Evidence for eosinophil activation in bronchiectasis unrelated to cystic fibrosis and bronchopulmonary aspergillosis: discrepancy between blood eosinophil counts and serum eosinophil cationic protein levels

BACKGROUND—Increased serum levelsof eosinophil cationic protein (ECP) have been detected in adolescentpatients with cystic fibrosis. However, ECP concentrations in adultpatients with bronchiectasis unrelated to cystic fibrosis have not been studied.
METHODS—Eosinophil numbers and serumconcentrations of ECP were determined in 14 patients with known ornewly diagnosed bronchiectasis and compared with age and sex matchedpatients with allergic bronchial asthma, chronic obstructive pulmonarydisease (COPD), and controls in whom bronchiectasis or obstructivepulmonary disease could be excluded.
RESULTS—Serum ECP levels were significantlyraised both in patients with bronchiectasis (median (range) 22.5 µg/l(7-85)) and allergic asthma (35.0 µg/l (7-128)) compared with thesex and age matched subjects suffering from COPD (6.7 µg/l (1.5-28);p<0.006) and non-obstructive normal controls (7.5 µg/l (3.5-19);p<0.003). In contrast, significantly increased peripheral eosinophilnumbers were observed in patients with bronchial asthma (305 × 10⁶/l; p<0.01) but not in those with bronchiectasis(10² × 10⁶/l), COPD (117 × 10⁶/l), and healthy controls (101 × 10⁶/l).
CONCLUSIONS—The discrepancy betweeneosinophil counts and eosinophil numbers in patients withbronchiectasis suggests that serum ECP levels may be more relevant inassessing local eosinophil involvement than blood eosinophil numbers.

     

Epidermolysis bullosa acquisita: diagnosis by optic immunofluorescent demonstration of junctional antigens and vitamin E treatment

In a patient with epidermolysis bullosa acquisita the characteristic dermolytic cleavage was demonstrated by electron microscopy and by mapping of antigenic determinants (type IV collagen, laminin, bullous pemphigoid antigen) of the dermal-epidermal junction. The latter method represents a rapid and reliable way to determine the cleavage plane in diseases which display subepidermal blister formation at the light-microscopic level. The classification of epidermolysis bullosa acquisita is still under dispute. Due to its highly characteristic clinical, ultrastructural, and immunologic features and pending further experimental data, epidermolysis bullosa acquisita should be regarded as a separate disease entity; its lumping together with cicatricial pemphigoid, as proposed by some authors appears speculative. Therapy of epidermolysis bullosa acquisita is generally regarded as difficult; following a 3-year course of high dose vitamin E therapy our patient underwent complete clearing; the possibility of a spontaneous remission, on the other hand, cannot be unequivocally ruled out.     

Antegrade internal ureteral stenting: a technical refinement

A pliable, easy to place, double pigtail, internal ureteral stent made of elastomeric polyurethane is described. The tapered distal pigtail end minimizes bladder irritation and the combination of a pusher and absorbable suture enables optimal placement of the proximal pigtail end in the renal pelvis. Ten stents used in eight patients remained functional without bladder irritation for a mean period of 8 months (range, 2-14 months).