Antigen-Presenting Activity of Non-Langerhans Epidermal Cells in Contact Hypersensitivity Reactions

Despite the critical role of the Langerhans cells in the induction of contact hypersensitivity reactions, non-Langerhans antigen-presenting cells in already sensitized individuals may play a role in the elicitation phase of a contact hypersensitivity reaction. Following epicutaneous challenge with antigens, the number of CD1+DR+ epidermal Langerhans cells increased in a time-dependent way and, concomitantly, CD1-OKM5+DR+ epidermal non-Langerhans cells appeared. In parallel with this, the capacity of epidermal cells to present both alloantigens and auto/nominal antigens increased, and 4 days after initiation of the contact hypersensitivity reactions 33-53% of the epidermal antigen-presenting capacity was due to CD1- non-Langerhans antigen-presenting cells. Thus, contact hypersensitivity skin reactions are accompanied by the appearance of non-Langerhans antigen-presenting cells capable of presenting both alloantigens and auto/nominal antigens.     

In situ lymphocyte subsets in alopecia areata before and during treatment with a contact allergen

In situ lymphocyte subsets in 12 patients with patchy alopecia areata or alopecia universalis were estimated using monoclonal antibodies and immunoperoxidase technique. The majority of the inflammatory cells around the hair bulbs and follicles where leu 4⁺ T-cells with the subphenotypes of either leu 2a⁺ (suppressor/cytotoxic T-cells) or leu 3a⁺ (helper/inducer T-cells). Many of the T-cells expressed HLA-DR class II antigen. In about half of the patients, the hair bulbs and follicles were also infiltrated with T-cells. Eight of the 12 patients were treated with dinitroch-loro-benzene. Six of these patients were biopsied during treatment. The number of T-cells around the hair bulbs and follicles increased during; treatment and niam T-cells were seen in the hair bulbs and follicles. In five of the six patients treated with dinitrochlorobenzene, an increase in the percentage of leu 2a+ cells around the bulbs and follicles was noticed. The increase in leu 2a⁺ cells may be of importance for the DNCB-induced re-growth of hair.     

Immunochemical studies on an IgG lambda cryoglobulin in cold-induced urticaria

A type I cryoglobulinaemia associated with cold-induced urticaria was demonstrated in a 64-year-old woman without primary disease. The cryoglobulin contained only IgG lambda as disclosed by immunofixation technique. Different physicochemical studies indicated that the IgG lambda component was monomeric at temperatures above 35 degrees C, but became polymerized below 35 degrees C. In addition crossed immunoelectrophoresis of plasma fibronectin from the patient showed a heterogeneous precipitate at low temperatures but a homogeneous precipitate at 25 degrees C indicating a complex formation at low temperature between IgG lambda and fibronectin. Fibronectin, however, was not essential for the cold precipitation of the cryoglobulin. The precipitation phenomenon at low temperatures was found to be a result of the physicochemical properties of the cryoglobulin itself unrelated to the antibody specificities tested. The importance of performing the immunochemical and physicochemical techniques at low temperature (7 degrees C) and at high temperature (35 degrees C) to gain knowledge of the nature of the protein, is emphasized. We conclude that only results obtained by relevant laboratory procedures might lead to correct classification and understanding of cryoglobulinaemia.     

Distribution and degradation of albumin in extensive skin disease

The distribution and degradation of albumin were determined in twelve patients with extensive skin disease and in ten control subjects by measuring the metabolic turnover and transcapillary escape of ¹³¹I-labelled albumin. The ratio of intravascular to total mass of albumin was normal. Thus the observed hypoalbuminaemia and the low intravascular mass reflect a reduced mass of total body albumin. The rate of synthesis was normal, but the transcapillary escape rate reflecting the micro-vascular leakiness to macromolecules, and the fractional disappearance rate were significantly higher n i the patients than in the controls (P<0·001). It is concluded that the hypoalbuminaemia in these patients is the result of an increased endogenous catabolism of albumin without signiflcant loss via urine, stools or skin. A positive correlation between the transcapillary escape rate and fractional catabolic rate of albumin supports the concept of a causal relationship between these parameters.     

