Idiopathic hypertrophic pachymeningitis with anticardiolipin antibody: A case report

RATIONALE

Idiopathic hypertrophic pachymeningitis (IHP) is a rare neurological disorder without a definite etiology. Diagnosis is mainly based on exclusion of other etiologies.

PATIENT CONCERNS

A 41-year-old male patient presented with insidious onset headache of 3-month duration.

DIAGNOSES

Contrast-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement over bilateral cerebral hemispheres and the tentorium cerebelli. Lumbar puncture showed increased pressure, lymphocytic pleocytosis, and elevated protein level with normal glucose concentration. Blood tests detected elevated erythrocyte sedimentation rate (ESR) and C-reactive protein. Pathological examination of the dura mater from the right frontal convexity disclosed coarse collagenous deposition with focal lymphoid aggregation. After malignancy and infectious etiologies were excluded, a diagnosis of IHP was made.

INTERVENTIONS

Oral prednisolone and azathioprine followed by methotrexate were administered.

OUTCOMES

During the 7-year follow-up period, although the patient was not totally headache-free, medical therapy significantly reduced the severity of headache. Follow-up MRI studies showed a reduction in meningeal enhancement and serial ESR measurements revealed a trend of improvement.

LESSONS

Methotrexate therapy may be considered in cases of steroid-resistant IHP. In addition to clinical evaluation, serial ESR testing may be considered to guide the treatment strategy and assess the response to therapy.

A long-term maternal diet transition from high-fat diet to normal fat diet during pre-pregnancy avoids adipose tissue inflammation in next generation

Recent studies have suggested that maternal high-fat (HF) diet caused inflammation changes in adipose tissue; however, it remains unclear if maternal diet intervention before pregnancy rescues such effects in offspring. To address this question, female mice were continued on a normal-fat (NF group), or a HF diet (HF group) or transitioned from a HF diet to a NF diet at 1 (H1N group), 5 (H5N group) or 9 weeks (H9N group) prior to pregnancy. Among the three intervention groups, the H9N offspring displayed less and steady body weight gain, and maintained glucose tolerance, whereas the H1N and H5N offspring showed exacerbate these phenotypes. The H1N and H5N, but not the H9N offspring, displayed adipocyte hypertrophy associated with increased expression of genes involved in fat deposition. The H1N and H5N, but not the H9N adipose tissue, displayed increased macrophage infiltration with enhanced expression of inflammatory cytokine genes. In addition, overactivation of the NF-κB and the JNK signaling were observed in the H1N adipose tissue. Overall, our study showed that a long-term but not a short- or medium-term diet intervention before pregnancy released offspring adipose tissue inflammation induced by maternal HF diet, which adds details in our understanding how the maternal environment either promotes or discourages onset of disease in offspring. Clinically, this study is of great value for providing evidence in the design of clinical trials to evaluate the urgently required intervention strategies to minimize the intergenerational cycle of obesity.

A case of gestational gigantomastia in a 37-years-old woman associated with elevated ANA: a casual linkage?

Hypertrophy of the breast (macromastia and gigantomastia) is a rare medical condition of the breast connective tissues. The etiology of this condition is still not clear; rarely, gigantomastia has been reported to develop in the setting of an autoimmune illness. We reported a case of a 37-years-old woman with undifferentiated connective tissue disease of 2-years duration presented with enlargement of breasts. The breast enlargment started at 5 months of gestation. She successfully underwent reduction mammoplasty with free nipple graft. In the succeeding months the level of antinuclear ANA remained stable. It is uncertain whether a positive antinuclear antibodies in gigantomastia is a casuative agent or an effect.

[DYNAMICS OF CYTOKINES IN INFANTS WITH ACUTE OBSTRUCTIVE BRONCHITIS AND THYMOMEGALIA]

The article contains the information about pro- and anti-inflammatory cytokines in infants with acute obstructive bronchitis and thymus hypertrophy. The content of IL-6 and IL-10 has been de- termined in 101 children in acute period of disease and during early convalescence. It was found the increasing of production of proinflammatory IL-6 and a low level of anti-inflammatory IL-10 in the first days of illness in all children with thymomegalia. During convalescence in patients with acute obstructive bronchitis and thymomegalia IL-6 level was decreasing, and the level of IL-10 was in- creasing, but it did not amount to the level of healthy children.

[The correlation studies between recurrent otitis media and adenoid hypertrophy in children]

OBJECTIVE

To investigate the relationship between the immune status of adenoids and secretory otitis media (SOM).

METHOD

The adenoids tissue samples of 30 cases of recurrent secretory otitis media (SOM), 17 cases of non-recurrent secretory otitis media and 20 cases of the adenoids hypertrophy without SOM were studied by immunohistochemical method.

RESULT

The expression of PCNA, BCL-2, CD4+, CD8+ cells and CD4+/CD8+ in recurrent SOM tissue were 30.85 +/- 1.73, 21.27 +/- 1.25, 41.90 +/- 9.07; 20.45 +/- 7.08 and 2.10 +/- 0.17, respectively, which was remarkably higher than those of non-recurrent SOM, (25.50 +/- 1.66, 14.23 +/- 1.06, 17.40 +/- 6.85, 13.02 +/- 5.88, 1.33 +/- 0.11, respectively) and those of simple adenoid hypertrophy (25.25 +/- 1.75, 14.05 +/- 1.02, 16.30 +/- 8.21, 11.15 +/- 5.71 and 1.39 +/- 0.15, respectively) (P < 0.01); the difference of the expression of PCNA, BCL-2, CD4+, CD8+ and CD4+/CD8+ between the latter two groups was not significant. Differences of the gender or the size were not significant (P > 0.05). In group of simple adenoid hypertrophy, PCNA in the subgroup of the age 3 to 6 was significantly higher than those in the other groups (P < 0.05).

CONCLUSION

In adenoid tissues of recurrent SOM patients, the activities of T-lymphocyte subsets cells in hypertrophic status increase, the adenoids enlarge and local immunity enhances. The age and gender have nothing to do with the SOM, but low age is one of the influencing factors of adenoid hypertrophy. Therefore, adenoidectomy for recurrent SOM patients with adenoid hypertrophy should be carried out as early as possible.

