also active in this assay, although its potency was much lower. The present study has demonstrated that the immature rat Sertoli cell aromatase assay in vitro is useful for measurement of FSH contents in mammalian species and of FSH activity in diverse nonmammalian species. It also provides an approach for the investigation of structure-function relations of gonadotropin in diverse vertebrate species in relation to phylogenic patterns and specificity of hormone-receptor interaction. The findings from the present study imply that the binding sites of vertebrate FSHs share a certain degree of homology and that the binding sites of FSH receptors on Sertoli cells from immature rat have a relatively low degree of animal class specificity.

Once daily mometasone furoate aqueous nasal spray is as effective as twice daily beclomethasone dipropionate for treating perennial allergic rhinitis patients

BACKGROUND

Perennial allergic rhinitis is chronic and persistent, may lead to a constellation of secondary complaints including sinusitis, mouth-breathing, and some symptoms resembling a permanent cold, and often requires constant medical intervention. Well-tolerated nasal corticosteroids, alone or in combination with antihistamines, have been found to be very effective in treating this condition.

OBJECTIVE

To compare the effectiveness and tolerability of mometasone furoate aqueous suspension, a new once daily nasal spray, to placebo vehicle and to beclomethasone dipropionate, administered twice daily, in patients with perennial allergic rhinitis.

METHODS

This was a randomized, double-blind, placebo-controlled, double-dummy, parallel group study, in 427 patients age 12 years and older at 24 centers in Canada and Europe. Patients allergic to at least one perennial allergen, confirmed by medical history, skin testing, and adequate symptomatology were eligible to receive one of the following regimens for 3 months: mometasone furoate, 200 micrograms only daily; beclomethasone dipropionate, 200 micrograms twice daily (400 micrograms total dose); or placebo vehicle control. The primary efficacy variable was the change from baseline in total AM plus PM diary nasal symptom score over the first 15 days of treatment.

RESULTS

Three hundred eighty-seven patients were valid for efficacy. For the primary efficacy variable, mometasone furoate was significantly (P < or = .01) more effective than placebo and was indistinguishable from beclomethasone dipropionate. Similar trends were seen among individual symptoms, physician symptom evaluations, and therapeutic response. There was no evidence of tachyphylaxis. All treatments were well tolerated.

CONCLUSIONS

Mometasone furoate nasal spray adequately controls symptoms of perennial allergic rhinitis, offers the advantage of once daily treatment, and is well tolerated.

Characterization of two urothelium cancer cell lines derived from a blackfoot disease endemic area in Taiwan

Established cancer cell lines with distinct characteristics are valuable in many aspects of in vitro study pertaining to tumor biology, as well as the possible geographic significance. Two long-term cell lines, BFTC905 and BFTC909, were established from primary transitional cell carcinomas (TCC) of patients from a blackfoot disease endemic area in Taiwan, where the prevalence and standard mortality rates of this cancer are unusually high. BFTC905 derived from a grade III TCC of urinary bladder has an epitheloid morphology, and BFTC909 derived from the sarcomatoid component of a grade III TCC of renal pelvis exhibits a fibroblastic growth pattern. They share similar morphological and immunocytochemical characteristics with the tumors of origin, have multiple chromosomal aberrations, and are tumorigenic in nude mice. BFTC905 reveals a unique homogeneously staining region at 11q13, the amplification of which has been detected in 20% of transitional cell carcinoma. In addition to the rarity of renal pelvic origin, the vimentin expression associated with an aggressive clinical behavior and a relatively high tumorigenicity as demonstrated by BFTC909 cells has also rarely been mentioned in TCC cell lines, but has been well documented in vivo and in vitro in renal cell carcinoma and breast cancer.

Prognostic factors of primary transitional cell carcinoma of the upper urinary tract

OBJECTIVES

We presented and analyzed our results in order to determine the relationship between patient survival and tumor grade and/or stage. In addition, a retrospective tumor DNA ploidy study was done to evaluate its possible role in predicting future tumor recurrence in the bladder.

