[Infection and reactive arthritis: clinico-bacteriological correlation in seronegative arthropathies]

The aim of this study was to search infections that trigger reactive arthritis. Eighty-six patients with seronegative arthritis (SNA) were studied; 32 had reactive arthritis, 21 ankylosing spondylitis, 7 psoriatic arthritis and 26 undifferentiated seronegative oligoarthritis. As controls, 70 patients with connective tissue diseases (CTD) and 55 healthy volunteers (HV) were studied. Serological evidence for infection with Chlamydia trachomatis was studied with micro immunofluorescence, looking for L2 and BED serotypes and serological evidence for Yersinia infection, using a commercial kit. Stool cultures were done in seven patients with recent diarrhea, and endourethral or endocervical cultures in 35 individuals. Serotypes L2 or BED were positive in 23 of 83 patients with SNA, 3 of 39 patients with CTD and 4 of 55 HV (p < 0.03). IgG class antibodies against L2 were detected in 17% of SNA patients, 2.6% of CTD patients and 5.4% of HV (p < 0.05). IgM class antibodies were detected in 6 SNA patients, 0 CTD patients and 2 HV (NS). Twelve of 35 cultures were positive for Chlamydia. As a whole 30% of SNA patients has serological or bacteriological evidence for Chlamydia infection. Serology for Yersinia was positive in 39 of 81 SNA patients, 1 of 54 CTD patients and 3 of 51 HV (p < 0.01). Rates of infections were similar among male, female, HLA B27 positive and HLA negative subjects. It is concluded that SNA patients have a high prevalence of infections by Chlamydia trachomatis or Yersinia enterocolitica.

Retroperitoneal fibrosis in a patient with Parkinson's disease treated with pergolide

We describe a 68-year-old patient with Parkinson's disease who developed retroperitoneal fibrosis during pergolide treatment. Because pergolide is an ergot derivative, it could be related to the development of this complication.

[Treatment with cyclosporine of refractory rheumatoid arthritis]

Cyclosporine may be useful in the treatment of rheumatoid arthritis refractory to other immunosuppressive agents, in doses of less than 10 mg/kg/day to minimize its nephrotoxic potential, that is enhanced with prolonged use or concomitant administration of anti-inflammatory drugs. We report 15 patients aged 50 +/- 12 years with erosive rheumatoid arthritis lasting 5 +/- 4 years and refractory to other immunosuppressive agents. They were studied during one year and received cyclosporine in initial doses of 2.5 mg/kg/day that were increased to 5 mg/kg/day, assessing clinical response, blood pressure and serum creatinine. Nine patients, that received a maximal dose of 3.4 +/- 0.7 mg/kg/day during 7 +/- 4 months, improved; a 30% increase in creatinine was observed in 3, blood pressure raised in six and two had hepatic toxicity. In the six patients that did not improve, the mean treatment lapse was 4 +/- 3 months and the maximal dose achieved was 2.7 mg/kg/day; creatinine increased in one and blood pressure increased in 4. It is concluded that although the clinical response to cyclosporine was good, only 4 patients completed one year of treatment, due to the frequent secondary effects of the drug.

Evaluation of phagocytic capacity with a modified flow cytometry technique

Phagocytic capacity was determined in human polymorphonuclear leukocytes with a modified flow cytometry technique. The advantages of this method include simplified sample preparation--the assay is done using whole blood--and quantification of phagocytosis with a phagocytic index obtained by comparison with controls, which obviates errors arising from non-specific adherence.

Factorial study of the BDI in pregnant women

This study was carried out to investigate the significance of Beck Depression Inventory (BDI) scores and the influence of somatic items in a non-psychiatric population presenting with somatic complaints. Internal consistency, item frequency, factor dimensions, and correlation with Eysenck's 'N' were analysed in a sample of 882 non-psychiatric pregnant women. The BDI showed a high level of internal consistency (Cronbach alpha coefficient was 0.85). Factor analysis yielded two major factors. Low BDI scores were determined mainly by items related to somatic complaints or decreased activity without unequivocal depressive content. In contrast, it was unambiguous depressive items that were endorsed in high scores, and these showed higher correlations with neuroticism. It is concluded that in non-psychiatric populations the BDI may measure conditions other than depression and that low or medium range scores should not be interpreted as indicators of mild depressive symptomatology.

Cognitive dysfunctions in recovered melancholic patients

Cognitive dysfunctions were studied in symptom-free patients suffering from Recurrent Depressive Disorder with melancholia. Their performances on a standard neuropsychological battery were compared with those of a healthy sample matched for age and educational level. Statistically significant differences were found in Immediate Visual Memory, Delayed Logical and Visual Memory, Paired Learning and Block Design. Results seem to indicate that the cognitive disfunctions are not likely to be only mnesic. All these data suggest that these disfunctions found in some melancholic depressives could not be state-dependent.

