Sodium fusidate in Gillain-Barré syndrome: a case report

A patient with Guillain-Barré syndrome is reported on who responded favourably to a short course treatment with the novel immunosuppressant sodium fusidate (Fucidin), given at a daily dose of 1.5 g for one week. Along with prompt and clear cut clinical improvement, treatment with Fucidin was associated with a rapid decline in the blood concentrations of inflammatory cytokines presumably implicated in the pathogenesis of Guillain-Barré syndrome such as interleukin-2, interferon-gamma, and tumor necrosis factor-alpha. The ex vivo production of these cytokines was also markedly diminished compared with pretreatment values. Fucidin was well tolerated and no clinical or biochemical side effects were seen.

Blood levels of transforming growth factor-beta 1 (TGF-beta1) are elevated in both relapsing remitting and chronic progressive multiple sclerosis (MS) patients and are further augmented by treatment with interferon-beta 1b (IFN-beta1b)

The serum levels of TGF-beta1, measured by solid-phase ELISA, were determined to be significantly augmented in patients with both relapsing remitting (RR) and secondary chronic progressive (CP) MS compared with sex- and age-matched healthy controls. Moreover, in RR MS patients, the blood levels of the cytokine were further augmented either during relapses or, in a rapid but reversible fashion, by s.c. injection with 8 million International Units (MIU) IFN-beta1b. Because TGF-beta1 possesses multiple anti-inflammatory activities, we hypothesize that the increase in its circulating levels in RR and CP MS patients might represent an endogenous anti-inflammatory mechanism aimed at counteracting ongoing immunoinflammatory events, and that IFN-beta may further potentiate this natural defensive apparatus.

Promoter analysis of RPE65, the gene encoding a 61-kDa retinal pigment epithelium-specific protein

PURPOSE

To identify the functional promoter region and cis-acting elements that regulate the expression of RPE65, the retinal pigment epithelium (RPE)-specific gene responsible for certain forms of autosomal recessive childhood-onset severe retinal dystrophy.

METHODS

A human genomic DNA clone containing the 5'-flanking region of RPE65 was isolated and, 4.0 kb proximal to the transcription start site, was sequenced and analyzed for the presence of transcription factor-binding sites. Promoter activity was assayed by transient transfection of luciferase reporter constructs containing nested deletions of the upstream sequence in the human RPE cell lines ARPE19 and D407, as well as in the SK-Mel-28 and HeLa cell lines. Specific DNA protein-binding sites present in the 340 bp upstream of the transcription start site were identified by DNase I footprint analysis.

RESULTS

Sequence analysis places the polymorphic marker, D1S2803, within the RPE65 upstream region and identifies a number of sequences homologous to the gene encoding the cellular retinaldehyde-binding protein. Functional analysis indicates that basal promoter activity is conferred by the sequence from -83 to +39 and is approximately equivalent in all cell lines tested, with no other control elements detected in 3.6 kb of the upstream sequence. At least eight protected regions are identified in DNase I footprint assays, including sequences corresponding to the predicted TATA box, AP-4, and nuclear factor-1 DNA protein-binding sites.

CONCLUSIONS

These findings localize the basal promoter activity of RPE65, identify potential cis-acting elements that act as positive regulators of gene expression, and suggest that additional regulatory elements are likely to be involved in restricting gene expression to the retinal pigment epithelium. Identification of promoter elements and genetic markers in the upstream sequence will enable the screening of patients with retinal degeneration for possible mutations that affect RPE65 expression.

[Evaluation of diastolic function of in patients addicted to recreational cocaine]

BACKGROUND AND AIMS

The recreational use of cocaine is associated with cardiovascular pathologies, such as ischemic cardiopathy, myocarditis and cardiomyopathies, owing to the increased catecholamine stimulus, a propensity to coronary spasm, increased coagulative activity and inflammatory and degenerative phenomena of myocardiac cells. Early alterations of the diastolic phase may be visualised by evaluating the diastolic Doppler pattern of left ventricular filling.

METHODS

For this purpose the authors compared blood pressure, heart rate, heart mass, protodiastolic (E wave) and telediastolic (A wave) filling rate and their ratio (E/A) on the Dopper mitral diastolic profile in a group of 10 patients addicted to the recreational use of cocaine (mean age 33 +/- 7) with those of 10 normal subjects (mean age 34 +/- 2).

