Suppression of cellular immunity to Listeria monocytogenes by activated macrophages: mediation by prostaglandins

We previously demonstrated the suppression of cell-mediated immunity to Listeria monocytogenes by Pseudomonas aeruginosa-induced, macrophage-like cells. The present study was undertaken to evaluate the mechanism for this suppression. P. aeruginosa supernatant was shown to activate macrophages by the criteria of increased bactericidal capacities and increased attachment to glass surfaces. Acquired cellular resistance to L. monocytogenes could also be inhibited by macrophages from L. monocytogenes-pretreated mice. The depression of acquired immunity by P. aeruginosa- or L. monocytogenes-activated macrophages did not appear to be due to a reduction of antigenic stimulus after nonspecific macrophage activation. In contrast, our findings suggest that suppression is mediated by activated macrophages through a prostaglandin-dependent mechanism. In vivo administration of aspirin blocked the immunosuppressive effect of P. aeruginosa- or L. monocytogenes-activated cells. Moreover, the suppressive activity of supernatants of macrophages from Listeria-infected mice was reversed when indomethacin was present during supernatant generation. Finally, prostaglandin E1 treatment in vivo profoundly inhibited the induction of cell-mediated immunity to L. monocytogenes. The possible role and mechanism of prostaglandin in suppressing cellular immunity to intracellular bacteria are discussed.

[Effect of laser therapy in diabetic retinopathy on the hemodynamics of retinal vessels]

Changes in retinal hemodynamics are a factor of major influence in diabetic retinopathy. With the aid of videoangiography, the changes in retinal circulation times before and after therapeutic laser coagulation were examined in a prospective study. A marked diminution of all circulation times was observed after laser coagulation procedures: the arterial circulation time decreased from 1.02 s to 0.74 s average, the early venous circulation time from 5.18 s to 3.50 s average, and the late venous circulation time from 9.07 s to 8.16 s. Laser coagulation has a more significant influence on the capillary circulation of the retina than on the venous phase. In diabetic retinopathy, the improvement in pathologic hemodynamic situations in the retina may be a very important mechanism of action in laser coagulation therapy.

[Changes in retinal hemodynamics in old age]

The influence of increasing age on the haemodynamics of the retina was examined in a prospective study using 377 consecutive videoangiograms. A significant alteration of the arm-to-retina time and the arterial, capillary and venous phases of the retinal circulation is not detectable before the 60th year of life. After the age of 60 all circulation times change in a negative sense. A further, pronounced slowing of retinal circulation appears after the 75th year of life. This shows that the well-known morphological alterations in the retinal vessels in old age are accompanied by haemodynamic changes.

[Bilateral retinal vein occlusions and general risk factors]

A report on 12 patients with retinal vein occlusion in both eyes. In addition to advanced age (67 years on the average) the following risk factors were present, often in combination: hypertension, cardiac insufficiency, adiposity, hyperlipidemia, hyperuricemia, hypercholesterinemia, diabetes mellitus etc. The rate of retinal circulation was determined by video fluorescein angiography. A pronounced decrease in visual acuity was observed in all patients with a slower retinal circulation rate. The causes of the decrease in central visual acuity were macular edema, neovascularization with vitreal hemorrhage and rubeosis iridis with secondary glaucoma.

[Modification of retinal hemodynamics by induced changes in intraocular pressure: a videoangiographic study]

This study used videoangiography to observe the effect of artificially produced rises in pressures in the eye on the haemodynamics of the retinal vessels. The intraocular pressure was increased with Müller's ophthalmodynamometer in stages of 10 mm Hg. A demonstrable effect upon the arterial and early venous times as well as the arm-retina time appeared. A constant rise in pressure appeared in the acute experiment: here the circulatory times more than doubled when intraocular pressure rose from under 20 mm Hg to 40 mm Hg. Above 50 mm Hg a further, statistically highly significant increase in the circulatory times of the eye became evident. The retinal vessels were obliterated in the rule at intraocular pressures above 50 mm Hg. When the data on changes in retinal circulation acquired by videoangiography are compared with the data on blood volume flow-through reached with microspheres, both methods reveal a good correlation. This shows that the determination of circulatory times in the eye is also a source of information on blood volume flow.

Clinical observations concerning choroidal folds

This paper deals with 6 patients who suffer from choroidal folds. Special emphasis will be laid on several aspects of differential diagnostics. In our 6 cases discussed here, we found a retrobulbar tumor in 3 patients, hypotony in 1, and a marked hyperopia in another as causes. In the 6th patient no pathological condition was found, and, therefore, we characterized the choroidal folds in this case as idiopathic.