Once-a-month administration of intravenous pentamidine to patients infected with human immunodeficiency virus as prophylaxis for Pneumocystis carinii pneumonia

We reviewed the charts of 52 patients infected with human immunodeficiency virus (HIV) who received at least three consecutive doses of intravenous pentamidine as prophylaxis for Pneumocystis carinii infections. Pentamidine isethionate was administered intravenously over 60-90 minutes once a month, at a dosage of 4 mg/kg, in 250 mL of 5% dextrose in water. During 387 months of administration of primary prophylaxis to 37 patients, no cases of P. carinii pneumonia were observed. During 200 months of administration of secondary prophylaxis to 15 patients, only one case of P. carinii pneumonia was diagnosed (6.0 cases per 100 patient-years). Side effects associated with the intravenous pentamidine were mild and did not necessitate withdrawal of the drug. Once-a-month administration of intravenous pentamidine is a valid alternative as prophylaxis for P. carinii pneumonia for patients who are intolerant of sulfonamides.

Chlamydia-induced reactive arthritis

Chlamydia trachomatis infection is now recognized as the most prevalent veneral disease in the Western World. The majority of cases of Reiter's syndrome, one type of reactive arthritis, are secondary to sexually transmitted infections. Evidence of urogenital C. trachomatis infection is found in 36% to 61% of cases of Reiter's syndrome. We investigated the prevalence of infection by this organism in a group of patients with spondyloarthropathies. Positive cultures were obtained in 39.4% of patients with Reiter's syndrome, as well as in 22.2% of patients with psoriatic arthritis and in 20% of patients with ankylosing spondylitis. An important percentage of patients also had positive serum antibodies against C. trachomatis (62.1% of patients with Reiter's syndrome), suggesting presence of infection at some point during the course of the disease. Our findings and those from other authors support the use of long-term antibiotic therapy in patients with reactive arthritis, mainly in those in whom positive culture for C. trachomatis has been obtained as well as in their sex partners.

[Characterization fo mycelial mutants of Mucor rouxii]

The consequences of two different mutations induced with N-methyl-N-nitrosoguanidine (Strain G1) and Trifluoperazine resistance (Strain G5) in Mucor rouxii, were studied. Mutants were stable and exhibited mycelial morphology in aerobiosis. Mutants cells exhibit phenotypic characteristics of slow-growing. The mutants G1 and G5 cultures showed 16.8% and 35.3% of reduction of the growth relative to parental strain. Morphologically mycelia of mutants cell were indistinguishable from wild-type cells, except from reduction in extension and branching of hyphal that has the mutant G5. Calcofluor and FITC-Concanavalin A were used to study the distribution of new cell-wall polymers i.e. Chitin, glucans. The two G1 and G5 strains showed a uniform distribution of fluorescence over the cell surface, indicating that active deposition of new-wall material has occurred. Cellular proteins of mutants and parental strains were labeled with 14C-aminoacid mixture. The proteins pattern revealed that the majority of polypeptides synthesized by parental strain were also synthesized by mutants. It is evident the synthesis preferential of peptides with apparent M(r) > 92K, 60K, 50K, 43K, 38K and 25K. These results indicated that the primary defect of the mutation was not on cellular differentiation. It discuss phenotypic and biochemistry characteristics from mutants.

Psoriatic arthritis: clinical response and side effects to methotrexate therapy

In the last decade, methotrexate (MTX) has emerged as a useful second line agent for a variety of arthritides. However, there still exists some reluctance for its wider use mainly because of concerns about its liver side effects. We describe our clinical experience with this drug in psoriatic arthritis (PsA). The study group included 24 men and 16 women, with a mean age of 47 years (16-75), with oligoarticular (13) or polyarticular (27) involvement, with a mean disease duration of 12 years (1-36). Patients received a mean dose of 11.2 mg of MTX orally/week during a mean period of 34 months (6-132). Seven had been previously treated with other second line agents. Thirty-eight patients had an excellent or good response. In them, the erythrocyte sedimentation rate dropped in a mean of 38 mm/h. Only 2 patients had a rather poor response. Two patients discontinued the medication because of side effects: leukopenia in one and stomatitis in the other. Eleven patients presented with liver test abnormalities: 3 mild, 6 moderate and 2 severe. Seven patients had 11 liver biopsies. Except for one, none had evidence of cirrhosis or inflammation. Indeed, no changes were observed in the histopathology in those with repeated biopsies. The case reported as cirrhosis occurred very early in the course of MTX therapy. He continued taking MTX treatment without further deterioration of liver chemistry and/or histology. It is concluded that MTX is an effective and safe agent in PsA. Results also indicate that it is not necessary to perform liver biopsies on a routine basis.

[Reactive arthritis. A review]

The arthritides that meet the definition or reactive arthritis include the so-called seronegative spondyloarthropathies. Patients are usually aged less than thirty-two. Preceding infection is generally intestinal or venereal, although the involved agent may remain unknown. Enteric forms occur in small epidemics, whereas venereal forms correlate with a recent new sexual partner. The clinical picture varies in severity, with manifestations overlapping between disorders, and often the first complaint is extra-articular. Highly suggestive of reactive arthritis is "sausage" deformity of fingers and toes, pain and stiffness about multiple joints accompanied by radiating lower back discomfort, and enthesitis, particularly at the Achilles tendon. One out of six or seven patients becomes disabled; therapy aimed at preventing disability is vital since medication has little effect on spinal involvement. Antibiotic therapy may be effective in cases in which specific etiologic agents are well defined.