The role of nasal cytology in the management of inferior turbinate hypertrophy

Inferior turbinate hypertrophy (ITH) is the main cause of nasal obstruction symptom. This study aimed at investigating whether a particular cellular pattern could be a predictive factor for failure of medical treatment for ITH in patients with rhinitis. Globally, 258 patients with chronic nasal obstruction due to ITH were evaluated by: visual analogue scale assessment of symptoms, skin prick tests, fiber-endoscopy, active anterior rhinomanometry, and nasal cytology. All patients were treated with drugs for 3 months and then re-evaluated. The symptom improvement depended on the different cellular pattern. There was improvement in: 54 (51.4 percent) patients with allergic rhinitis, 72 (69.2 percent) with non-allergic rhinitis with neutrophils (NARNE), 15 (42.8 percent) with non-allergic rhinitis with eosinophils (NARES), and 9 (64.3 percent) with non-allergic rhinitis with mast cells/non-allergic rhinitis with eosinophils and mast cells (NARMA/NARESMA). The non-responders (108; 41.9 percent) were therefore directed towards surgical treatment. Both patients with allergic rhinitis and patients affected by NARES had a higher failure rate to medical treatment compared with NARMA and NARESMA groups (pless than0.01). In conclusion, elevated number of eosinophils, in the nasal secretion of both allergic (allergic rhinitis) and non-allergic (NARES) patients with ITH, can be associated to a higher medical treatment failure rate.

Increased percentage of T cells with the expression of CD127 and CD132 in hypertrophic adenoid in children with otitis media with effusion

The hypertrophic adenoid may promote chronic suppurative otitis media in children as it fulfills its immune function. The number of lymphocytes in the adenoid and their cooperation in the immune response depend of on their proliferation and migration to the effector sites. Interleukin 7 (IL-7) is essential for the normal development and function lymphocytes. IL-7 plays pivotal role for activation and proliferation of T and B cells. The heterodimeric interleukin-7 receptor (IL-7R) is composed of the IL-7Rα (127) and the common cytokine receptor γc (CD132). The aim of this study was to evaluate the percentage of lymphocytes T (CD4⁺ and CD8⁺) with IL-7R (CD127 and CD132) expression in hypertrophic adenoid in children suffering with otitis media with effusion for a duration of 3 months. Adenoid excised due to hypertrophy with or without chronic otitis media with effusion was used as study material. CD4⁺ CD127⁺, CD4⁺132⁺, CD8⁺CD127⁺ and CD8⁺CD132⁺ cell subpopulations were identified using monoclonal antibodies and flow cytometry. The percentage of CD4⁺ and CD8⁺ T cells with CD127 receptor expression in hypertrophic adenoid of children with otitis media with effusion was statistically significantly higher than in hypertrophic adenoid group. The percentage of CD4⁺ T cells with CD132 expression in the study group was statistically significantly higher than in the reference group. The percentage of CD8⁺ T cells with CD132⁺ expression was not statistically different in both groups. The increased percentage of T lymphocytes with IL-7R expression (CD127 and CD132) in hypertrophic adenoid seems to influence the quantity of lymphocytes and upset the immunological function of tonsils which can influence the course of otitis media with effusion.

Idiopathic hypertrophic pachymeningitis responsive to mycophenolate

Idiopathic hypertrophic pachymeningitis (IHP) represents a rare inflammatory condition that affects the central nervous system, often difficult to treat. We report the case of a patient who presented with difficulty in swallowing, slurred speech and ataxia associated with headache, vomiting and weight loss. He was diagnosed with IHP. He deteriorated despite treatment with high dose steroids and other immunosuppressants, including pulsed cyclophosphamide. Mycophenolate mofetil was therefore administered resulting in improvement and stabilization. This is the first report in English literature of the use of mycophenolate mofetil in the treatment of IHP and could stimulate further research in its efficacy in managing this condition.

Dendritic cells and lymphocyte subpopulations of the adenoid in the pathogenesis of otitis media with effusion

OBJECTIVE

To assess dendritic cells and lymphocyte subpopulations of adenoid and peripheral blood in patients with adenoid hypertrophy and otitis media with effusion (OME). To explain the influence of immunological status of adenoid on the development of OME.

METHODS

The examined group covered 123 surgically treated patients due to adenoid hypertrophy (39 children with coexisting OME). Preoperative clinical examination included anamnesis and otorhinolaryngological examination with nasofiberoscopy, videootoscopy and assessment of the hearing organ. The material of the study were surgically removed adenoids and peripheral blood samples prepared and then analyzed by the means of tri-colour flow cytometry. The obtained results were statistically analyzed.

RESULTS

Significant differences between patients with adenoid hypertrophy with coexisting OME and children without OME concerning CD19+CD69+, CD3+CD69+, CD4+CD69+CD8+CD69+ and CD19+CD25+ cells were observed. No statistical differences were revealed in the blood of patients with and without OME. Several statistical differences were noted between the adenoid and peripheral blood in patients with otitis media with effusion concerning BDCA-2+/CD123+ cells, CD3+ and CD19+ lymphocytes with the markers of their activation.

CONCLUSIONS

The adenoid is involved in local immune response regardless of constitutional immunological mechanisms in patients with OME coexisting with adenoid hypertrophy. Significantly lower percentage of CD3+CD69+, CD4+CD69+, CD8+CD69+ and CD19+CD69+ cells of adenoid in patients with OME attests to reduced T-cells activation of the adenoid in relation to patients without OME.

[The prolipherative and proapoptotic activity of limfoid nodules cells in the hypertrophic pharyngeal tonsil]

The human immune system recognize and eliminate strange antigens by present of lymphoid cell clones, which to come into being in consequence of clonal proliferation inducted by contact with the antigen. The cell clones to be due to the somatic mutations and recognize antigens incorrectly are eliminate by apoptosis.

