CELL INFILTRATEN PROGRESSIVE PIGMENTED PURPURA (SCHAMBERG'S DISEASE): IMMUNOPHENOTYPE, ADHESION RECEPTORS, AND INTERCELLULAR RELATIONSHIPS

Background. Progressive pigmented purpura (Schamberg's disease), a form of purpura pigmentosa chronica, is a lymphocytic capillaritis of unknown etiology and obscure pathogenesis. Our purpose was to assess the expression of cell membrane antigens (CD3, CD4, CD1a, CD36), of adhesion receptors (leukocyte function adhesion 1, LFA-1, endothelial leukocyte adhesion molecule 1, ELAM-1) intercellular adhesion molecule 1, ICAM-1), and the intercellular relationships in the early phase of the disease. Methods. Quantitative immunohistochemistry and electron-microscopy were performed on specimens of five subjects, aged 45 to 63 years. These studies were repeated in two patients after treatment with topical corticosteroid (betamethasone valerate cream 0.1%) and psoralen-ultraviolet A (puva). Results. The infiltrate consisted mainly of CD4+ lymphocytes and CD1a+ dendritic cells. Electron-microscopic investigation showed typical lymphocytes and two distinct types of dendritic cells. In the very early phase of the disease the adhesion receptors LFA-i and ICAM-1 were expressed intensely by all infiltrating cells; the adhesion receptors icam-1 and ELAM-i were expressed by endothelial cells. Close contact occured between lymphocytes and dendritic cells. After PUVA (120 J per cm²) and topical steroid therapy the infiltrate disappeared completely. Conclusions. These data suggest that a cell-mediated immune mechanism may be important in progressive pigmented purpura and that the early endothelial expression     

SERUM EOSINOPHIL CATIONIC PROTEIN (ecp) IN BULLOUS PEMPHIGOID

Background. The importance of eosinophils in the pathogenesis of the major forms of pemphigoid (bullous pemphigoid, cicatricial pemphigoid, herpes gestationis) remains to be confirmed. Methods. To evaluate the role of eosinophilic Infiltrates in these diseases and to detect the presence and activity of eosinophils, we compared the serum levels of eosinophil cationic protein (ecp ), an eosinophil-derived protein, in 11 healthy subjects and in 10 patients with pemphigoid diseases (8 with bullous pemphigoid, one with cicatricial pemphigoid, and one with herpes gestationis). The serum of two patients with epidermolysis bullosa acquisita (l EBA) and one with linear IgA bullous dermatosis (labd ) were utilized as a further control. Results. There was a significant difference between the mean of serum ecp levels in patients with pemphigoid diseases (25.1 ± 12.3 μg/L, M = SD) and control subjects (2.30 ± 2.41, μg/L ± SD 2.41) (T = 4.272 P < 0.0001). The two patients with EBA (10.8 and 17.7 μg/L) showed contrasting results; the patient with labd had normal ecp serum levels. The serum levels of ecp were not significantly correlated with the blood eosinophil count (R = 0.103; P = 0.777) in any of the cases. Conclusions. In pemphigoid disease, the serum levels of ecp seem to be correlated with the activated secreting and tissue-damaging eosinophils found in the dermis, supporting the concept of an active participation of eosinophils in generating cutaneous lesions.     

Communication from Abroad Does Secretin Influence Rat Colonic Absorption and Secretion?

In rats, a secretin (Jorpes) intravenous infusion superimposed on an intracolonic sodium acetate perfusion elicits, with respect to control values, a significant depression of Na+ absorption (0.16 mEq./h-0.00 mEq./h.) and mucus secretion (230-40 mg.). When the hormone is superimposed upon an intracolonic infusion of acetic acid, mucus secretion is also significantly inhibited (790-340 mg.). The influence of secretin on organic anion movement was pH related. At pH values of 7.0, absorption was unchanged (0.34--0.33 mEq./h.), at pH values of 2.9, absorption was significantly reduced (0.67-0.41 mEq./h). The secretin impairment of colonic mucus secretion could influence the transport of watersoluble (Na+) and lipid soluble (acetic acid) substances, probably through changes at the "unstirred layer" level.     

Age at commencing smoking and number of cigarettes smoked in an Ialian Population Survey

The objective of the study was to describe a group of adolescentswho have no smokers in their social environment and to examinetheir beliefs regarding the benefits of smoking. The designwas a telephone survey. A population-based survey was conductedin California in 1990. There were 7,767 adolescent respondentsbetween 12 and 17 years of age, 373 (5%) of whom were unexposedto smokers in their social environment. A positive responseto any 1 of 5 questions concerning a belief in the benefitsof smoking was the main outcome measure. In teenagers unexposedto smokers in their social environment 70% were 12 or 13 yearsof age compared to only 35% of teenagers exposed to smokers.Unexposed teenagers were more often female and more often whiterather than Hispanic, African-American or Asian. After adjustingfor demographic factors, unexposed teenagers were only one-quarteras likely as exposed teenagers to harbour a belief in the benefitsof smoking. However, 40% of unexposed teenagers held such abelief with 28% believing that smoking helps people feel morecomfortable in social situations, 19% believing that smokinghelps people relax and 13% believing that smoking helps peoplekeep their weight down. It is unlikely that the group of teenagersunexposed to smokers in their social environment acquired theirbeliefs about the benefits of smoking through contact with smokers.Cigarette advertising might be a likely source of these perceptions.     

