Apmis

LAMPINEN, MARIA; ÖBERG, GUNNAR; VENGE, PER; CARLSON, MARIE

doi: 10.1111/j.1600-0463.2006.apm_493.xpmid: 17078855

The idiopathic hypereosinophilic syndrome (HES) is characterised by blood eosinophilia associated with organ involvement. Elevated numbers of blood neutrophils have been observed during episodes of active HES. However, an increased responsiveness of eosinophils to chemotactic and chemokinetic stimuli may explain the selective eosinophil infiltration of the tissue. We have studied the migratory responses of blood eosinophils and neutrophils from 9 patients with HES and from 13 healthy control subjects. Chemokinetic and chemotactic responses to factors acting on both cell types were analysed by means of a modification of the Boyden chamber technique. We found increased migratory responses of the eosinophils, but not of the neutrophils, from the patients with HES. Increased blood neutrophil counts in three of the patients did not coincide with alterations of the neutrophil migratory responses. Our finding of increased migratory responses of eosinophils from patients with HES towards non‐specific chemoattractants suggests selective priming of eosinophils in this disease. Interleukin (IL)‐5 has previously been shown to prime eosinophils for migratory responses, and successful anti‐IL‐5 therapy of patients with HES indicates an important role for this cytokine in the development of hypereosinophilia.

PARADOWSKA, EDYTA; PRZEPIÓRKIEWICZ, MARZENA; NOWAKOWSKA, DOROTA; STUDZIŃSKA, MIROSŁAWA; WILCZYŃSKI, JAN; EMERY, VINCENT C.; LEŚNIKOWSKI, ZBIGNIEW J.

doi: 10.1111/j.1600-0463.2006.apm_31.xpmid: 17078856

Human cytomegalovirus (HCMV) is the most common cause of viral intrauterine infection. Progress in rapid, specific, and dependable detection of HCMV has recently been achieved by the use of DNA hybridization techniques and other molecular methods. We examined 21 placentas after delivery for the presence of HCMV DNA by polymerase chain reaction (PCR). To test the reliability of the PCR for the detection of HCMV DNA in clinical specimens, two simple PCR assays and a real‐time quantitative PCR were used. PCR analysis of villous and decidual cells showed that HCMV DNA was present in 16 placentas (76.2%). Transmission of HCMV infection to chorionic villi was confirmed in 11 organs (52.4%), and congenital infections in newborns were detected in 9 cases (42.8%). These results suggest that HCMV genome detection in placentas at later gestational ages is common. Our results demonstrated that detection of HCMV DNA in placental tissues by DNA amplification provides a specific and sensitive method for diagnosis of intrauterine HCMV infection.

HUANG, LING‐JU; CHEN, HSIN‐PAI; CHEN, TE‐LI; SIU, L.‐K.; FUNG, CHANG‐PHONE; LEE, FA‐YAUH; LIU, CHENG‐YI

doi: 10.1111/j.1600-0463.2006.apm_470.xpmid: 17078857

Aeromonas peritonitis remains a rare condition. In this study we describe the clinical features of primary and secondary Aeromonas peritonitis, and compare the differences between these two diseases entities. Patients with Aeromonas peritonitis were identified from microbiological and medical records during the period between March 1994 and March 2003. Clinical characteristics, laboratory data, microbiological results, treatment and outcome of patients were obtained by retrospective chart review. 22 and 27 patients with primary or secondary peritonitis caused by Aeromonas species were identified. All except two of these patients were adults, with a median age of 62.4 (31–76) vs 65.8 (8–85) years, respectively. Males were predominant (82 vs 78%). Peritonitis was community acquired in 73% and 56% of patients in these two groups, respectively. Significantly higher prevalence of underlying liver cirrhosis (96 vs 7%, p<0.001), which was Child‐Pugh class C in 91% of cases, in primary peritonitis was noted. Primary peritonitis was more likely to be monomicrobial (100 vs 15%, p<0.001) and complicated by bacteremia (50 vs 7%, p=0.011). A source of intraabdominal infection should be sought when Aeromonas peritonitis occurs in a patient who has no history of liver cirrhosis or who has a polymicrobial result of ascites culture.

