Substance P levels are decreased in lesional skin of atopic dermatitis

There is increasing evidence that neuropeptides (NP) such as substance P (SP) and vasoactive intestinal polypeptide (VIP) are involved in the pathogenesis of atopic dermatitis (AD). Vasoactive intestinal polypeptide levels were found to be significantly elevated in lesional skin of AD as compared to controls. We evaluated by radioimmunoassay the SP content in whole skin homogenates from chronic lichenified lesions of patients with AD. The levels of SP were significantly decreased in lesional skin from AD patients as compared to control skin (0.25 +/- 0.03 vs. 0.97 +/- 0.24 pmol/g tissue, p < 0.01). The diminished SP levels as opposed to increased VIP concentrations could be consistent with different roles of these NP as modulatory agents in the mechanisms associated with AD.

Cutaneous innervation in chronic renal failure patients. An immunohistochemical study

Most chronic renal failure patients suffer from generalized pruritus. An involvement of cutaneous nerve terminals in the pathogenesis of uremic pruritus has been suggested. Skin specimens from 24 uremic patients and 10 healthy subjects were processed with an indirect immunofluorescence method to investigate the presence and distribution of a number of neuronal markers and neuropeptides. No difference was found between the two groups in the distribution pattern of the positive nerve fibres. However, a reduction in the total number of skin nerve terminals in the uremic patients was detected. No correlation could be found between the immunohistochemical findings and the clinical features. Our results suggest that the skin innervation is altered in most chronic renal failure patients, possibly as a consequence of neuropathy.

Substance P Is Diminished and Vasoactive Intestinal Peptide Is Augmented in Psoriatic Lesions and These Peptides Exert Disparate Effects on the Proliferation of Cultured Human Keratinocytes

An involvement of neurogenic components in the pathogenesis of psoriatic lesions has been suggested and neuropeptides are thought to play a modulatory role in cutaneous inflammation. In this study, we evaluated the immunoreactivity of the neuropeptides vasoactive intestinal polypeptide (VIP) and substance P (SP) in the skin of patients with chronic plaque psoriasis, by immunohistochemistry and radioimmunoassay. No differences were observed, by immunohistochemistry, in the expression and localization of VIP and SP between psoriatic and normal skin. Using the radioimmunologic technique on whole skin homogenates, VIP levels were significantly increased in psoriatic lesions as compared to normal skin. By contrast, SP levels were significantly lower in lesional and non-lesional psoriatic skin than in normal skin. In addition, we examined the effect of VIP and SP on the proliferation of cultured normal human keratinocytes. VIP (1-28) (1 nM-1 microM) as well as VIP fragments (10-28) (1 nM-1 microM) and (22-28) (1 nM-1 microM) stimulated the proliferation of keratinocytes in a dose-dependent manner, whereas the VIP fragment (1-12) (1 nM-1 microM) was ineffective. The VIP antagonist (N-Ac-Tyr1, D-Phe2)-GRF (1-29)-NH2 (0.1 microM) significantly inhibited the VIP effect on keratinocytes. On the other hand, SP (0.1 microM) not only failed to stimulate keratinocyte growth, but also blocked the VIP-induced stimulation of these cells. The imbalance of cutaneous VIP and SP and their disparate effects on the proliferation of normal human keratinocytes in culture would suggest that these peptides are involved in the pathogenesis of psoriasis and may exert different modulatory activities in the mechanisms underlying the psoriatic lesion.

Early hemodynamic results of left ventricular reconstructive surgery for anterior wall left ventricular aneurysm

To assess the efficacy of left ventricular (LV) reconstruction after aneurysmectomy, 35 consecutive patients with anterior LV aneurysm were studied before and after surgery. Surgical technique was performed by applying a circular patch after aneurysmectomy to maintain a "more physiological" LV cavity. Myocardial revascularization was performed in all but 1 patient concurrently. Global perioperative mortality was 4.8%. LV filling pressure and volumes and regional wall motion were assessed before and after surgery. The major indication for surgery was angina; 8 patients were in New York Heart Association class III/IV. The results showed a significant decrease in end-diastolic volume index (from 120 +/- 55 ml/m2 to 76 +/- 22 ml/m2, p less than 0.001), end-systolic volume index (from 74 +/- 44 ml/m2 to 40 +/- 18 ml/m2, p less than 0.001) and end-diastolic pressure (from 17 +/- 7 mm Hg to 13 +/- 5 mm Hg, p less than 0.05). Ejection fraction significantly increased (from 39 +/- 13% to 49 +/- 15%, p less than 0.001). LV wall motion significantly improved in all but the anterobasal region; the extent of LV asynergy significantly decreased after surgery. Six of the 35 patients had a deterioration of postintervention ejection fraction (from 44 +/- 14% to 34 +/- 9%). They had no reduction in LV volumes and no improvement in wall kinetics. It is concluded that LV reconstruction after aneurysmectomy induces significant early improvement of global and regional LV function in most patients; postoperative functional improvement is mainly related to the increase in inferior LV wall motion.

