Virtual reality in paraplegia: a VR-enhanced orthopaedic appliance for walking and rehabilitation

Spinal cord injuries (SCIs) have a profound physical, social and emotional cost to patients and their families. Obviously SCIs severely disrupt normal patterns of interaction with the environment. Firstly, the opportunities for active interaction are inevitably diminished due to motor or sensory impairment. Moreover, such problems may increase as the time since injury lengthens and the patient becomes more withdrawn and isolated in all spheres of activity. However, advances in Information Technology are providing new opportunities for rehabilitation technology. These advances are helping people to overcome the physical limitations affecting their mobility or their ability to hear, see or speak. In this chapter an overview is given of the design issues of a VR-enhanced orthopaedic appliance to be used in SCI rehabilitation. The basis for this approach is that physical therapy and motivation are crucial for maintaining flexibility and muscle strength and for reorganizing the nervous system after SCIs. First some design considerations are described and an outline of aims which the tool should pursue given. Finally, the design issues are described focusing both on the development of a test-bed rehabilitation device and on the description of a preliminary study detailing the use of the device with a long-term SCI patient.

Virtual environments in neuroscience

Virtual environments (VE's) let users navigate and interact with computer-generated three-dimensional (3-D) environments in real time, allowing for the control of complex stimuli presentation. These VE's have attracted much attention in medicine, especially in remote or augmented surgery, and surgical training, which are critically dependent on hand-eye coordination. Recently, however, some research projects have begun to test the possibility of using VE's for the study and rehabilitation of human cognitive and functional activities. This paper highlights recent and ongoing research related to the applications of VE's in the neuroscience arena. In particular, it focuses on the American and European initiatives in this field, including a description of the European Commission (EC)-funded VREPAR projects. Finally, the paper provides a general introduction to virtual reality (VR), as it relates to its impact on cognitive and functional abilities.

Allergic reactions to honey and royal jelly and their relationship with sensitization to compositae

Honey and royal jelly are complex etherogeneous mixtures of flowers' nectar, sugars, proteins and bee's glandular secretions. The existence of a type I hypersensitivity to honey is still matter of debate, while an aetiological role of Compositae pollens in the clinical manifestations following honey ingestion has been envisaged. We describe two cases of severe systemic reactions (anaphylaxis and generalized urticaria/angioedema) due to honey and royal jelly ingestion in patients sensitized to compositae (mugwort). Both patients had a skin and RAST positivity to mugwort and a positive prick-by-prick to the offending foods. Moreover, in one of the two patients the RAST-inhibition assay showed the strong cross-reactivity between the proteins of honey and mugwort and the SDS-PAGE analysis showed that the major proteic bands from honey and mugwort extracts are largely superimposable. Both the clinical data and the laboratory analysis support the hypothesis of a strict link between sensitization to compositae and adverse reactions to honey and jelly.

Experiential cognitive therapy in anorexia nervosa

The paper details the characteristics of Experiential Cognitive Therapy (ECT), a relatively short-term, integrated, patient-oriented approach that focuses on individual discovery. Its novelty is the use of Virtual Reality, a new technology that could play an important role in clinical psychology, since it enables ECT to address both body experience disturbances and motivation for change, two key topics in the treatment of anorexia nervosa. All the phases of ECT are described with reference to an actual clinical case: a 22-year-old female anorectic patient.

Factor structure of the Italian version of the Body Satisfaction Scale: a multisample analysis

The paper describes the factorial structure of the Italian version of the Body Satisfaction Scale, a simple self-report questionnaire designed to assess satisfaction with 16 body parts. The results suggest that the structure of the questionnaire can be adequately represented by three different factors. Even if this solution is different from the one obtained in the original English samples, this interpretation was confirmed by a cross-validation on 806 subjects, a clinical sample and two normal samples. This result may be useful for the screening of subjects at risk for eating-disorders because it makes possible prediction of targeted areas of dissatisfaction which is not generally possible with other inventories. The analysis of the factor loadings also suggested that three items should be removed (teeth, eyes, and ears) from the Italian version.

Replicated factor analysis of the Italian Version of the Body Image Avoidance Questionnaire

A multisample factor analysis identified two different solutions, a 3-factor solution from the high school sample of 439 subjects and a 4-factor solution from both the university sample of 200 subjects and an obese sample of 142 subjects. However, in the first sample Factor 1 included the same items which formed Factor 2 and Factor 4 in both the second and the third samples. This suggests that the structure of the questionnaire can be adequately described by four different factors. The analysis of the factor loading also indicated that six items should be removed (Items 2, 3, 10, 11, 17, 19) from the Italian version.

