The prevalence and the causes of minimal intestinal lesions in patients complaining of symptoms suggestive of enteropathy: a follow-up study

AIMS

Although they are non-specific, minimal intestinal lesions are at the end of the coeliac histological damage spectrum. To investigate whether minimal intestinal lesions in patients without endomysial antibodies are due to coeliac disease, their prevalence, causes and risk of evolving into frank coeliac disease were studied.

METHODS

From January 2000 to December 2005, 645 duodenal biopsies were performed. In 209 patients, duodenal biopsies were performed independently of endomysial antibody results. Clinical data and HLA-typing of all the patients negative to endomysial antibodies but with minimal mucosal lesions were re-evaluated. Three years later, they were offered to be seen again, and further investigations were proposed.

RESULTS

14 out of 209 patients had minimal mucosal lesions and negative endomysial antibodies. Two patients were lost to follow-up; in 7/12 patients, symptoms and histological lesions were due to a different condition, not related to coeliac disease. In 11/12 patients, HLA-typing made diagnosis of coeliac disease very unlikely. Only one patient was on a gluten-free diet because of gluten-sensitive symptoms and was DQ2(+)/DQ8(+).

CONCLUSIONS

Minimal duodenal lesions in patients negative to endomysial antibodies are rare and are likely to be due to conditions unrelated to coeliac disease.

Prevalence of metabolic syndrome (MS) in children and adolescents with varying degrees of obesity

OBJECTIVE

Childhood obesity is increasingly common and is associated with health problems; in particular, obesity plays a central role in the metabolic syndrome (MS). We estimated the prevalence of MS in Caucasian children and adolescents with varying degrees of obesity.

PATIENTS AND METHODS

We studied 191 obese [body mass index (BMI) > 97th percentile] children and adolescents. Obesity was stratified on the basis of a threshold BMI z-score and subjects were classified as moderately (z-score 2-2.5) or severely obese (z-score > 2.5). Seventy-six, nonobese subjects were recruited into a comparison group. Thirty-one of them were of normal weight (BMI < 75th percentile) and 45 overweight (BMI 75th-97th percentile). Patients were classified as having MS if they met three or more of the following criteria for age and sex: BMI > 97th percentile, triglyceride levels > 95th percentile, high density lipoprotein (HDL) cholesterol level < 5th percentile, systolic or diastolic blood pressure > 95th percentile and impaired glucose tolerance (blood glucose level: 7.8-11.1 mmol/l at 2 h). Insulin resistance was calculated using the homeostasis model assessment for insulin resistance (HOMA-IR) and impaired insulin sensitivity was defined as a HOMA-IR > or = 2.5 in prepubertal patients and HOMA-IR > 4 in pubertal subjects.

RESULTS

The overall prevalence of MS was 13.9% and was present in 12.0% of moderately obese and 31.1% of severely obese subjects; no overweight or normal weight subjects met the criteria for MS. The rate of the MS increased progressively with increasing BMI categories (P < 0.001). Severely obese patients had a threefold increased risk with respect to moderately obese patients.

CONCLUSIONS

The prevalence of the MS is higher in obese as opposed to nonobese subjects and increases with severity of obesity.

Comparing the efficacy and safety of continuous epidural analgesia in abdominal and urological surgery between two opioids with different kinetic properties: morphine and sufentanyl

BACKGROUND

Ample evidence is now available showing the analgesic efficacy of a local anaesthetic-opioid combination to control postoperative pain. This retrospective study aimed to analyze any improvement in the ability of sufentanyl, a highly lipophilic opioid, and morphine, a poorly lipophilic opioid, to control postoperative pain at rest and in motion when combined with ropivacaine 0.2%.

METHODS

In this retrospective study, 171 patients who underwent major abdominal or urological surgery were evaluated. The therapeutic protocol provided for continuous epidural perfusion (5 mL/h) of ropivacaine 0.2% + morphine 0.03 mg/mL or ropivacaine 0.2% + sufentanyl 0.75 mug/mL for 48 h. Pain at rest (numeric rate scale, NRS) and in motion (NRSm) was evaluated by means of the NRS upon waking and at 3, 6, 12, 24, 36, and 48 hs, providing for the administration of a rescue dose if NRS >4. The overall analgesic effect was evaluated by comparing the area under the NRS curve (AUC) of both treatments using the Mann Whitney U test. Any differences between treatments in terms of NRS and NRSm in time were evaluated using ordinal logistic regression. To compare the frequency of patients who reported NRS >4 at least once during the follow-up period, logistic regression was used. Finally, the frequency of patients who required at least one additional drug or reported side effects was compared using Fisher's exact test.