THE AIM OF THE STUDY

To estimation of expression of chosen proliferative and proapoptotic proteins in lymphoid follicles and extra-follicular region of pharyngeal tonsil.

MATERIAL AND METHODS

Histochemical examination of chosen proapoptotic (p53, Bax) and proliferative (Ki-67, PCNA) proteins in adenoidectomised pharyngeal tonsil was done.

RESULTS

The most greater proliferation activity was in the germinal centers of lymphoid follicles, much less in the mantle zone and in the extrafollicular region. Similarly, maximal expression of proapoptotic proteins was in germinal centers of tonsil lymphoid follicles, the least in the mantle zone.

CONCLUSIONS

The high proliferative and proapoptotic activity of lymphoid follicles germinal centers to bear evidence of clonal selection of undistinguished lymphoid cells to come into being by somatic mutations.

[Expression of adhesion molecule CD44 on subpopulations of lymphocytes in hypertrophied adenoids in children with otitis media with effusion]

INTRODUCTION

The CD44 on lymphocytes binding to its ligand hyaluronan can mediate primary adhesion (rolling interactions) of lymphocytes on high endothelial venules (HEV). This adhesion molecule plays an important role to maturation and proliferation of lymphocytes in the secondary lymphoid organs. CD44 has a crucial role in migrate of lymphocytes to inflammatory sites. The AIM of this study was evaluation of the percentage and MFI (mean fluorescence intensity) of lymphocytes CD4+, CD8+, CD19+ with expression of surface adhesive molecule CD44 in hypertrophied adenoids in children with otitis media with effusion.

MATERIAL AND METHODS

42 children with otitis media with effusion and 30 children with hypertrophied adenoids were tested. Children were also divided into two subgroups: young (below 5 years) and older children (above 5 years old). Expression of adhesion molecule CD28 on lymphocytes of adenoids tissue was estimated by flow cytometry method.

RESULTS

This study showed significantly higher percentage of lymphocytes CD19+CD44+ in children with otitis media with effusion (OME 87,83%) than in comparative group with hypertrophied adenoids (AH 85,61%). We did not find difference between OME and AH in mean fluorescence intensity of subpopulations lymphocytes T and B with expression CD44.

CONCLUSIONS

Adhesion molecule CD44 is important for developing of effectors lymphocytes in hypertrophy adenoid. Increase percentage of lymphocytes CD19 with expression CD28, especially in older children confirms their participation in developing and forming of immunological response in otitis media with effusion.

[Expression of adhesion molecule CD28 on subpopulations of lymphocytes in hypertrophied adenoids in children with otitis media with effusion]

INTRODUCTION

The expansion of an optimal immune response requires fully activated T lymphocytes. For complete activation several signals are needed. The first signal is an antigen dependent via the TCR receptor, and the second signal is a costimulatory that can be delivered by the CD28 molecule after binding to their ligands. Fully activated T lymphocytes are competent to deliver activation to B cells. We suppose that this way can be important for development of immune response in hypertrophied adenoid (AH) in children with otitis media with effusion (OME). The aim of this study was evaluation of the percentage and MFI (mean fluorescence intensity) of lymphocytes CD4+, CD8+, CD19+ with expression of superficial adhesive molecule CD28 in hypertrophied adenoids in children with otitis media with effusion.

MATERIAL AND METHODS

37 children with otitis media with effusion and 35 children with hypertrophied adenoids were tested. Children were also divided into two subgroups: young (below 5 years) and older children (above 5 years old). Expression of adhesion molecule CD28 on lymphocytes of adenoids tissue was estimated by flow cytometry method.

RESULTS

This study showed significantly higher percentage of lymphocytes CD4+CD28+ in children with otitis media with effusion (OME 93,87%) than in comparative group with hypertrophied adenoids (AH 91,01%). Mean fluorescence intensity CD28 was higher on subpopulation lymphocytes CD4+ to children with OME (3,94) than AH (3,32). We did not find difference between OME and AH in percentages and MFI of subpopulations CD8+CD28+ and CD19+CD28+ lymphocytes.

CONCLUSIONS

Adhesion molecule CD28 is very important for adenoidal lymphocytes activation and protection against apoptosa. Higher percentage of lymphocytes CD4 with expression CD28 confirms their participation in developing and forming of immunological response in otitis media with effusion.

[The cytofluorometric opinion of expression of adhesion molecules CD11a and CD54 on lymphocytes T and B in children's hypertrophied adenoids, which are sick on the otitis media with effusion]

INTRODUCTION

Otitis media with effusion (WZU) is highly prevalent among young children. The hypertrophied adenoid favorables to development (WZU). The pharyngeal tonsil delivers the essential lymphocytes for developed immunological answer. The migrations of lymphocytes to pharyngeal tonsil and to places inflammatory proceed with part of adhesive molecules (CD11a, CD54) presented on lymphocytes. The aim of this study was examination the percentage of the lymphocytes CD4+, CD8+ and lymphocytes B with expression of adhesion molecules ICAM-1 (CD54) and LFA-1 (CD11a). We examined their expression in hypertrophied adenoid by children with otitis media with effusion.

MATERIAL AND METHODS

RESULTS

In investigations was showed statistically significant decrease of percentage of lymphocytes CD4+CD11a+ and CD8+CD11a+ and increase of percentage of lymphocytes CD19+CD54+ in otitis media with effusion in comparison to group with hypertrophied adenoid.

CONCLUSIONS

Molecule adhesive ICAM-1 and LFA-1 fulfills important part in many immunological processes proceed to pharyngeal tonsil. The considerably lower percentage of lymphocytes T CD4+ and CD8+ with expression LFA-1 in hypertrophied adenoids is possibly of causes of incorrect their immunological answer, and the same factor favourables to prolonging the otitis media with effusion at children.