[Use of videoangiography of the retina]

A system is presented with the help of which high-quality visual presentation of fluorescein angiographies is possible. The individual elements of the unit are described (TV camera, light source, adapter for the TV camera, fundus camera, video recorder, video timer). The filming process is less strenuous for the patient than serial angiography since he is no longer dazzled by high-intensity light. The pictures are available immediately after filming, thus eliminating both the cost of developing and the delay involved. The examiner can make picture adjustments during filming. The high degree of resolution of this examination method in proportion to the time required for it makes a precise analysis for the physiological and pathological hemodynamics of the retinal- and choroidal blood vessels possible.

Quantitative measurement of retinal blood flow in human beings by application of digital image-processing methods to television fluorescein angiograms

A method is presented that allows the quantitative determination of the blood flow in retinal arteries in human beings. Television fluorescein angiograms are used as input. This method does not need any gauge procedures since all the necessary information is taken from the image itself. Also, the patients' eye movements do not introduce errors because their influence is removed by the computer program.

Opportunistic toxoplasmic retinochoroiditis following chemotherapy for systemic lymphoma. A light and electron microscopic study

After a prolonged period of chemotherapy for a disseminated nodular lymphoma, a 51-year-old woman developed a white lesion in the left macular region, in the absence of any overt lymphomatous disease elsewhere. The initial retinal diagnosis was nonetheless a lymphomatous infiltrate. Due to her severely immunocompromised state, the patient developed pneumonia and died. The involved left eye was examined postmortem by light and electron microscopy. The retinal lesion was discovered to be caused by infection with Toxoplasma gondii, which on postmortem evaluation was also found in the brain together with subclinical lymphomatous disease and multifocal leucoencelphalopathy. Many viable and intact cysts were observed floating within the necrotic retina as well as lodged within recognizable retinal cells. Most of the organisms were encysted bradyzoites, although a rare tachyzoite was discovered in the extracellular space. Unusual features examined ultrastructurally were a preretinal membrane formed exclusively by glial cells, residual proliferating glial cells within the retina that were frequently related to surviving capillaries, and a multilaminar spindle cell placoid proliferation of pigment epithelial cells, assuming almost pseudo-sarcomatous proportions. Banded extracellular membrane material was focally observed between the proliferating pigment epithelial cells. No neoplastic lymphoreticular cells were discovered within the choroid, but a curious feature was the production of basement membranes by the surviving choroidal melanocytes. Toxoplasmosis should therefore be considered along with fungi and viruses in the differential diagnosis of white retinal lesions appearing in immunocompromised patients.

The perfluorocarbon gases in the treatment of retinal detachment

Four straight chain perfluorocarbon gases that had been studied in animals were tried in 30 patients. The larger volumes injected into patients made for extended disappearance times. Two milliliters of CF4 diminished to half volume in six days and had a total disappearance time of 16 days; 0.8 ml of C2F6 diminished to half volume in 10 days and had a disappearance time of 40 days; 1 ml of C3F8 diminished to half volume in 35 days and disappeared in 70 days; 0.6 ml of C4F10 diminished to half volume in 45 days and disappeared in 120 days. The expansion potential was estimated to be the same as measured in the animal model.

Continuous ambulatory peritoneal dialysis in a pediatric population

Seven children aged from 6 weeks to 14 years were treated for end-stage renal disease by continuous ambulatory peritoneal dialysis (CAPD) for 60 patient months. Satisfactory control of their uremia was achieved. Peritonitis was diagnosed on seven occasions (one case per 8.6 patient months) and did not interfere with continuation of dialysis or decrease peritoneal membrane permeability. Patients older than 5 years grew at rates comparable with those of patients receiving hemodialysis. Two infants receiving CAPD exhibited normal growth rates. Families demonstrated good psychosocial adjustment to the technique. Thus, CAPD seems to be a satisfactory alternative to hemodialysis for long-term therapy .

[Arterial vascular occlusions of the eye following surgical intervention]

In this paper the author reports on 6 patients who developed occlusion of a retinal artery following trauma or surgery. Three of these occlusions occurred in the central retinal artery after operations in the orbital area. Two of the operations were ear-nose-throat procedures with subsequent infection, causing compression of the optic nerve and a decrease in circulation. Two patients probably had genuine embolisms after either a carotid angiography or the removal of an aneurysm complex of the anterior communicating artery. An occlusion of the central retinal artery was also observed in one case after trauma (impact of a fist). All 6 patients experienced a large-scale decrease in visual acuity. When there is a risk of embolism or compression of the optic nerve, prophylactic measures such as a thrombosis prophylaxis or the prompt relief of pressure in the orbit should be considered.