Obesity, psychopathology and eating attitudes: are they related?

The aim of this study was to verify the link between psychopathological disorders and eating attitude in a clinical sample of 195 female obese subjects. A battery of psychological tests, including the Italian versions of the MMPI2, ASQ and EAT scales were administered to all the patients. We analyzed the link between psychopathological traits and eating attitudes by using both Multiple Regression analysis and non-parametric Segmentation Modeling. The results showed that psychopathological aspects, and depression in particular, are strongly linked to the eating attitude of clinically obese subjects. This is an important result also for therapeutic purposes, as it highlights the need for psychological support in diet therapy to intervene on the psychological perceptions and experiences of the patient.

An examination of the reliability and validity of scores on the Italian version of the Dieter's Inventory of Eating Temptations

The aim of this paper was to highlight some psychometric characteristics of scores on the Italian version of the Dieter's Inventory of Eating Temptations. The analysis included assessment of the internal consistency of the individual scales, test-retest reliability, and estimates of both convergent and discriminant validity. Analyses showed that the Italian version of the inventory can be considered reliable and valid, which suggested its use as screening test for the identification of subjects who may be at risk for over-eating.

Severe and complicated Falciparum malaria in Italian travelers

Imported malaria has been an important public health problem in Western countries in the last 20 years, since international travel has become an increasing habit for nonimmune populations and since chemoresistance to most antimalarial drugs has been spreading throughout the world. Moreover, immigration from African and Asian countries has been rapidly increasing, especially in Italy in the last few years. Malaria had been widespread in Italy in the past, but no new autochthonous cases have been reported since 1961. Nonetheless the number of reported cases throughout the country has been steadily growing because of imported malaria1-3 in nonimmune travelers as well as in immigrants from tropical countries. In our experience as well as according to other statistics, the vast majority of patients have Plasmodium falciparum malaria acquired in Africa.4,5 The clinical spectrum of this disease is wide, and severe cases are frequently observed, including a few fatal cases, which, although rare, are highlighted by mass media and impress the public opinion.5-8 The purpose of this study was to examine the clinical spectrum of malaria, with particular interest in severe falciparum malaria, and to define the frequency of this phenomenon and epidemiologic characteristics of patients who experience it as a life-threatening disease.

Modifications of body-image induced by virtual reality

In contrast to the great number of publications on body image, only a few papers have focused on the treatment of a disturbed body image. In general, two direct and specific approaches are usually used, a cognitive/behavioural therapy to influence patient's feelings of dissatisfaction and a visuomotor therapy with the aim of influencing bodily awareness. The aim of this study was both to develop a virtual reality environment integrating the two approaches and to test its efficacy on a nonclinical sample of 24 women. Before and after a 10-min. virtual experience all the subjects made ratings on the Figure Rating Scale and the Contour Drawing Rating Scale. Analysis showed a significant reduction in body dissatisfaction without any major side effect.

[Natriuretic peptides and the heart. Critical review and application]

This paper deals with a literature survey on natriuretic peptides (NP) and their clinical use in prognostic stratification and therapy of arterial hypertension and cardiac failure. After a brief historical introduction, the phylogenesis of NP is analyzed and the reasons of their preservation in the evolution are emphasized. The biochemistry of the NP is then treated, and the structure, synthesis, mechanism of cellular action and systems of regulation are analyzed. Subsequently, the authors have analyzed the physiology of the NP as well as their hemodynamic and biohumoral effects and actions on the central nervous system. A literature review on the significance of NP in arterial hypertension, on their usefulness as indicators of damage and on their therapeutic practice is then made. In particular, the possible future applications in the prevention of atherosclerotic damage are analyzed. The significance of NP and of their metabolites in heart failure and the prognostic implication of these peptides particularly in ischemic heart failure are then discussed. The most important papers on this topic are described. Finally the studies on the use of NP in the therapy of heart failure are analyzed and a guide on research of this topic is defined.

