Prevalence of respiratory and atopic disorders among children in the East and West of Germany five years after unification.

Living conditions in eastern Germany have changed rapidly since unification in 1990 and little is known about how these changes affect the prevalence of atopic diseases. This study describes methods and prevalences of a large epidemiological project investigating determinants of childhood asthma and allergies in eastern (Dresden and Leipzig) and western (Munich) Germany in 1995/1996. Community based random samples of 9-11 yr old children in Dresden (n=3,017) and Munich (n=2,612), and of 5-7 yr old children in Dresden (n=3,300), Leipzig (n=3,167) and Munich (n=2,165) were studied by parental questionnaires, bronchial challenges with hypertonic saline, skin examination, skin-prick tests, and measurements of specific and total serum immunoglobulin (Ig)E using Phase II modules of the International Study of Asthma and Allergies in Childhood (ISAAC). In 9-11 yr old children, the prevalence of physician diagnosed asthma (7.9% versus 10.3%; p<0.01) and bronchial hyperresponsiveness (15.7% versus 19.9%; p<0.05) was lower in Dresden than in Munich. No difference between Munich and Dresden was observed in the prevalence of diagnosed hay fever, skin test reactivity to > or = 1 allergen, and increased levels (>0.35 kU x L(-1)) of specific IgE against inhalant and food allergens. Symptoms and visible signs of atopic eczema tended to be more prevalent in Dresden. Similar East-West differences between the three study areas were seen in the younger age group. These findings are in line with recently observed increases in the prevalence of hay fever and atopic sensitization, but not of asthma and bronchial hyperresponsiveness, among 9-11 yr old children in Leipzig.     

T cell receptor vbeta repertoire in bronchoalveolar lavage in Wegener's granulomatosis and sarcoidosis.

BACKGROUND: Lymphocytic alveolitis is a common feature of Wegener's granulomatosis (WG) and sarcoidosis. In pulmonary sarcoidosis analysis of the T cell receptor (TCR) configuration disclosed a biased TCR repertoire in cells obtained by bronchoalveolar lavage (BAL), suggesting that the pulmonary T cell population contains an oligoclonal, probably antigenically selected component. We examined whether this is also a feature of WG. METHODS: The distribution of 16 TCR Vbeta phenotypes on BAL cells was compared with the distribution on autologous blood cells in 8 WG patients with lymphocytic alveolitis. A control group was composed of 5 patients with active pulmonary sarcoidosis. The two groups were comparable with respect to the lymphocyte count in BAL and the distribution of the CD4+ and CD8+ T cell subsets in BAL and the blood. Overutilization of individual Vbeta phenotypes on BAL cells was considered to be significant when the percentage of positive cells in BAL doubled than in the blood and the frequency in BAL was at least 10% of total BAL T cells. RESULTS: All 5 sarcoidosis patients showed substantial overutilization of individual Vbeta families in BAL as compared with the blood. By contrast, only 2 of the 8 WG patients showed overutilization of individual Vbeta phenotypes in BAL. CONCLUSIONS: These findings do not suggest that the T cell population in BAL of WG patients contains a prominent oligoclonal component. While BAL is a convenient approach to obtain T cells from a site of active disease, BAL cells do not appear to be good material for the isolation of clonally selected T cells in WG.     

IL-15-IgG2b fusion protein accelerates and enhances a Th2 but not a Th1 immune response in vivo,while IL-2-IgG2b fusion protein inhibits both

We have explored how IL-15 influences Th1 or Th2 type immune response in vivo. Intraperitoneal application of an IL-15-IgG2b fusion protein (FP) to mice did neither significantly affect the footpad swelling nor the production of hemagglutinizing antibodies in a delayed type hypersensitivity reaction to sheep red blood cells. In contrast, in an established murine Th2 model of sensitization to ovalbumin (OVA), IL-15-IgG2b FP plus OVA sensitization resulted in massively accelerated and enhanced allergen-specific IgE and IgG1 antibody production. In vitro, stimulation of spleen cells from OVA-sensitized mice with OVA+IL-15 or OVA+IL-15-IgG2b resulted in a significantly enhanced IgE production. IL-4 secretion was significantly induced by IL-15 but not by IL-15-IgG2b. An IL-2-IgG2b FP with the same Fc tail as the IL-15-IgG2b FP was used as control in both models. In striking contrast to the IL-15-IgG2b FP, IL-2-IgG2b significantly inhibited the Th2 type antibody production in vivo. The current study suggests that IL-15-IgG2b may be employed as a potent accelerator and enhancer of Th2 type immune responses in vivo, while IL-2-IgG2b can suppress the latter.     