[Expression of adhesion molecule CD62L on subpopulations of lymphocytes T and B in hypertrophied adenoids at sick's children with otitis media with effusion]

INTRODUCTION

Otitis media with effusion (OME) and hypertrophy adenoid (AH) are still common diseases during childhood. Adenoid has particular meaning in develop of immunological answer to inflammation in upper respiratory inclusive middle ear. The CD62L lymphocyte adhesion molecule plays an important role in controlling lymphocyte extravasations into adenoid and at sites of tissue infection. The aim of this study was evaluation of the percentage lymphocytes CD4+, CD8+, CD19+ with expression of superficial adhesive molecule CD62L and its expression in hypertrophied adenoids at sick's children with otitis media with effusion.

MATERIAL AND METHODS

In investigations has tested 37 children with otitis with effusion and 35 children from hypertrophied adenoids. Expression of adhesion molecule CD62L on lymphocytes of tissue adenoids estimated by flow cytometry method.

RESULTS

In this study showed higher significant percentage of lymphocytes CD19+CD62L+ in children in otitis media with effusion (OME. 59.33 +/- 9.65%) with reference to comparative group with hypertrophied adenoids (AH 53.47 +/- 9.67%). Mean fluorescence intensity CD62L was higher on subpopulation lymphocytes CD8+ and CD19+ at children with OME than AH.

CONCLUSIONS

The increase of percentage's lymphocytes CD62L+ in tissue of adenoids can to testify to enlarged migration lymphocytes from whole blood to adenoid. The increase of density of CD62L receptor on lymphocytes can be effect local inflammatory process.

Smooth muscle hypertrophy in distal airways of sensitized infant rhesus monkeys exposed to house dust mite allergen

BACKGROUND

Airway smooth muscle hypertrophy is closely associated with the pathophysiology of hyper-reactive airways in allergic asthma.

OBJECTIVE

To determine whether repeated exposure to allergens during postnatal lung development promotes remodelling of airway smooth muscle.

METHODS

Infant, male rhesus monkeys (30-day-old) were sensitized to house dust mite allergen (HDMA) and then exposed to HDMA aerosol periodically over 5 months. Smooth muscle mass and bundle size and abundance in conducting airways were measured and compared with age-matched control (filtered air-exposed) monkeys.

RESULTS

Total smooth muscle mass and average bundle size were significantly greater in the conducting airways of monkeys exposed to HDMA. Smooth muscle bundle abundance was not affected by exposure to HDMA.

CONCLUSION

Repeated cycles of allergen exposure alter postnatal morphogenesis of smooth muscle, affecting both total mass and bundle size, in conducting airways of infant monkeys.

[The occurrence of atopic hypersensitivity in children with adenoid hypertrophy]

Allergic sensitization of the airways occurs in the mucosa. The lymphatic structure closest to the nasal mucosa is the adenoid. Adenoid hypertrophy (AH) may cause significant morbidity in children but its relationship to atopy has not been intensively studied. To examine the influence of atopy on the adenoid hypertrophy we studied 134 children ages 4 to 8 years, with an average age of 5.4 who had AH. In the analysed group 102 children suffered from difficulty in nose breathing, 61 of children from recurrent upper respiratory tract infections, 51 from recurrent otitis and 40 from hearing disorders. On the basis of allergic and immunological examinations, in 30.6% atopy was confirmed--41 out of 134 children showed positive skin test for allergy, mostly to different kinds of pollen or house dust. From these positive patients the respective allergens could be determined by RAST tests in serum of 87%. Increased total IgE level in serum was confirmed only in 17.5%. 8.5% of children showed peripheral blood eosinophilia. Some children were qualified for adenotomy and removed adenoid was examined histopathologically. Pharmacological treatment was also recommended.

CONCLUSIONS

The study shows that allergy and sensitivity to different kinds of allergens is an important risk factor for a greater degree of AH in children. Therefore, early prevention of exposure to them may help reduce occurrence of AH.

Cytokine responses to physical activity, with particular reference to IL-6: sources, actions, and clinical implications

The present review examines the cytokine response to acute exercise stress, with particular emphasis on the balance between proinflammatory and anti-inflammatory mechanisms, and the release of IL-6. Prolonged endurance exercise induces a sequenced release of pro- and anti-inflammatory cytokines, and IL-6 plays a dominant role. The magnitude of this response bears a general relationship to the intensity of effort, but the duration of activity and many environmental factors also modulate cytokine release. Although many types of cells are capable of producing cytokines, the main source of the exercise-induced IL-6 production appears to be the exercising muscle. The primary function of the additional IL-6 may be to regulate the supply of carbohydrate as muscle reserves of glycogen become depleted. There is also a delayed release of cytokines following eccentric exercise that is related to the repair of muscle injury. Since the production of cytokines is greater with endurance than with resistance exercise, it seems unlikely that they play an important role in the hypertrophy of muscle and bone. More research is needed on a number of important clinical issues where the exercise-induced release of cytokines may have relevance. Exercise-induced cytokine secretion has the potential to provide a simple model of sepsis. Preliminary observations suggest it may also modulate the risk of type 2 diabetes mellitus. Cytokine concentrations are increased in chronic fatigue syndrome, although it is less dear that the cytokine secretion is responsible for fatigue in humans. Exercise-induced modulations in cytokine secretion may contribute to allergies, bronchospasm, and upper respiratory infections in the endurance athlete. Further, the cytokine cascade is involved in the process of atherogenesis, and exercise-induced changes in cytokine production may expose latent HIV to chemotherapeutic agents.

