Chronic urticaria and blastocystis hominis infection: a case report

We report a case of a 45 year old woman which fulfilled the criteria of chronic urticaria (remitting and relapsing bouts of erythematous and pruriginuos lesions without angioedema, lasted four months). Cutaneous manifestations were not related to a specific inducing factor, had no benefit from antihystamine and steroid drugs and were associated sometimes with mild gastroentric disorders. Patient was submitted to extensive clinical, laboratory and intrumental investigations which permit to exclude many conditions: allergy to inhalants, food, insects and drug adverse reactions, autoimmune urticaria, autoimmune diseases, neoplastic and infectious diseases. Finally coprocolture disclosed the presence of Blastocystis hominis in stool samples thus permitting to associate urticaria to parasitic infection. Both cutaneous manifestations and mild abdomen disturbs disappeared after appropriate treatment. Despite the high diffusion the aetiopathogenesis of chronic urticaria remains often undefined. A large number of parasites have been correlated with urticaria but few data exist as regards Blastocystis hominis infection; then our findings may add evidence to the role of this parasite in inducing chronic urticaria. Considering that Blastocystis hominis is a modest pathogen for humans, the mechanism is probably the typical one of cutaneous allergic hypersensitivity; antigen parasites induce the activation of specific clones of Th2 lymphocytes, the release of related cytokines and the consequent IgE production.

[Lymphocyte apoptosis in non-ST segment elevation acute myocardial infarction ]

It is well known that lymphocytes play a major role in coronary plaque destabilization in acute coronary syndromes. The aim of this study was to evaluate circulating lymphocyte apoptosis in patients with non-ST elevation myocardial infarction (NSTEMI) in comparison with subjects with stable angina and with healthy controls. We considered spontaneous lymphomonocyte apoptosis (evaluated by ELISA), interleukin (IL)-2 production (evaluated by ELISA), Fas expression on T cells (evaluated by flow cytometry) and Fas ligand mRNA (evaluated by reverse transcriptase polymerase chain reaction), as well as Fas functionality. To evaluate T-cell activation, we also investigated T-cell subpopulations (CD4/CD8 ratio), T-cell surface HLA-DR and CD69 expression (evaluated by flow cytometry) in blood taken within 6 hours from onset of NSTEMI. Spontaneous apoptosis was significantly increased in NSTEMI patients in comparison with the two control groups and it was associated with an increased expression of Fas, an increased susceptibility to the Fas agonist (CH-11) and a normal production of IL-2 in cell cultures. We also found a significant increase of HLA-DR+ CD3+ and CD69+ CD4+ cells in NSTEMI patients. These data suggest that the enhanced apoptosis is due to a mechanism of "active" antigen-driven death, induced by the expression of death cytokines and not by the failure of cell growth factors. We conclude that in case of NSTEMI peripheral lymphocytes are activated and undergo an enhanced programmed cell death due to activation mechanisms. It is likely that lymphocyte activation occurs before the onset of acute ischemia and contributes to the plaque rupture and to the myocardial ischemic insult.

Microvascular assessment in Behçet disease: videocapillaroscopic study

The aim of this study was to evaluate microvascular assessment in patients with Behcet disease (BD) by means of an intravital videocapillaroscopic study. Sixteen BD patients were compared with an equivalent group of healthy subjects matched for age and sex. Videocapillaroscopy (VCP) was performed in peripheral areas and in conjunctiva, and morphological and quantitative parameters were assessed. In both areas VCP showed several morphological alterations (microaneurysms, megacapillaries, desertification areas) detectable in a high percentage of patients; quantitatively we found significant changes of incisuring and sludging score, of capillary loop intermediate branch length (in peripheral areas) and of arteriole/venule diameter (in conjunctiva). Therefore, vessel involvement included both the number and the whole vessel structure and was seen both in peripheral and conjunctival areas when the two different vascular beds of micro- and paramicrocirculation were examined. We conclude that an important rearrangement of microcirculation is detectable in BD and that VCP may have diagnostic and prognostic value, providing qualitative and quantitative information able to define the systemic extension of vascular damage and the degree of vessel wall alteration.