Histopathology and Immunophenotype of the Spleen During Acute Antibody‐Mediated Rejection

Splenectomy has been reported to have a beneficial effect in treating Acute antibody‐mediated rejection (ABMR). This reason for this often rapid and profound beneficial effect is not readily apparent from what is known about normal splenic immunoarchitecture. While the spleen is rich in mature B cells, it has not been noted to be a repository for direct antibody‐secreting cells. We present a case of a Native American female who received a renal transplant and developed a severe episode of ABMR. The patient was initially refractory to both plasmapheresis and IVIG. The patient underwent an emergent splenectomy with almost immediate improvement in her renal function and a rapid drop in her DR51 antibodies. Immunohistochemical stains of the spleen demonstrated abundant clusters of CD138+ plasma cells (>10% CD138 cells as opposed to 1% CD138 cells as seen in traumatic controls). Though this is a single case, these findings offer a rationale for the rapid ameliorative effect of splenectomy in cases of antibody rejection. It is possible that the spleen during times of excessive antigenic stress may rapidly turn over B cells to active antibody‐secreting cells or serve as a reservoir for these cells produced at other sites.     

Cardiac chamber quantification using magnetic resonance imaging at 7 Tesla—a pilot study

Objectives  

Interest in cardiovascular magnetic resonance (CMR) at 7 T is motivated by the expected increase in spatial and temporal resolution, but the method is technically challenging. We examined the feasibility of cardiac chamber quantification at 7 T.     

Correlation of contrast agent kinetics between iodinated contrast-enhanced spectral tomosynthesis and gadolinium-enhanced MRI of breast lesions

Objectives

Assessment of contrast agent kinetics in contrast-enhanced MRI (CE-MRI) with gadolinium-containing contrast agents offers the opportunity to predict breast lesion malignancy. The goal of our study was to determine if similar patterns exist for spectral contrast-enhanced digital breast tomosynthesis (CE-DBT) using an iodinated contrast agent.

Methods

The protocol of our prospective study was approved by the relevant institutional review board and the German Federal Office for Radiation Protection. All patients provided written informed consent. We included 21 women with a mean age of 62.4 years. All underwent ultrasound-guided biopsy of a suspect breast lesion, spectral CE-DBT and CE-MRI. For every breast lesion, contrast agent kinetics was assessed by signal intensity–time curves for spectral CE-DBT and CE-MRI. Statistical comparison used Cohen’s kappa and Spearman’s rho test.

Results

Spearman’s rho of 0.49 showed significant (P?=?0.036) correlation regarding the contrast agent kinetics in signal intensity–time curves for spectral CE-DBT and CE-MRI. Cohen’s kappa indicated moderate agreement (kappa?=?0.438).

Conclusion

There is a statistically significant correlation between contrast agent kinetics in the signal intensity–time curves for spectral CE-DBT and CE-MRI. Observing intralesional contrast agent kinetics in spectral CE-DBT may aid evaluation of malignant breast lesions.

Key Points

? Contrast agent kinetics can be assessed using spectral digital breast tomosynthesis (DBT). ? Contrast agent kinetics patterns in spectral DBT are similar to those in contrast-enhanced MRI. ? Multiple contrast enhancement for spectral DBT gives additional diagnostic information.     

Therapie der periprothetischen Infektion

The increasing number of prosthesis implantations and higher life expectancy lead to a growing number of periprosthetic infections (PPI). Optimal therapy necessitates interdisciplinary coordination of surgical and antimicrobial treatment. Challenges in the treatment are the increased occurrence of resistant pathogens, selection of adequate antimicrobial and surgical treatment strategies, inappropriate pretreatment and comorbidities of patients. Current treatment concepts lead to a high success rate in terms of infection eradication, when correctly applied. The individual expectations and underlying conditions of each patient must be considered when determining the therapy concept. The first step is to distinguish between acute and chronic infections. In acute infections the prosthesis can be retained but chronic infections necessitate a complete exchange of the prosthesis. Complicating factors, such as compromising soft tissue and bone conditions, osteomyelitis and infections caused by difficult-to-treat bacteria should, however, always be treated by a complete exchange of the prosthesis, even for acute infections. The antimicrobial treatment must be tailored to the causative agent, the surgical strategy as well as comorbidities and drug intolerances of the patient. It is important to distinguish between biofilm-active eradication therapy with rifampicin for gram-positive pathogens and quinolones for gram-negative organisms and suppression therapy. This article gives a structured presentation of the therapy algorithm.