Naive and memory T cells in hypertrophied adenoids in children according to age

The anatomic location of the adenoid implies that this organ is the first site of contact with inhaled antigens. Depending on the expression of different isoforms of the CD45 molecules, T cells can be divided into naive (CD45RA(+)) and memory (CD45R0(+)) cells, the latter representing T cells that have already been exposed to antigens. The purpose of this study was to analyse the lymphoid cells' subsets in adenoids and relate the findings to the age. The analysed material was adenoid tissue removed on the grounds of hypertrophy from 22 children. The patients were divided into two groups: up to 5 and above 5 years of age. The analyses of the lymphocytes subpopulations in the adenoid were performed in an EPICX XL (Coulter) flow cytometry. The results are expressed as the percentage of positively labeled cells (CD4(+), CD8(+), CD4(+)/CDB(+), CD4(+)CD45RA(+), CD8(+)CD45RA(+), CD4(+)CD45R0(+), CD8(+)CD45R0(+)). The percentage of CD4(+)/CD45R0(+) in children up to 5 years of age was significantly lower than in older children. We found the positive regression between age and the percentage of CD4(+) cells was CD45R0(+) (r=0.64). There were no statistically significant differences between study subgroups for the other parameters. The positive regression for CD4(+)/CD45R0(+) cells and age may result from increased stimulation by bacterial, viral and other antigens. Our results indicate that the adenoid have an important role in the development of an immunological memory among younger children.

[Clinico-immunological effects of cryosurgery in chronic hypertrophic pharyngitis]

The authors observed a clinico-immunological effect of cryosurgical treatment for chronic hypertrophic pharyngitis resistant to previous conservative therapy. Cryosurgery results in the patients' recovery with normalization of basic indices of local and systemic immune defense to day 30. Thus, cryosurgical treatment of patients with chronic hypertrophic pharyngitis has both clinical and immunological advantages over conservative treatment.

Analysis of V(lambda)-J(lambda) expression in plasma cells from primary (AL) amyloidosis and normal bone marrow identifies 3r (lambdaIII) as a new amyloid-associated germline gene segment

Primary (AL) amyloidosis is a plasma cell dyscrasia characterized by extracellular deposition of monoclonal light-chain variable region (V) fragments in the form of amyloid fibrils. Light-chain amyloid is rare, and it is not fully understood why it occurs in only a fraction of patients with a circulating monoclonal component and why it typically associates with lambda isotype and lambdaVI family light-chain proteins. To provide insights into these issues, we obtained complete nucleotide sequences of monoclonal V(lambda) regions from 55 consecutive unselected cases of primary amyloidosis and the results were compared with the light-chain expression profile of polyclonal marrow plasma cells from 3 healthy donors (a total of 264 sequences). We demonstrated that: (1) the lambdaIII family is the most frequently used both in amyloidosis (47%) and in polyclonality (43%); (2) both conditions are characterized by gene restriction; (3) a very skewed repertoire is a feature of amyloidosis, because just 2 germline genes belonging to the lambdaIII and lambdaVI families, namely 3r (22% of cases, lambdaIII) and 6a (20%, lambdaVI), contributed equally to encode 42% of amyloid V(lambda) regions; (4) these same 2 gene segments have a strong association with amyloidosis if their prevalences are compared with those in polyclonal conditions (3r, 8.3%, P =.024; 6a, 2.3%, P =.0008, chi2 test); (5) the J(lambda)2/3 segment, encoding the fourth framework region, appears to be slightly overrepresented in AL (83% versus 67%, P =.03), and this might be related to preferential J(lambda)2/3 rearrangement in amyloid (11 of 12 cases) versus polyclonal 3r light chains (13 of 22 cases). These findings demonstrate that V(lambda)-J(lambda) expression is more restricted in plasma cells from amyloidosis than from polyclonal bone marrow and identify 3r as a new disease-associated gene segment. Overusage of just 2 gene segments, 3r and 6a, can thus account for the lambda light-chain overrepresentation typical of this disorder.

Lymphocyte subpopulations in hypertrophied adenoid in children

Adenoid hypertophy is a common feature of childhood. It is currently accepted that it is caused by the antigen-stimulated increased activity of lymphocyte B (D. Bani, O. Gallo, O. Fini-Storchi, Intraepithelial lymphocyte subpopulations and dendritic accessory cells in normal and hypertrophic adenoids, Laryngoscope 10 (1994) 869-873). The adenoid decreases its size with age but the accompanying function alterations are not fully understood (L. Zawadzka-Glos, M. Chmielik, M. Wasik, Cell mediated response in hypertrophied tonsils in children, Nowa Pediatr. 4 (1997) 12-13). The understanding of the adenoid structure that undergoes some changes during the growth period is essential for evaluation of indications for adnoidectomy and assessment of its potential results. The aim of this study was to evaluate lymphocyte subpopulations in adenoid according to age. The analysed material was adenoids removed on the grounds of hypertrophy, which caused obstructive symptoms and/or otitis media with effusion onset. In the present study, we did not find any statistically significant differences among lymphocytes B, Th, and Ts subpopulations, respectively, in the adenoids of any of the age groups. We have found a statistically significant CD3(+) HLA-DR(+) cell percentage decrease in the group of children from 5 to 10 and above 10 years of age, respectively. We have also found a statistically significant increase in the percentage of NK (CD3(-) CD16(+) 56(+)) lymphocytes in relation to age. On the grounds of the current study, it may be stated that some changes in lymphocyte subpopulations in the adenoid take place with age.

Mast cell proliferation and alterations in bFGF amount and localization are involved in the response of muscle to dystrophin deficiency in hypertrophic feline dystrophy

To test the hypothesis that basic fibroblast growth factor and mast cells play a key role in the phenotypic differences between human dystrophinopathies and hypertrophic feline muscular dystrophy, serial sections of dystrophin-deficient, carrier and normal cat muscle biopsy specimens were examined. They were stained immunohistochemically for dystrophin and different markers of differentiation such as desmin, vimentin and utrophin. Basic fibroblast growth factor was increased in the myofibers of dystrophic cats compared to normal controls and carriers. An association of basic fibroblast growth factor with fiber regeneration and necrosis was shown. The amount of mast cells was markedly increased in muscle tissue of dystrophic cats with a clear predominance of tryptase-positive cells present in large amounts in the endomysium. Mast cells, like basic fibroblast growth factor, were concentrated in areas of muscle fiber regeneration and necrosis. Our data concerning basic fibroblast growth factor and mast cells are consistent with a highly abnormal cellular environment in feline dystrophic muscle with very high levels of basic fibroblast growth factor which is likely modulated by mast cells.