POEMS syndrome with vascular lesions: a role for interleukin-1beta and interleukin-6 increase--a case report

The authors describe the case of a 60-year-old man with POEMS syndrome associated with vascular lesions. The patient had osteosclerotic myeloma IgA (lambda), polyneuropathy, endocrinopathy, and skin changes. Subsequently, he developed gangrene of the lower limbs with no response to heparin therapy. The humoral study showed thrombocythemia, high levels of interleukin-1beta (IL-1beta) and IL-6 and of some coagulative/fibrinolytic and endothelial factors (von Willebrand factor, plasmin-antiplasmin complexes, plasminogen activator, and endothelial adhesion molecule ICAM-1). The authors suggest that these factors, induced by the increased levels of cytokines, could be responsible for microvascular damage, gangrene, and heparin resistance.

POEMS syndrome with vascular lesions and renal carcinoma - possible role of cytokines

We describe here the case of a 60 years man with POEMS syndrome associated with renal tumor and vascular lesions. The patient had osteosclerotic myeloma IgA-lambda, polyneuropathy, endocrinopathy and skin changes. In addition, he developed renal clear cell carcinoma and gangrena of lower limbs. The humoral study showed thrombocytosis, high levels of IL-1beta and IL-6 and of some coagulative/fibrinolytic and endothelial factors (von Willebrand factor, plasmin-antiplasmine complexes, plasminogen activator). We suggest the hypothesis that these factors are capable of determining some manifestations of POEMS syndrome.

Evaluation of some immune functions in a patient affected by common variable immunodeficiency using luminescent techniques

Common variable immunodeficiency is a primary immunodeficiency characterized by a failure of antibody synthesis, whose fundamental immunologic abnormality is still unknown. In our study, we evaluated some immune functions using chemiluminescence in a 32-year-old woman affected by common variable immunodeficiency. In particular, we showed an impairment of her lymphomonocyte proliferative response which was evaluated using a method based on the bioluminescent measurement of ATP. Besides, we found a reduction of her lymphomonocyte IL2 and IL4 production: the IL4 production was evaluated through an ELISA method, whereas the IL2 activity was determined by its ability to support the IL2-dependent murine T-cell line (CTLL) proliferation which was established through a method based on the bioluminescent measurement of ATP. Finally, we evaluated both yeast-induced and fMLP-induced polymorphonuclear and monocyte oxidative metabolism through a luminol-amplified chemiluminescence; these functions were within normal values. Therefore, in our patient affected by common variable immunodeficiency, we demonstrated an impairment of cellular immunity, which might contribute to the pathogenesis of the disease.

The in vitro effect of Pidotimod on some immune functions in cancer patients

There are several reports concerning an impairment of cellular immune response in patients affected by malignant disease. The aim of this study was to evaluate the in vitro effect of Pidotimod, a synthetic biological response modifier, on some immune functions in 14 cancer patients. In particular, we showed that these subjects had a significantly reduced peripheral blood mononuclear cell (PBMC) proliferation both in response to PHA and to Con A in comparison with a group of healthy subjects. Besides, they showed a significantly reduced PBMC IL2 production, which was evaluated both through an ELISA method and a biological assay. The in vitro addition of increasing concentrations of Pidotimod (10, 25 and 50 ug/ml) was able to enhance PBMC proliferation and IL2 production significantly. However, in spite of the addition of Pidotimod, both immune functions in our neoplastic patients did not reach normal values.

Changes of some immune functions after percutaneous transluminal coronary angioplasty (PTCA)

This study aimed to evaluate some aspects of the immune response in 10 cardiopathic patients during the execution of percutaneous transluminal coronary angioplasty (PTCA) by obtaining blood samples from coronary sinus. In particular we considered some PMN functions as well as lysosomal release and oxidative metabolism evaluated as chemiluminescence and superoxide anion (O2) production. We also studied serum levels of complement C3 and C4, lymphocyte populations (CD3, CD4, CD8, CD19, CD16) and plasmatic determinations of interleukin 2 (IL2). After PTCA, we found a decrease of total count of blood lymphocytes, whereas the number of neutrophils remained unchanged. The decrease involved to a similar extent the lymphocyte subsets CD3, CD4 and CD8, whereas CD19 and CD16 were unchanged. The plasmatic levels of IL2 did not show any significant modification. Concerning PMN, their chemiluminescence was significantly increased after PTCA as compared to basal values: this response was promptly detectable in isolated PMN, both without and with stimulation with fMLP. Similarly superoxide anion production, both spontaneous and stimulated, was increased in PMN suspensions after PTCA, even if this increase did not reach statistical significance. As regards circulating levels of lysosomal enzymes, we found a significant increase of plasmatic levels of elastase, whereas the serum determinations of lysozyme and betaglucuronidase did not change. Concerning the complement system, we found a significant decrease of complement fractions C3 and C4. In conclusion, our results showed certain changes in some humoral and cellular systems; in particular the neutrophil activation through the release of proteolytic enzymes and the generation of oxygen radicals could increase the damage to vessel walls and activate other systems having a negative effect in the ischaemia-associated consequences.