RESULTS

While both groups showed a comparable overall analgesic effect, the baseline values of NRS and NRSm were lower for the sufentanyl group (P<0.001), perhaps as a result of its quicker onset due to higher lipophilicity. No statistically significant difference was observed in the frequency of patients requiring administration of an additional analgesic drug (P=0.136) or in the incidence of complications (P=0.799).

CONCLUSION

Both protocols providing a combination of a local anaesthetic and an opioid demonstrated an excellent safety and efficacy profile. The differing lipophilicity of the opioids did not cause any clinically or statistically significant differences in terms of efficacy or safety, other than a reduced onset time of sufentanyl, ensuring better pain control upon waking. We therefore believe that morphine should be the standard opioid for neuraxial use, although these results must be confirmed in the setting of a randomized controlled clinical trial.

Echocardiographic evaluation of left ventricular diastolic function: correlation between echocardiographic and hemodynamic parameters

AIM

The aim of this study was to assess the correlation between non invasive echo-Doppler parameters of diastolic function and invasively measured end-diastolic left ventricular (LV) filling pressures in patients with normal or depressed LV function.

METHODS

The patient population was composed of 44 subjects, (34 men and 10 women) 52% with normal ventricular function, who underwent echo-Doppler and hemodynamic evaluation within 24 hours between the two exams.

RESULTS

LV end-diastolic pressure was statistically different (P=0.022) in the 4 subgroups divided on the basis of the mitral flow pattern in the overall population and in the patients with depressed LV function, but not in those with normal LV function. In the overall population LV end-diastolic pressure was significantly correlated with: 1) E/A ratio of mitral flow (r=0.45, P=0.002); 2) mitral E wave peak velocity (r=0.39, P=0.017); 3) isovolumic relaxation time (r=-0.34, P=0.01); 4) left atrial diameter (r=0.33, P=0.037); 5) duration of retrograde A wave of pulmonary venous flow (r=0.33, P=0.03); 6) Pulmonary vein D wave peak velocity (r=0.29, P=0,05). Multivariate analysis showed that the correlation between the echo-Doppler variables and LV end-diastolic pressure was statistically significant only in patients with depressed LV function, but not in those with normal function.

CONCLUSION

Among the echo-Doppler variables examined, those derived from transmitral flow and pulmonary vein flow show the best correlation with left ventricular end-diastolic pressure; however, the correlation is statistically significant only in patients with depressed LV function. Thus, the echo-Doppler evaluation of LV diastolic function should take into account this limitation and should be based on a multiparametric approach.

Quality of life in allergic rhinitis: relationship with clinical, immunological, and functional aspects

BACKGROUND

The relationship among nasal obstruction, T-helper type 2-dependent inflammation, nasal airflow limitation, and reversibility to the nasal decongestion test has been evidenced in allergic rhinitis (AR). Moreover, quality of life (QoL) has been widely evaluated in AR and its evaluation is considered in numerous trials.

OBJECTIVE

The aim of this cross-sectional study was to identify the QoL as measured by the Quality of Life Questionnaire in a population of patients with AR and to compare it with clinical, immunological, and functional parameters.

METHODS

One hundred and twenty-three patients with persistent AR were prospectively and consecutively evaluated. Clinical evaluation, skin prick test, nasal scraping for cytology, rhinomanometry, decongestion test, and QoL questionnaire were performed in all subjects.

RESULTS

There was a significant relationship among QoL and functional and immunological parameters. Particularly, the multivariate analysis showed that having more than two sensitivities was a determinant of the QoL. The eosinophil count was significantly associated with QoL as well as the baseline nasal flow (mL/s) with the eye symptoms scale only.

CONCLUSIONS

This study provides the first evidence that QoL in AR is strictly associated with allergic inflammation and eye symptoms significantly contribute to impairment of QoL. QoL, moreover, represents an important aspect to consider in managing patients with AR as it has a relationship with clinical, immunological, and functional parameters.