AGNARSSON, BJARNI A.; GUDBJARTSSON, TOMAS; EINARSSON, GUDMUNDUR VIKAR; MAGNUSSON, KJARTAN; THORODDSEN, ASGEIR; BERGTHORSSON, JON THOR; AMUNDADOTTIR, LAUFEY; BARKARDOTTIR, ROSA B.; BJÖRNSSON, JOHANNES

doi: 10.1111/j.1600-0463.2006.apm_468.xpmid: 17078858

The purpose of this study was to examine the pathology of all germ cell tumours of the testis diagnosed in Iceland 1955–2002. A total of 214 patients were included in the study. The current age‐standardized incidence was found to be 6.1 per 100,000 and had increased almost fourfold during the study period. Seminoma was diagnosed in 55% of cases. Non‐seminomas were diagnosed in 45%, and these were further classified as mixed germ cell tumours (33%), embryonal carcinoma (8%), teratoma (3%), and yolk sac tumour (n=1). The mean age at diagnosis was significantly higher for the seminomas than the non‐seminomas (38 years versus 29 years) (p<0.001) and the non‐seminomas were diagnosed at a significantly higher stage than the seminomas (p<0.001). Thus, in seminoma patients the tumour was localized to the testis (stage I) in 81% of cases, in 17% of patients the tumour had spread to the lymph nodes (stage II or III), and only 2% had extranodal metastasis at diagnosis (stage IV). In contrast, in the non‐seminoma patients, the tumours were found to be stage I in 56%, stage II or III in 24%, and stage IV in 20% of cases. No significant difference in staging was found between non‐seminoma subtypes. Identification of necrosis or vascular invasion was significantly associated with metastatic disease at diagnosis (p=0.002). During the study period a significant increase in stage I tumours was found as well as a decrease in the size of the tumours.

GAZI, HORU; DEGERLI, KENAN; KURT, OZGUR; TEKER, ASLI; UYAR, YILDIZ; CAGLAR, HUSNU; KURUTEPE, SEMRA; SURUCUOGLU, SUHEYLA

doi: 10.1111/j.1600-0463.2006.apm_485.xpmid: 17078859

The purpose of this study was to evaluate a DNA hybridization test (Affirm VPIII) as an alternative to Gram stain for the rapid diagnosis of bacterial vaginosis in women with clinical signs of vaginal infection. Vaginal specimens were collected from 321 symptomatic women, and analyzed for bacterial vaginosis by both Gram stain using Nugent criteria and DNA hybridization test. Sensitivity, specificity, positive predictive value, and negative predictive value of the DNA hybridization test were determined using the Gram staining as the standard for diagnosis of bacterial vaginosis. Of the 321 patients, 115 (35.8%) were Gram positive for bacterial vaginosis and 126 (39.2%) were negative. 80 patients (25.0%) demonstrated intermediate Gram staining that was also considered negative. The Affirm system detected G. vaginalis in 107 (93.0%) of 115 vaginal specimens positive for bacterial vaginosis diagnosed by Gram stain. Compared to the Gram stain, DNA hybridization test had a sensitivity of 87.7% and a specificity of 96.0%. Positive and negative predictive values of the DNA hybridization test were 93.0% and 92.7%, respectively. In conclusion, Affirm VPIII hybridization test correlated well with Gram stain and may be used as a rapid diagnostic tool to exclude bacterial vaginosis in women with genital complaints.

SANZ, JUAN CARLOS; DEL MAR MOSQUERA, MARÍA; ECHEVARRÍA, JUAN EMILIO; FERNÁNDEZ, MARISA; HERRANZ, NIEVES; PALACIOS, GUSTAVO; DE ORY, FERNANDO

doi: 10.1111/j.1600-0463.2006.apm_463.xpmid: 17078860

The aim of the study was to evaluate the usefulness of serological detection of mumps IgM and titration of IgG in patients with acute parotitis according to their vaccination status. The detection of mumps virus RNA in saliva by RT‐PCR was used as reference. 116 patients (109 of them previously vaccinated) with mumps RT‐PCR‐negative results and 21 (19 vaccinated) with mumps RT‐PCR‐positive results were studied. Mumps‐specific IgM and IgG were assayed by EIA (Enzygnost, Dade Behring, Germany). IgM results were expressed as positive or negative. For IgG, several cut‐offs were calculated using receiver operating characteristic (ROC) curves. Seven RT‐PCR‐positive and five RT‐PCR‐negative patients showed IgM‐positive results (sensitivity 33.3% and specificity 95.7%). Among vaccinated patients, the sensitivity and specificity of IgM were 26.3% (5/19) and 99.1% (108/109). For IgG, a titer of 5,000 in all the patients showed a sensitivity of 76.2% (16/21) and a specificity of 83.6% (97/116). In vaccinated patients, the corresponding figures for this cut‐off were 84.2% (16/19) and 83.5% (91/109), respectively. Although IgM detection against mumps is highly specific, its sensitivity is very low in immunized subjects. In this group, the titration of IgG could serve as an additional diagnostic tool.