[Clinical and immunological studies of Behçet's disease]

8 patients with clinically diagnosed Behçet disease were immunologically investigated. Uveitis was present in 7 of these patients. Although uveitis is a rare presentation of Behçet's disease, it tends to be bilateral when it does occur and to involve both the anterior and posterior segments repeatedly. Nowadays it is rare to observe a hypopyon, thanks to early initiation of therapy. In the late stages, recurrent vitreous haemorrhage complicates the course of the disease and can lead to blindness. HLA-B5 can frequently be demonstrated in patients with Behçet's disease. Detailed serological investigations, as measles hemagglutination inhibition test+complement fixation test (CFT), rubella hemagglutination inhibition test, hepatitis HB2 antigen, adenovirus antigen, varicella zoster CFT, mumps CFT, herpes simplex CFT, anticytomegalovirus IgM and IgG, toxoplasmosis immunofluorescence, tuberculosis Middlebrock-Dubois, were unable to uncover a connection with past or present infections. Determinations of haptoglobulin, lactate dehydrogenase, albumin and ceruloplasmin showed nothing worth remarking. Electrophoresis can indicate the duration of the illness. In 1 patient the lymphocyte adherence inhibition test was abnormal.

[Retinal changes in cystinosis]

Cystinosis is a rare autosomal recessive hereditary enzymopathy which leads to accumulation of cystine in the reticuloendothelial system of the liver, spleen, lymph nodes, etc. The pathognomonic alterations of the cornea are characterized by multiple crystalline deposits, chiefly in the limbus area and in the anterior corneal stroma. The retinal changes are seldom described in the literature; they are characterized by a fine-grained pigment shift which intensifies from the macula toward the preequator area and which gives the fundus a 'salt and pepper' appearance.

[Absence of the anterior chamber following cataract extraction ]

A non-existent or extremely flat anterior chamber following cataract extraction is now very rare due to the fact that waterproof wound closure has become standard practice. Among 1,051 cataract operations carried out in our clinic during the past three years this complication was observed only 13 times, i.e. in 1,2 percent of the cases. The complication occurred slightly more frequently in diabetics and patients with glaucoma. Methods of preventing the complication and both drug and surgical treatment are discussed. In our cases surgical intervention was never necessary.

[Synergistic activity between ticarcillin, azlocillin, cefsulodin, ceftazidime and tobramycin or amikacin against Pseudomonas aeruginosa (author's transl)]

Activity of azlocillin, cefsulodin, ceftazidime, ticarcillin in combination with amikacin or tobramycin was investigated against 17 Pseudomonas aeruginosa isolates. Synergistic activity was evaluated by the microtiter checkerboard technique. The bactericidal effect of the antibiotic combination was determined by subculturing onto agar and into broth. Synergistic activities of cefsulodin and ticarcillin combined with amikacin or tobramycin were similar in the inhibitory as well as in the bactericidal tests. Synergistic effects of the combination of ceftazidime and amikacin or tobramycin were moderate or indifferent in the inhibitory and bactericidal tests. The combination of azlocillin and amikacin or tobramycin produced synergistic effects greater in bactericidal tests than in inhibitory tests. The bactericidal synergistic activities of the combinations of azlocillin, cefsulodin, ticarcillin were similar. There was no difference between amikacin and tobramycin combined with a beta-lactamine. Antagonism was not observed. A synergistic effect of the combinations was observed against 4 isolates resistant to tobramycin and/or ticarcillin. However the result of the interaction seemed to depend upon the level of resistance to the antibiotic : if the MIC or the MBC of either antibiotic in the test combination was very high, synergy could not be achieved.