RESULTS

Patients using cocaine presented mean systolic arterial blood pressures of 130 +/- 12 versus 127 +/- 8 in control subjects (p = ns); mean heart rate was statistically significant with 98 +/- 14 versus 76 +/- 12 in controls (p < 0.05). There were no differences in cardiac mass between the two groups. In cocaine addicts the speed of the E wave was significantly slower: 58.4 +/- 8.6 versus 73 +/- 7.4 cm/sec (p < 0.05), and the speed of the A wave was significantly higher: 70.5 +/- 10.5 versus 62.6 +/- 4.3 cm/sec (p < 0.05), when compared with normal controls subjects; the E/A ratio of cocaine addicts was lower (0.75 +/- 0.34) compared to normal subjects (1.07 +/- 0.7), (p < 0.05).

CONCLUSIONS

These data show that patients addicted to the recreational use of cocaine show preclinical alterations of the left ventricular diastolic phase prior to the onset of clinically evident pathologies.

Mutations in RPE65 cause autosomal recessive childhood-onset severe retinal dystrophy

Autosomal recessive childhood-onset severe retinal dystrophy (arCSRD) designates a heterogeneous group of disorders affecting rod and cone photoreceptors simultaneously. The most severe cases are termed Leber congenital amaurosis (LCA), while the less aggressive forms are usually considered juvenile retinitis pigmentosa. Recently, mutations in the retinal-specific guanylate cyclase gene were found in patients with LCA. Disease genes implicated in other forms of arCSRD are expected to encode proteins present in the neuroretina or in the retinal pigment epithelium (RPE). The RPE, a monolayer of cells separating the vascular-rich choroid and the neuroretina, is in intimate contact with the outer segments of rods and cones via the microvilli surrounding the photoreceptors. The RPE expresses a tissue-specific and evolutionarily highly conserved 61 kD protein (RPE65) present at high levels in vivo. Although the function of RPE65 is not yet known, an important role in the RPE/photoreceptor vitamin-A cycle is suggested by the fact that RPE65 associates both with serum retinol-binding protein and with the RPE-specific 11-cis retinol dehydrogenase, an enzyme active in the synthesis of the visual pigment chromophore 11-cis retinal. Here we report that the analysis of RPE65 in a collection of about 100 unselected retinal-dystrophy patients of different ethnic origin revealed five that are likely to be pathogenic mutations, including a missense mutation (Pro363Thr), two point mutations affecting splicing (912 + 1G-->T and 65 + 5G-->A) and two small re-arrangements (ins144T and 831del8) on a total of nine alleles of five patients with arCSRD. In contrast to other genes whose defects have been implicated in degenerative retinopathies, RPE65 is the first disease gene in this group of inherited disorders that is expressed exclusively in the RPE, and may play a role in vitamin-A metabolism of the retina.

Inflammatory cells and myocardial fibrosis: spatial and temporal distribution in renovascular hypertensive rats

OBJECTIVE

The fibroblasts producing collagen are co-localized with inflammatory cells in myocardial fibrosis areas of spontaneously hypertensive rats, suggesting that collagen overproduction in this model may be modulated by inflammatory cells. The present study extends these observations to the Goldblatt model of hypertension in which the renin-angiotensin system is activated.

METHODS

Inflammatory cells were identified with monoclonal antibodies directed against macrophages (ED1+), T helper (CD4+) and cytotoxic lymphocytes (CD8+), and MHC class II-expressing cells (Ia+). The alkaline phosphatase-anti-alkaline phosphatase (APAAP) immuno-staining technique was used. A new computer-assisted morphometric method was utilized to quantify the inflammatory infiltrate in each cardiac compartment with polarized-light microscopy. Cells responsible for the collagen synthesis were identified by in situ hybridization. The collagen content was estimated by morphometry on left ventricle sections stained with Sirius red, and by biochemical quantification of the hydroxyproline concentration.

