The Unknown Role of Periostin in Psoriatic Epidermal Hyperplasia

Psoriasis is an inflammatory skin disease that affects 1-2% of the general population. The pathomechanism is based on type 1 immunological reactions. Hyperplasia of the epidermis in psoriasis is a result of disrupted epidermal architecture due to increased synthesis and expression of extracellular matrix proteins. In our study, we analyzed the involvement of periostin (POSTN) in the pathogenesis of psoriasis, as one of the extracellular matrix proteins belonging to the fasciclin family. The study group consisted of 70 patients with psoriasis, while the control group comprised 30 healthy individuals. The serum concentrations of POSTN, Il-6, Il-17, Il-22, TNF-α and IFN-γ were measured in all participants. The severity of psoriasis was determined using the PASI (Psoriasis Area and Severity Index) score. The presence of POSTN in biopsy samples of 50 patients was assessed using the direct immunofluorescence method. The results were subjected to statistical analysis. The serum concentrations of POSTN, Il-6, Il-17, Il-22, TNF-α and IFN-γ in the study group are significantly higher than in the control group. Positive correlation has been demonstrated between the PASI score and the investigated cytokines, but not with POSTN. There was no statistically significant correlation between the POSTN level and the cytokines levels. POSTN deposits were localized in the epidermis in 66% of patients with psoriasis. The role of POSTN in the pathogenesis of psoriasis remains unclear. The mechanisms inducing the synthesis and expression of POSTN in psoriatic skin are not yet fully understood. Further research is needed to enhance our understanding of the mechanism underlying epidermal hyperplasia in psoriasis.

Analgesic Effect of Fortral (Pentazocine) in Acute Intermittent Porphyria

Five patients, all suffering severe abdominal pain in acute intermittent porphyria, were admitted to an investigation of the analgesic effect of Fortral (pentazocine) in this condition.

A single dose of Fortral was given daily to each patient at the time of severe abdominal pain and an attempt was made to use the smallest possible dose to achieve an analgesic effect. The analgesic effect produced was considered good in two cases and excellent in the remaining three cases. Pain ceased or decreased to a great extent within ten to twenty minutes of administration of Fortral. The drug appeared to act as rapidly when given orally as when given by intramuscular injection. The analgesic effect persisted from two to six hours, with an average of four hours.

In the doses of 50 mg three patients demonstrated side-effects which could be avoided by dividing the single dose into smaller ones.

[Uniform programme in caring for patients with acute hepatic porphyria]

The programme commissioned by the Ministry of Health is presented. Data basis for the years 1996-1998 were created. A booklet on diagnosis, treatment and prophylaxis of porphyrias was edited and distributed in Poland in 5000 copies to all hospitals, major laboratories, medical libraries, regional officers as well as patients. The booklet lists simple diagnostic methods which can be easily introduced to hospital laboratories for early diagnosis of porphyria. It also includes a list of the safe drugs for patients with porphyria. Several lectures for doctors and medical staff were delivered, nine publications appeared and six others were accepted for publication. Results of the work, evaluated after three years are as follows. Early clinical diagnosis of porphyria and its prophylaxis among family members has significantly improved. The frequency of severe attacks and the mortality rate due to porphyria has been reduced to singular cases. The proposed organization of small regional centers (with help of Porphyria Center), oriented at early diagnosis of porphyria appears to be impossible without further financial support.

[Anti - T. gondii antibody concentration in sera of pregnant women in the sample of Lódź population]

The aims of the study were: to estimate the prevalence of Toxoplasma gondii in pregnant women in the Lódź region; to assess the rate of incidence of suspected recent infection based on the results of the standard test for specific anty -T. gondii IgG and IgM antibodies. The study covered 1920 pregnant women served in 1998 by Toxoplasma Reference Laboratory in Lódź. T. gondii specific IgG and IgM were quantitated by an enzym-linked immunoabsorbent assay (ELISA, Organon). We have demonstrated high prevalence of T. gondii among pregnant women in the Lódź region. In the analysed sample of Polish population the T. gondii-specific IgG with negative IgM occurred in 43.4% (n = 837). In 1.42% of pregnant women IgG and IgM specific antibodies were detected.