METHODS

A total of 112 patients with upper urinary tract transitional cell carcinomas (TCCs) were recorded at our hospital. Of these, 68 patients without concurrent bladder tumors (ages ranged from 36 to 80, mean 62.4 years; male:female = 1:1.2) were treated by nephroureterectomy and bladder cuff resection. They were followed up for 14-79 months (average 38.2 months). Eight (36.4%) of the 22 patients who had stage C or D tumors had received adjuvant systemic methotrexate, vinblastine, epirubicin, cisplatin chemotherapy after surgery. DNA flow cytometry using paraffin-blocked tumor specimens was performed on the tumors of 52 patients.

RESULTS

Their pathologic stages and grades were 11 at stage 0, 15 at stage A, 20 at stage B, 14 at stage C, 8 at stage D; 9 of grade I, 41 of grade II, and 18 of grade III. Postoperatively, 13 patients (19.1%) subsequently developed bladder tumors with a latent period ranging from 2 to 37 months (average 14.9 months). The difference of the tumor DNA ploidy distribution pattern among tumors of high versus low stages and/or grades is not statistically significant (p > 0.05). Overall, the 5-year survival rates for patients with low- and high-stage tumors were 100 and 66.7%, respectively; for patients with grade I-II and III tumors they were 93.6 and 28.3%, respectively.

CONCLUSIONS

Patient survival was mainly related to both tumor stages (p = 0.0037) and grades (p = 0.0001), rather than to tumor DNA ploidy. For patients with grade II upper urinary tract tumors, tumor DNA ploidy seems to provide no additional predictive value on subsequent tumor recurrence in the bladder.

Detubularized folded O-shaped ileal bladder

Using a submucosal needle tunneling technique for ureteral implantation, detubularized folded O-shaped ileal bladders were created for seven patients in need of bladder replacement. A segment of ileum of only 300 to 400 mm in length was required. Anastomosis of the reservoir to the urethra was simply performed by tailoring the ileum to reduce tension at the anastomosis site. Follow-up periods ranged from 24 to 46 months. Excellent upper tract function and good evacuation function with minimal residual urine were demonstrated. Urodynamic studies revealed a mean bladder capacity of 367 mL, with low intra-ileobladder pressure. All patients are continent during the day. Mild enuresis was noted in three patients. No reflux was noted on follow-up voiding cystourethrography. This type of ileal bladder is simple to create and provides reliable results. The presence of a short mesentery is not a serious limiting factor.

Physiological mechanisms regulating the conversion of selenite to elemental selenium by Bacillus subtilis

We have demonstrated that the common soil bacterium, Bacillus subtilis, reduces selenite to an insoluble and much less toxic product--the red form of elemental selenium. Reduction was effected by an inducible system that appears to deposit elemental selenium between the cell wall and the plasma membrane. Glucose and sucrose supported selenite reduction. Although malate and citrate supported growth, no significant reduction of selenite occurred, indicating the importance of the redox state of the culture substrate. Selenite reduction in the millimolar concentration range (i.e., cultures supplemented with 1 mM selenite) was not affected by a ten-fold excess of nitrate or sulfate--compounds that serve as alternate electron acceptors and antagonize selenite reduction by anaerobic bacteria. Similarly, nitrite and sulfite did not significantly affect the rate or extent of selenite reduction. B.subtilis was able to grow and produce selenium (Se degree) at selenite concentrations ranging from 0.6 microM to 5 mM (50 ppb to 395 ppm selenium). At the lowest selenite concentration tested, 50 ppb selenium, B.subtilis removed 95% of the selenite from the liquid phase. The results suggest that selenite is reduced via an inducible detoxification system rather than dissimilatory electron transport. The findings establish the potential utility of B.subtilis for the bioremediation of selenite-polluted sites.

Correlation of transrectal ultrasonographic findings of the prostate with the occurrence of detrusor instability in patients with benign prostatic hyperplasia

Forty patients with benign prostatic hyperplasia were evaluated with urodynamics and transrectal ultrasonography. Seventeen patients were found to have detrusor instability while the remaining 23 did not. No significant differences were noted during ultrasonography in the estimated prostatic volume, the presumed circle area ratio and the incidence of finding prostatic calcification between these two groups. However, the incidence of detecting intravesical protrusion of the prostate is significantly higher in patients with instability than in patients with stable bladder (53 vs. 13%, p < 0.01). It is therefore postulated that intravesical protrusion may increase afferent impulses from the prostate and alter the stability status of the urinary bladder.