[Transcoronary chemical ablation of ventricular tachycardia in a patient with chronic chagas cardiomyopathy]

A case of recurrent ventricular tachycardia in the setting of chronic chagasic heart disease refractory to conventional antiarrhythmic agents as well as high doses of amiodarone (600 mg/day) is reported. Left ventriculography disclosed an apical aneurysm and a filling defect image suggestive of a thrombus. Sustained monomorphic ventricular tachycardia with the same QRS configuration as "clinical" tachycardia could be induced by means of right ventricular programmed electrical stimulation. The risk of systemic embolization precluded endocardial activation mapping of ventricular tachycardia. Intracoronary cold saline injections were done during induced ventricular tachycardia looking for a coronary artery branch related to the arrhythmogenic substrate. Cold saline mapping results pointed to an apical site of origin. Next step was intracoronary injection of ethyl alcohol in the distal part of the left anterior descending artery leading to a small and uncomplicated myocardial infarction. Control programmed stimulation was unable to reinduce ventricular tachycardia. Clinical outcome was uneventful and there was no recurrence of clinical arrhythmia in 6 months of follow-up.

Neuron-specific enolase is a marker of cutaneous Langerhans' cell histiocytosis ("X")-a comparative study with S100 protein

The immunohistochemical expression of neuron-specific enolase (gamma/gamma) (NSE) was studied comparatively with S100 protein in a group of Langerhans-cell-type ("X") (n = 8) and non-Langerhans-cell-type ("non X") (n = 24) cutaneous histiocytoses. NSE was expressed by the majority (70-90%) of histiocytic cells in all cases of Langerhans-cell histiocytoses, whereas it was absent from non-Langerhans-cell histiocytoses. S100 protein was expressed by the majority of Langerhans-cell histiocytosis cells but also by a small percentage (1-5%) of cells in non Langerhans-cell histiocytoses. These results show that NSE is almost as sensitive as, but more specific than, S100 protein in discriminating Langerhans-cell from non-Langerhans cell cutaneous histiocytoses, and that it consequently represents a useful adjunct in the immunohistochemical diagnosis of histiocytic skin diseases.

Skin levels of vasoactive intestinal polypeptide in atopic dermatitis

Atopic dermatitis (AD) can be exacerbated by various factors, including emotional stress, scratching and sweating. The aim of the present study was to evaluate the hypothesis that the inflammatory reaction in AD is also neurogenic. For this purpose, the levels of vasoactive intestinal polypeptide were measured radioimmunologically in whole-tissue homogenates of lesional skin of 13 patients with atopic dermatitis. Radioimmunoassay was performed using an antiserum, AH78, recognizing the carboxy-terminal fragment vasoactive intestinal polypeptide (22-28). Vasoactive intestinal polypeptide immunoreactivity was detected in relatively low amounts in control skin (0.428 +/- 0.08 pmol/g tissue), whereas a marked increase in the peptide was observed in lesional skin of patients with atopic dermatitis (5.62 +/- 1.25 pmol/g tissue). These results seem to suggest that vasoactive intestinal polypeptide could have a pathogenetic relevance in skin lesions of atopic dermatitis.