Satellite cell regulation following myotrauma caused by resistance exercise

It is generally accepted that the primary mechanisms governing skeletal muscle hypertrophy are satellite cell activation, proliferation, and differentiation. Specific growth factors and hormones modulate satellite cell activity during normal muscle growth, but as a consequence of resistance exercise additional regulators may stimulate satellite cells to contribute to gains in myofiber size and number. Present knowledge of the regulation of the cellular, biochemical and molecular events accompanying skeletal muscle hypertrophy after resistance exercise is incomplete. We propose that resistance exercise may induce satellite cells to become responsive to cytokines from the immune system and to circulating hormones and growth factors. The purpose of this paper is to review the role of satellite cells and growth factors in skeletal muscle hypertrophy that follows resistance exercise.

Lack of lymphoid cell apoptosis in the pathogenesis of tonsillar hypertrophy as compared to recurrent tonsillitis

The pathogenic mechanism of tonsillar hypertrophy is unknown and lacks a proper infectious or immunological explanation. Epidemiological studies point to polluted environments as the main cause of tonsillar hypertrophy in the adaptation of the juvenile organism. Tonsils and adenoids of 67 children aged 2-16 years (mean 5.9 years) were divided into three groups: recurrent tonsillitis (n = 21), recurrent tonsillitis with tonsillar hypertrophy (n = 21) and tonsillar hypertrophy without history of tonsillitis (n = 25). The following biological markers were studied: anti-streptolysin O antibody and anti-deoxy ribonuclease B antibody serology, microbiology and cell count of granulocytes in tonsils and adenoids as well as lymphocyte subsets and "ex vivo" endonuclease activity in tonsils. Anti-streptolysin O antibody and anti-deoxyribonuclease B antibody titres were significantly raised in recurrent tonsillitis. Positive bacterial cultures for Streptococcus pyogenes were rare in cases of tonsillar hypertrophy. T-lymphocytes counts were lower and the proportion of basophils was higher in hypertrophic tonsils than in recurrent tonsillitis. Two parameters of apoptosis were studied; the activation of endonuclease, inducing breakdown of DNA resulting in cell death, and the sensitivity to thapsigargin, known to trigger the cleavage of DNA by apoptotic endonuclease. In children with tonsillar hypertrophy both parameters were decreased contrasting with those with recurrent tonsillitis where apoptosis is increased. It may be speculated that the increase of basophils in children with tonsillar hypertrophy results in increased release of interleukin-4, which could prevent lymphoid apoptosis and lead to cell proliferation in tonsillar tissue.

CONCLUSION

Whereas recurrent tonsillitis is characterised by apoptotic death of lymphoid tissue, tonsillar hypertrophy is caused by environmental pollution agents that trigger the chronic inflammatory process without apoptotic cell death.

Haemophilus influenzae and Streptococcus pyogenes group A challenge induce a Th1 type of cytokine response in cells obtained from tonsillar hypertrophy and recurrent tonsillitis

We have previously shown that tonsil tissue both from children with tonsillar hypertrophy and recurrent tonsillitis is colonized and invaded by Haemophilus influenzae and Streptococcus pyogenes group A. In order to evaluate if these bacteria are involved in the immunopathogenesis of these two conditions, tonsillar cells from both groups were stimulated in vitro with intact, heat-inactivated H. influenzae or S. pyogenes A. The immunoreactivity was evaluated by assessing the induction of cytokine production (IL-1 alpha, IL-1 beta, TNF-alpha, IL-6, IL-8, IL-2, IFN-gamma, IL-4, TNF-beta and IL-10), which was detected at the single-cell level. All cytokines studied except IL-4 were induced in both groups after stimulation with H. influenzae or S. pyogenes A. The dominating cytokines were IL-1 beta, IFN-gamma and TNF-beta. No major differences in the cytokine pattern or number of cytokine-producing cells were noticed between the two patient cohorts after H. influenzae stimulation. Activation by S. pyogenes A bacteria gave rise to higher frequencies of IFN-gamma- and TNF-beta-synthesizing cells in the recurrent tonsillitis group. The incidence of CD4-, CD8-positive T cells and CD40-positive B cells was comparable between the two groups while the MAC-387-positive macrophages were significantly higher in the recurrent tonsillitis groups. In conclusion, a Th1 type of cytokine response was found in both groups following stimulation with H. influenzae or S. pyogenes A.

CD44 isoforms with exon v6 and metastasis of primary N0M0 breast carcinomas

New isoforms of CD44 with alternatively spliced exons have recently been described. Expression of exon v6 seems to be of particular interest. It has indeed been associated with poorer outcome of breast cancer patients with node invasion at diagnosis. However, no data were available for patients N0M0 (with neither metastasis nor node invasion at diagnosis). Moreover, previous statistical analyses were realized using immunohistochemical methods to detect CD44v6 expression although several variants with exon v6 have been described. We investigated expression of isoforms containing CD44v6 using an RT-PCR approach and a panel of 25 normal breast specimens, 10 mammary fibroadenomas, 8 cystic samples and 52 primary breast tumors (38 invasive N0M0). Normal breasts, fibroadenomas, and cysts all express the same variant, A (with exon v6 only), while several transcripts are amplified in tumors. Expression of variants other than A correlates with acquisition of a malignant phenotype. Invasive cancers also express additional variants in comparison with in situ carcinomas. Metastasis capacities seem to be associated with transcription of variants other than A but also with no transcription of some of them, variants D (with exons v6 and v10) and L (with exons v6 to v10). Expression of variants D and L correlates with higher percentages of disease-free survival and better outcome. Expression of CD44 splice variants with exon v6, as detected by RT-PCR, might be a useful prognostic factor for breast cancer. However, since the series size is small, our results need to be confirmed by later studies on a larger number of patients.