Melanocytes in the anal canal epithelium

We studied the presence of melanocytes in the various epithelial zones of the anal canal, using a recently introduced melanocyte-specific antibody (HMB-45) together with antibody to S-100 protein. In normal and canals and in haemorrhoids, melanocytes, defined as intraepithelial HMB-45/S-100 positive cells, were frequently demonstrated in the anal squamous zone, only sporadically in the anal transitional zone, and not at all in the colorectal zone. In the epithelium surrounding, but clearly separated from, resected primary anal malignant melanomas, increased numbers of benign melanocytes were demonstrated in the squamous zone and transitional zone, but also in the colorectal zone. We interpret this finding as a tumour-induced proliferation of benign melanocytes normally present, but in very small numbers or in some way 'masked', in the epithelium of the upper anal canal. The demonstration of melanocytes in all three zones of the anal canal substantially supports the observation that malignant melanoma of the anal canal may originate not only below but also above the dentate line.     

Salivary agglutinin and secretory IgA reactions with oral streptococci

abstract — S. mutans, S. salivarius, S. mitis and S. sanguis strains were isolated from three subjects of blood groups A, B and O. Parotid saliva samples obtained from the same subjects induced aggregation of some of the bacteria, the S. sanguis and the S. mutans strains in particular. While parotid saliva from the three subjects gave almost identical reactions, slight interindividual differences were observed for a few strains with the submandibular sublingual salivas. In parotid saliva, secretory antibodies reacting with all strains were present. The antibody levels differed between the three subjects but no specific pattern was observed when homologous strains were compared with heterologous strains.     

The lichen planus-like eruption after bone marrow transplantation

A lichen planus-like eruption was seen in four patients after bone marrow transplantation. The skin and mucous membrane appearance closely mimicked lichen planus. The histopathology was also very similar to lichen planus. The occurrence of a lichen planus-like eruption (LPLE) after an immune basal cell damage related to the graft-versus-host reaction raised the question of the immune nature of this eruption. The correlation found between biological signs of graft-versus-host reaction and the out-break or relapse of the lichen planus-like eruption supports the hypothesis that the skin changes could be a sign of a chronic immune response against recipient epidermis.     

RAPID DETECTION OF KARYOTYPE CHANGES IN INTERPHASE BONE MARROW CELLS BY OLIGONUCLEOTIDE PRIMED IN SITU HYBRIDIZATION (PRINS)

Fluorescence in situ hybridization (FISH) using DNA probes of several hundred or thousand base pairs in length enables the visualization of chromosomal aberrations in interphase nuclei. A new method for in situ labelling of chromosomes is the oligonucleotide primed in situ labelling (PRINS) technique. So far, this has mainly been used to demonstrate subtle changes in metaphase spreads. The aim of the present study was to investigate the suitability of PRINS for detecting chromosome gains or losses in interphase nuclei. This technique was compared with FISH analysis by examining the bone marrow cells of ten patients in whom the karyotypes were known from conventional chromosome banding. Corresponding results by both PRINS and FISH were obtained for chromosomes 1, 3, 7, 8, and Y in five patients with normal chromosome patterns, as well as in five patients with clonal karyotype changes, e.g., monosomy 7, trisomy 8, or loss of the Y chromosome. Being faster and approximately ten times less expensive, PRINS can replace FISH for detecting numerical karyotype changes. © 1997 by John Wiley & Sons, Ltd.     

Patient rehabilitation in hospitals a prioritized discipline after hospital reform: a Norwegian perspective

tingvoll w., snellvedt t. & haggblom a. (2010) Journal of Nursing Management  18, 767–775
Patient rehabilitation in hospitals a prioritized discipline after hospital reform: a Norwegian perspective Aim The purpose of the present study was to highlight the effects of hospital reform introduced in Norway 2002 on patient rehabilitation. Background The Norwegian hospital reform is an activity-controlled financing system with diagnosis-related groups (DRG). Method A multi-case study with embedded design methods was used. Document analysis and interviews are sources of evidence. Results The rehabilitation service offered a treatment service that was inadequately funded. The focus of the rehabilitation team was negatively affected by the lack of organization. The different patient groups did not receive optimal and individualized rehabilitation as required by individual treatment plans. There were two different levels of rehabilitation at the hospitals. Conclusions The financing system did not provide for a differentiated treatment service tailored to each patient’s individual plan, as stipulated by health policy. An increase in the number of patients receiving rehabilitation in the health authorities was not accompanied by an increase in allocated resources, leading to an insufficient overall rehabilitation service. The organizations included in the case study were not those who finance specialized rehabilitation at specialized rehabilitation centres. Implications for nursing management Specially trained nurses are strategically placed to shape and influence funding of rehabilitation programmes through leadership.