Evaluation by dual-photon absorptiometry of bone mineral loss in rheumatic children on long-term treatment with corticosteroids

The introduction of reliable and non-invasive methods of measuring bone mass has allowed investigators to study the bone mass loss (ostopenia) related to rheumatic diseases and corticosteroid therapy. Serial measurements of lumbar bone mineral density (BMD) by dual-photon absorptiometry (DPA) is an effective method of checking bone mineralisation. In children, however, the bone mass is not constant over time, so bone densitometric measurements must take into account not only the net loss but also the missing increase in BMD. In order to study the effects of both chronic rheumatic disease and the long-term administration of corticosteroids in children, as a first step the reference curves of bone mineralisation (mean BMD values and annual % BMD growth rates) were calculated from a control population of 79 children (32 males and 47 females) aged 3 to 20 years. All the subjects involved in the study underwent DPA utilising a Norland Bonestar instrument provided with a 153 Gadolinium source and the average BMD (g/cm2) of the lumbar spine was calculated. As a second step, a transverse study was carried out on a series of 157 children and young adults affected by chronic rheumatic diseases with juvenile onset. As a third step, a longitudinal study on the adverse effect of the chronic administration of corticosteroids on bone mineralisation was carried out on a series of 58 patients affected by chronic rheumatic diseases with juvenile onset who were being treated with long-term corticosteroids. Serial measurements of bone mass should help us to improve our strategies in preventing and counteracting osteopenia due to the chronic administration of corticosteroids also in children.

[Ventricular fibrillation in a patient with ventricular dysplasia and mitral valve prolapse]

A 30 year-old male patient with arrhythmogenic right ventricular dysplasia was submitted to implantation an automatic cardioverter-defibrillator. So far he is well in a follow-up of 7 months.

[Rheumatic fever]

While rheumatic fever (RF) remains a major problem in underdeveloped countries, in continental United States and Western Europe the incidence of this disease declined markedly in the sixties and reached a nadir during the seventies. However in the last eighties a resurgence of RF has been documented in some areas of the United States with an eightfold increase of incidence over the prior 15 year average. Although a true outbreak of RF has not been documented in Italy, a trend towards an increased number of new cases per year has been observed at the Centre for Rheumatic Children at the Gaetano Pini Institute in Milan. Most of these children presented a mild disease with clinical features rather different from those described in classical textbooks. Most of them satisfied the revised Jones' criteria, in some cases the objective signs of arthritis could not be noticed, but the joint involvement presented as marked arthralgia while other features supported the diagnosis of RF. Rheumatic carditis was observed in more than 1/3 of cases with a high rate of residual valvular heart disease of a mild degree of severity in most cases. In conclusion RF has not completely disappeared in Italy and remains as a possible cause of permanent valvular heart damage in children. It is possible that the increasing morbidity observed in the last eighties may be related to the reduced primary prophylaxis against streptococcal infections due to the wrong conviction that RF is no more a risk in developed countries.

[Reactive arthritis]

The term reactive arthritis was introduced to describe an acute non-purulent arthritis complicating an infection elsewhere in the body. Reactive arthritis can also be classified into HLA-B27 associated and non-associated forms. Rheumatic fever is an example of the HLA-B27 non-associated forms with genetic factors other than HLA-B27 involved. HLA-B27 associated reactive arthritis includes enteric, urogenic and idiopathic arthritides. The bacteria known to trigger post-enteritic reactive arthritis are: Yersinia, Salmonella, Shigella, Campylobacter, Clostridium difficile and Brucella; those known to trigger post-urethritic reactive arthritis are Chlamydia trachomatis and Ureaplasma urealyticum, but often the germ remains unidentified. Mechanisms through which susceptibility to reactive arthritis is linked to HLA-B27 antigen are still incompletely understood, but a clue could be cross-reactivity between B27 and a surface antigen of pathogenic germs. The clinical profile of the disease is characterized by an asymmetrical oligoarthritis with involvement particularly of the peripheral joints of the lower limbs. The arthritis generally recovers without sequelae within a few weeks or months. Accompanying features can be the involvement of enthesis and tendon sheets in form of a talalgia or dactylitis. In some cases the arthritis can relapse and chronicize. In some cases, in addition, involvement of the axial skeleton can occur (spondylitis and/or sacroiliitis). Another feature of the disease is the frequent association with typical extra-articular manifestations such as uveitis and muco-cutaneous lesions.

[Mortality study of workers employed in the construction of railway cars in Collefero]

The mortality of 276 workers employed in a facility for the manufacturing and maintenance of railroad equipment has been studied in the town of Colleferro (province of Rome). The cohort was based on the 1968 payrolls, and follow-up was conducted up to 1988. Exposure to asbestos took place both during insulation (performed by specialized companies in the same workplaces where study subjects were operating) and during repair work. Mortality for all causes was lower than expected (45 observed, SMR: 71), while mortality from all neoplasms was consistent with expected figures (21 observed, SMR: 107). An increase for respiratory neoplasms was observed (10 observed, SMR: 138); the increase was statistically significant allowing for 20-30 years of latency (7 observed, SMR: 337).