Hemodynamic and hemorheologic effects of i.v. Dilevalol in hypertensive patients

The authors evaluated the effect of Dilevalol infusion on blood pressure, heart rate, central hemodynamics, and rheologic parameters in hospitalized inpatients affected with mild or moderate hypertension. After a dose-finding phase and a washout period of one week, 10 patients aged fifty to seventy-two-years (median 61.5) were given either a single dose of Dilevalol 60 mg or placebo, and seven days later they underwent the other treatment, according to a single-blind, crossover design. Central hemodynamic measurements were performed by means of M-mode echocardiography, and hemorheologic parameters were evaluated by means of strain-gauge plethysmography. The maximal increase in lower extremity flow at rest had been obtained with the infusion of 60 mg Dilevalol during dose-finding, and so this dose was chosen for the second part of the study. The infusion of Dilevalol significantly increased rest flow and decreased blood viscosity, but the changes in central, parameters were not considered clinically relevant, although statistically significant. Blood pressure decreased without significant changes in heart rate. Thus, the acute administration of Dilevalol reduced blood pressure, without affecting heart rate and central hemodynamics, confirming the vasodilating effect of the drug. A significant improvement was also shown on blood viscosity in these hypertensive patients.

[The effects of the acute administration of vinburnine on blood rheology, oxygen transport and regional circulation under normal conditions and in hypoxemia. In vivo research]

Vinburnine has been shown to be effective in avoiding chronic ischaemic tissue injury. Many studies have demonstrated the antihypoxic and oxygenation properties of this drug. In our study we have evaluated in two groups of patients the effects on blood rheology, oxygen transport, regional circulation and ergospirometric data of 40 mg vinburnine infused in a systemic vein. We have selected in the first group 10 patients with low hemoglobin oxygen affinity (p50 28.6 +/- 1.37 mmHg), in the second one 7 patients with normal values (p50 26.6 +/- 0.84 mmHg). In the two groups of the study we evaluated nutritional blood flow by a plethysmographic method, blood gas analysis [correction of hemogasanalitic] parameters in arterial and venous blood, haemoglobin oxygen affinity expressed as p50 and erythrocytic 2,3-DPG, hemorheologic and ergospirometric parameters. Data were evaluated in basal conditions and at the end of the infusion. The improvement of rheological properties, hemodynamic and metabolic data in the two groups of the study seems to confirm the oxyphoretic properties of this drug.

[The effects of vinburnine on the blood rheology parameters and on the oxyhemoglobin dissociation curve and 2,3-diphosphoglycerate. In vitro research]

The authors investigate the protective action of vinburnine on impairment of blood haemorheology and on metabolic parameters due to in vitro ageing of blood samples. In each sample the following parameters were measured: blood viscosity and filterability, p50 and 2,3-DPG. Vinburnine is able to induce a slight improvement of haemorheological parameters and of p50 compared to controls. After incubation for 4 hr, a reduced impairment of the mentioned parameters was observed in comparison with controls. Some hypotheses are discussed about the mechanisms of action of the drug.

Immunoelectrophoretic characterization of the molecular weight polydispersion of polysaccharides in multivalent bacterial capsular polysaccharide vaccines

The molecular weight polydispersion of single antigens present in multivalent bacterial capsular polysaccharide vaccines has been characterized by an immunoelectrophoretic method. Chromatographic effluents from Sepharose gel of bacterial capsular polysaccharide vaccines were tested by fused-rocket immunoelectrophoresis and the distribution coefficient (Kd) of each polysaccharide present in the mixture was calculated. The method appeared to be efficient and reproducible. However, different Kd values were obtained by immunoelectrophoretic and chemical or physical analysis of the chromatographic effluents of each single polysaccharide component. The use of this immunoelectrophoretic procedure was extended to the potency control of multivalent meningococcal and pneumococcal polysaccharide vaccines in order to detect changes in the molecular weight polydispersion of each antigen with time.