WIEBE, B. M.; BURTON, C. M.; MILMAN, N.; IVERSEN, M.; ANDERSEN, C. B.

doi: 10.1111/j.1600-0463.2006.apm_508.xpmid: 17078861

The aim of the study was to estimate the degree of lung damage in patients with α1‐antitrypsin (α1AT) deficiency, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF) at the time of lung transplantation. Using unbiased stereological methods, lung‐, bronchial‐ and vessel‐volume, capillary length, and alveolar surface area and densities were estimated in recipient lungs from 21 consecutive patients with pre‐transplant diagnoses including COPD (n=7), α1AT deficiency (n=6) and CF (n=8). Six unused adult donor lungs served as controls. Information relating to patient demography and pre‐transplant lung function was obtained by retrospective chart review. Disease groups differed significantly with respect to demographics and pre‐transplant lung function. Total lung volume was similar in all groups. Bronchial volume was significantly larger in CF patients compared to the control group (p<0.0001) and to the other two diagnostic groups: α1AT deficiency (p=0.0001) and COPD (p<0.0001). Alveolar surface density and capillary length density were significantly lower in patients with α1AT deficiency and COPD compared to controls (p<0.0001, respectively) and to patients with CF (p<0.0002, respectively). There were no correlations between clinical lung function and morphometric measurements. We conclude that unbiased microscopic stereological morphometry is an evolving science with the potential to elucidate pulmonary disease pathogenesis.

DAHL, KIRSTEN; BUSCHARD, KARSTEN; GRAM, DORTE X.; D'APICE, ANTHONY J. F.; HANSEN, AXEL K.

doi: 10.1111/j.1600-0463.2006.apm_393.xpmid: 17078862

Xenotransplantation holds the promise of replacing failing human organs with organs of animal origin. Transplantation of pancreatic islets from pigs to humans might restore glucose homeostasis and offer diabetic patients considerable improvement in their quality of life. The α‐gal epitope, present in all mammals except humans, apes and Old World monkeys, is a decisive obstruction to successful xenotransplantation of vascularized organs as the reaction of α‐gal‐bearing endothelia with natural α‐gal antibodies in the human blood mediates hyperacute rejection of the xenograft. Alpha‐galactosyl transferase knockout mice (α‐GT KO) develop cataract, but no other lesions have been established in these mice. Here we report for the first time that α‐GT KO mice have impaired glucose tolerance (p<0.001) and decreased insulin sensitivity (p<0.0001). Homeostasis model assessment shows impaired β‐cell function (p<0.05). Similar physiological changes have not been examined in the α‐galactosyl transferase pig. However, an association between α‐galactosyl transferase knockout and impaired β‐cell function could have critical importance for islet xenotransplantation.

TAPIAINEN, TERHI; YLITALO, SAMULI; EEROLA, ERKKI; UHARI, MATTI

doi: 10.1111/j.1600-0463.2006.apm_488.xpmid: 17078863

The aim of the study was to evaluate the dynamics of gut colonization and the main source of intestinal bacterial flora in infancy in a quantitative manner using computerized analysis of bacterial cellular fatty acid (CFA) profiles. Each stool was collected from 10 healthy newborn infants during their first 2–7 days of life and a follow‐up sample at 6 months of age. Stool samples were collected from mothers and nurses for comparison. Gas‐liquid chromatography of the 159 stool samples was used to produce bacterial cellular fatty acid (CFA) profiles by means of a previously developed computerized program. The CFA profiles for the infants fluctuated from hour to hour during the first days of life and resembled those for both the mothers and the nurses, doing so all the more in the case of the five infants examined 6 months after birth. Gut colonization fluctuated markedly from hour to hour in the perinatal period. The effect of the maternal flora on the initial gut colonization may be less than expected as the fecal flora of infants started to resemble both the fecal flora of the mother as well as that of the first nurse.