[Complications following Nd: YAG laser posterior capsulotomy]

We used neodymium-YAG laser to perform discissions of the posterior capsules in 221 eyes of 203 patients who had undergone previous extracapsular cataract extractions. After a follow-up period ranging from 1-96 months, in the mean 10.5 months, 47.06% of the eyes achieved corrected visual acuities of > or = 0.5. The complications included rhegmatogenous retinal detachment in 3 eyes (1.36%) and bullous keratopathy in one eye (0.45%). Although cystoid macular edema and glaucoma were not seen in this series, they had been reported. The author suggests that patients undergoing Nd: YAG laser capsulotomies require ongoing medical observations to detect and treat these complications.

Multicenter trial of fluticasone propionate aqueous nasal spray in ragweed allergic rhinitis

A 4-week multicenter, double-blind, placebo-controlled, parallel-group trial was carried out with 416 adults with ragweed allergic rhinitis to compare 200 micrograms of fluticasone propionate once daily and 100 micrograms of fluticasone propionate twice daily with placebo. Compared with placebo, both groups receiving fluticasone propionate had greater number of symptom free days (P < .01), lower median symptom scores (P < .01), and greater number of days not requiring rescue medications (P < .001). No significant differences for individual symptoms were found between the two fluticasone propionate groups except that those taking the twice daily dosage used less antihistamine (P < .01) and had greater number of days free of rescue medications (P < .05). Adverse events were comparable between the three groups. These results indicate that topical intranasal fluticasone propionate 200 micrograms once daily and 100 micrograms twice daily are both efficacious and well tolerated.

Expression of c-erbB-2 protein in normal and neoplastic urothelium: lack of adverse prognostic effect in human urinary bladder cancer

The clinical significance of c-erb B-2 expression in urinary bladder cancer remains controversial. We performed an immunohistochemical study to examine the expression of c-erb B-2 in non-neoplastic urothelium (n = 12) and transitional cell carcinoma of the urinary bladder (n = 82). c-erb B-2 protein was localized in superficial and some intermediate cells of non-neoplastic urothelium. A total of 29 out of 82 (35%) tumors were positive for c-erb B-2 over-expression. There was no significant association of c-erbB-2 expression with tumor grade (p = 0.12), stage (p = 0.93), DNA ploidy status (p = 0.56) and the sex of patients (p = 0.5). Expression of epidermal growth factor receptor and Ki-67 index was available in 33 cases. Both parameters showed no apparent association with c-erbB-2 expression (p = 0.53 and 0.58 respectively). Factors correlated with poor patient survival by univariate analysis were tumor stage (p = 0.0001), tumor grade (p = 0.001), development of second recurrence (p = 0.002) and negative expression of c-erbB-2 (p = 0.017). Important indicators associated with first recurrence were tumor stage (p = 0.028), and c-erbB-2 expression with the risk of second recurrence (p = 0.031). Multivariate survival analysis revealed that tumor stage was among the most important prognostic factors (p = 0.029), followed by tumors without c-erbB-2 expression (p = 0.031) with a median follow-up at 46 months. The age of patients and c-erbB-2 expression were significantly associated with developing second recurrence (p = 0.031 and 0.046 respectively). The results indicate that expression of c-erbB-2 is independent of the stage and grade of bladder cancer. Although c-erbB-2 status can discriminate subpopulations with a high risk of recurrence, evaluation of its expression in paraffin-embedded tumors does not indicate poor prognosis for patients with urinary bladder cancer. To address this discrepancy a better understanding of the regulatory mechanism and physiological properties of c-erbB-2 protein in urothelium is required.