Inflammation of paranasal sinuses: the clinical pattern is age-dependent

Acute rhinosinusitis (ARS) represents a common disorder, associated with consistent morbidity as well as with a large prescription of antibiotics. ARS has a significant impact on clinical practice; it usually presents with respiratory complaints persisting longer than 10 days and showing no signs of improvement. Throughout the evaluation of 256 pediatric patients (152 males and 135 females, aged between 2 and 15 yr), with ARS confirmed by nasal endoscopy, we have been able to provide evidence that age has a significant influence on clinical patterns in children with ARS.

Allergic patients have more numerous and prolonged respiratory infections than nonallergic subjects

BACKGROUND

Allergic disorders are characterized by type 2 helper T cell (Th2)-polarization, thus physiological type 1 helper T cell (Th1)-dependent mechanisms involved in fighting respiratory infections (RI) may be defective. It has previously been reported that allergic children have more numerous and severe RI than nonallergic ones.

OBJECTIVE

The aim of the study was to evaluate the number and duration of RI in adult allergic and nonallergic subjects.

METHODS

Six hundred and twenty-four subjects were studied; 202 of them were allergic (i.e. suffering from allergic rhinitis). The number of RI as well as the duration of the disease were recorded for 2 years.

RESULTS

Allergic subjects showed a significantly higher rate of RI episodes [adjusted incidence rate ratio (IRR) = 2.16, 95% confidence interval (CI) 1.94-2.41, P < 0.001] than subjects without allergy. The number of mild RI episodes was slightly higher in allergic subjects (IRR = 1.68, 95% CI 1.50-1.89, P < 0.001), while the number of severe episodes was markedly higher (IRR = 15.71, 95% CI 10.35-23.84, P < 0.001) when compared with nonallergic subjects. Moreover, allergic patients showed a longer total duration of RI than nonallergic subjects, with a mean difference of 17.4 days (95% CI 15.5-19.4, P < 0.001).

CONCLUSIONS

This study provides evidence that adult allergic patients have more numerous and prolonged RI than nonallergic subjects.

A comparison of three diagnostic techniques for malaria: a rapid diagnostic test (NOW Malaria), PCR and microscopy

Malaria is a common, life-threatening infection in endemic tropical areas and one that presents a diagnostic challenge to laboratories in most non-endemic countries. A rapid and accurate diagnosis is a prerequisite for effective treatment, especially for the potentially fatal cases of Plasmodium falciparum infection. In the present, multi-centre study, the performances of a rapid diagnostic test (NOW) Malaria) and several, commercial, PCR-based assays (AMS61, AMS42, AMS43, AMS4 and AMS45) were compared against the results of microscopical examination of bloodsmears (the current 'gold standard'). The subjects were either non-European immigrants (N=135) or international travellers (N=171). There was good concordance between the results of all the detection methods, with kappa values of >0.8. Although the NOW Malaria rapid test was both sensitive (100%) and specific (100%) in detecting P. falciparum infections, it was less specific (93.1%) and sensitive (90.7%) in identifying the other Plasmodium species. The results from the AMS61 assay, designed to detect any malarial infection, generally parallelled those of the microscopy (kappa = 0.89), giving a specificity of 98.2% and a sensitivity of 91.0%. Although the use of species-specific molecular primers to identify pure infections with P. falciparum and P. vivax gave results that were in good agreement with those of the microscopy, the subjects who had apparently pure infections with P. ovale or P. malariae were always found PCR-negative. Compared with the standard microscopy, both the NOW Malaria test and the PCR-based assays were therefore poor at identifying mixed infections. The NOW Malaria test and the PCR-based assays clearly need to be improved, particularly for the correct identification of infections with Plasmodium spp. other than P. falciparum, including mixed infections. For now, expert microscopy must remain the mainstay of the laboratory diagnosis of malaria.

Pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension: short-term functional assessment in a longitudinal study

AIM

Presently, the surgical treatment choice in chronic thromboembolic pulmonary hypertension (CTEPH) consists in a pulmonary endarterectomy (PEA). The aim of the present study is the functional assessment of patients submitted to PEA both preoperatively and shortly after the intervention. A longitudinal study was developed to study the quality and quantity of functional performance possible in these subjects.