Effects of diltiazem on postextrasystolic potentiation in coronary heart disease patients

The effects of the calcium antagonist, diltiazem (D), on left ventricular (LV) response to postextrasystolic potentiation (PESP) were investigated in 15 coronary artery disease patients. Several haemodynamic and LV function parameters, as well as regional wall kinetics, were analysed. During LV angiography, which was performed before and after D administration (0.25 mg kg-1 bolus and 1.4 microgram kg-1 min-1 infusion), programmed atrial stimulation was applied with the sequence: S1-S1 = 600 ms; S1-S2 = 400 ms; S2-S3 = 800 ms. The results indicate that D exerts a mild negative inotropic effect which is more evident in the postextrasystolic beat (postextrasystolic ESP/ESV and dP/dtmax were significantly lower after D) but the postextrasystolic increase of EF is maintained by the effects of the drug on loading conditions of the left ventricle. Our results indicate that both a reduction of afterload and an increase of preload take place after D. The greater preload reserve induced by the drug (EDVI was significantly higher in each patient after D) was associated with a slight increase in left ventricular filling rate, while end-diastolic compliance and pressure did not show significant variations. These results suggest that the increase in left ventricular preload is due to an increase in left atrial driving pressure, an improvement of left ventricular relaxation or both. D does not affect regional wall kinetics either in basal or in the postextrasystolic beat when overall areas are considered, however its effect seems to be related to the degree of basal regional contraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Neuropeptides in skin from patients with atopic dermatitis: an immunohistochemical study

The distribution and localization of several neuropeptides were investigated in the lichenified lesions of 11 patients with atopic dermatitis using indirect immunofluorescence. Substance P-positive nerve fibres were observed in most of the cases of atopic dermatitis, but not in normal controls. Somatostatin immunoreactive nerves were not found in the skin of atopic dermatitis, whereas a normal pattern of immunoreactivity could be detected in most of the healthy subjects. Neuropeptide Y-positive dendritic epidermal cells were observed in lesional skin from patients with atopic dermatitis, but not in controls. Calcitonin gene-related peptide and vasoactive intestinal polypeptide immunoreactivity in patients with atopic dermatitis did not differ from that in healthy subjects. With galanin antiserum a diffuse intracellular staining was observed in the epidermis of both atopic patients and controls, while no positive staining was found with either neurotensin or neurokinin A antibodies in either group. These findings suggest a possible involvement of some neuropeptides in the pathomechanisms of atopic dermatitis.

Is onset type evaluated during the first 3 months of disease satisfactory for defining the sub-groups of juvenile chronic arthritis? A EULAR Cooperative Study (1983-1986)

This study represents an attempt to collect observations from co-operating countries to evaluate the previously suggested criteria for juvenile chronic arthritis during the onset periods 0-3 and 3-6 months, preferably studied prospectively. Only 267 of 378 forms returned were satisfactory for inclusion because of failure to observe exclusion criteria or insufficient information. Despite this it was possible to conclude that systemic disease represented 25% of the group and that these features tended to decline during the 6 month period. Gut inflammation was seen in 4.5% and the frequency of chronic iridocyclitis increased during the observation period to 4.5%. Variation in joint state during this period suggests that course classification may be important, as 23 of 118 who were pauciarticular at 3 months became polyarticular by six months, but only 46 of 76 who were polyarticular at 3 months remained in this state at six months.

