Telomere length identifies two different prognostic subgroups among VH-unmutated B-cell chronic lymphocytic leukemia patients

Some evidences suggest that telomere restriction fragment length (TRF-L) is an effective indicator of histopathogenesis in B-cell tumors. As histopathogenesis is relevant for B-cell chronic lymphocytic leukemia (B-CLL) prognosis, TRF-L was assessed by Southern blot in 201 patients and compared to variable immunoglobulin heave chain gene mutational status (VH-MS) and to other known prognostic features. Overall survival (OS), time to first treatment (TTFT) and progression-free survival (PFS) were evaluated. Our results indicate the following: (1) TRF-L is heterogeneous among B-CLL patients (median 6014 bp, range 1465-16 762); (2) TRF-L correlates to VH-MS (r(2)=0.1994, P<0.0001) with VH-mutated patients showing long and VH-unmutated short telomeres; however, 41% of VH-unmutated and 5% of VH-mutated patients did not show this correlation and were thus defined as 'discordant'; (3) TRF-L effectively predicts outcome in terms of TTFT, PFS and OS; (4) VH-unmutated discordant patients have a better clinical outcome than VH-unmutated concordant patients (OS P<0.01, PFS P<0.05) and similar to that of VH-mutated patients (OS, PFS P=NS). Compared to VH-unmutated concordant patients, VH-unmutated discordant patients showed no peculiarity in their immunoglobulin rearrangement nor in their flow cytometry or fluorescence in situ hybridization profile. In conclusion, TRF-L can be helpful to refine prognostication of B-CLL patients, particularly those with a VH-unmutated immunoglobulin sequence.

p53 evaluation in gastric mucosa of patients with chronic Helicobacter pylori infection

Gastric cancer is often associated with p53 over-expression and Helicobacter pylori (HP) infection. In this study we have investigated the production of the p53 protein and mutation of its gene in precancerous gastric lesions with HP infection. For this purpose 130 patients who underwent endoscopy for dyspepsia were enrolled in the study. To assess p53 production and mutation of the p53 gene we employed an immunoluminometric assay and polymerase chain reaction single strand conformation polymorphism (PCR-SSCP) analysis, respectively. Histologically, 52 of the 130 enrolled patients showed intestinal metaplasia type I (IM) (90.4% of these were also HP positive), 47 had HP-related gastritis and 31 were normal. p53 cytosol levels were significantly higher in patients with IM or HP-related gastritis than in normal patients (p = 0.0137 and p = 0.0411, respectively). All DNAs extracted from gastric mucosa samples with higher p53 values and examined for p53 mutations by PCR-SSCP analysis were characterized by a normal run. Our data indicate, that irreversible genetic changes in the p53 protein has not yet occurred in morphologically non-neoplastic gastric mucosa with IM and HP-related chronic gastritis. In conclusion, the increase in p53 cytosolic levels found in our study is due to an increased production of the wild-type protein probably related to an inflammatory response induced by HP infection.

[Common variable hypogammaglobulinemia associated with intestinal lymphoid hyperplasia]

A case of adult common variable hypogammaglobulinemia with nodular lymphoid hyperplasia characterized by malabsorption and enteric protein loss, probably due to bacterial overgrowth, is reported. This clinical condition is of particular interest because of the unusual pathology and the lack of an efficient treatment. The association between common variable hypogammaglobulinaemia and nodular lymphoid hyperplasia must be considered in young adults with recurrent respiratory tract infection, gastrointestinal symptoms, diarrhoea, hypogammaglobulinemia and low serum albumin.

Autonomic nervous dysfunction in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA): possible pathogenic role of autoantibodies to autonomic nervous structures

Autonomic nervous dysfunction has been previously reported in SLE, RA and systemic sclerosis, but the pathogenesis of such a complication is poorly understood. In the present study, four standard cardiovascular autonomic function tests were performed in 34 female patients with connective tissue diseases and in 25 healthy control subjects, and results expressed as cardiovascular (CV) test scores. Moreover, in each subject the presence of circulating complement-fixing autoantibodies directed against sympathetic and parasympathetic nervous structures, represented by superior cervical ganglia and vagus nerve, respectively, was simultaneously assessed by an indirect immunofluorescent complement-fixation technique, using rabbit tissue as substrate. None of the patients reported autonomic symptoms. However, an abnormal CV test score (> or = 5) was detected in 15% of the patients and in none of the healthy control subjects, approaching statistical significance (P = 0.07). No correlation was found between CV test results and disease duration, type of therapy or presence of conventional autoantibodies. One or two autoantibodies to autonomic nervous structures were detected in six patients (18%) and not in the control subjects (P < 0.05). Values of deep breathing test were significantly lower in autoantibody-positive patients compared with those amongst the control subjects (P < 0.05), and an abnormal CV test score was significantly associated with the presence of autoantibodies to autonomic nervous structures (P < 0.05). In conclusion, we confirm that autonomic nervous function can be impaired in patients with connective tissue diseases, and suggest that autoantibodies directed against autonomic nervous system structures may play a role in the pathogenesis of the autonomic dysfunction.