[Anticoagulation and electrical cardioversion of chronic atrial fibrillation: proposal for an abbreviated protocol]

BACKGROUND

Several weeks of prophylactic anticoagulation are routinely prescribed before and after electrical cardioversion of atrial fibrillation. Recent studies have supported the use of transesophageal echocardiography to guide early cardioversion: patients in whom no thrombus is observed are treated with heparin followed by one month of warfarin therapy after the procedure. This kind of treatment requires hospital admission during heparin infusion, because of the need for monitoring partial thromboplastin time.

AIM OF THE STUDY

To evaluate if a short at-home treatment (three days) with warfarin is sufficient to reach a good level of anticoagulation, in order to permit safe electrical cardioversion in day-hospital for patients who show no thrombi on transesophageal echocardiography.

METHODS

One hundred twenty-four patients with atrial fibrillation, who were candidates for cardioversion, were treated with warfarin: 10 mg the first and second day, 5 mg the third day in group A patients (n = 79); 15 mg the first day, 10 mg the second and third day in group B patients (n = 45). On the fourth day, INR value was measured and if it was < 2, warfarin therapy was prolonged until patients reached a good level of anticoagulation. Transesophageal echocardiography was performed when the INR was > or = 2, and patients were cardioverted with DC shock if there were no thrombi. The patients were discharged on the same day of the procedure, and warfarin therapy was continued for 4 weeks there-after. If a thrombus was detected, patients repeated transesophageal echocardiography after 6 weeks of warfarin therapy, and were cardioverted if the thrombus disappeared. Otherwise, cardioversion was deferred and they received prolonged warfarin treatment. If there was poor visualization of the left atrial appendage, patients received conventional warfarin therapy for 3 weeks before and 4 weeks after electrical cardioversion.

RESULTS

Mean INR value after three days of warfarin treatment was 2.41 in group A patients and 3.02 in group B patients. Twenty-one patients from group A and 3 patients from group B required anticoagulant therapy for a mean of 3.3 and 5.1 days, respectively, before reaching a good level of anticoagulation (INR value > or = 2). Eight patients reverted spontaneously to sinus rhythm before transesophageal echocardiography. Eighteen thrombi (15.5%) were identified on the transesophageal echocardiography, all of which were in the left atrial appendage. In 11 cases, thrombus disappeared after 6 weeks of warfarin therapy. In 7 patients (6%), the atrial appendage was not sufficiently visualized. Electrical cardioversion was performed on 109 patients and was successful in 88 (80.7%). None of them experienced a clinical thromboembolic event.

CONCLUSIONS

In the majority of patients in atrial fibrillation, a short at-home warfarin treatment is sufficient to reach a good level of anticoagulation in order to permit safe electrical cardioversion in a day-hospital situation. Larger initial doses can achieve even better results. This treatment algorithm minimizes the anticoagulation period, hospital stay, overall duration of atrial fibrillation and the time required for the mechanical function of the left atrium to return.

Oral environment temperature changes induced by cold/hot liquid intake

The use of NiTi shape memory alloys, introduced into orthodontics because of their ability to develop light continuous forces that prove more effective than heavy intermittent forces in the teeth movement, requires the mastering of the functional properties of NiTi wires. More specifically, the recovery force acting on the teeth is a sensitive function of temperature: knowledge of oral temperature modifications is therefore required to understand the stress state modification felt during orthodontic therapy. The temperature modifications induced by cold or hot drink intake in the oral cavity were investigated by using arch wires, fixed to removable Hawley retainers, similar to those currently used in orthodontic practice, by means of six temperature sensors placed in correspondence with specific teeth. Similarly, the temperature changes were detected on a metallic frame, fixed onto the palatal zone to a Hawley retainer, where a palatal expander was placed to correct unilateral or bilateral crossbites in deciduous or in early mixed dentition. The maximum temperature change was observed in the interincisor area: The temperature modification on other teeth depends on the modality of drink intake, with the highest temperature variations being detected in the palatal zone. Hence modifications in the stress state during orthodontic therapy with NiTi wires are to be expected.

Representations of eating among adolescent Italian girls

The representations of eating of 200 adolescent girls, 100 obese and 100 of normal weight, were examined. Factor analysis was used to detect any qualitative, quantitative, or structural differences between the two groups' representations of eating. The results indicated a difference in the emotional characteristics of the representation: Obese participants not only failed to recognize the "abnormality" of overeating but considered it "ideal" because of what they perceived to be its components of strength and power.