Abnormalities of left ventricular shape in patients with stable angina

In this study, left ventricular shape was evaluated quantitatively by calculating the power spectrum and the regional curvatures of angiographic outlines as seen in the right oblique anterior projection. Two groups of patients were studied: 16 normal subjects and 16 patients with stable angina who were selected because of normal left ventricular function (normal left ventricular volumes, pressures, ejection fraction and no regional wall motion abnormality at subjective analysis of ventriculograms). The two groups did not differ in terms of mean age of the patients. Regional curvatures were calculated using the Frenet-Serret formula starting from the mitral corner (point 1) and extending to the aortic corner (point 90). The power spectrum was calculated by means of Fourier analysis. The ventricular shape during diastole of the patients with angina differed significantly from that of the normal group in that there was a greater posterobasal curvature; a lower curvature of the inferior wall showing an inward convexity; a greater parietal curvature of the inferoapical region and a minor curvature of the anterobasal region. The power spectrum differed significantly from that of the normal subjects. The 1st and 2nd harmonics were reduced and the 3rd, 4th, 5th and 6th ones increased. The end-systolic contour of the group of patients with stable angina showed a higher amplitude of the 3rd and 5th harmonics and a lower amplitude of the 1st, 2nd, 9th, 10th and 11th harmonics with respect to the group of normal patients. Regional curvatures showed significant differences between the two groups in the antero-basal region. These modifications of left ventricular shape in patients with stable angina did not appear to be related to age and/or heart rate; to abnormalities in hemodynamics and wall motion; or to acute ischemia. Abnormalities of shape in patients with stable angina, therefore, may indicate a remodeling of the left ventricle due to the structural effects (myocardial and/or interstitial) of chronic ischemia.

[Analysis of the shape of the left ventricle by studying the regional curvature and power spectrum. II. Morphologic changes in post-infarction ischemic heart disease]

The quantitative analysis of left ventricular shape in ischaemic heart disease has seldom been performed because of the lack of a reliable and reproducible method of analysis. Diastolic and systolic left ventricular outlines in two groups of patients with previous myocardial infarction (anterior in 13 cases and inferior in 14 cases) were studied by analyzing the regional curvature and the power spectrum. This method allowed us to obtain left ventricular curvatures from the mitral to the aortic corner and the power spectrum of the first 12 harmonics. The results obtained in these two groups were compared with those obtained in 16 normal subjects. The diastolic power spectrum in both infarcted groups was similar. It was characterized by a double peak which was different from that of the normal subjects. Slight differences between the two infarcted groups were due to the diverse amplitude of the highest harmonics. The regional analysis of the curvature in both groups showed similar abnormalities of the posterobasal, inferior and antero-basal regions. The posterior wall showed a uniform curvature with the point of minimum shifted towards the mitral corner; the anterior wall showed a rounded profile with a regular curvature. In the group with anterior myocardial infarction the curvature of the inferior wall was negative, i.e., convex towards the left ventricular cavity. The systolic power spectrum showed a double peak profile which was different from that of the normal subjects. There were some differences between the two groups as regards the first and the highest degree harmonics. In inferior myocardial infarction the apex was rounded whereas in the anterior one the most important abnormalities were the convexity of the inferior wall towards the inside and the presence of a region with minor curvature between two regions with greater curvature of the anterior wall. Some of the systolic abnormalities involved the probable site of the infarct while others were in remote regions. The meaning of remote abnormalities is not clear. However, we did not verify a correlation between wall motion, at least as shortening of radii, and regional curvature. The abnormalities of the diastolic outline were independent of the site of the infarct and did not appear to be correlated to end-diastolic pressure or to the ejection fraction. They seemed to be the morphological counterpart of the filling abnormalities reported in ischaemic cardiac disease and they may depend on the regional distribution of stresses.

[Analysis of the shape of the left ventricle by studying the regional curvature and power spectrum. I. Methodology and results in normal subjects]

Quantitative analysis of left ventricular shape, obtained by measuring the regional curvatures and power spectrum of the harmonics of left ventricular outlines, is a useful method that has seldom been used in clinical research because of the need for a reliable and replicable method. The curvature of each point of an outline is the reciprocal of the radius of the circle that best fits a segment of the arc (window) centred at any specified point. We proposed a method based on the rate of change of the tangent vector with respect to the change in arc length, normalized for the width of the considered segment (Frenet-Serret formula). The series of curvature values allows us to obtain the power spectrum by means of Fourier analysis. The application of the method to a series of ellipses with variable eccentricity and size demonstrated that the width of the window is critical in the circulation of the curvature, and the choice of the number of points for computing has to be optimized to obtain the best signal-noise ratio. The method, applied using a sampling every 0.1 mm and optimized using a window of 25 points in the experimental model, is independent of the size of the samples, is able to distinguish small variations of eccentricity and to separate the signal from the noise due to digitizing and computing up to the 12th harmonic. The method has been applied to the left ventricular outlines of 16 subjects without any cardiac abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)