RESULTS

Computer-assisted morphometry under polarized light was well suited to quantify inflammatory cells labeled by the APAAP technique. Inflammatory cells were co-localized with collagen-synthesizing fibroblasts. The main inflammatory cells were CD4+ lymphocytes > Ia+ > ED1+ > CD8+ cells. These cell densities were increased in hypertensive rats in all cardiac areas compared to control rats except for IA+ cells which were concentrated in microscars. Macrophage density was correlated with plasma renin activity. The inflammatory cell density which best correlated with fibrosis was macrophage density, and which best correlated with systolic blood pressure was macrophage and T helper lymphocyte densities.

CONCLUSIONS

One can speculate that the correlation between macrophage density and blood pressure as well as with plasma renin activity may indicate that angiotensins and/or elevation of blood pressure could participate in the initial signalling which may mobilize inflammatory cells. These inflammatory cells could promote fibrosis by releasing mediators such as growth factors or cytokines which act upon fibroblasts.

Elevated serum levels of interleukin-12 in chronic progressive multiple sclerosis

The serum levels of the heterodimeric cytokine IL-12 were measured by solid-phase ELISA in a group of healthy subjects, multiple sclerosis (MS) patients with secondary chronic progressive course of the disease and patients suffering from other neurological diseases (OND). Serum levels of IL-12 higher than 5 pg/ml (limit of sensitivity of the assay) were only found in 2/30 (6.7%) of the healthy subjects and none of the 8 subjects with OND. In contrast, IL-12 was found in the majority of CPMS patients' sera (10/15, 66.7%) with values ranging between 5.5 and 18.6 pg/ml. These results are suggestive for an up-regulated production of IL-12 in CPMS.

Circulating serum levels of IL-1ra in patients with relapsing remitting multiple sclerosis are normal during remission phases but significantly increased either during exacerbations or in response to IFN-beta treatment

Interleukin (IL)-1 receptor antagonist (IL-1ra) is a naturally occurring inhibitor of IL-1 which binds to IL-1 receptors without generating immunologic responses. Evidence has recently been provided that the balance between the production of IL-1 and IL-1ra might influence the course of immunoinflammatory diseases such as inflammatory bowel diseases, rheumatoid arthritis (RA) and Lyme arthritis. To assess whether endogenous IL-1ra may also have a role on the course of multiple sclerosis (MS) we presently studied the fluctuation of the serum levels of IL-1ra in patients with relapsing remitting (RR) MS either during remission or exacerbation. Moreover, to evaluate whether the beneficial effect of IFN-beta on the course of MS might also be mediated by an increased production of IL-1ra, we measured the levels of circulating IL-1ra in MS patients prior to and after 6 months of continuous treatment with natural human IFN-beta (6,000,000 IU three times a week for 6 months). Our results demonstrated that, relative to control subjects, IL-1ra serum levels are "normal' during remitting phases of RR MS but significantly elevated either during exacerbations or in response to IFN-beta treatment.

An alternative quantitative polymerase chain reaction method

The exponential nature of the polymerase chain reaction (PCR) makes quantitation of amplified products possible only if the efficiency of the enzymatic steps is estimated or cast off. To obtain a relative quantitative measurement of the reverse transcription (RT)-PCR products, a series of seven progressive dilutions achieved by mixing RNA solutions of two different samples to be compared was prepared in a constant final volume. An aliquot of each dilution mix was submitted to a standard RT-PCR. This range of concentrations allowed the elimination of the tube-to-tube efficiency variations. Indeed, after gel densitometric analysis of the amplified products, the alignment of the seven measurements along a regression line demonstrated that the PCR efficiencies in all tubes was equal allowing a direct comparison between the two samples. To illustrate this method, the renal erythropoietin (EPO) expression level was compared in anemic and control rats. Reverse transcription was performed using specific primers for EPO and GAPDH genes. The EPO mRNA expression was also checked by Northern blotting. Quantitative PCR indicated that anemic rats produced 19 times more EPO mRNA than did control rats. The results from Northern blotting matched with those of PCR. This simple new method does not provide absolute amounts of nucleic acid but relative ones, and it works with any set of primers. It could be used alternatively to methods such as competitive RT-PCR.