Immune responses against Streptococcus pyogenes in human palatine tonsils

We investigated cellular immunity against Streptococcus pyogenes in human tonsils by measuring antigen-specific immunoglobulin-secreting cells and the production of cytokines from CD4+ T cells in response to M proteins. The incidence of S pyogenes in tonsils was significantly higher in patients with recurrent tonsillitis (RT) than in patients with tonsillar hypertrophy (TH). M protein-specific immunoglobulin A (IgA) and immunoglobulin G spot-forming cells were increased in patients with RT compared with patients with TH. In RT the number of M protein-specific IgA spot-forming cells was significantly greater in the S pyogenes-negative subjects than in the S pyogenes-positive subjects. Proliferation of CD4+ T cells and production of interferon-gamma (IFN-gamma) and interleukins -2, -4, -5, and -6 (IL-2, IL-4, IL-5, and IL-6) from those T cells were observed in response to M protein. The concentrations of IFN-gamma and IL-4 were higher in RT than in TH. These findings suggest that S pyogenes is associated with the pathogenesis of RT and that immune responses against M protein may play an important role in preventing the colonization of this bacteria in tonsils.

CD4+ T lymphocytes injected into severe combined immunodeficient (SCID) mice lead to an inflammatory and lethal bowel disease

Transfer of 2 x 10(5) congenic or semiallogenic purified TCR alphabeta+ CD4+ T cells to SCID mice leads to an infiltration of the recipient gut lamina propria and epithelium with a donor-derived CD4+ T cell subset which induces a lethal inflammatory bowel disease (IBD) in the recipients. In contrast, IBD was not observed in SCID mice transplanted with unfractionated splenic cells. The earliest detectable pathological changes after CD4+ T cell transfer were proliferation and hypertrophy of the entire colonic epithelial layer, including increased mitotic activity, increased expression of epithelial nuclear proliferation antigen, and elongation of the crypts. Later on, massive mononuclear cell infiltration, hypertrophy of all layers of the colon and occasional epithelial ulcerations were observed. At this stage, accumulations of IgA, IgM and small numbers of IgG1-, IgG2- and IgG3-secreting plasma cells were present in the lamina propria of both the small and large intestine. We conclude that low numbers of intraveneously transferred CD4+ T cells induce IBD in SCID mice. In the late stages of CD4+ T cell-induced IBD, the colonic lamina propria becomes infiltrated with macrophages, neutrophils and plasma cells secreting IgA, IgM, and to a lesser degree IgG antibodies which might play an accessory role in the pathogenesis of IBD.

A novel method for isolating mononuclear cells from the stomachs of mice with experimental autoimmune gastritis

Autoimmune gastritis induced in BALB/c mice by neonatal thymectomy is a CD4+ T cell-mediated disease. The disease is characterised by mononuclear cell infiltrates in the gastric mucosa, loss of gastric parietal and chief cells and autoantibodies to the gastric H/K ATPase. Here we describe a simple non-enzymatic method for isolating cellular infiltrates from stomachs of gastric mice by injection of medium directly into stomach walls, causing swelling and rupture. Using this method, large numbers of viable lymphocytes were released from stomachs for analysis by flow cytometry. An 8.3 fold increase in the total number of lymphocytes from diseased stomachs compared to normal controls was observed. Total cell numbers of CD4+ and B cells were increased 4.8 fold and 39.5 fold respectively, in diseased stomachs compared with controls. No change was observed in the CD8+ T cell population. This method will allow detailed quantitative analysis of cellular infiltrates during the development of the gastric lesion and enrichment of pathogenic T cells for analysis and cloning. This procedure may have general application for the isolation of cellular infiltrates from lesion sites of other organs.

Palpable lymph nodes of the neck in Swedish schoolchildren

We studied 3592 Swedish schoolchildren, 8 or 9 years old, examined for palpable submandibular, cervical and supraclavicular lymph nodes. All children were skin tested with 2 TU PPD RT23 and with 0.1 microgram of Mycobacterium avium sensitin or 0.1 microgram of M. scrofulaceum sensitin. A total of 991 children had palpable lymph nodes in any of the three locations. Among them, 811 had lymph nodes in one location, 162 in two locations and 18 in three. In 312 children, the lymph nodes were > or = 5 mm in size in any location. The most common location was submandibular. Boys had a significantly higher prevalence of palpable lymph nodes than girls. There was also seasonal variation. Children infected by atypical mycobacteria (sensitin reaction > or = 6 mm) did not have a higher prevalence of palpable lymph nodes than those not infected.

Distribution characteristics of immunoglobulin-secreting cells in adenoids. Relationship to age and disease

Forty-four adenoids and 52 palatine tonsils from 71 children and adolescents (age 3-21 years) undergoing surgery because of adenoidal hypertrophy or recurrent tonsillitis were examined for the presence of immunoglobulin-secreting cells (ISC) employing an enzyme-linked immunospot assay (ELISPOT). ISC constituted less than 2% of the mononuclear cell population. Adenoids contained IgG, IgA, and IgM ISC in significantly lower numbers than palatine tonsils. The predominant isotype of the ISC was IgG, in adenoids accounting for 62% of the ISC and in palatine tonsils for 73%. The relative numbers for IgA and IgM ISC were similar. A significant correlation existed between autologous adenoids and palatine tonsils for the numbers of IgA and IgM ISC, but not for the numbers of IgG cells. These observations suggest that, adenoid and palatine tonsils display similar immunoglobulin distribution patterns within a single individual. However, individuals with hypertrophied adenoids exhibited a numeric decrease in IgG ISC with increasing age (P less than 0.01). Both lymphoid tissues may be involved in mucosal immune defense.

Sural nerve immunoreactivity for nerve growth factor receptor in a case of localized hypertrophic neuropathy

Immunoreactivity for nerve growth factor receptor (NGFR) was examined using a monoclonal antibody against human NGFR in the sural nerve of a 24-year-old woman, affected by localized hypertrophic neuropathy (LHN). NGFR expression was correlated with electron microscopy and with immunoreactivity for S-100 protein, laminin, HLA-DR, HNK-1, P0 glycoprotein and neurofilament peptides. Our results indicate that in LHN most of whorl-forming cells are NGFR positive and S-100 protein or HLA-DR negative. These data along with the ultrastructural features suggest their origin from perineurium.