Alexithymia in a clinical sample of obese women

The purpose was to examine the rate of alexithymia as measured by the Toronto Alexithymia Scale in a clinical sample of obese women without Binge Eating Disorder. Subjects included 165 inpatients in an eating disorder unit and 135 normal-weight individuals (comparison group). The obese subjects also completed a series of tests including the Minnesota Multiphasic Personality Inventory, the Anxiety Scale Questionnaire, and the Eating Attitude Test. Analysis showed that the subgroups of obese persons differ in important ways and cannot necessarily be treated, studied, or understood through a single paradigm. Alexithymic behaviour, too, was not characteristic of obesity, but it was present only in the subgroup of subjects with psychopathological characteristics.

Virtual reality environments for psycho-neuro-physiological assessment and rehabilitation

Virtual Reality Environments for Psychoneurophysiological Assessment and Rehabilitation-is an European Community funded project (Telematics for health-HC 1053 http:/(/)www.etho.be/ht_projects/vrepar/) whose aim is: to develop a PC based virtual reality system (PC-VRS) for the medical market that can be marketed at a price which is accessible to its possible end-users (hospitals, universities and research centres) and which would have the modular, connectability and interoperability characteristics that the existing systems lack; to develop three hardware/software modules for the application of the PC VRS in psychoneurophysiological assessment and rehabilitation. The chosen development areas are eating disorders (bulimia, anorexia and obesity), movement disorders (Parkinson's disease and torsion dystonia) and stroke disorders (unilateral neglect and hemiparesis). This paper presents the rationale of the different approaches and the methodology used.

Virtual reality as assessment tool in psychology

Virtual environments (VEs), offering a new human-computer interaction paradigm, have attracted much attention, in clinical psychology, especially in the treatment of phobias. However, a possible new application of VR in psychology is as assessment tool: VEs can be considered as an highly sophisticated form of adaptive testing. This chapter describes the context of current psychological assessment and underlines possible advantages of a VR based assessment tool. The chapter also details the characteristics of BIVRS, Body Image Virtual Reality Scale, an assessment tool designed to assess cognitive and affective components of body image. It consists of a non-immersive 3D graphical interface through which the patient is able to choose between 9 figures of different size which vary in size from underweight to overweight. The software was developed in two architectures, the first (A) running on a single user desktop computer equipped with a standard virtual reality development software and the second (B) splitted into a server (B1) accessible via Internet and actually running the same virtual ambient as in (A) and a VRML client (B2) so that anyone can access the application.

Virtual reality for the treatment of body image disturbances

This chapter describes the characteristics and preliminary evaluation of The Virtual Environment for Body Image Modification (VEBIM), a set of tasks aimed at treating body image disturbances and body dissatisfaction associated with eating disorders. Two methods are commonly used to treat body image: (1) a cognitive/behavioural therapy to influence patients' feelings of dissatisfaction; (2) a visual/motorial therapy with the aim of influencing the level of bodily awareness. VEBIM tries to integrate these two therapeutic approaches within an immersive virtual environment. This choice would not only make it possible to intervene simultaneously on all of the forms of bodily representations, but also to use the psycho-physiological effects provoked on the body by the virtual experience for therapeutic purposes. The chapter, together with the description of the VEBIM theoretical approach, it also presents a study on two preliminary samples (71 normal subjects, uncontrolled study, 48 normal subjects, controlled study) to test its efficacy.

Tracheobronchial aspergillosis in a patient with AIDS treated with aerosolized amphotericin B combined with itraconazole

The clinical features of a tracheobronchial infection due to Aspergillus flavus in an AIDS patient with a normal neutrophil count is described. Diagnosis was made by culture and microscopic examination of biopsies obtained from bronchial vegetations seen at bronchoscopy. Radiographic examination of the neck revealed the presence of large endoluminal fungal masses. Initially the patient was treated with a combination of itraconazole, flucytosine and aerosolized amphotericin B, then only with itraconazole plus aerosolized amphotericin B. A good therapeutic response was observed.

The role of emotional and socio-cognitive patterns in obesity: eating attitudes in obese adolescents before and after a dietary-behavioural therapy

The aim was to examine attitudes towards eating in a group of obese and nonobese female adolescents (N = 200), in particular whether obese subjects have characteristic attitudinal patterns associated with obesity. Analysis concluded that our sample, both overweight and normal subjects, share the negative stereotypic attitudes towards obese persons. However, there was a considerable difference in emotional evaluation of eating behaviour. If normal subjects attribute a strong negative emotional connotation, obese subjects not only did not recognise the "abnormality" of overeating, but preferred it. This can be explained by the presence of an association of strength and power with overeating: at the moment of eating, obese subjects feel themselves "strong" and even "superior," thereby compensating for their rather weak and fragile personalities. The emotional evaluation of eating behavior did not change after a 10-week dietary/behavioural treatment.