METHODS

Twenty-two subjects were assessed immediately prior to PEA and 3 months later in order to obtain quantitative measurements of short-term functional recovery. The functional assessment included the 6-min walk test (6mWT), the measurement of the oxygen percent saturation (HbS%O(2)) and the degree of dyspnea subjectively perceived by each patient.

RESULTS

Three months after the surgical intervention, there was a definite increase in the number of meters walked during the 6mWT with respect to preintervention; the difference between the distances walked in the 6mWT (6mWD) in the pre and post-PEA was statistically significant (Paired t-test P<0.001).

CONCLUSION

In this study the 6mWT resulted to be a useful tool in the functional evaluation of patients affected by CTEPH and submitted to PEA. The average 6mWD significantly improved already at 3 months after the intervention, thus reaching the minimum limit of the range predicted for the healthy control, but remains lower than the average theoretical value predicted (about 75% of the same).

Antibiotic treatment alone for acute rhinosinusitis gives a poor response in allergic children

Acute rhinosinusitis (ARS) is frequent in children. Patients with allergic rhinitis show signs of more impaired paranasal sinus functioning than normal subjects during viral colds. This study evaluated the effectiveness of administering antibiotics alone to treat ARS in both allergic and non-allergic children. We obtained informed consent from the parents of each patient enrolled in the study. 97 children, 55 males and 42 females aged between 4 and 9 years (46 of whom were allergic), suffering from ARS, were treated with amoxicilline-clavulanate (50 mg/Kg bid) for 14 days. Symptoms and endoscopic signs of illness were evaluated at baseline and immediately after treatment. Symptoms improved significantly (p<0.001) after treatment in 84 patients, equally distributed between allergic and non-allergic subjects. On the contrary, endoscopic signs disappeared only in 49 children, 9 of whom were allergic (OR 14.9, 95%CI 4.6-40.1, p<0.001). Slight to fair agreement was observed between clinical symptoms and endoscopic signs (agreement 64% , Kappa=0.28, McNemar test p<0.001). Antibiotic therapy alone in the treatment of ARS may be generally insufficient to resolve symptoms, mainly endoscopic signs. Moreover, in allergic children this issue appears to be more evident.

A different schedule of zoledronic acid can reduce the risk of the osteonecrosis of the jaw in patients with multiple myeloma

Osteonecrosis of the jaw (ONJ) is a reported complication of bisphosphonate use. The incidence ranges between 6 and 13% and seems to be higher in people treated with zoledronic acid (ZA) than with pamidronate. We retrospectively evaluated the incidences of ONJ and skeletal-related events (SRE) in 106 patients with multiple myeloma divided in two groups according to the schedule of administration of bisphosphonates: 51 received monthly administrations until tolerated (group A, standard schedule), 55 were treated monthly during the first year and then every 3 months (group B, reduced schedule). The incidence of SRE was similar (15.1 per 100 person years in group A and 17.7 in group B). ONJ occurred in seven patients, six in group A and one in group B (P=0.049). The risk of ONJ was eight-fold lower with the reduced schedule than with the standard schedule. The only significant risk factor for ONJ was the type of bisphosphonate (P=0.006). The incidence of ONJ was significantly higher with ZA than with pamidronate + ZA (9.1 vs 1.6 per 100 person-years). No ONJ was observed in patients treated only with pamidronate. A reduced schedule of ZA may be safer than the standard schedule while maintaining anti-resorptive efficacy.

Deficiency of INFgamma producing cells in adenoids of children exposed to passive smoke

Exposure to passive smoke is a very common event associated with increased susceptibility to respiratory tract infections. Many related adverse effects result from the ability of cigarette smoke extracts to interfere with the immune system, but the mechanism is not yet completely understood. The aim of the present study is to evaluate the intracellular cytokine profile in adenoids and peripheral blood cells of children exposed to passive smoke. Children undergoing adenoidectomy exposed or not exposed to passive smoke were studied. The intracellular cytokine profile of lymphocyte subsets in adenoids and in peripheral blood were evaluated by flow cytometry analysis. Children exposed to tobacco smoke showed a significantly lower percentage of INF-gamma producing CD4+ and CD8+ cells in adenoids. Moreover a significant correlation was observed between the quantity of exposure and reduction in Th1 (CD4+INFgamma+ and CD8+INFgamma+) cells in adenoids. This reduction may be a contributing factor in the increasing susceptibility to respiratory tract infection in children exposed to tobacco smoke.

