Role of adenoids and adenoiditis in children with allergy and otitis media

Adenoids and/or tonsil inflammation with concomitant obstructive hypertrophy is one of the oldest and most common pediatric problems. Adenoids are a component of Waldeyer’s ring and because of their anatomic position can be relevant in the pathogenesis of otitis media when they are inflamed and/or enlarged. Adenoid pads can create mechanical eustachian tube obstruction. Therefore, in some cases, adenoidectomy may have a role in the clinical management of otitis media with effusion. However, eustachian tube dysfunction related to the adenoids may also have an allergy-related functional component. Allergic inflammation has been described for middle ear effusion, and some studies have reported that mast cells increase and allergic mediators release in adenoids as well. Nasal endoscopy has a key role in confirming a diagnosis of adenoid hypertrophy and/or adenoiditis and in detecting an association between adenoid inflammation/infection and otitis media with effusion, especially during infancy and early childhood.     

Sublingual immunotherapy may affect serum neopterin: Preliminary findings

Background

Neopterin is a protein produced by monocytes/macrophages. It has been considered a biomarker of immune activation in several disorders. However, there are few studies in allergic rhinitis (AR).This study evaluated the serum neopterin levels in patients with pollen-induced AR or treated with sublingual immunotherapy (SLIT) and in healthy subjects.

Methods

146 subjects (70 males, median age 30.5 years): 56 with moderate–severe persistent AR, 40 with AR and successfully treated with 2 year SLIT, and 50 healthy controls were consecutively evaluated outside the pollen season. A skin prick test and blood sampling for assessing serum neopterin levels were performed in all subjects.

Results

SLIT-treated patients had lower neopterin levels than untreated patients and healthy subjects (respectively p = 0.012 and p = 0.0001).

Conclusions

Neopterin is a biomarker for immune activation, SLIT may affect serum neopterin probably as a consequence of Treg response to SLIT.     

Atypical erythema annulare centrifugum in a child with celiac disease

Herpetiformis dermatitis is the best characterized extraintestinal manifestation of celiac disease (CD). However, other chronic heterogeneous skin lesions have been associated with CD and should be considered in the differential diagnosis.     

Role of respiratory pathogens in infants hospitalized for a first episode of wheezing and their impact on recurrences

In order to evaluate the infectious agents associated with the first episode of severe acute wheezing in otherwise healthy infants and to define the role of each of them in recurrences, 85 patients in Italy, aged <12 months, hospitalized because of a first acute episode of wheezing, were prospectively enrolled between 1 October 2005 and 31 March 2006. Upon enrolment, nasopharyngeal swabs were collected for the real-time PCR detection of respiratory syncytial virus (RSV) types A and B, influenza virus types A and B, adenovirus, parainfluenza viruses types 1, 2, 3 and 4, rhinovirus, human metapneumovirus, human coronavirus types 229E, OC43, NL63, and HKU1, bocavirus, enterovirus, and paraechovirus; nasopharyngeal aspirates were also obtained to detect atypical bacteria. At least one infectious agent was identified in 76 children (89.4%). RSV was the most frequently detected pathogen and its prevalence was significantly higher than that of the other pathogens in both age groups, and significantly higher in the children aged 3–12 months than in those aged <3 months. Only the children with RSV infection experienced recurrent wheezing. Viral load was significantly higher in children with than in those without recurrent wheezing. This study shows that RSV is the main reason for hospitalization during the first wheezing episode in infants, and that it appears to be the only pathogen associated with a high frequency of recurrences. A high viral load seems to be strictly related to the likelihood of recurrence.     

Increased percentage of activated Ia+ T lymphocytes in peripheral blood of neonates following exchange blood transfusion

The expression of Ia-like antigens in peripheral blood T lymphocytes from newborns receiving postnatal total blood exchange was analyzed. A significantly increased percentage of Ia-positive T lymphocytes (Ia+ T cells) was observed 2 days after postnatal transfusion with total blood in comparison to data observed on Days 0, 5, and 15. Ia+ T cells were also significantly higher than in normal control newborns tested in the same period. When newborns received the blood exchange with irradiated total blood or with leukocyte-depleted blood, no increase in Ia+ T cells was observed and the percentage of these cells remained in the normal range (1-7%) on all the days tested (0, 2, 5, 15 days). For easy identification of the origin of Ia+ T cells, sex-incompatible blood was used for exchange, and a karyotype analysis was carried out for the detection of the Y chromosome on Ia+ T cells separated from peripheral blood on Day 2 and then cultured with interleukin 2 (IL-2) for 48 hr. It was thus established that Ia+ T cells were not of donor origin. Simultaneously with the expression of Ia-like antigens, host T cells also carried the interleukin-2 receptor (TAC). An allogeneic response, comparable to a host-versus-graft reaction, was probably responsible for the activation of T cells 2 days after total blood exchange in newborns.     