[[35 Years of effort to improve the diagnosis of porphyria]

World history of porphyria is given in brief. The activities of Porphyria Center during period of 25 years have shown how difficult it was to introduce diagnostic measures for this rare and very little known group of diseases. The obstacles encountered during the popularization of the knowledge of porphyria were: minimal information on porphyria, very seldom seen in Poland, therefore rather negative approach of the doctors to these patients,--almost never porphyria was seen in differential diagnostics of abdominal pains or polyneuropathies, herefore diagnosis, if made, was very late, often just before death. From the other side insufficient support for doctors was given by laboratories because of the lack of simple diagnostic tests. Along the 35 years of the work in the Institute of Haematology and Transfusiology the situation was steadily improving but slowly due to technical and economical difficulties. The Center was organized, now well equipped and able to diagnose and differentiate all types of porphyrias. A computerised basis of the collected material consist of 383 families (6000 persons registered). Among them there are nearly 600 acute (who have passed one or more attacks of porphyria) and about 1000 latent cases of porphyria. The mortality which was 52% in the first collected group of patients (1960-1970) has fallen to less than 10% concerning very severe and late diagnosed attacks. In 1996-1998 there were only two deaths during attacks of porphyria in Poland.

[Social problems of porphyria]

Late consequences of the attacks of acute porphyrias were studied. Among 312 patients who were investigated the motor disability (neuropathy) was found in 9 patients, psychoneurological changes in 1 case and drug abuse in 7 subjects. In the group of 200 patients in remission (chosen at random) 72 persons (36%) received a disability pension. The existence of problems in change of the profession when it was necessary for health-reasons was marked. It was find that Dolargan (Pethidine) is too often applied to the patients in remission. It was made the warning that drug dependence will arise very easy in patients with porphyria.

[The course of acute hepatic porphyria]

Acute hepatic porphyrias are the diseases dependent on the congenital metabolic defects of the hem biosynthesis. The diagnosis of porphyria only on the grounds of clinical picture is extremely difficult as it is presented by the variety of symptoms, often imitating other diseases. In each case the diagnosis must be confirmed by the biochemical and enzymatic investigations. In the paper we described different clinical courses of the acute hepatic porphyrias. The acquaintance with the symptoms of porphyrias enables to decrease the number of complications connected with diagnostic and therapeutic errors what is still a serious economic problem.

Acute hepatic porphyrias. Detection, prophylaxis and treatment

Between 1962 and 1944, 300 families with acute hepatic porphyrias were seen at the Porphyria Centre in Warsaw. Among members of these families, 443 overt and 707 latent cases were diagnosed, and 211 persons had intermediate values of enzyme activity without clinical symptoms and biochemical changes in urine and stool. Three dual porphyrias were detected. Five children with acute symptoms were also seen. The patients and their relatives were registered and routine prophylactic measures were introduced. The treatment of the attacks was based on glucose and hemearginate infusions, a high carbohydrate diet and maintenance of body homeostasis. As a late consequence of the attack acute intermittent porphyria arterial hypertension was observed.

Coexistence of hereditary coproporphyria with acute intermittent porphyria

A new form of acute hepatic porphyria with double genetic defect--deficiency of porphobilinogen deaminase and coproporphyrinogen oxidase--is described. Among 17 studied family members this double enzymatic deficiency was found in five individuals, deficiency of porphobilinogen deaminase in four, and deficiency of coproporphyrinogen oxidase in two. Only the proband had an attack of porphyria. Apart from the proband, all family members had normal urinary PBG excretion. Increased faecal coproporphyrin excretion was found in three people. The results obtained suggest that deficiency of porphobilinogen deaminase and coproporphyrinogen oxidase can be inherited independently. coproporphyrinogen oxidase can be inherited independently.

[Porphyrin fluorescence in plasma of various types of porphyria]

Fluorescence spectra of plasma porphyrin were measured in 6 patients with the acute intermittent porphyria (AIP), 30 patients with variegate porphyria (PV), 2 patients with hereditary coproporphyria, 2 patients with porphyria cutanea tarda, and in 6 patients with erythropoietic protoporphyria (EPP). It was found that the excitation and emission wavelengths at which maximum fluorescence is seen may help to diagnose and differentiate PV and EPP. In patients with AIP spectrum characteristic for porphyria of such a type was noted in all patients during the attack of disease and in only 33% of patients in remission. Fluorescence spectrum was normal in asymptomatic family members. In variegate porphyria spectrum with a characteristic maximum of fluorescence was noted in all patients during an attack and remission, and 62% of the asymptomatic family members.

Heme arginate (Normosang) in the treatment of attacks of acute hepatic porphyrias

The treatment with heme arginate of 47 attacks of acute hepatic porphyrias are presented. Distribution of patients into three groups of severity has shown that the best clinical response is obtained when the treatment starts in the first three weeks from the beginning of the symptoms and in patients without deep involvement of the nervous system. The decrease in elimination of the precursors of heme was about 60% (mean) in comparison to the preinfusion values, non corresponding firmly with the clinical improvement.