Physiological Sensitivity of Respiratory-Dependent Cardiac Pacing: Four-Year Follow-Up

Clinical and physiological data on long-term follow-up of 143 patients with respiratory-dependent pacemakers (RDP3) are reported; 121 patients received ventricular (VVI-RD) and 22 patients atrial (AAI-RD) respiratory-dependent stimulation. Functional evaluation was based on the exercise testing (130 pts) with oxygen uptake VO2, ventilation, ECG and arterial pressure monitoring and the dynamic Holter electrocardiogram (95 pts). In each patient, the stimulation rate curve selected was that which produced the best work tolerance and moved the anaerobic threshold to the right. Respiratory levels were assessed by telemetry verifying proper sensing of tidal volume variations and absence of interference and artefacts. In patients with VVIR or AAIR stimulation, exercise tolerance, oxygen uptake and anaerobic threshold increased significantly in comparison with VVI or AAI pacing respectively. The physiological sensitivity of the stimulation system (i.e., a linear relationship of the pacing rate with metabolic requirements) was excellent (up to exhaustion) in 70%, very good (up to anaerobic threshold) in 20% and erratic (no relationship between pacing rate and VE/VO2) in 10% of patients. In dynamic electrocardiographic monitoring, the automatic pacing rate was always predominant during the night and during rest periods; the pacing rate increased properly with daily activity; myopotential inhibition (none longer than 3,500 ms) was observed in 38 patients, but without subjective complaints. The incidence of the RDP3 malfunction was less than 8%; it may have stemmed from the pacing system itself, or from other clinical conditions. Oversensing of impedance system pulses has not been recorded in the last 3 years. Partial respiration undersensing results from incorrect accessory lead position, pulmonary emphysema, marked obesity or other causes. Respiratory sensing becomes erratic at the anaerobic threshold point in such patients, but functions well at submaximum exercise levels. In patients with left ventricular failure, exercise tolerance was improved by setting a lower ratio between the pacing rate and respiration, which prevented the occurrence of excessive pacing rates.     

THE EFFECT OF CHRONIC ETHANOL CONSUMPTION ON IRON ABSORPTION IN RATS

Alcoholics often have an increased amount of iron in the liverwhich may contribute to the development of alcoholic liver disease,although the mechanism is unknown. It has been shown that chronicethanol intake decreases the enterocyte turnover and enhancesgalactose absorption. Whether it affects iron absorption isstill controversial. The aim of this study was to investigatethe effect of chronic ethanol ingestion on whole body iron absorptionin rats. Twenty-eight adult male Sprague-Dawley rats were pair-fed aliquid diet containing either ethanol as 36% of total caloriesor an isocaloric diet where fat was substituted, for ethanol.On the 28th day, four-hour fasted rats were given an oral doseof ⁵⁹Fe (0.5µCi) and were immediately counted by a wholebody counter. ⁵⁹Fe levels were then monitored over the followingnine days. Although ethanol- and control-fed rats had a similarhepatic iron content (59.5±5.8 vs 60.2±7.4 µg/100mg dry liver weight) (mean±S.E.M.), the ⁵⁹Fe total bodycontent was greater in the ethanol group (75%±3%) comparedwith the control group (45%±4%). These results show thatchronic ethanol ingestion increased iron absorption in rats.A reduction of enterocyte turnover may play a role in determiningthis effect.     

Wavelength Index at Three Atrial Sites in Patients with Paroxysmal Atrial Fibrillation

PADELETTI, L., et.al .: Wavelength Index at Three Atrial Sites in Patients with Paroxysmal Atrial Fibrillation . The purpose of this study was to evaluate the wavelength index (WLI) at three atrial sites in a group of 23 patients with recurrent episodes of lone paroxysmal atrial fibrillation (LPAF) and a control group (n = 20). All patients underwent programmed atrial stimulation (paced cycle length = 600 ms) at high, medium, and low lateral right atrial wall. P wave duration, sinus cycle length, and corrected sinus node recovery time were not significantly different between the two study groups. WLI was calculated according to the following formulas: atrial effective refractory period (AERP)/duration of atrial extrastimulus electrogram (A₂) or AERP/A₂+ atrial latency; and atrial functional refractory period (AFRP)/A₂. WLI was significantly shorter in LPAF than in the control group at each of the paced atrial sites independently of the formula used. Duration of premature atrial electrogram appeared to play the major role in determining the difference in WLI between patients with paroxysmal atrial fibrillation and the control group.     

Multiple Shocks Affect Thoracic Electrical Impedance During External Cardioversion of Atrial Fibrillation

Background: Thoracic impedance (TI) influences the success of external cardioversion (ECV) or defibrillation because current intensity traversing the heart is inversely related to TI. Experimental data suggest that TI decreases after multiple shocks. We undertook a clinical study to determine changes of TI values in patients with atrial fibrillation or flutter requiring ECV. Methods: We enrolled 222 consecutive patients (age 73 ± 11 years; males 67%; body weight 75 ± 13 kg) who underwent ECV between January 2004 and February 2007. Biphasic shocks were delivered through adhesive pads placed in the anteroposterior position. The initial energy was set at 1 J/kg, with progressive increases up to a maximum of 180 J in case of failure. In the last 39 elective patients, plasma concentration of interleukin‐6 (IL‐6) and tumor necrosis factor (TNF)‐α were determined before and 6 hours after ECV. Results: Sinus rhythm was restored in 202 patients (91.0%). Of these, 155 (69.8%) required more than one shock (on average, 2.5 ± 1.5 shocks/patient). Final values of energy and peak current intensity were 136 ± 47 J and 50 ± 14 A, respectively. TI decreased significantly by 6.2% from baseline after ≥2 shocks (P < 0.001). The absolute reduction was correlated with baseline TI, number of delivered shocks, and hemoglobin oxygen saturation. IL‐6 and TNF‐α increased with ECV (P < 0.001 and P = 0.014, respectively). Conclusions: TI decreases significantly after multiple shocks, possibly by activation of acute inflammation.