Depression by Pseudomonas aeruginosa of two T-cell-mediated responses, anti-Listeria immunity and delayed-type hypersensitivity to sheep erythrocytes

Pseudomonas aeruginosa was studied for its effects on T-cell-mediated responses in mice, as exemplified by anti-Listeria immunity and delayed-type hypersensitivity to sheep erythrocytes. Immunity to Listeria monocytogenes was measured by quantitation of bacteria in spleens and mortality; delayed hypersensitivity to sheep erythrocytes was tested by the footpad reaction. Three different preparations of P. aeruginosa were used: the supernatant of a heat-killed culture, living bacteria, and heat-killed organisms. Similar results were obtained with the three preparations. Administration of P. aeruginosa 24 h before Listeria infection reduced the resistance to the secondary challenge, as measured by increased bacterial multiplication in the spleen and rate of mortality. Cell transfer experiments showed that pretreatment of normal recipient mice with P. aeruginosa prevented them from being adoptively immunized against a Listeria challenge infection with spleen cells from immune donors. They also showed that treatment of donors with P. aeruginosa before immunization affected the capacity of their spleen cells to protect normal recipients against Listeria. Furthermore, spleen and peritoneal exudate cells obtained from mice given P. aeruginosa were capable of preventing immunization of normal recipients against Listeria. Similar results were obtained when the delayed hypersensitivity response to sheep erythrocytes was studied. The suppressive activity of P. aeruginosa-treated spleen cells was lost by removing adherent cells. Conversely, the adherent, heat-killed, anti-immunoglobulin-treated spleen cells exerted a suppressor effect. It thus appears that P. aeruginosa injection changes macrophage and T-lymphocyte activities and results in the development of adherent, macrophage-like suppressor cells in the spleen and peritoneal cavity.

[Fundus albipunctatus in primary oxalosis (author's transl)]

Primary oxalosis causes a flecked retina showing multiple small luminous spots at the posterior pole which can be seen by fluorescein angiography. In a young female patient who was observed for 4 years we did not find any deterioration. In 2 patients with secondary oxalosis, there was no evidence of fundus alterations.

[Immunological examinations in Vogt-Koyanagi-Harada disease (author's transl)]

In eight patients with clinical sure Vogt-Koyanagi Harada-syndrome (VKHS) immunological examinations were performed. We tested whether there were signs of former or present infections (measles HHT and complement fixation test (C.F.T.), rubella HHT, hepatitis HBs-antigen, adenovirus AG, varicella-zoster C.F.T., herpes simplex C.F.T., cytomegaly IgM and IgG, toxoplasmosis immunofluorescence, tuberculosis Middlebr. Dubois). In none of all cases we could find HLA B12. The rheumatic tests, LDH, albumin an electrophoresis, coeruloplasmin and haptoglobin were negative. The uveal pigment failed to stimulate the leucocyte cultures from VKHS-patients in leucocyte-migration-inhibition-test and in leucocyte-adherence-inhibition-test.

[Genodermatosis with changes in eyes not previously described (author's transl)]

Report on a patient with several symptoms which had not previously occurred together. The main symptom is palmoplantar keratosis; further alterations were kypho-skoliosis, brachytelephalangia of the thumbs, and in the eyes, keratoconus, a cataract and electroretinographic alterations.

[Therapy of arterial vascular occlusions of retinal and optic nerve (author's transl)]

The authors report on 136 cases of arterial occlusion (80 patients suffering from occlusion of the retinal vessels and 56 patients with vascular occlusion in the optic nerve) who were treated with the vasoactive xanthic substance Pentoxifylline (Trental). A part from its positive effect on the vascular circulation, Trental also helps to improve microcirculation in the retinal and optic nerve tissue damaged by hypoxia. After a 2-week infusion therapy with additional digitalisation, treatment was continued for another 3-6 months with oral administration of Trental 400. In 50 cases therapy was combined with the systemic administration of corticosteroids. Under the mentioned therapy a definitely improved visual acuity (at least 3 lines on the eye charts) was achieved in 56% of the cases with occlusion of the retinal vessels and in 51% of the cases with vascular occlusion in the optic nerve, i.e., in 54% of the total number of patients. Whether or not the additional administration of corticosteroids helped to this effect was not proved.

Spectrum of multicystic renal dysplasia: diagnosis and management

Multicystic renal dysplasia represents a spectrum of pathologic states, from unilateral multicystic kidney through segmental and focal multicystic dysplasia to bilateral multicystic kidney. Diagnosis can be established with low-risk procedures with reasonable accuracy. Treatment may be nonoperative in selected cases, but the physician must be responsible for long-term follow-up of the child until more is known about the natural history of this process.

Five-hour renal functional evaluation

Children with urogenital disease frequently require evaluation of glomerular and tubular functions. Herein is presented a practical method of performing glomerular and tubular functional studies requiring short time periods and utilizing readily availabe laboratory techniques.