Changes in autonomic modulation to the heart and intracellular catecholamines. A longitudinal study in differentiated thyroid carcinoma during short-term hypothyroidism and thyroid hormone replacement

BACKGROUND

The effects of thyroid deprivation on the autonomic modulation to the heart remain controversial.

METHODS

In this study in patients followed for thyroid carcinoma, we investigated (1) heart rate variability parameters and the baroreflex gain and (2) intracellular catecholamine levels in circulating lymphocytes during short-term hypothyroidism (phase 1) and after reinstitution of TSH-suppressive thyroid hormone replacement (phase 2).

RESULTS

The RR interval value (p < 0.01) and systolic blood pressure (p < 0.05) were higher in phase 1 than in phase 2. The low-frequency/high-frequency (LF/HF) ratio was significantly lower in the hypothyroid state (p < 0.05), with a higher HF component (p < 0.05). After adjusting for mean RR interval in the regression model, the difference between the power of RR interval oscillations calculated in the two states was greater for the LF band (p = 0.005) and it was borderline significant for the HF band (p = 0.052). The baroreflex gain alpha(LF) index was similar in the two phases. The stimulus-induced cellular production of norepinephrine and epinephrine in peripheral blood mononuclear cells was significantly higher in phase 2.

CONCLUSION

The neurally-mediated influences on the sinus node and the study of intracellular catecholamine production suggest a reduced sympathoexcitation in hypothyroidism compared with the treatment phase. The early increase in blood pressure observed after thyroid hormone withdrawal is not due to impaired sensitivity of the baroreflex arc.

Determinants of quality of life after lung transplant: an Italian collaborative study

BACKGROUND

With the improvement in survival rates after lung transplantation, concern has arisen about evaluating quality of life (QoL). This multicenter cross-sectional study aimed at describing QoL and identifying factors associated with it.

METHODS

We assessed QoL in 129 lung transplant recipients from 5 centres in Italy, during scheduled follow-up visits, using the SF-36, GHQ and St George's respiratory questionnaires (SGRQ).

RESULTS

The SF-36 elicited impaired QoL in the physical, but not in the mental domains (PCS = 44; MCS = 53). The GHQ identified 29 patients (23%) with psychological discomfort and the SGRQ scores were significantly better than those of patients with chronic respiratory disease. On multivariate analysis, exertional dyspnea was an independent predictor of the PCS (adjusted delta -6.3 (p < 0.001), while osteoporosis (delta = -3.1), BOS (delta = -4.3), acute rejection (delta = -3.9) and heart and lung transplant (delta = +6.4) were only marginally associated. Dyspnea was also related to a GHQ score > 5.

CONCLUSIONS

The study identified exertional dyspnea as the main determinant of QoL as measured both by SF36 (PCS) and GHQ. Other objective measures contributed only to the PCS. Thus, the SF-36 (PCS) and GHQ were useful in identifying patients who needed treatment not only for complications but also psychological support and continued physical rehabilitation.

Screening spirometry to detect respiratory allergy

BACKGROUND

Recently, it has been evidenced that the forced expiratory flow at the 25 and 75% of the pulmonary volume (FEF25-75) might be considered as a possible marker of early bronchial impairment in patients with allergic rhinitis alone.

OBJECTIVES

The aim of this study was to determine whether a spirometric impairment may predict allergy during screening visit.

METHODS

The study included 283 Navy soldiers (255 males, mean age 27.1 + 8.2) who had to undergo spirometry for attending specific courses. Fifty-four showed slight spirometric anomalies. Thus, they referred to Navy Hospital of La Spezia for standardized tests: skin prick test, spirometry, and methacholine bronchial challenge.

RESULTS

Forty seven (87%) subjects were sensitized (47% monosensitized and 53% polysensitized). Allergic rhinitis was diagnosed in 25 subjects with median nasal TSS 5. FVC and FEV1 values were normal, whereas FEF25-75 values were reduced (61.8 + 14.8 % of predicted), bronchodilation test was significant for FEF25-75 (82.9 + 16.8% of predicted; p<0.001) only. Bronchial hyperreactivity (BHR) was detected in 28 subjects, all but 1 were sensitized.

