Primary lymph node invasive aspergillosis

Summary A case of apparently primary lymph node granulomatous aspergillosis is described. A review of the so-called primary aspergillosis cases since 1977 shows that granulomatous instead of exudative inflammation patterns have been observed in histological sections only when neither major nor minor predisposing factors have been detected in the clinical history of the patients. A possible pathogenetic role of selectively impaired cell-mediated immune response in these cases is hypothesized. Flucytosine treatment is indicated in a few selected cases of deep aspergillosis.

---

Primäre invasive Lymphknotenaspergillose

Zusammenfassung Ein Fall von offensichtlich primärer granulomatöser Aspergillose der Lymphknoten wird beschrieben. Eine retrospektive Analyse der Fälle von sogenannter primärer Aspergillose, beginnend im Jahr 1977, zeigt, daß in den histologischen Schnitten vor allem granulomatöse anstelle von exsudativen Infiltraten beobachtet werden konnten. Dieses trifft besonders dann zu, wenn weder bedeutende noch geringfügige prädisponierende Faktoren in der Anamnese der Patienten entdeckt werden konnten. Eine mögliche pathogenetische Rolle wird in diesen Fällen der selektiven Beeinträchtigung der zellvermittelten Immunantwort zugesprochen. Die Behandlung mit Flucytosin ist in wenigen ausgewählten Fällen von tiefer Aspergillose indiziert.

     

Efficacy and tolerability of manidipine in the treatment of hypertension in patients with non-diabetic chronic kidney disease without glomerular disease. Prospective, randomized, double-blind study of parallel groups in comparison with enalapril

BACKGROUND: Calcium channel blockers (CCBs) are effective blood pressure lowering agents, giving rise to a prevalent dilation of the afferent arteriole. Manidipine, a long-lasting dihydropyridine CCB, demonstrates its action not only on the afferent arteriole, but also on the efferent one. This suggests theoretically a renoprotective effect in patients with chronic kidney diseases (CKD). METHODS: This was a multicenter, prospective, randomized, double-blind, parallel group study, to evaluate the efficacy and tolerability of manidipine (M; 10-20 mg/day), in comparison with enalapril (E; 10-20 mg/day) in the treatment of hypertension in 136 patients with CKD secondary to primary renoparenchymal disease. Changes in blood pressure values from baseline were considered as the primary outcome of the study. Proteinuria changes and the rate of renal function decline were also evaluated. RESULTS: During a 48-week follow-up, mean SBP decreased from 155+/-11.7 to 138.7+/-13.9 mmHg in M and from 157.3 +/-11.8 to 134.2+/-13.9 mmHg in E; mean DBP decreased from 100.3+/-4.2 to 86.1+/-6.5 mmHg in M and from 100.3+/-4.2 to 84.7+/-6.3 mmHg in E. Proteinuria remained unchanged in M (from 1.6+/-1.59 to 1.62+/-1.79 g/24h), and decreased significantly in E (from 1.37+/-1.45 g/24h to 1+/-1.55 g/24h). No significant difference was observed in the rate of renal function decline in the two groups. CONCLUSIONS: Manidipine was safe and effective, obtaining a significant reduction in SBP and DBP from baseline. Although patients treated with enalapril showed a better antiproteinuric response, the two treatments were equally effective in reducing the rate of CRF progression in patients without glomerular disease.