Thermal (heat) shock biothermomechanical viewpoint

Thermal (or heat) shock phenomena have been observed in all organisms at the cellular level. They cause an acceleration in the rate of expression of specific genes (heat shock genes), resulting in an increase and accumulation of heat shock proteins in cells. The purpose of this study is to investigate the mechanisms of thermal shock from two different viewpoints: biothermal and biothermomechanical aspects. The former predicts more severe consequences on cells that the latter, whose thermal wave fronts are smoothed due to the coupling effects of thermoelasticity. In conclusion, it is the thermal wave propagation (the so-called "second sound" effect) which triggers a perturbation of normal gene expression. Thermotolerance is found to be inherited in the heat flux equation of the thermal wave model. The information obtained from this study can also be useful to therapeutical hyperthermia, preservation of organs and tissues, and laser and cryogenic surgery.

Impaired fibrinolysis in patients with Blackfoot disease

Blackfoot disease is a unique endemic and chronic progressive arteriosclerotic vascular disease in southwest area of Taiwan. In this study, we determined the plasma levels of tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI), urokinase plasminogen activator (uPA), and von Willebrand factor (vWF) antigen in Blackfoot disease patients, in comparison with normal controls from non-endemic areas and the endemic area, Putai. Blackfoot disease patients had mean tPA antigen level of 7.9 ng/ml (n = 27) which was significantly lower (p < 0.05) than both the normal controls with 11.0 ng/ml (n = 20) and the Putai normal controls with 9.7 ng/ml (n = 39). However, the mean PAI-1 antigen level in the patient group was 41.2 ng/ml (n = 28) which was significantly higher (p = 0.0001) than both the normal controls with 19.7 ng/ml (n = 23) and the Putai normal controls with 21.3 ng/ml (n = 40). Furthermore, in the patient group, a significantly lower (p < 0.005) mean uPA antigen level (2.3 ng/ml, n = 18) was noted as compared with that in the normal controls (3.2 ng/ml, n = 14). No significant difference was observed in vWF antigen level between patients and normal controls. This study suggests that a reduced capacity for fibrinolysis is associated with Blackfoot disease.

Yang needle tunneling technique in creating antireflux and continent mechanisms

A total of 7 patients underwent cystectomy due to bladder malignancy and the ileum was used for lower urinary tract reconstruction (5 underwent bladder substitutions, 1 an internal ileal reservoir and 1 ileal conduit diversion). Antireflux mechanisms were created by submucosally tunneled ureters and in 1 case the continent mechanism was created by a submucosally tunneled ileal tube. In all cases the Yang needle was used, which consists of a needle portion and a forceps portion. The selected position of the ileum for ureteral and ileal tube implantation is injected with normal saline submucosally to form a wheal. The Yang needle is introduced submucosally, guided under the wheal for a certain distance and then directed through the ileal wall. Smooth dilation of the tunnel is achieved with the dilated portion of the needle without laceration of the mucosa. The needle portion is then removed. The ureter or ileal tube is grasped by the forceps portion of the needle and brought through the tunnel to the mucosal side of the ileal plate, followed by mucosa-to-mucosa anastomosis. For all 14 ureteral implantations only 1 ureter had reflux on postoperative radiographic studies and only 1 of 4 hydroureters remained. No additional obstructive lesions or pyelonephritis was noted postoperatively. The patient whose continent mechanism is formed by the submucosal tunneled ileal tube method is continent and free of an appliance. The Yang needle tunneling technique may be a choice in the creation of antireflux and continent mechanisms.

[Modern extracapsular extraction for cataract of uveitis]

Cataract of uveitis is difficult for extracapsular extraction (ECE) because of posterior synechiae. 21 cases (24 eyes) of the cataract were performed modern ECE with satisfactory results. Postoperative visual acuity was 0.1 or better in 20 eyes, and 0.5 or better in 7 eyes. The optimal time for the operation and the procedures were discussed. The authors opined that removal of the cataract could prevent recurrences in some severe refractory cases of uveitis.