CONCLUSIONS

This study provides evidence, relevant to clinical care, that mild spirometric impairment may generate the suspect of allergic disorders, thus spirometry could be more frequently performed in general population screening.

Thyroid hormone and thyrotropin regulate intracellular free calcium concentrations in human polymorphonuclear leukocytes: in vivo and in vitro studies

Intracellular free calcium concentrations (Ca++i) were studied in polymorphonuclear leukocytes (PMNs) from 13 athyreotic patients who had been previously treated by total thyroidectomy and radioiodine therapy for differentiated thyroid carcinoma, and from age- and sex-matched euthyroid healthy controls. Patients were studied twice, when hypothyroid (visit 1) and after restoration of euthyroidism by L-T4 TSH-suppressive therapy (visit 2). PMNs from patients at visit 1 had significantly lower resting (Ca++)i levels compared to both visit 2 and controls. Values at visit 2 did not differ from those of the controls. Stimulus-induced (Ca++)i rise was also significantly blunted at visit 1 and normalized at visit 2, possibly through a differential contribution of distinct intracellular Ca++ stores, as suggested by the response pattern to the chemotactic agent, N-formyl-Met-Leu-Phe (fMLP), to the selective SERCA pump inhibitor, thapsigargine, and to the mitochondrial uncoupler, carbonyl cyanide p-trifluoromethoxyphenyl-hydrazone (FCCP). In vitro treatment of PMNs from healthy subjects with high TSH concentrations impaired intracellular Ca++ store function. Both resting (Ca++)i levels and fMLP-induced (Ca++)i rise increased in the presence either of low-concentration TSH or of T4, but effects of TSH and T4 were not additive. T3, rT3, and TRIAC had no effect. In conclusion, this study provides evidence for a direct relationship between thyroid status and (Ca++)i homeostasis in human PMNs, mainly related to direct actions of TSH and T4 on these cells.

Ovarian cancer and venous thromboembolic risk

OBJECTIVE

To determine the incidence and the prognostic factors of objectively diagnosed deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients with epithelial ovarian malignancy.

METHODS

We reviewed the records of all patients with epithelial ovarian cancer who were diagnosed, treated, and followed-up at our institution between 1990 and 2001. Data were collected regarding age, body mass index, previous DVT and PE, menopause status, FIGO stage, grade, histology, type of surgery, residual disease, first line chemotherapy, and relapse status.

RESULTS

Of the 253 cases, the overall incidence of symptomatic venous thromboembolic events (VTE) was 16.6% (42 patients): 1.6% (4) with PE and 15% (38) with DVT. 8 events (3.2%) were detected before tumor diagnosis, 6 (2.4%) in the postoperative period, 16 (6.4%) during first line chemotherapy and 12 (4.8%) throughout the follow-up period. Risk factors associated with occurrence of VTE were: at diagnosis, history of deep vein thrombosis (P = 0.001); during chemotherapy, older age (P = 0.017), larger body mass index (P = 0.019), FIGO stage 2c-4 (P = 0.004), no surgery (P = 0.003), and presence of residual tumor (P = 0.026). None of the considered risk factors were found to be predictors of VTE postoperatively. The multivariate regression analysis found that residual tumor, age, and body mass index were independent prognostic factors.

CONCLUSION

The incidence of VTE throughout the entire history of ovarian malignancy is high. Prognostic factors could be used to establish prophylaxis protocols based on risk stratification.

Relationships between allergic inflammation and nasal airflow in children with persistent allergic rhinitis due to mite sensitization

BACKGROUND

Allergic rhinitis is associated with Th2-dependent inflammation. Nasal obstruction is the most typical symptom in children with mite allergy.

OBJECTIVES

The aim of this study was to evaluate the possible relationships among nasal symptoms, allergic inflammation, including inflammatory cells and cytokine pattern, and nasal airflow in children with persistent allergic rhinitis because of mite sensitization.