Growth, growth hormone and cognitive functions

The interactions among short stature, growth hormone (GH) and cognitive functions have been extensively studied so far. However, although it seems well established that short stature is associated with cognitive problems, little effort has been made to point out the presence of specific psychological effects related to the different forms of short stature. In 'short normal' children, the presence of a scholastic underachievement seems to suggest that short stature 'itself' might predispose these patients to some of their psychosocial difficulties. The higher incidence of academic failure, in presence of a normal intellectual functioning, has been attributed to environmental and psychosocial factors, including over-protective parents and low self-esteem resulting from the impact of short stature. These problems appear to be common also to other forms of short stature (such as Turner's syndrome) where, however, they are frequently associated with other specific deficits. The in vivo model which might allow, at least in part, better understanding of GH (per se)-dependent effects is represented by GH deficiency (GHD), in which, however, the specific role of GH on psychological functioning is frequently masked by the presence of associated hormonal deficiencies. Children with isolated GHD are reported to have specific educational deficits, in particular learning disability and attention-deficit disorders, which have been tentatively attributed to a compromised intellectual potential. The psychological effects of long-term GH treatment in children with GHD still remain controversial, with some retrospective studies describing a generally beneficial outcome. Since early experiences in school are closely related to success in adult life, the possible implications that GHD during childhood holds during adulthood have been recently considered. Although regional differences have been observed in subgroups of adults with GHD, it seems that these patients have normal cognitive functions and educational attainment, but are more likely to be unemployed (and unmarried) than members of the general population. In general, patients with GHD, who have been treated at centers where psychological counselling was an integral part of the treatment program, seem to be better adjusted in adult life. For these reasons, a multidisciplinary treatment approach could allow early detection of problems in academic achievement and psychosocial development in patients with short stature, being immediately able to provide the appropriate educational and counselling interventions.

[Alexithymia and psychopathology in a clinical sample of obese subjects]

The study examines the relationship between obesity and alexithymia, focusing on relations with the level of psychopathology. The Toronto Alexithymia Scale (TAS) was performed in 200 women (100 obese subjects and 100 normal weight individuals). In obese subjects TAS was accompanied by a series of tests including the Minnesota Multiphasic Personality Inventory (MMPI), Ipat Anxiety Scale (ASQ) and the Eating Attitude Test (EAT). The results obtained show that from a psychopathological point of view obesity cannot be considered a single phenomenon, and that it is possible to identify at least 3 groups with different psychopathological phenomenon as a whole, but it appears to be present, in association with other psychological traits, only on the subgroup (35% of the total) of subjects with borderline personalities.

Dot immunobinding assay as a new diagnostic test for human hydatid disease

Bovine and human hydatid antigens collected from hepatic cysts and characterized by SDS-PAGE immunoblotting show similar patterns. The bovine hydatid antigen has been used to develop a simple and fast in vitro diagnostic assay for human hydatidosis. This method, named HA-DIA (hydatid antigen dot immunobinding assay), consists of incubation of a serum sample with a textile colloidal dye (pink) and a nitrocellulose stick to which the hydatid antigen has been bound. The presence of parasite-specific antibodies leads to dyeing of the stick reactive area, and a coloured spot appears. HA-DIA sensitivity and specificity have been studied in comparison with RAST-IgE and ELISA-IgG by testing 17 sera of patients with hydatid disease and 36 control sera from patients affected with other parasitic and non-parasitic diseases. HA-DIA showed positive results in all the patients' sera and in none of the control sera. Correlation with ELISA--IgG and RAST-IgE was significant. HA-DIA has been demonstrated to be of good predictive value, allowing a speedy diagnosis of hydatid disease. In view of its simplicity, not requiring any laboratory instruments, it is particularly suitable for large-scale field screening.

Body image and social attitude in growth-hormone-deficient adults

This study was done to evaluate the perception of body image and psychosocial attitudes in a sample of 8 male adult subjects with growth-hormone deficit before and after six months of therapy. Before treatment the subjects tended to underestimate body size and were characterized by low self-esteem, a closed attitude towards social relationships, a pessimistic attitude with a tendency towards depression, and a strong sense of detachment from the outside world. After the treatment, even if the subjects continued to underestimate body size, we observed an improvement in terms of emotional control and well-being, accompanied by lower scores on anxiety. An integration of a psychological support in the GH therapy could help the patients to overcome problems of bodily and social acceptance.