Mediators of perivascular inflammation in the left ventricle of renovascular hypertensive rats

OBJECTIVE

Inflammatory cells invade the fibrotic myocardium of spontaneously hypertensive rats at the same sites as where fibroblasts are produced. The role of these inflammatory cells in myocardial fibrogenesis was studied in the present work.

METHODS

The production and distribution of proteins that may be implicated in inflammation was examined by immunohistochemistry of sections of left ventricles from 1-month and 4-month renovascular hypertensive and age-matched control rats using antibodies against ICAM-1, LFA-1, TGF beta 1, PDGF-A, T and H kininogens, IgG, IgM, C3, and C5b-9. Infiltrating inflammatory cells were phenotyped by immunohistochemistry. The TGF beta 1 and PDGF-A mRNA levels were checked by RT-PCR.

RESULTS

Infiltrating cells were mainly T helper lymphocytes and macrophages, and there were more inflammatory cells in hypertensive rats than in control rats, localized especially around coronary arteries and in microscars. There were more ICAM-1 and LFA-1 in the ventricles of hypertensive than in control rats at 1 month, but the ICAM-1 expressions in hypertensive and control rats were similar at 4 months. TGF beta 1 and PDGF-A mRNA steady states increased in 4-month hypertensive rats, but there was no labeling for TGF beta or PDGF by immunohistochemistry. There was only faint labeling for T and H kininogens, and it was not increased in hypertensive rats. There were deposits of IgM and C5b-9 only in hypertensive rats.

CONCLUSION

Thus, inflammatory cells infiltrate the cardiac tissue of renovascular hypertensive rats as in the case of spontaneously hypertensive rats and these cells may use the ICAM-1/LFA-1 system to infiltrate, but neither TGF beta 1 and PDGF-A, nor the kininogen system seem to be associated with cardiac fibrogenesis. Otherwise, the complement system could act as arteriosclerotic and/or leukocyte mobilizing factors.

Prevalence of epilepsy. A door-to-door survey in the Sicilian community of Riposto

In a door-to-door survey of common neurological disorders in Sicily (SNES Project), we administered a screening symptoms questionnaire and a brief neurological examination to detect epileptic patients. All of the subjects effectively resident in the community of Riposto on 1 November 1987 (prevalence day) were investigated (n = 9956). The subjects with a positive questionnaire or a previous diagnosis of epilepsy were extensively examined by a neurologist and then definitively classified for epilepsy by a panel of senior neurologists. The crude prevalence of active and non-active epilepsy was 3.21/1000; the prevalence of active epilepsy alone was 2.71/1000. Of the 27 active cases, sixteen were affected by generalized tonic-clonic seizures, four by absences and four by complex partial attacks. All except two were being treated with antiepileptic drugs, most with phenobarbital. Our prevalence rate is lower than that reported by most authors, but similar to the rates in other Sicilian communities.

Right ventricular late filling termination time and its relation to interstitial collagen content in early transplanted heart: a color M-mode Doppler digital analysis

BACKGROUND

Histologic changes in cardiac allografts resulting from fibrosis or acute rejection can modify ventricular diastolic function and ventricular inflow characteristics. These abnormalities may be detected by color M-mode Doppler echocardiography which has been shown to be sensitive in assessing ventricular diastolic function.

METHODS

Twelve cardiac allograft recipients were prospectively studied with serial color M-mode and single-gated Doppler echocardiography, as well as with endomyocardial biopsy, with a follow-up of approximately 10 weeks. The myocardial interstitial collagen content as evaluated by videodensitometry was compared with right and left ventricular late filling termination times measured in the absence of a severe episode of rejection.

RESULTS

A positive and significant correlation was found between the collagen content and the corresponding right ventricular late filling termination time (r = 0.89, p < 0.0001), but no correlation was found with the left ventricular late filling termination time. Moreover, variations in collagen content and variations in right ventricular late filling termination time were also highly correlated (r = 0.91, p < 0.0001). In allograft recipients who had episodes of rejection of grade 3A or greater, both right and left ventricular late filling termination times were significantly increased during rejection.

CONCLUSIONS

Measurements of right ventricular late filling termination time by color M-mode Doppler echocardiography performed in the absence of acute rejection can be use to monitor the evolution of interstitial collagen content in cardiac allografts. The early detection of abnormally prolonged late filling termination time could be followed by endomyocardial biopsy to confirm the histologic changes.