[Acute intermittent porphyria and arterial hypertension]

A group of 40 female patients with acute intermittent porphyria from 5 to 34 years after attacks of porphyria were examined. In two patients arterial hypertension developed before attack. In 18 cases hypertension was observed in different periods of time after attack. The comparison of these findings with epidemiological data of similar group of the Polish population suggests that arterial hypertension develops earlier and more frequently in female patients with acute intermittent porphyria. Periodic control of blood pressure in patients with acute intermittent porphyria is proposed.

[A decrease in plasma sodium ion during the course of an acute attack of porphyria]

Sodium ion level disorders were analysed in 53 patients with porphyria during 84 acute attacks of the disease. Thirty two daily water-electrolyte balances in 6 patients treated at ICU were analysed in detail. A decrease in sodium ion levels in patients with porphyria is rather rare and most frequently transient during the acute attack of the disease. Noted disorders were not characteristic for the reported syndrome of the abnormal antidiuretic hormone release. The treatment of the acute attack of porphyria requires the achievement of the positive energy balance which leads to the normalization of sodium ion levels despite intensive hydratation of some patients.

Abnormalities in liver function and morphology and impaired aminopyrine metabolism in hereditary hepatic porphyrias

The aminopyrine breath test and measurement of postprandial serum bile acids were performed in 67 patients with well-documented hereditary hepatic porphyria. Elevated postprandial serum bile acids levels were found in 75% and the aminopyrine breath test was abnormal in 42% of the patients studied. These function tests exhibited a statistically significant correlation with the excretion of porphyrin precursors in patients with acute intermittent porphyria. Furthermore, all 12 patients with acute intermittent porphyria who had a liver biopsy because of abnormalities in the aminopyrine breath test or postprandial serum bile acids measurement, or both, were found to have diffuse, moderately severe, but nonspecific ultrastructural changes of hepatocytes, indicative of significant subcellular damage. While a direct relationship between functional and morphologic abnormalities is speculative, it is possible that the defective heme biosynthesis, perhaps related to the reduced aminopyrine demethylation, could form the basis for the ultrastructural hepatic changes in porphyria. This, in turn, could be the cause of the elevated postprandial serum bile acids levels.

[Effect of gelatin and dextran infusion on the reticuloendothelial system]

The purpose of this study was evaluation of the phagocytic ability of peripheral blood leucocytes and reticuloendothelial system of the lungs, liver and spleen after one infusion of plasma-substituting preparations: Fluigel and dextran 70 in volumes of 20 ml/kg of body weight. The experiments were done in rabbits. The response of the reticuloendothelial system was assessed on the basis of its ability of eliminating foreign erythrocytes labelled with 51Cr from the circulating blood and radioactivity accumulation in the liver and spleen. It was found that infusion of Fluigel and dextran produced transient changes in the function of the reticuloendothelial system with increased number of granulocytes and a fall of their radioactivity 3 and 6 hours after infusion, reduced ability of pulmonary 51Cr accumulation and increased storage in the spleen observed 24 hours after infusion.

[Neurologic disorders in acute intermittent porphyria]

In a material of 28 patients with acute intermittent porphyria and 2 with mixed porphyria neurological disturbances occurring in acute attach and the degree of their persistence during remission were analysed. The obtained results indicate that the symptoms of acute attach are neurogenic. In the acute phase of the disease a reversible disturbance of function develops in the first place in the nerve fibres with acetylcholine-type of impulse transmission. Clinically detectable permanent signs of polyneuropathy were observed only in some cases with most severe and prolonged acute attack.

Porphyric polyneuropathy and its pathogenesis in the light of electrophysiological investigations

Twenty-four patients with acute intermittent porphyria were examined by means of routine electromyographic (EMG) tests, measurements of motor and sensory conduction in peripheral nerves and stimulation fatigue tests. The EMG results gave evidence of an initial, reversible disorder of function of the peripheral neuron, only sometimes followed by evidence of axonal degeneration of the "dying back" type. In stimulation fatigue tests there was some evidence of potentiation but none of fatigue. Attention is drawn to some analogies between the electrophysiological changes in porphyric polyneuropathy and in botulism. It seems that the pathogenesis of porphyric polyneuropathy may be dependent upon a block of cholinergic endings.

Increased protoporphyrin in erythrocytes in a child with acute intermittent porphyria

A child is described with acute intermittent porphyria but having an erythropoietic component, with disordered metabolism of porphyrins in bone marrow.