Distribution of lymphoid cells in tonsillar compartments in relation to infection and age. A quantitative study using image analysis

The distribution of lymphoid cells in the mantle zone, germinal center, interfollicular area, and subepithelial area of the tonsil was evaluated quantitatively by image analysis in 66 subjects aged 3 to 66 years. The number of Ig-positive cells in the tonsil decreased with advancing years in all compartments. This inverse correlation to age was statistically significant for IgD-, IgM-, and IgG-positive cells. For T-cells, overall change of each T-cell subset with age was smaller than those of Ig-positive cells. An age-related marked decline was seen for CD4-positive cells only in the subepithelial area and for CD8-positive cells only in the interfollicular area. Ki-67-positive cells, cells undergoing active division, were mainly found in the germinal centers and also diminished with advancing years. Patients with frequent episodes of tonsillitis demonstrated a significant increase of IgD-positive cells and IgG-positive cells in interfollicular and subepithelial compartments and a decrease of CD4-positive T-cells in the germinal centers and subepithelial areas. These results suggest that the tonsillar involution with age is immunologically associated in all compartments with the decrease of Ig-positive cells and Ki-67-positive activated cells resulting in a relative increase of T-cell subsets. The method of image analysis provides a novel and unique approach for quantitative immunohistological study of the tonsil.

Studies of intestinal lymphoid tissue. XIII. Immunopathology of the evolving celiac sprue lesion

Observations, by computerised image-analysis on the evolution of flat mucosae in two celiac sprue patients, are described. Initial immunopathologic features comprised infiltration of epithelium of normal villi by small, non-mitotic lymphocytes, accompanied by crypt hypertrophy and increased crypt cell mitotic activity. The subsequent development, several years later, of flat mucosae was accompanied by mitotic, "immunoblastoid" EL thus fulfilling the diagnostic criteria for celiac sprue. These sequential phases in the evolving flat celiac mucosa parallel experimental graft-versus-host reactions, suggesting that they are fundamentally cell-mediated in type. In becoming flat, it appears obligatory for the mucosa to pass through the early "proliferative-infiltrative" stage in which crypt hypertrophy is a prominent feature.

Thymic abnormalities induced by castration in aged (NZB X SJL)F1 male mice: distinct effects of early and late castration

Female but not male (NZB X SJL)F1 (NS) hybrid mice develop thymic abnormalities during aging. To determine the possible participation of androgens in this sex-related difference, we investigated the effect of androgen deprivation, as can be achieved by orchidectomy, on the cellular composition of the thymus of old NS males. Mice were orchidectomized at ages ranging from 3 weeks to 9 months and their thymuses were studied at the ages of 12 or 18 months. Phenotypic characterization of the intrathymic lymphocyte population was carried out using flow cytofluorometry analysis. Orchidectomy performed early in life (3 weeks-3 months) resulted, at 12 months of age, in thymic alterations (expansion of dull Thy-1+ cells, emergence of surface immunoglobulin-bearing cells) resembling those occurring spontaneously in old NS females. In contrast, when orchidectomy was performed later in life (6-9 months), there was a numerical increase of all thymocyte subsets but no major qualitative abnormality at either 12 or 18 months of age. Therefore, the absence of thymic disease in intact NS males may reflect primarily a suppressive effect of androgens that can be reversed by early but not by late orchidectomy.

Influence of tonsillar disease on the expression of J chain by immunoglobulin-producing cells in human palatine and nasopharyngeal tonsils

A significant reduction of the percentage of J-chain-positive intra- and extra-follicular IgA immunocytes was found in inflamed palatine tonsils. There was a tendency to similar alterations in hypertrophied adenoids. Tonsillar disease apparently enhances local maturation of the B-cell system, perhaps on the basis of intensified proliferation of memory clones. Alternatively, there may be a disease-associated defect in the mechanism(s) that normally induced switchover to the IgA isotype early in clonal development. It is speculated that, by decreasing the J-chain expression during local B-cell differentiation, tonsillar disease may jeopardize the potential of the tonsils as a putative precursor source for the secretory immune system of the upper aero-digestive tract.

Disseminated systemic expression of the "local" popliteal lymph node assay in rats

In contrast to the traditional belief that the popliteal lymph node (PLN) assay of graft-versus-host (GVH) reactivity is a local phenomenon, this study describes significant systemic components of both donor and host lymphoid cell activity. Not only are host radiosensitive lymphocytes of systemic origin necessary for the manifestation of normal PLN hypertrophy, but as few as 2.5 X 10(6) parental lymph node cells (LNCs) injected into the hind footpad of adult F1 hybrid rats disseminate widely, provoking significant systemic GVH reactions, as measured by splenomegaly, and distant lymphadenopathy. Futhermore, locally injected donor LNCs ultimately engender three forms of attenuated GVH reactivity: (1) the dissipation of potentially unlimited GVH reactivity, (2) refractoriness of the host to subsequent rechallenge by GVH-inducing cells, and (3) progressive loss of GVH reactivity in donor LNCs when serially transferred to secondary F1 recipients. Whether this modulation of the cell-mediated immune response is the expression of an anti-recognition structure response by the host or the activation of some other immunoregulatory protein, it is absent or reduced in splenectomized recipients. The data suggest that the spleen provides an immunoregulatory microenvironment in which cell-mediated immune responses, such as the GVH reaction, are modulated.

[The presence of scleroderma and chronic lymphadenosis concurrently in a patient (author's transl)]

This report deals with the case of a 50 year-old woman with long-standing scleroderma of the acral-asphyxial type with a relatively slight tendency to progression. Chronic lymphadenosis has been an additional feature of this case over the past few years. The following findings appear of particular interest: autoimmune phenomena in the form of antinuclear antibodies, a virtually monoclonal proliferation of B-lymphocytes and a relative T-lymphocyte deficiency. It is suggested that both conditions may be pathogenetically connected with an immunologically defined insufficiency of the lymphocytic system. Hence, in view of this observation, it may not be correct to consider scleroderma a "paraneoplastic phenomenon".