Cardiac angiotensin converting enzyme overproduction indicates interstitial activation in renovascular hypertension

OBJECTIVES

Angiotensin converting enzyme (ACE) activity in the plasma does not change significantly with hypertension in two-kidney, one-clip hypertensive (2K-1C) rats. However, heart ACE activity and mRNA increase with hypertension. We measured the ACE activity and mRNA in hypertrophied hearts at different times after clipping, and determined the cellular distribution of its increase in the left ventricle of 2K-1C hypertensive rats.

METHODS

Cardiac ACE activity was quantified in left and right ventricles using a radiolabeled synthetic ACE substrate, and ACE mRNA steady-state level was quantified by ribonuclease protection assay. Tissue localization of ACE in normal and hypertrophied hearts was determined by measuring ACE activity in isolated ventricular cells. In situ hybridization with a rat ACE cDNA and immunohistochemistry with a monoclonal anti-ACE antibody were used to identify tissue compartments producing ACE mRNA and protein.

RESULTS

The left ventricle was hypertrophied 2 weeks after clipping and remained hypertrophied at 12 weeks. Left ventricular ACE activity was significantly increased 2 and 4 weeks (3.2 +/- 0.3 in 2K-1C vs. 1.7 +/- 0.1 pmol/mg prot/min in sham-operated rat) after renal artery clipping, but not at 12 weeks. The right ventricle was slightly hypertrophied 4 weeks after clipping and remained hypertrophied at 12 weeks. Right ventricular ACE activity was significantly increased at 4 (6.7 +/- 0.6 in 2K-1C vs. 3.1 +/- 0.3 pmol/mg prot/min in sham-operated rat) and 12 weeks. ACE activity was not detectable in cardiomyocytes isolated by Percoll gradient. Neither was ACE mRNA detected in isolated cardiomyocytes, even after ACE mRNA amplification by RT-PCR. In contrast, ACE activity and mRNA were detected in pooled non-cardiomyocytic cells. Thus the increase in cardiac ACE activity associated with hypertension must be due to an increase in ACE expression by non-cardiomyocytic cells. In situ hybridization showed an autoradiographic signal for ACE mRNA over the endothelial cells of coronary arteries and over the interstitial spaces including pericoronary and fibrosis areas. Immunohistochemistry confirmed these data, showing ACE on endothelial cells and in pericoronary spaces with an increased signal in pericoronary and fibrosed areas in hypertensive hypertrophied left ventricle.

CONCLUSION

Besides its usual endothelial expression, ACE is absent from cardiomyocytes and present in interstitial tissue, in the pericoronary spaces in normal tissue and more markedly in hypertrophied ventricles.

Left ventricular fibrosis in renovascular hypertensive rats. Effect of losartan and spironolactone

Myocardial fibrosis resulting from arterial hypertension alters myocardial structure and function. Myocardial fibrosis is characterized by a pathological accumulation of types I and III collagens. We used an aldosterone antagonist (spironolactone) and an angiotensin II antagonist (losartan) to elucidate the respective role of these hormones and hypertension in the development of myocardial fibrosis in the Goldblatt model of two-kidney, one clip hypertension in the rat. Fibrosis was assessed by computer-assisted morphometry in the interstitial space, around coronary arteries, in microscar areas, and on left ventricular sections stained with Sirius red and by biochemical techniques. Morphometry was performed with both standard light and polarization microscopy; this latter method was used to quantify yellow-red and green collagen fibers. Concurrently, type I and type III collagen mRNAs were evaluated by a semiquantitative polymerase chain reaction method. The collagen content of the untreated two-kidney, one clip hypertensive rats increased mainly around the coronary arteries; the number and surface area of microscars also increased in chronic hypertension. Losartan treatment decreased systolic pressure and yellow-red collagen fiber content in all areas, whereas spironolactone treatment decreased green collagen fiber content without decreasing systolic pressure. mRNA levels for types I and III collagens showed profiles similar to those of yellow-red and green collagen fiber contents, respectively, suggesting that yellow-red collagen fibers are mainly type I collagen fibers and green collagen fibers are mainly type III collagen fibers. These results suggest that angiotensin II, possibly together with hypertension, and aldosterone, independently of hypertension, have a major influence on myocardial fibrosis, inducing type I and type III collagen deposits, respectively, mainly around coronary arteries.