Melkersson-Rosenthal syndrome: clinical, pathologic, and therapeutic considerations

Melkersson-Rosenthal syndrome (MRS) has been described as a rare disease. Localized swelling (usually of the lips) with noncaseating epithelioid granuloma is necessary for diagnosis. We report 11 patients with biopsy-proven MRS. Mean age was 28 years (range 12-47 years). Mean duration of lesions was 4.4 years. Lip biopsy confirmed typical sarcoid-like granuloma. Five additional patients with typical symptoms are awaiting or refused lip biopsy. Clinically all patients presented with localized swelling of the lips. Treatment with clofazimine (100 mg 4 times weekly for 3-11 months) was associated with complete remission in 5/10 patients and clinical improvement in 3/10 patients with moderate constant swelling. Two patients (one severe and one moderate swelling) failed to respond to treatment. Rebiopsy in four patients confirmed improvement with disappearance or decreased granulomatous inflammation in 3/4. Complete spontaneous remission was also seen in three untreated patients. We conclude MRS is not uncommon, clofazimine may be effective treatment in moderate lesions and spontaneous remissions can occur.

Studies of the HLA class II alleles involved in human responses to ragweed allergensAmbrosia artemisiifoliaV (Ra5S) andAmbrosia trifidaV (Ra5G)

Previous studies have associated skin test sensitivity and specific IgE response to Ambrosia artemisiifolia V (Amb a V) with HLA-DR2, and to Ambrosia trifida V (Amb t V) with HLA-DRw52 haplotypes in atopic individuals. Using HLA class II typing by restriction fragment length polymorphism (RFLP) analysis with DRB, DQB and DQA DNA probes to define the HLA-D alleles, we have demonstrated the association of the DQw6 in 16 out of 16 (100%) Amb a V-responsive individuals, compared to 3 out of 18 (17%) ragweed-sensitive but Amb a V-nonresponsive individuals (p = 5.7 x 10(-6), RR greater than 75). We suggest that the DQw6 association with Amb a V sensitivity may be a reflection of an association with the DQA*0102 allele. This suggests an association of a particular HLA class II allele with an immune response to a well-characterized antigen (Amb a V). The HLA-DRw52 haplotypes in the Amb t V-sensitive individuals are not of one particular subtype. The HLA-DRw52 association with Amb t V sensitivity may reside in homologous DRB1 alleles linked on HLA-DRw52-bearing haplotypes.

Clinical evaluation of the efficacy and safety of noberastine, a new H1 antagonist, in seasonal allergic rhinitis: a placebo-controlled, dose-response study

Noberastine (NOB), a new histamine H1 antagonist, has potent and specific peripheral antihistaminic activity. To evaluate the efficacy and safety of NOB in ragweed seasonal allergic rhinitis, 250 eligible patients were randomized to one of four parallel, double-blind treatment groups: NOB, 10, 20, and 30 mg, or placebo, each administered once daily for 3 weeks. Rescue medication was prohibited. Efficacy parameters included global response rate (percentage of responders), physician visit, patient-diary symptom scores, and onset of action. Efficacy analyses used alpha = 0.0167 (adjusted for multiple comparisons). Efficacy parameters demonstrated universal superiority of NOB therapy over placebo therapy with statistical significance achieved frequently; no statistically or clinically significant separation was demonstrated among NOB-treated groups. Global-response rates for all active-treatment groups (range, 62.7% to 71.1%) were statistically significantly greater than rates for the placebo-treated group (39.6%). Median time to first relief of symptoms was within 2 to 4 hours for NOB-treated groups versus 72 hours for the placebo-treated group. No significant abnormalities in safety parameters were ascribed to NOB treatment. Incidence and severity of adverse experiences of NOB-treated groups were comparable in incidence and severity to placebo treatment. NOB treatment did not appear to cause weight gain or sedation. Once-daily NOB, 10, 20, and 30 mg, is equally and highly effective and safe in the symptomatic management of seasonal allergic rhinitis compared to placebo.

Potentially fatal hereditary angioedema: a review and case report

Hereditary angioedema is a disease based upon a biochemical deficiency which may result in sudden and unexpected death principally from respiratory distress due to swelling of the pharyngeal tissues. Dental treatment is not an uncommon initiator of such edema. To perform dental care safely, it is necessary to understand the etiology, diagnosis, and treatment of the condition. This article presents a review of these features, and indicates via a case report how knowledge of them was essential in conducting safe, effective and efficient dental treatment.