Immunological marker patterns in granulomatous lymph node lesions

The distribution of various types of lymphocytes and macrophages was studied in 19 cases with granulomatous lymph node lesions using 14 monoclonal antibodies. Cases of sarcoidosis, tuberculosis and atypical mycobacteriosis all showed well demarcated granulomas devoid of B-lymphocytes and natural killer cells. In these cases, T-helper: T-suppressor cell ratios were greater than 2 and poor preservation of the normal lymphoid tissue outside the granulomas was seen. In contrast, cases of non-specific lymphadenitis showed less well-demarcated granulomas always containing B-lymphocytes and natural killer cells, with a T-helper:T-suppressor cell ratio less than 1 and good preservation of the normal lymphoid tissue outside the granulomas. Immunological marker studies may be helpful in the differential diagnosis of granulomatous lymph node lesions, as well as in the study of the pathogenesis of such lesions.     

Pressure-dependent,enhanced natriuretic response to low-dose,atrial natriuretic peptide infusion in essential hypertension

Abstract. Objective. To examine whether the effect of atrial natriuretic peptide (ANP) on renal glomerular and tubular segmental handling of sodium in patients with essential hypertension is pressure dependent. Design. Part 1. The renal effects of a low-dose continuous infusion (10 ng kg^?1 min^?1) with ANP for 1 h were compared in 10 untreated essential hypertensives (EH) and 13 normotensive control subjects (CS). Part 2. The hypertensives were studied on another day with ANP infusion during preceding acute BP reduction with sodium nitroprusside infusion (NP). The results were compared with those obtained during infusion with ANP + placebo (Part 1). Methods. Lithium clearance was used to estimate the proximal tubular reabsorption of sodium. Results. Part 1. Atrial natriuretic peptide caused an exaggerated increase in urinary sodium excretion (+ 102 vs. + 38%; P < 0.05), fractional excretion of sodium (+ 80 vs. + 37%; P < 0.05), and urinary output (+ 56 vs. + 8.3%; P < 0.05) in EH compared with CS. Glomerular filtration rate and filtration fraction increased to the same degree in both groups. Absolute lithium clearance (C_L1) increased and FE_L1 tended to increase (P = 0.061) in EH, but these were unchanged in CS. The increase in plasma cyclic guanosine 5′-phosphate (cGMP) and urinary excretion of cGMP and the decrease in plasma aldosterone during ANP infusion were the same in the two groups. Part 2. During NP infusion the natriuresis caused by ANP in EH was reduced (+ 51 vs. +99%; P <0.05). The relative changes in GFR, C_L1, and FE_L1 during ANP infusion were not affected by the preceding BP reduction with NP. Mean arterial pressure was reduced from 122 to 101 mmHg during NP infusion. The relative increase in sodium excretion in EH was significantly correlated to mean arterial pressure. Conclusions. Low-dose ANP infusion causes an exaggerated natriuresis in untreated essential hypertensives due to a more pronounced reduction in tubular reabsorption. After BP reduction, the natriuresis induced by ANP in essential hypertensives is decreased, probably due to a less pronounced reduction in tubular reabsorption beyond the proximal tubules. We suggest that the enhanced natriuretic response to ANP in EH is secondary in some degree to the elevated systemic pressure.     

Impaired human coronary artery distensibility by atherosclerotic lesions: a mechanical and histological investigation

The objective of this study was to evaluate the relationship between human coronary artery distensibility and vessel wall morphology assessed by histomorphometry. Coronary artery pressure-cross-sectional area relations and distensibility were studied in excised autopsy hearts by means of a balloon-based impedance planimetric technique 2 cm from the aortic orifice of the arteries. Later the hearts were perfusion fixed at 100 mm Hg and cross-sectioned 17, 20 and 23 mm distal to the aortic orifice. The areas of lumen, intima and media were measured. Nineteen left anterior descending coronary arteries (LAD) and 15 right coronary arteries (RCA) from 25 hearts (12 women and 13 men) were investigated. The age of the subjects was 48–97 years (mean 73.8 years). Non-linear relations were found between balloon pressure and coronary cross-sectional area (according with the function y = a + bx^0.5) and between balloon pressure and coronary distensibility, but there were no differences in these relations between the LAD and RCA. Subjects'' age was positively correlated with wall thickness (r = 0.44, P < 0.05), intima area (r = 0.46, P < 0.01) and media area (r = 0.44, P < 0.05) of the coronary arteries. Additionally, the distensibility at low pressures was inversely correlated with arterial wall thickness (r = −0.37, P < 0.05). When focusing only on arteries with concentric atherosclerotic lesions, distensibility at low pressures was inversely correlated with arterial wall thickness (r = −0.57, P = 0.01) and intima area (r = −0.53, P < 0.05). Arteries with concentric lesions were less distensible at low pressures compared with arteries having eccentric lesions (5.4 ± 0.8.10⁻²vs. 3.6 ± 0.7.10⁻² kPa⁻¹, P < 0.05) but this difference was absent at higher pressures. No difference in coronary artery distensibility was found between men and women. Age and distensibility were not correlated. These findings may have in vivo implications for complications to angioplasty procedures such as recoil and restenosis.     