[Familial Mediterranean fever: a report of 2 cases of Italian origin]

Familial Mediterranean fever is an inherited disease, occurring almost exclusively in Arabs, Jews and Turks. Cases are very rarely described in the USA, USSR, France, and patients are all natives to the Mediterranean area. This paper describes two cases of familial Mediterranean fever in brothers native to Campania, Italy. Both had complained of repeated episodes of fever, with acute abdomen, thoracalgia and arthralgia since the age of about 20. One of them had had pleuritis when he was 6 years old. In the period preceding our first observation, both underwent laparotomy to evaluate abdominal symptoms, with negative results. After ruling out other diseases with similar signs and symptoms, we raised the hypothesis of familial Mediterranean fever, despite the fact that the literature has described very few Italian natives affected by this disease. The diagnostic hypothesis was confirmed by the positivity of the metaraminol provocation test. At the same time we evaluated the presence of amyloidosis by rectal biopsy, with negative results. Treatment with colchicine 1 mg/day per os was established. Dramatic improvement of the symptoms was observed in both patients. The present paper stresses the importance of familial Mediterranean fever, its correct diagnosis in Italy and the fundamental role played by the metaraminol provocation test as a determinant diagnostic tool. It allows establishment of appropriate treatment as soon as possible, so that renal amyloidosis, the most severe complication and major prognostic determinant of familial Mediterranean fever, can be prevented. Inappropriate, useless and potentially harmful surgical diagnostic procedures are also avoided.

An association of primary hyperparathyroidism and non medullary thyroid carcinoma

A 40-year-old woman was admitted because of long-lasting asymptomatic hypercalcaemia. About 2 years earlier she underwent thyroidectomy and further 131 I therapy because of well-differentiated non medullary thyroid carcinoma. On admission biochemical data and hormonal values (serum calcium, serum phosphorus, i-PTH) were consistent with primary hyperparathyroidism; ultrasonography, computed tomography, thallium-technetium scintiscanning disclosed right paratracheal mass; on surgical procedure a right parathyroid adenoma was removed. The coexistence of non medullary thyroid carcinoma and primary hyperparathyroidism is rare: the prior 131 I therapy might be linked to subsequent development of parathyroid adenoma.

Association of the Budd-Chiari syndrome with lupus anticoagulant. Case report and critical review

The Budd-Chiari syndrome (BCS) was diagnosed in a 30-year-old male hospitalized with hepatomegaly, abdominal collateral vessels and hepatic veins and inferior vena cava thrombosis (IVC) in 1988. The presence of circulating lupus anticoagulant (LAC) was suspected and demonstrated on this occasion in view of an earlier diagnosis of systemic lupus erythematosus (SLE) and recurrent vein thrombosis dating from 1981. There are sporadic reports of an association of BCS with SLE and other autoimmune diseases. The recent literature also describes associations with hypercoagulability due to LAC. These are reviewed together with the personal case to provide the rationale for correct diagnosis and therapy.

Two cases of congenital hepatic fibrosis in children of consanguineous marriage

An association of congenital hepatic fibrosis (CHF), Caroli's disease, medullary sponge kidney, type II interventricular defect with right transposition of the aorta, multiple cervical vertebra malformations, and first sacral vertebra schisis in a 16 year old son of consanguineous parents (consanguinity factor = 1/32), is described. The patient's sister presented asymptomatic CHF and medullary sponge kidney only. Parental consanguinity in this case lends support to the view that CHF, medullary sponge kidney and cardiac malformations are more likely to be manifestation of a single recessive gene, with a varying phenotypic expression, than of different mutant genes.