Treatment of paracoccidioidomycosis with ketoconazole: a three-year experience

The results of ketoconazole therapy in 38 patients with active paracoccidioidomycosis are described. Treatment consisted of a 200 mg tablet a day for 6 months. Evaluation was accomplished by means of a scoring system and the results were as follows: none of the patients worsened during therapy, one was found to be unchanged, five had minor improvement, 330 had major improvement, and there was complete resolution of the pretherapy conditions in 13. These findings plus the lack of toxicity of the drug and the facility for oral administration, make of ketoconazole a first line drug for the treatment of paracoccidioidomycosis.

Post-therapy status of paracoccidioidomycosis treated with ketoconazole

Twenty-four paracoccidioidomycosis patients who completed a course of therapy with ketoconazole were followed for 12 months after treatment, and 10 of these patients were followed for 24 months. Only two of these patients relapsed; the remaining continued in remission. There were no fatalities. Immunologic tests showed decreased antibody activity and increased skin test reactivity to paracoccidioidin in comparison with the results obtained at the end of therapy. These findings indicate that ketoconazole therapy has improved the prognosis of patients with paracoccidioidomycosis.

Relationship between foreign H-2-like antigens on MCG4 sarcoma and the in vivo rejection of this tumor by syngeneic and semisyngeneic mice

MCG4, a BALB/c sarcoma (H-2d), that abnormally expresses H-2k and h-2b-like antigens, regressed spontaneously when inoculated in BALB/c and in BALB/c hybrids F1. A relationship was found between the anti-H-2k and/or anti-H-2b activity detected in the sera and spleen cells of the regressor mice and their capacity to reject the tumor.

Immunogenetic studies of H-2 antigens of MCG 3 tumour cells

MCG 3 is a B 10(H-2b) sarcoma induced as a solid tumour with 0.2 mg of methylcholantrene in our laboratory. The ascites form obtained was used to study the expression of H-2 antigeneic specificities in a postlabelling radioassay. H-2D.2, H-2K.33 (private specificities of H-2b) and H-2.28, H-2.35 (public specificities) were normally expressed for MCG 3 while H-2.5, H-2.29, H-2.36 (public specificities) were abnormally absent. These results were confirmed by quantitative absorption analysis using MCG 3 and positive-negative normal lymphoid cells for a particular specificity.

A comparative study between Fc receptor bearing cells and antibody dependent cell cytotoxicity in cancer patients

The capacity of 14 cancer patients lymphoid cells to destroy antibody-coated target cells (antibody-dependent cell cytotoxicity ADCC), and to form rosettes with immunoglobulin-coated erythrocytes (EA) was compared. The lymphocyte functions were investigated immediately prior to chemo-immunotherapy. Our observations show a correlation between the percentage of EA-rosette forming cells and ADCC activity of cancer patients and controls. However, the regressive lines were different in both groups. Interestingly, cancer patients with a lower. EA rosette forming cells than controls, showed higher cytotoxic activity.

[Strain-specific antigens detected on murine tumour cells by means of rabbit heteroantisera (author's transl)]

The rabbit heteroantisera anti-Meth A sarcoma (H-2d) (RAMA) and rabbit anti-RBL-5 leukemia (H-2b) (RAR-5) have been used to study the presence of normal strain antigens on the surface of different murine tumour cells. RAR-5 detected H-2-like structures on TLX9 (H-bb) lymphoma, however RAMA did not on LSTRA leukemia (H-2d) mastocytoma. Neither RAR-5 nor RAMA contained antibodies against non-H-2 and differentiation antigens.

The gamut of paracoccidioidomycosis

Paracoccidioidomycosis is a systemic mycosis of importance in Latin America. Because of its polymorphic manifestations, it is not always suspected and patients are sometimes misdiagnosed. Case histories of patients with paracoccidioidomycosis are presented in order to illustrate its various manifestations, with emphasis on the primary pulmonary localization.

Pathogenesis of paracoccidioidomycosis: a model based on the study of 46 patients

Forty-six Paracoccidioidomycosis patients were studied with emphasis on lung pathology. It was found that the greatest clinical involvement of the reticuloendothelial system occurred in younger individuals. On the other hand, the frequency of tegumentary lesions was low in young patients and increased with age. Lung involvement was nearly always demonstrated when searched for and showed no relationship to the patient's age. In the young patients the disease was acute while in the older individuals its course was chronic. The findings from this study permitted formulation of a model for the pathogenesis of paracoccidioidomycosis in which the respiratory tract is accepted as the primary site of infection. Based on this model, a classification of the various forms of the entity is proposed.