[Acute Candida arthritis. Isolation of Candida krusei in a heroin addict]

Candida arthritis in men is very rare. In most cases Candida albicans is isolated from joints (commonly the knee) of immature infants or of immunodeficient subjects without underlying joint disease; Candida non albicans is isolated from joints of immunodeficient patients with underlying joint disease. A case of Candida arthritis in a heroin addict is described. This is the second report of Candida arthritis in a heroin addict, but it is the first in which Candida krusei has been isolated.

Immunogenic correlation between cross-reacting material (CRM197) produced by a mutant of Corynebacterium diphtheriae and diphtheria toxoid

The in vivo immunizing potency of diphtheria toxoid and formalin-treated corss-reacting material (CRM197, a nontoxic mutant protein) was compared in guinea pigs. Major antigenic differences between the two untreated proteins were also tested in rats. The results showed that diphtheria toxoid and CRM197 were equally effective immunogens, but only if the latter was treated with formalin in the same concentration (0.7% vol/vol) was that of the toxoid. Formalin treatment rendered the antigens more resistant to enzymatic proteolysis by trypsin in vitro.

[Serological response in man to an anticholera vaccine made from killed vibrios and partially purified with aluminium hydroxide]

The immunizing capability of a new anticholera vaccine (choleric anatoxin + vibrios Ogawa and Inaba) was tested on a group of 113 subjects. The vaccination was carried out with two inoculations of the vaccine, administered a month apart. Testings were taken before the vaccination, before the second inoculation and 10 to 14 days after the vaccination was completed. The determination of the vibriocide antibodies was made following the test-tube method described by Verwey and al., and the research of the antitoxic antibodies following Craig's method, using a live rabbit. Eighty two per cent of the subjects vaccinated had antitoxic antibodies with a varying strength of from 10 to greater than 320 A.U. In all those subjects treated who had previously been vaccinated at the time of the cholera epidemic with traditional vaccine, the geometric average of strength in vibriocide antibodies had increased from 2,810 to 14,700.

A modified assay for the Waaler-Rose test using latex particles coated with rabbit gamma-globulins

A simplified method is described for the Waaler-Rose reaction, comparing the results obtained with this technique to those found with the standard procedure. The test, which is prepared on a principle identical to that of the Waaler-Rose reaction using latex particles coated with rabbit <i>γ</i> -globulins, has shown a specificity greater than that obtained with the latter reaction; moreover, some other interestingadvantages are an easier and more rapid execution of this technique than the standard Waaler-Rose and a better reproducibility and comparability of results obtained in the various laboratories.

Experiments with cholera toxin detoxified with glutaraldehyde

Studies on the production, purification, and detoxification of cholera toxin are reported. The toxin was first partially purified with aluminium hydroxide and further purification was effected with Bio Gel A-5m and Sephadex G-75. The toxins were detoxified with glutaraldehyde; the toxoids so obtained, when injected into the skin of rabbits, appeared to have no residual toxicity. All the toxins were immunogenic. The toxoid partially purified with aluminium hydroxide retained most of its immunizing capacity, but the highly purified toxoids did not retain their capacity to stimulate antibody production in rabbits.

Experiments on monkeys with cholera toxin partially purified and detoxified with formol and glycine

Cholera toxoid partially purified and detoxified with formol and glycine and inoculated in monkeys proved safe. Histological examination revealed no changes in the skin of the animals treated. Blood samples taken from monkeys immunized with 2 doses of toxoid 12 days after the second inoculation revealed appreciable levels of antitoxin in the animals that had received two 100-mug doses of toxoid. The monkeys vaccinated with toxoid, when inoculated with challenge doses of cholera toxin, had the capacity to neutralize the toxin. Detoxification with formol and glycine may be the first step towards the preparation of a highly purified, innocuous, and antigenic cholera toxoid.