Fulminant legionellosis in two patients treated with infliximab for Crohn’s disease: Case series and literature review

Two cases of fulminant pulmonary legionellosis, complicated by prolonged intensive care unit stays and acute respiratory distress syndrome, and who were recently treated with infliximab for Crohn’s disease, are described. A review of the literature revealed three additional cases in patients with inflammatory bowel disease, and a total of 22 cases of Legionella pneumophila pneumonia in the context of treatment with antitumour necrosis (TNF)-alpha medications. The median age of the patients was 49 years, and men and women were affected equally. The case fatality rate was 14% (three of 22). Early recognition and treatment of this anti-TNF-alpha-related complication would likely result in reduced mortality and morbidity. Physicians prescribing anti-TNF-alpha drugs should be aware of this association.     

Thoracoplasty: its forgotten role in the management of nontuberculous postpneumonectomy empyema

The role of thoracoplasty in the management of empyema complicating pneumonectomy is controversial because alternative techniques, such as pedicled muscle transplants or open-space sterilization, have now replaced the conventional collapse procedures. Among 46 patients treated for postpneumonectomy empyema during the years 1975 to 1984, 17 underwent space-reducing thoracoplasty as the final step in pleural space management. Technical considerations, critical in the success of the operation, were: (a) single-stage extramusculoperiosteal resection of the second to the seventh rib, (b) sparing of the first rib to maintain integrity of the neck and shoulder girdle, (c) intercostal muscle closure of large fistulas and (d) adequate drainage of pleural and extrapleural spaces. Immediate control of the empyema was obtained in 15 (88%) patients. Fourteen patients were alive at the time of follow-up (mean 4.5 years) and none had major thoracic deformity or residual infection. Our data show that thoracoplasty is an excellent therapeutic option for patients with chronic postpneumonectomy empyema. Adherence to strict surgical principles ensures that the space is obliterated and the cosmetic result is satisfactory.     

Calcitonin-secreting carcinomas of the prostate. An immunohistochemical and ultrastructural analysis

Two cases of calcitonin-producing carcinomas of the prostate are reported. Light microscopical, immunohistochemical, and ultrastructural investigations have been performed. These tumors displayed a remarkable dual, endocrine and common epithelial (exocrine), differentiation. However, they presented two different architectural growth patterns. Of particular interest, numerous calcitonin cells were immunocharacterized. In addition, the endocrine component could harbour carcinoembryonic antigen, serotonin, human chorionic gonadotrophin, and prostate-specific acid phosphatase immunoreactive cells. Ultrastructural analysis confirmed the presence of numerous endocrine cells. These findings are not unexpected, since calcitonin, serotonin, and human chorionic gonadotrophin immunoreactive cells are normal and constitutive inhabitants of prostate gland. In the current cases, calcitonin cells showed a strong carcinoembryonic antigen immunoreactivity, as observed also in thyroidal C-cells. This peculiar kind of prostatic carcinoma might be compared to certain thyroidal tumors of intermediate type coupling parafollicular and follicular differentiation.     

Determination of hepatitis B virus subtypes by an enzyme immunoassay method using monoclonal antibodies to type-specific epitopes of HBsAg

We described a Hepatitis B surface antigen (HBsAg) subtyping method based on a commercial enzyme immunoassay (EIA) for detection of HBsAg in which the procedure was modified to include the use of monoclonal antibodies with restricted anti-HBs specificities. This method, which was able to classify HBsAg as: ayw1, ayw2, ayw3, ayw3 * (intermediate between ayw3 and ayw4 ), ayw4, ayr, adw2, adw4 and adr , was compared to counter electrophoresis procedure (CEP) by testing HBsAg positive sera from blood donors included in a prospective national epidemiological survey. Among the 256 HBsAg positive samples tested with both techniques, 111 (43.3%) could not be subtyped with CEP vs 10 (3.9%) with our modified EIA. This difference was related to the serum HBsAg concentration which must be greater than 3000 ng/mL and 100 ng/mL for CEP and EIA, respectively. The results obtained from 145 sera with both methods were concordant. Seventeen out of 18 samples partially classified as ay with CEP were completely determined with EIA.
This reliable procedure, derived from commercially available reagents, can be easily used in several applications such as large epidemiologic studies and as a substitute for nucleotide sequencing genotyping which is not adapted for large-scale screening and not applicable on samples from nonviremic hepatitis B virus (HBV) carriers.     

Influence of the central nucleus of the amygdala on the content of corticotropin-releasing factor in the median eminence

The central nucleus of the amygdala possesses numerous neurons containing corticotropin-releasing factor (CRF). This study demonstrates a striking decrease of the CRF-like immunoreactivity in the median eminence at both 1 and 2 weeks after bilateral lesions of the amygdaloid central nucleus. Lesion of the amygdaloid central nucleus did not alter the neurophysin-like immunoreactivity in the internal zone of the median eminence, indicating the integrity of the efferent neurophysin-containing fibers of the supraoptic and paraventricular hypothalamic nuclei. However, there was a concomitant decrease of neurophysin and CRF-like immunoreactivity in the external zone of the median eminence. These results substantiate the hypothesis that the amygdaloid central nucleus can influence the content of CRF-like material in the median eminence via a multisynaptic pathway involving the synthesis of CRF at the level of the paraventricular nucleus of the hypothalamus. The exact mechanism by which lesion of the amygdaloid central nucleus influences the CRF content in the median eminence remains to be determined.