[Liver and thyroid gland. Physiopathologic and clinical relationships]

The liver plays a dominant role in the metabolism of the thyroidal hormones; it is here that the 5' deiodase acts to convert part of T4 to T3. There are eight further circulating iodothyronines: the rT3, mainly derived from T4, appears to be the major inhibitor of T4 and T3. Thus, if rT3 increases, the metabolic effects of T3 and T4 can be quite different. In the course of some chronic systemic diseases (e.g. hepatic cirrhosis) rT3 increases simultaneously with the decrease of T3 levels. Therefore we can describe particular alterations of the thyroidal pattern typical of chronic liver diseases: low T3 syndrome, low T3 and T4 syndrome, high T4 syndrome, mixed forms. T3 and T4 diminish due to inefficient hepatic deiodination and defective hepatocellular uptake. Inefficient hepatic deiodination and defective hepatocellular uptake. T4 levels decrease, most likely because of an inefficient production of thyroid binding globulin, or the action of a peripheral binding inhibitor. During acute liver diseases and primitive biliary cirrhosis, we can observe an increase of T4 and TBG together with an increase of the acute phase proteins. Such complex hormonal mechanisms are not influenced by TSH, which appears normal or inhibited, as the TRH stimulus test is normal. The explication can be found in an enhanced conversion of T4 to T3 in the pituitary gland. The biological and clinical significance of these mechanisms might be that of creating a "protective" state for an organism in a catabolic state by reducing the circulating T3. A relationship has been found between circulating thyroidal hormones levels, particularly the T3, rT3 and rT3/T3 ratio, and the state of hepatic functional insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Cortisol at physiological concentrations and prostaglandin E2 are additive inhibitors of human natural killer cell activity

The effects of cortisol and prostaglandin E2 on preparations of human peripheral blood mononuclear cells that mediate natural killer cytotoxicity were evaluated. Natural killer cell activity was measured using 51Cr-labelled K562 target cells and effector to target cell (E:T) ratios of 50:1, 25:1, 12.5:1 and 6:1. In vitro preincubation of mononuclear cell preparations for 20 h with 1 X 10(-8) to 1 X 10(-5) M cortisol resulted in a significant decrease of natural killer cell activity. The magnitude of the suppression was directly related to the steroid concentration and inversely related to the E:T ratio. Exposure of cortisol-treated mononuclear cells to 1 X 10(-6) M prostaglandin E2 resulted in a significantly higher level of inhibition than after treatment with the two agents singularly. In contrast, the concomitant incubation with 1 X 10(-5) to 1 X 10(-4) M theophylline, or with 1 X 10(-6) to 1 X 10(-5) M isobutyl-methylxanthine, two widely used phosphodiesterase inhibitors, failed to demonstrate a significant enhancement of cortisol-induced suppression. Prostaglandin E2-dependent inhibition, on the other hand, was more intense after the inhibition of phosphodiesterase activity. Taken together, these results show that cortisol at physiological concentrations has the property of depressing human natural killer cell activity in vitro and suggest that endogenous glucocorticoids play a role in the in vivo regulation of this natural cytotoxicity. Additionally, cortisol and prostaglandin E2 are additive inhibitors of natural killer cell activity. Since the effect of cortisol in our experiments was not changed by theophylline or isobutyl-methylxanthine it is conceivable that the hormone acts at a level different from the adenylate cyclase/phosphodiesterase system.

Primary humoral immune response against tumor membrane antigens and foreign antigens by plasma cell tumor bearer mice

The MOPC-460 plasma cell tumor possesses tumor specific antigens. It nevertheless grows and kills its syngeneic host. The possible impairment of immune responsiveness in tumor bearing mice was investigated by measuring their ability to mount a humoral immune response against foreign antigens, such as sheep red blood cells or bacteriophage T4. No significant decrease in the response to either antigen was found until the tumor mass exceeded 10-15% of the host's body weight. Moreover, circulating anti-tumor antibodies were detected in the serum throughout the initial period of tumor growth. The possible interference of these antibodies with cell-mediated defence mechanism was ruled out by experiments where the humoral response was selectively suppressed from birth by repeated administrations of anti-immunoglobulin heavy chain antiserum. In a "suppressed" mice, tumors took, grew and developed more rapidly than in controls. It is concluded that, at least in the model studied, the humoral immune response operates as a defence mechanism against expansion of the tumor clone.

An approach to simultaneous immunofluorescent and autoradiographic analysis of human normal and neoplastic blood cells

A technique for evaluating membrane immunofluorescence and isotope (3H-Thymidine, 3H-Uridine, 3H-Leucine) labelling in the same cell is described in detail. The possible interference of autoradiographic labelling on the fluorescent staining have been considered and found not to alter the final preparations. The technique proved valid both in normal and in neoplastic cells irrespective of their origin (peripheral blood, bone marrow, lymph node). Its possible extensions are finally discussed.