METHODS

Twenty children (13 males and seven females, mean age 13.4 +/- 1.6 years) with persistent rhinitis because of mite allergy were evaluated. All of them had moderate-severe grade of nasal obstruction. Total symptom score (TSS), rhinomanometry, nasal lavage, and nasal scraping were obtained in all subjects. Inflammatory cells were counted by conventional staining; interleukin (IL)-5, and IL-8 were measured by immunoassay on fluids recovered from nasal lavage.

RESULTS

Eosinophils were significantly associated with TSS (R = 74.4%, P = 0.0002), with IL-5 (R = 90.6%, P < 0.0001) and with nasal flow (R = -69%, P = 0.0007), but not with IL-8 (R = 0.1%, P = 0.995). Eosinophil levels were shown to independently predict nasal flow (P < 0.001), with flow decreasing linearly for increasing eosinophils, together with a significant effect of neutrophils (P = 0.016, linear increase in flow) and a borderline effect of IL-8 (P = 0.063, linear increase in flow).

CONCLUSIONS

This study demonstrates the close association between IL-5 concentration and eosinophil infiltration. In addition, there is clear evidence concerning the relationship between eosinophil infiltration and nasal airflow. Thus, nasal eosinophils can be regarded as the most important predictor of upper airway function. These findings constitute first evidence of the relationship between nasal airflow impairment and Th2-related eosinophilic inflammation in children with persistent allergic rhinitis because of mite sensitization.

Incidence and prognostic significance of karyotype abnormalities in de novo primary myelodysplastic syndromes: a study on 331 patients from a single institution

The impact of clinical parameters, International Prognostic Scoring System (IPSS) scores/cytogenetic categories, and some single cytogenetic defects on overall survival (OS) and time to myelodysplastic syndromes (MDS)/AML progression (progression-free interval (PFI)) was evaluated in 331 MDS patients. Statistical analysis demonstrated that OS and PFI were significantly affected by all these parameters. Since single 7q- showed a better survival than the poor IPSS cytogenetic category (P=0.009), it was considered as a new prognostic entity ('modified IPSS categories'). In multivariate analysis OS was significantly influenced by age, marrow blast cell percentage, number of cytopenias and either modified or standard IPSS cytogenetic categories; hazard ratios for MDS/AML progression were influenced by all the former, except for age and cytopenias. Multivariate analysis of del(7)(q31q35) confirmed the results of univariate analysis, but the Akaike Information Criterion showed no difference in evaluating OS and PFI between the modified and standard IPSS cytogenetic grouping. In conclusion, (i) chromosome defects as grouped by IPSS and blast cell percentage are the most relevant parameters for predicting OS and PFI; (ii) the prognostic power of the IPSS cytogenetic grouping is not ameliorated by the introduction of del(7)(q31q35) as a new entity; (iii) complex karyotypes have a prognostic value independent of blast cell percentage.

Intraepithelial lymphocytes in the villous tip: do they indicate potential coeliac disease?

BACKGROUND

The counting of intraepithelial lymphocytes (IELs) in the villous tips of architecturally normal small bowel biopsy specimens was proposed as a method to measure mucosal infiltration in gluten sensitive patients.

AIMS

To apply this straightforward method in duodenal biopsy specimens from patients affected by potential coeliac disease (PCD) to verify whether it can discriminate these patients from controls.

METHODS

Paraffin wax embedded duodenal sections from 11 patients affected by PCD were stained with an antihuman CD3 antibody. Sections from 19 patients affected by treated coeliac disease (TCD) and 17 patients in whom coeliac disease was excluded were stained with the same antibody to serve as controls. The slides were examined blindly. IELs/20 enterocytes in five randomly chosen villous tips were counted. Patients affected by PCD were all on a gluten containing diet. They had an architecturally normal duodenal mucosa and were positive for endomysial antibody. Both TCD and non-coeliac controls were negative for endomysial antibody.

RESULTS

The mean villous tip IEL scores were 4.6 (SD, 1.5; range, 1.4-7.8) in non-coeliac controls, 7.9 (SD, 4.0; range, 2.0-18.6) in TCD, and 9.2 (SD, 4.7; range, 5.8-21.8) in patients with PCD. The difference between PCD and non-coeliac controls was significant.

CONCLUSIONS

This is a very simple and sufficiently reliable method to count IELs. In patients with an architecturally normal duodenal mucosa, the IEL count in villous tips helps to distinguish between patients with PCD and non-coeliac controls.