Molecular and biochemical characterization of the mouse brain corticotropin-releasing hormone-binding protein

A 37 kDa corticotropin-releasing hormone-binding protein (CRH-BP), distinct from the CRH receptor, is expressed in rat anterior pituitary corticotrophs and many regions of the brain, suggesting that CRH-BP may modulate the biological activity of CRH. In these studies a mouse brain CRH-BP (mCRH-BP) cDNA has been isolated and characterized. The 1666 nucleotide mCRH-BP cDNA is expressed in brain and pituitary and encodes a 322 amino acid protein that is highly homologous to human and rat CRH-BPs. Recombinant mCRH-BP, expressed in cultured mammalian cells, binds human CRH (Kd(app) = 0.56 nM and Ki(app) = 0.37 nM) and the alpha-helical (9-41) CRH antagonist (Ki(app) = 0.28 nM) with high affinity, but exhibits much weaker affinity for ovine CRH (Ki(app) = 206 nM). Recombinant mCRH-BP also blocks CRH-induced adrenocorticotropin release from AtT-20 cells. Additional biochemical characterization of the binding activity of mCRH-BP indicates that CRH-BP and CRH receptor utilize different molecular interactions to bind CRH.

Short therapy for tinea unguium with terbinafine: four different courses of treatment

Terbinafine has partly solved the well-known problems in the treatment of dermatophyte nail infections. The aim of our study was to assess the effectiveness of very short treatment of dermatophyte nail infections with four different courses of terbinafine with or without chemical onycholysis. For this purpose, 60 patients, divided into four groups, were given different courses of treatment with oral terbinafine. Clinical, mycological and tolerability tests were performed before, during and after treatment. Clear microscopy and culture findings confirmed cure rates in the four groups of 95%, 95%, 70% and 100% without any side-effects. In conclusion, terbinafine has proved to be effective and well tolerated in the very short-term treatment of dermatophyte nail infections.

Molecular characterization of the human gene encoding an abundant 61 kDa protein specific to the retinal pigment epithelium

The retinal pigment epithelium (RPE) of the eye expresses an abundant 61 kDa protein (RPE65), that is developmentally regulated and tissue-specific. In our efforts toward understanding the specialized functions and development of the RPE, and the origins of inherited retinal degenerations, we have characterized the human gene encoding the 61 kDa protein. This is the first structural characterization of a gene transcribed specifically in the RPE. The gene maps to human chromosome 1p31. The sequence encoding the transcript spans over 20 kb, and is interrupted by 13 introns. A putative transcription start site lies 54 bp upstream of the initiation codon. A single transcript of approximately 2.9 kb is present in human RPE, and is not detected in other tissues. The deduced 533 amino acid sequence of the human protein is 98.7% identical to the bovine, but shows no significant similarity to any other entry in the databases. Expression of the 61 kDa protein appears to depend on the presence of environmental cues, since the corresponding transcripts are rapidly lost from RPE cells established in culture. Down regulation may occur post-transcriptionally, since AU-rich elements proposed to target RNA for rapid degradation are present throughout the 3'-untranslated region. The tissue-specific expression, high abundance, evolutionary conservation, developmental regulation, and sequence of the 3'-untranslated region suggest that the 61 kDa protein is the product of a functionally important gene whose expression is tightly regulated.

Colocalization of myocardial fibrosis and inflammatory cells in rats

BACKGROUND

Left ventricular overload and aging lead to an increase in fibrosis in the rat cardiac interstitium. The relationship between fibrosis, fibroblast activity, and inflammatory cell infiltration, was explored in spontaneously hypertensive rats (SHR) and Wistar controls.

EXPERIMENTAL DESIGN

The left ventricle of three groups of eight SHR and eight Wistar controls hearts were sectioned for light microscopy, immunohistochemistry, and in situ hybridization with a cDNA probe encoding the murine alpha 1 chain of type I collagen. Fibrosis was measured morphometrically. Monoclonal antibodies directed against Ia antigen, CD8+ cytotoxic, CD4+ helper lymphocytes and monocyte/macrophages were used to localize and quantify the inflammatory cells.