Self-others perception in a clinical sample of obese women

The purpose of this research, using correspondence analysis on responses to semantic differential scores, was both to examine self-perception in a clinical sample of 120 obese women and to compare this with their attitudes toward obese, thin, and normal persons. Analyses allow us to conclude that, if obese women, as reported previously, consider obesity as a largely negative condition, they have an ambivalent attitude towards themselves. Even though they share the negative connotations socially attributed to obesity, emotionally these obese women not only tend not to recognize their "abnormality" but strongly desire it.

Growth hormone treatment in adults with childhood onset growth hormone deficiency: effects on psychological capabilities

The psychological aspects (personal traits, way of relating to the surrounding environment, perception of body image, degree of self-esteem) of eight adults with childhood onset growth hormone (GH) deficiency (GHD) were studied before and after 6 months of recombinant GH therapy. Each subject was evaluated using the following tests: the Bem Sex Role test, the non-verbal scales of the WAIS test for adults, the State-Trait Anxiety Inventory, the Experiential-World Inventory, the Image-Marking Method and the Draw-a-Person test; a psychoneurophysiological profile was also evaluated in order to monitor, by means of four neurophysiological variables (muscular tension, galvanic resistance, skin temperature and heart rate), the reactions to specific and aspecific stress. Before treatment, adults with GHD tended to underestimate their body size by an average of 30%, with peaks of 47% for the head area; furthermore, they showed a low level of self-esteem, a closed attitude towards social relationships, a pessimistic attitude with a tendency towards depression and a strong sense of detachment from the outside world. After 6 months of GH treatment, patients presented an overall improvement in relation to intellectual tasks, accompanied by a lower level of stress during their performance. A clear improvement was also observed in terms of emotional control during specific and aspecific stress, which might contribute a positive effect on their interrelationships. As expected, the treatment was not able to reduce the subjects' highly distorted perception of body image, due to the fact that GH treatment, despite a clear amelioration of lean/fat body mass ratio, did not change their body proportions.(ABSTRACT TRUNCATED AT 250 WORDS)

Screening for atopy in a coffee processing factory

Screening for blood IgE mediated allergy (atopy) by the RAST technique among 76 people working in a coffee processing factory showed rather unexpected findings: although we found a prevalence of positivity (17.1%) to the common airborne antigens (pollens, mites, cat, Alternaria tenuis) which was close to the prevalence of atopy among normal adults in our area (19.3%), only one case of allergy to green coffee and two cases to castor bean came to the fore. Specific IgG4 antibodies were measured only for castor bean and green coffee, and rather elevated figures were found: green coffee 17.1%, castor bean 13.1%. The occurence of positive RASTs to castor bean is more likely to be due to contamination of the bags containing green coffee. The low prevalence of RAST positivities to green coffee, and the elevated specific IgG4 antibodies to both castor bean and green coffee antigens, raise several possibilities which are discussed; however, all the subjects but one having elevated specific IgG4 levels to green coffee worked in more exposed areas. Probably IgG4 antibodies in this particular case are acting as blocking antibodies.

Prevalence of patent and latent atopy among a general normal adult population in the south east of France by RAST investigation and correlation with circulating total IgE levels

A population of 512 adults (men: 266, 52%, women: 246, 48%) with mean age 41.4 years (S.D. 10.7) was investigated. This population was subdivided into five groups: Marseilles city, Manosque a small town in a prealpine area, the area surrounding the Etang de Berre, a rural area in Northern Bouches du Rhône and Chateaurenard, a small town in an intensive agricultural area. RASTs to a panel of eight allergens (Lolium perenne, Parietaria officinalis, Cupressus sempervirens, Olea europea, Cat dander, Alternaria tenuis, Dermatophagoides pteronyssinus, and Castor bean seed) were done. 99 subjects were found to have a RAST positive to one or several allergens. The main positives found by RAST were a grass pollen (Lolium perenne) and the mite Dermatophagoides pteronyssinus with respectively 10.1% and 11.3% of the results followed by the pollens of Olea Europea 4.4%, Parietaria officinalis 3.1% and Cupressus sempervirens 1.9%, Castor bean seed 1.7% Cat dander 0.9% and Alternaria tenuis 0.9%. Allergy to cstor bean (Ricinus communis) seed was found mostly in the Chateaurenard area where castor castor bean pomace is used in the fields as a fertilizer. There is an almost equal number of RAST positivities to mites (13.3%) than to pollens (11.1%). The prevalence of RAST positive was higher in men (24.1%) than in women (14.2%), p < 0.01). This prevalence is lower when age is increasing. Thirty four subjects (6.6%) had clinical symptoms: This group has a higher prevalence of positive RAST in cases of allergic rhinitis (p < 0.01) and of asthma (p > 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Screening for IgE mediated allergy among people working in the Marseilles harbour