Neonatal stridor and laryngeal cyst: Which comes first?

Neonatal stridor is a rare condition usually caused by laryngomalacia. Congenital laryngeal cyst represents an uncommon cause of stridor in the neonatal population and may be misinterpreted as laryngomalacia, leading to serious morbidity and mortality if diagnosis and treatment are delayed. Herein we report the case of a full‐term infant with stridor, feeding problems and failure to thrive. Initially, direct laryngoscopy diagnosed only laryngomalacia. As stridor worsened, however, and respiratory distress appeared, repeat laryngoscopy showed vallecular laryngeal cyst, visible macroscopically. The patient was successfully treated with endoscopic marsupialization. There was no evidence of recurrence at follow up after 3 months. This case highlights the importance of laryngoscopic assessment for suspected laryngeal abnormalities in infants with stridor. If symptoms worsen, endoscopy should be repeated, because congenital laryngeal cysts may not be immediately visible macroscopically.     

Prevalence of atopic symptoms among blood donor carriers of mannose-binding lectin variant alleles

Mannose-binding lectin (MBL) is a C-type soluble collectin involved in the innate immune response. Carriers of MBL gene variant alleles (MBLva) have decreased plasma concentrations of MBL and increased susceptibility to bacterial and viral infections. The aim of the present study is to test the hypothesis that carriers of MBLva could have a different frequency of atopic symptoms as compared to wild-type carriers. A total of 385 consecutively enrolled Caucasian blood donors were studied. Blood specimens underwent genomic analysis and genotyping for MBLva by polymerase chain reaction (PCR). MBLva carrier status was associated with a reduced frequency of allergic rhinitis (OR 0.41 [95% CI 0.2 to 0.8], chi2 = 6.98, p =.008). No relationship was found between MBLva carrier status and asthma or atopic skin symptoms. MBLva might be one of the host-related genetic factors involved in atopic disorders, namely allergic rhinitis.     

BMP2,3,4,5 mRNA在三叉神经中的表达分析

目的：明确 Ｂ Ｍ Ｐｓ 与外周神经的关系。方法：用原位杂交方法观察 Ｂ Ｍ Ｐ２,３,４,５ 的ｍ Ｒ Ｎ Ａ在三叉神经中的表达。结果：在外周神经（三叉神经）中均有 Ｂ Ｍ Ｐ２,３,４,５ ｍ Ｒ Ｎ Ａ 分布, Ｂ Ｍ Ｐ２,３,４,５ 的分布主要位于构成神经纤维髓鞘的雪旺细胞中;此外发现 Ｂ Ｍ Ｐ２ 在部分神经纤维中也有表达。结论：首次确定了 Ｂ Ｍ Ｐ２,３,４,５ 在外周神经中的表达和分布,揭示了 Ｂ Ｍ Ｐ２,３,４,５可能在外周神经的发育和再生以及形态结构的维持中发挥着调控作用。     

An immunohistochemical study of keratin expression in ameloblastoma from a Kenyan population

OBJECTIVES: Ameloblastomas appear to exhibit biological heterogeneity and, except in the case of malignancy, histological appearances that do not always allow their behaviour to be predicted. The aim of this study was to assess keratin expression in African ameloblastomas and to correlate this with their clinical and histological features. MATERIALS AND METHODS: Expression of simple keratins 7, 8, 18 and 19; cornification keratins 1 and 10; basal and differentiation keratins 5 and 14 and hyperproliferation-related keratins 6 and 16 in 14-39 cases of ameloblastoma was assessed by immunohistochemical methods. RESULTS: There was patchy expression of keratin 7 in the suprabasal and stellate reticulum-like cells in some cases. All cases showed similar weak expression for keratins 8 and 18 in suprabasal and stellate reticulum-like cells but none showed keratin 1 or 10 expression. There was intense expression of keratins 5, 14 and 19 by all tumour cells suggesting that they may retain basal cell characteristics with a potential for proliferation. No consistent relationship was seen between histological types and keratin expression pattern. However, keratins 6 and 16, expressed by suprabasal and stellate reticulum-like cells, showed a marked variation within and between cases, with the highest levels of expression in squamous strands. CONCLUSIONS: We propose that squamous strands may represent the sites of most active growth within individual tumours and expression of keratins 6, 16 and 19 may be predictors of rapid growth. There is a need for further investigation of this in longitudinal clinical studies.     

Safer, more expensive iodinated contrast agents: how do we decide?

The advantages of the new, safer, but more expensive iodinated contrast agents are discussed, and opinions on which patient groups should receive the agents are presented.