The HLA system and neurofibromatosis, type I

In 23 patients suffering from neurofibromatosis (von Recklinghausen's disease), we determined the serum HLA antigens. The phenotypical frequencies obtained were compared with those of 1314 people presumably healthy. Higher frequency along with a relative risk of more than 3 were found for the antigens HLA-A2, HLA-B5, HLA-B15, HLA-CW2, and HLA-CW3.     

Distribution of neuropeptide Y (NPY) in the cerebral cortex of the lizards Psammodromus algirus and podarcis hispanica: co-localization of NPY, somatostatin, and GABA.

The aim of the present study was to analyze the distribution and characteristics of NPY immunoreactive structures in the cerebral cortex of lizards and to investigate the degree of co-existence of this neuropeptide with somatostatin and GABA. The immunoperoxidase method was applied to vibratome sections as well as to semithin sections. NPY neurons are multipolar or fusiform and were unevenly distributed throughout the brain cortex. Within the medial, dorsomedial and dorsal cortices, most NPY perikarya were located in the plexiform layers, especially in the deep one. This suggests that these cells could be regarded as interneurons. In the lateral cortex, NPY neurons were found throughout all layers. The dorsomedial cortex displayed the highest NPY cell density. Here, neuronal perikarya projected many immunoreactive processes toward two distinct zones: the deep plexiform layer of the medial cortex and the superpositio medialis. The NPY neurons of the dorsomedial cortex differed from the other NPY cortical immunoreactive cells in that the latter displayed very few immunoreactive processes. A high degree of co-existence among NPY, somatostatin, and GABA (approx. 80%) was found. This co-existence rate is very similar to that reported in mammals and suggests that co-localization is a phylogenetically ancient phenomenon.     

Extracorporeal photochemotherapy: a treatment for organ graft rejection.

Extracorporeal photochemotherapy (ECPC) has been investigated experimentally and in clinical conditions in transplant rejection treatment and prevention. Repeated injections of photochemically modified syngeneic alloreactive T cells prior to transplant significantly delay rejection in a mouse skin graft model as well as in a heterotopic heart transplant model in rats. In the latter, we found this effect to be dependent on 3 main parameters, i.e., treatment intensity (number of injections), schedule (injections before and after transplant), and associated immunosuppression (because there is no detectable effect in animals without immunosuppression). In human beings, ECPC was first used for the treatment of acute rejection episode after heart transplantation. At least 2 studies provided evidence that ECPC is as effective as high dose corticosteroids in controlling moderate acute rejections, and several case reports showed that ECPC could be effective in recurrent and/or steroid resistant rejections. ECPC has also been investigated in an open trial to prevent rejection episodes after heart transplantation in patients at high risk of acute rejection because of human leukocyte antigen (HLA) immunization and/or a second or third transplant and found to be successful. In heart transplant recipients at standard risk of rejection episodes, a small scale randomized trial showed a reduction in both rejection episodes and infections in the ECPC treated vs. the standard group. Beyond these studies and other isolated case reports, several large scale randomized trials in heart, lung, and even kidney transplantations (some of them already ongoing), will enable us to define the role of ECPC in the management of transplant recipients.     

Differentiating between malignant and idiopathic pleural effusions: the value of diagnostic procedures

BACKGROUND: Which diagnostic procedures should be used to differentiate between idiopathic and malignant pleural effusions, is not well established. AIM: To identify which parameters allow differentiation between idiopathic and malignant pleural effusions. DESIGN: Case-note review. METHODS: Over a 12-year period, we treated 1014 consecutive pleural effusion patients, of whom 346 were diagnosed as having an idiopathic or malignant aetiology. We analysed medical history, chest X-ray, pleural fluid analysis (biochemical, microbiological and cytological), chest CT scan and additional examinations that were used according to clinical findings, and compared them with the eventual diagnosis and outcome. RESULTS: Eighty-three patients with idiopathic effusions and 263 with malignant effusions were included. Idiopathic pleural effusion resolved in 47 patients, improved in 20 and persisted in 16. Biochemical pleural fluid analysis did not predict these outcomes. A history of neoplasm, chest X-ray and CT features, as well as additional examinations according to clinical findings, established a diagnosis or suspicion of malignancy in 256 (97.7%) of the 263 patients who received a diagnosis of malignant effusion. Diagnostic thoracoscopy was helpful in seven patients in whom malignant disease was strongly suspected, despite the absence of other pathological findings. DISCUSSION: Non-invasive complementary examinations generally allowed accurate differentiation between malignant and idiopathic effusions. Patients with idiopathic pleural effusions generally had favourable outcomes.     

Junctional communication of pancreatic beta cells contributes to the control of insulin secretion and glucose tolerance

Proper insulin secretion requires the coordinated functioning of the numerous beta cells that form pancreatic islets. This coordination depends on a network of communication mechanisms whereby beta cells interact with extracellular signals and adjacent cells via connexin channels. To assess whether connexin-dependent communication plays a role in vivo, we have developed transgenic mice in which connexin 32 (Cx32), one of the vertebrate connexins found in the pancreas, is expressed in beta cells. We show that the altered beta-cell coupling that results from this expression causes reduced insulin secretion in response to physiologically relevant concentrations of glucose and abnormal tolerance to the sugar. These alterations were observed in spite of normal numbers of islets, increased insulin content, and preserved secretory response to glucose by individual beta cells. Moreover, glucose-stimulated islets showed improved electrical synchronization of these cells and increased cytosolic levels of Ca(2+). The results show that connexins contribute to the control of beta cells in vivo and that their excess is detrimental for insulin secretion.     

Tuberculous empyema necessitatis in a man infected with the human immunodeficiency virus

Empyema necessitatis is a collection of inflammatory tissue that ruptures spontaneously through a weakness in the chest wail into surrounding soft tissues. Although empyema necessitatis can be caused by a number of infectious agents, mycobacteria are the most frequently implicated. Empyema was a much more common complication of pulmonary tuberculosis in the preantibiotic era than it is today. We describe a 22-year-old man with human immunodeficiency virus (HIV) infection who had tuberculous empyema necessitatis and was successfully treated with surgical debridement and antibiotic therapy.     

Tui-Na, an oriental massage

Tui-Na is an oriental massage whose principles are based on traditional Chinese medicine. This medicine conceives a person as one entire entity giving as much importance to emotional and physical aspects as to everything that surrounds a person, including climate, social relationships, diet. This philosophy believes that an individual will achieve his/her ideal health state when he/she has found interior harmony and is in balance with all his/her environment. From this viewpoint, this philosophy understands pathology as an unbalance or a lack of harmony in an organism. Tui-Na massage is one of the techniques which make use of traditional Chinese medicine to maintain, or to recuperate, an organism's balance.