Normal Myocardial Enzymes and Normal Echocardiographic Findings During Noninvasive Transcutaneous Pacing

Noninvasive transcutaneous pacing was performed for 30 minutes in 10 healthy volunteers. The pace rate was from 85 to 115 min-1, and the threshold for pacing was from 38 to 70 mA, median 59 mA. Echocardiography before and during pacing showed no changes in left ventricular end-diastolic diameter, in fractional shortening nor in contraction pattern. Also, blood pressure remained unchanged. Blood samples for determination of myoglobin, creatine phosphokinase, creatine kinase MB and lactate dehydrogenase were drawn prior to pacing and 1,2,3,4,6,8 and 24 hours after pacing. The serum concentrations were the same before and after pacing for all enzymes and myoglobin. We conclude that non-invasive transcutaneous pacing for 30 minutes causes no muscular or myocardial injury and that the left ventricular function remains normal.     

Plasma Calprotectin Predicts Mortality in Patients with ST Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

Background: We investigated the predictive value of plasma calprotectin levels for mortality in patients with ST segment elevation myocardial infarction (STEMI) successfully treated with primary percutaneous coronary intervention (pPCI). Methods and Results: Plasma calprotectin levels were measured in 141 STEMI patients with acute occlusion of the left anterior descending artery and treated with pPCI. The plasma calprotectin levels were significantly higher in the STEMI patients compared with the 42 healthy controls (P < 0.001). Furthermore, plasma calprotectin levels were higher in the 13 STEMI patients who died after a median follow‐up period of 12 months compared to the STEMI patients who survived: 209 μg/L versus 174 μg/L (P < 0.001). After adjustment for age, sex, complex lesions, and peak creatine kinase MB in a multivariate Cox proportional hazards regression analysis, the relative risk of mortality was 1.26 (95% CI: 1.1–1.4) per 10 μg/L increase in calprotectin (P = 0.001). Furthermore, for patients with plasma calprotectin >177 μg/L the relative risk of mortality was 11.11 (95% CI: 2.2–56.0) (P = 0.004). Conclusion: Plasma calprotectin levels, determined at admission in STEMI patients successfully treated with pPCI, predict mortality over a period of 12 months, indicating that plasma calprotectin may be a new important prognostic biomarker in acute ischemic heart disease. (J Interven Cardiol 2010;23:123‐129)     

Short report: a double-blind placebo-controlled trial of omeprazole on characteristics of gastric emptying in healthy subjects

The aim of the study was to investigate a possible effect of omeprazole on the characteristics of the gastric emptying of liquid and solid in healthy subjects. The study was performed as a double-blind crossover study and the gastric emptying studies were performed after 10 days of treatment with placebo or omeprazole 40 mg o.m. Omeprazole was without effect on the characteristics of liquid emptying or the lag phase of solid. It does, however, decrease the emptying rate of solid as the omeprazole group had a median half-time duration of the linear emptying period which had twice the duration of the corresponding figure in the placebo group.     

Rhinitis,sinusitis and otitis media in Kartagener's syndrome (primary ciliary dyskinesia)

Ear, nose and throat symptoms and signs were studied in 15 patients with Kartagener's syndrome: a triad consisting of chronic rhinosinusitis, chronic bronchitis with bronchiectasis, and situs inversus. The triad is caused by primary ciliary dyskinesia and characterized by absent or considerably reduced mucociliary transport. Daily accumulation of secretions in the nose, chronic recurrent secretory otitis media and sinusitis occurred in all subjects. Characteristically, nasal discharge started at birth or was first detected in early childhood. Apparently, the frequency of common colds and of acut purulent otitis media was not increased. As primary ciliary dyskinesia can occur without situs inversus, knowledge of the typical ENT symptoms is essential for making an early diagnosis, which is important for the correct management of the disease. While a conservative surgical approach to treatment of the ENT symptoms is recommended, early and active treatment of the bronchial symptoms is probably important for prevention of further lung damage and development of bronchiectasis.