RESULTS

In 2-month-old rats, with nearly normal interstitial cardiac tissue, fibroblasts expressing collagen mRNA were located around coronary vessels. The areas of fibrosis and interstitial cellular infiltration were more extensive in 22-month-old rats than in 12-month-old rats and greater in SHR than in Wistar. Fibroblasts expressing collagen mRNA were mainly found at the border between fibrosis and myocytic cells, and were always colocalized with lymphocytes and macrophages. The interstitial areas of fibrosis and collagen I expressing fibroblasts had the same pattern of infiltrating cells in normotensive rats than in SHR. Fibrosis and the density of macrophages and CD4+ lymphocytes were correlated.

CONCLUSIONS

Thus, fibroblast activity could be closely related to the presence of lymphocytes and macrophages in the myocardium of spontaneously hypertensive and aged rats.

Preliminary evaluation of immunoadjuvant activity of an orally administered glucan extracted from Candida albicans

The immunoadjuvant activity of an orally administered glucan (Glucanil, Gluimmun) was investigated in mice. Glucan was extracted from Candida albicans ATCC 20955 and purified by an alkali-acid and detergent treatment. In this study the chronic intravenous infection with Candida albicans (treated or not with amphotericin B) or Staphylococcus aureus was the experimental model. Moreover the production of interleukin-2 was evaluated in treated animals. Oral treatment with glucan at 1 mg/mouse/day repeated doses, starting from 10 days before the experimental infection, significantly increased polymorphonuclear leukocytes and peripheral monocytes number. A significant increase in number and in vitro candidacidal activity was also observed for alveolar macrophages. The resistance towards systemic infection with Candida albicans or Staphylococcus aureus increased, significantly reducing the growth of microorganisms in the kidneys of infected animals. Glucan significantly increased the candidacidal spleen cells activity and synergized with amphotericin B chemotherapeutic action. Higher doses (eg. 2 or 5 mg/mouse) were not effective. A 10 days oral treatment with 1 mg/mouse/d significantly increased the interleukin-2 production. Toxicological studies showed that glucan is highly tolerated.

Microbiological considerations of the etiological agents of lower respiratory tract infections

One hundred eight-four sputum specimens from the same number of patients with lower respiratory tract infections were examined to determine the bacterial count and the relationship between the microorganisms isolated and the presumptive pathology. The sputa were subdivided into three groups; "high probability", "low probability", and "contaminated sputa", following the criteria of the microscopic readings: sputum with more than 25 white cells and low numbers of squamous epithelial cells represents true lower respiratory tract infections (high probability); those with fewer than 25 white cells represent non-bacterial infections or non-infected sputa (low probability) while sputa with more than 25 squamous cells per field represent contaminated specimens (contaminated sputa). Statistical analysis was carried out to correlate these data. Haemophilus influenzae, Haemophilus parainfluenzae, Streptococcus pneumoniae, and Streptococcus pyogenes showed significant differences in the three groups considered.

[Unilateral nevoid syringoma]

A case of unilateral naevoid syringoma is reported. Syringoma is an adnexal benign neoplasia originating from the ducts of eccrine sweat glands. Localized (neck, anterior portion of the chest, genitalia, fingers) and generalized forms are known, but unilateral naevoid syringoma is quite uncommon. The existence of this variety can be explained with reference to the theory of "genetic mosaicism".

[Psoriasis and bullous pemphigoid. Description of 3 clinical cases]

Three cases with coexisting psoriasis and bullous pemphigoid are reported and the possible etiopathogenetic relationships between the two diseases are discussed.

[Skin metastasis of clear cell carcinoma of the kidney]

A case of a 70 year old man, affected by a solitary cutaneous metastasis of a clinically asymptomatic clear cell adenocarcinoma of the kidney is reported and some histopathological differential diagnoses are considered.

[Lichen aureus with zonal dissemination. Apropos of a case]

The Authors describe the case of a 23 year old woman affected by lichen aureus in a zosteriform pattern localized at the right side of the trunk.