Screening for IgE mediated allergy by RASTs to professional (castor bean, green coffee, peanut, soy protein, wheat, rice), and non professional (pollens, mites, cat, Alternaria tenuis) air borne antigens among 36 people working in the Marseilles harbour has showed rather unexpected findings: only one case of IgE positivity to Dermatophagoides pteronyssinus (class I) and one case of IgE positivity to castor bean seed (Ricinus communis) (class IV). IgG4 specific antibodies against castor bean and green coffee were also measured by an ELISA technique, with eleven cases of positivity to castor bean and only one case to green coffee being recorded. Several explanations can be put forward for the low incidence of IgE responses to the commonest airborne antigens and to the professional antigens (castor bean being the only offender), and for the rather high incidence of specific IgG4 antibodies to castor bean. Most likely, the low incidence of latent atopy is the result of a natural selection among the workers who gave up their job if experiencing of discomfort. As far as the elevated IgG4 antibody levels to castor bean are concerned, these are probably natural blocking antibodies.

Specific binding of endothelin on human bronchial smooth muscle cells in culture and secretion of endothelin-like material from bronchial epithelial cells

Endothelin, synthesized by endothelial cells, is the most potent vasoconstrictor and bronchoconstrictor agent known. We investigated endothelin release from human bronchial epithelial cells and the binding of the peptide to autologous bronchial smooth muscle cells in culture. Epithelial and smooth muscle cells were isolated by enzymatic digestion of bronchial tissue obtained on surgery, and cultured to confluency by standard methods. Epithelial cells stained positively for cytokeratin filaments. Smooth muscle cells stained uniformly for alpha-smooth muscle actin. Immunoreactive endothelin contents in the supernatants of epithelial cells extracted on C8 Amprep columns were evaluated by radioimmunoassay. Epithelial cells released appreciable amounts of immunoreactive endothelin into the culture medium (from 0.65 to 2.1 pmol/ml). A single specific binding site for [125I]endothelin 1 was identified on bronchial smooth muscle cells with an apparent Kd of 113 pM and a maximal binding capacity of 22.1 fmol/10(6) cells. At room temperature the binding was saturable, reached equilibrium at 120 min (25 pM endothelin 1), and was slowly and incompletely reversed by unlabeled endothelin over a period of 8 h. Conditioned medium from epithelial cells inhibited the [125I]endothelin 1 binding, dose dependently, and the effect was antagonized by monospecific antiserum. Thus, human bronchial smooth muscle cells possess specific binding sites for endothelin 1 and human bronchial epithelial cells secrete an endothelin-like material. This may have a role in the pathogenesis of asthma.

Allergic manifestations due to castor beans: an undue risk for the dock workers handling green coffee beans

The main cause of allergic manifestations among workers handling green coffee beans (GCB) is sensitization to castor beans (CB), which are considered a common contaminant of the sacks used to transport coffee beans. The RAST inhibition test was used to evaluate the presence of GCB and CB allergens on the surface of the sacks coming from the major world producers of coffee and to ascertain the presence of the CB allergen in coffee beans. A significant concentration of the two allergens, i.e., GCB and CB, on the sacks was demonstrated, with the highest values found on sacks from Brazil, while the hypothesis of a significant CB contamination in coffee beans was not confirmed. We believe the presence of the CB allergen on the surface of the sacks is due to contamination occurring during stocking and transport and could easily be prevented. Appropriate measures taken during transport could effectively prevent this "undue" risk in dockers and probably also in coffee industry workers.

Micropreparative-scale enrichment of some allergenic components of Parietaria pollen extract

A preparative-scale enrichment of the allergenic components of the pollen extract of Parietaria judaica, which grow all over the Mediterranean area, has been obtained by high-performance liquid chromatography, operating in the ion-exchange mode at pH 7 with a curvilinear ionic-strength gradient.

Analysis of allergenic components of a Parietaria judaica pollen extract by chromatographic methods for the evaluation of purification procedures

Size-exclusion and ion-exchange high-performance liquid chromatography were used to monitor the presence of polymeric aggregates and of families of allergens of similar isoelectric point in Parietaria judaica pollen extracts. A radio-allergo-sorbent test and chromatofocusing were used for the analysis of individual fractions. This allows the detection of two groups of allergens, having pI of 4.7 and greater than 5.7, respectively, and shows the effect of dialysis or ultrafiltration on the distribution of allergens.

Purification and molecular weight studies on the components of a Parietaria pollen extract

The pollen extract of the allergenic plant Parietaria judaica, growing throughout the Mediterranean region, has been purified by high performance liquid chromatography (HPLC) operating in size-exclusion followed by ion exchange. Molecular weight determination of the components and isoelectrofocusing studies on the enriched material have been performed.

Long term results (15-30 years) of surgical repair of aortic coarctation

The late outcome in 226 patients who survived surgical repair of aortic coarctation was assessed 15-30 years after operation. Twenty six patients died during the follow up mainly from causes related to surgical repair or to associated cardiovascular anomalies. The survival rates of patients operated on between the ages of four and 20 years are 97%, 97%, 92% at 10, 20, and 30 years after operation. For patients operated on after the age of 20 the corresponding rates are 93%, 85%, and 68%. This difference is statistically significant from the fifteenth year of follow up onwards. The survival of patients operated on before the age of 20 is not significantly different from that of a comparable general Italian population. Recoarctation occurred in only 8% of patients who had end to end anastomosis, whereas it occurred in 35% of those who had other types of operation. Two thirds of the patients were hypertensive at the last visit. The actuarial curve shows that blood pressure was normal in most patients 5-10 years after operation, but 30 years after coarctation repair only 32% of patients are expected to be normotensive. Thus early repair of aortic coarctation appears to improve long term survival. Intervention in older patients and when blood pressure is high seem to be the most important predictors of late hypertension.

Short and long-term clinical effects of plasma-exchange in 33 cases of myasthenia gravis

The authors examine the results of plasma exchange (PE) treatment in 33 patients with myasthenia gravis, who underwent a total of 49 cycles of treatment. On the basis of clinical response, evaluated in relation to a modification of the functional state and to the duration of improvement after PE, we selected a group of 20 responsive patients ("responders" = 60.6%) and 13 non-responsive patients ("non-responders" = 39.4%). Positive effects, some only short-lasting, were observed in 24 patients (72.7%) after 32 cycles of a total of 49 cycles (65.3%). Out of the 11 most critical patients, 7 (63.6%) were considered responders, given the importance and duration of the improvement they presented, while 2 other patients had clear but short-lasting improvements; in these 9 patients, the positive effects amounted to 81.2%. Factors presumably responsible for therapeutic failure in the non-responders are discussed.

Peptichemio induction therapy in myelomatosis

Fifteen patients with multiple myeloma, two of whom had plasma cell leukemia, were treated between May 1974 and December 1978. Peptichemio was administered intravenously at doses of 40-80 mg/48 h, courses including 4-17 administrations in association with moderate doses of prednisone (15-50 mg/day) and androstanes at high dosages (250 mg weekly). In two patients PTC was associated with vincristine (VCR) administered on the first day of the course. Eight patients were previously untreated, four had been resistant to melphalan (MPH) and/or cyclophosphamide (CTX), and three had been treated irregularly with one or both of these alkylating agents. The criteria of response to therapy are reported. Out of a total of 15 PTC courses administered we obtained 13 responses, eight complete and five partial; no response was achieved in the other two patients. In the four patients who were resistant to MPH and/or CTX we obtained three responses, which were maintained with the same alkylating agent to which they had been resistant previously. The time needed to obtain a response in 90% of the patients was 6 weeks. Peptichemio was shown to be effective in patients in an advanced stage of the disease, in patients with light-chain myeloma and in those with plasma cell leukemia. The association of VCR potentiated the antitumor effect, but also increased the myelotoxicity. The PTC treatment was well tolerated. It is suggested that PTC be used in induction treatment of myelomatosis and in patients resistant to traditional alkylating agents.