27. Tagung der Österreichischen Gesellschaft für Lungenerkrankungen und Tuberkulose

Abstract

27. Tagung der ?sterreichischen Gesellschaft für Lungenerkrankungen und Tuberkulose Alpbach/Tirol, 29. Mai bis 1. Juni 2003     

Selected loss of tolerance evidenced by Crohn's disease-associated immune responses to auto- and microbial antigens

BACKGROUND & AIMS: Previous studies in Crohn's disease suggest global loss of tolerance with sonicated bacteria preparations containing hundreds of antigens. Monoassociation studies show that a solitary bacterium can induce colitis in one animal model, whereas another is responsible in other models. Among patients with Crohn's disease, serum responses have been documented to microbial and autoantigens (antibodies to the Escherichia coli outer-membrane porin C and the Pseudomonas fluorescens-associated sequence I2, antisaccharomyces cerevisiae antibody (ASCA), and perinuclear antineutrophil cytoplasmic antibodies). Our aim was to determine whether there are heterogeneous responses to these specific antigens. METHODS: Sera from 330 Crohn's patients were analyzed. Immunoglobulin A enzyme-linked immunosorbent assays to ASCA, outer-membrane porin C, or I2 and immunoglobulin G enzyme-linked immunosorbent assay to ASCA and ANCA determined the presence and level of antibodies. Perinuclear antineutrophil cytoplasmic antibodies were determined by immunofluorescence. RESULTS: ASCA was detected in 56% of patients; 55% were seroreactive to outer-membrane porin C, 50% were seroreactive to I2, and 23% were perinuclear antineutrophil cytoplasmic antibody positive. Eighty-five percent responded to at least 1 antigen; only 4% responded to all 4. Among microbial antigens, 78% responded to at least 1, and 57% were double positive, but only 26% responded to all 3. The level of response was stable over time and with change in disease activity. Among patients with the same qualitative antigen-response profiles, quantitative response differed. Cluster analysis of these antibody responses yielded 4 groups: ASCA, outer-membrane porin C/I2, perinuclear antineutrophil cytoplasmic antibodies, or no/low response. CONCLUSIONS: Rather than global loss of tolerance, there seem to be patient subsets with differing responses to selected microbial and autoantigens.     

Does a family history of glaucoma affect disease severity at the time of diagnosis?

PURPOSE: Progressive glaucomatous optic neuropathy is an asymptomatic process with an insidious onset. Patients who are aware of glaucomatous signs and who suspect that they may have the disease may present earlier. If a person has glaucoma, this may alert his or her other family members to seek assessment and thereby permit earlier diagnosis. The authors sought to determine whether glaucoma patients with a family history of the disease were younger and showed less evidence of glaucomatous optic neuropathy at diagnosis than glaucoma patients without a family history of the disease. PATIENTS AND METHODS: Family history of glaucoma, age at diagnosis, and visual field mean defect within 2 years after diagnosis were recorded in 292 patients with primary open-angle glaucoma. Results were analyzed to compare visual field loss with age and family history. RESULTS: At diagnosis, patients with a family history of glaucoma were younger than those without such a history (mean +/- SD, 58 +/- 12.7 years versus 63 +/- 10.8 years; = 3.68, P<0.001). Patients who were younger than 50 years at the time of diagnosis and had a positive family history were significantly less likely to have a worse visual field than those with a negative family history (OR = 0.3; 95% CI, 0.1-0.6; P<0.001), whereas those aged 50 years or older showed no such correlation (OR = 0.9; 95% CI, 0.7-1.3; P = 0.6). CONCLUSION: A family history of glaucoma was associated with a better visual field at diagnosis in patients younger than 50 years, but not in patients 50 years or older.     

Early neonatal discharge guidelines: Have we dropped the ball?

OBJECTIVES:

To determine patterns of follow-up and prenatal education by family physicians and to assess whether practice patterns comply with the 1996 Canadian Paediatric Society/Society of Obstetricians and Gynecologists of Canada (CPS/SOGC) guidelines for early neonatal discharge.

DESIGN:

Mail survey.

SETTING:

A community of 300,000 people who were served exclusively for obstetrical care by a tertiary care hospital that performs 5000 deliveries per year and provides an early discharge program (EDP).

PARTICIPANTS:

Family physicians who provide prenatal and/or newborn care.

MAIN OUTCOME MEASURES:

The timing of neonatal follow-up and parental teaching by family physicians.

RESULTS:

Thirty-two per cent of the respondents scheduled their first postnatal visits two or more weeks after early discharge. There was no significant difference (P=0.7) in scheduling of follow-up for babies who were part of an EDP compared with those who were not. Fewer than 20% of physician respondents provided antenatal education in preparation for early discharge.

CONCLUSIONS:

The 1996 CPS/SOGC guidelines for physician follow-up after early neonatal discharge and for anticipatory parental education are not being followed consistently; however, these guidelines were disseminated without reinforcement. Until further study supports a change in practice guidelines, appropriate implementation strategies must be employed to ensure compliance.     

Case of the month. Acute frosted angiitis

A 42-year-old woman presented with acute visual loss in the left eye with funduscopic evidence of marked retinal periphlebitis (frosted angiitis) and a macular star. Extensive serologic testing identified no etiology. The purpose of this report is to review the clinical features and systemic associations of acute frosted angiitis, a rare ophthalmologic entity.     

Morphology and performance of world championship triathletes

Performance is related to body morphology in many sports. With triathlon making its debut into the Olympic programme in 2000, it was deemed important to determine which physical characteristics of elite-level triathletes were significantly related to performance. Seventy-one elite and junior elite triathletes, from 11 nations, competing at the 1997 World Triathlon Championships were measured on a battery of 28 anthropometric dimensions. A factor analysis was conducted, which reduced the number of variables to four and these were used in a stepwise linear regression to determine which morphological factors were important to performance. Elite triathletes were significantly (p < 0.05) faster than their junior counterparts (males 1:52:26 vs. 2:03:23 and females 2:07:01 vs. 2:14:05) and showed less variation in performance times. Run time variation was the largest of the component disciplines and tended to show the importance of this discipline to the final outcome. Following a factor analysis the four distinguishable morphological factors that emerged were: robustness, adiposity, segmental lengths and skeletal mass. Relating these factors to the total time obtained by the triathletes in this study yielded a regression equation that correlated significantly with all triathletes, accounting for 47% of the variance in total triathlon duration. The regression equations illustrated the importance of low levels of adiposity for elite triathletes for total time and most of the subdisciplines. The other factor that showed importance was that proportionally longer segmental lengths contributed to successful swimming outcome.     

Levels of vaginal secretory leukocyte protease inhibitor are decreased in women with lower reproductive tract infections

OBJECTIVE: Secretory leukocyte protease inhibitor contributes resistance to primary human immunodeficiency virus infection in the oral cavity. However, the levels of this inhibitor in the genital tract of women with sexually transmitted diseases or vaginitis are not well described. The objective was to determine vaginal inhibitor levels in women with symptomatic and asymptomatic genital infections. STUDY DESIGN: We tested 207 nonpregnant women for Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, Candida species, and bacterial vaginosis by standard methods. A second group of symptom-free pregnant women (N = 231) was also studied. Secretory leukocyte protease inhibitor was measured by enzyme-linked immunosorbent assay, and results were compared by nonparametric methods. RESULTS: Vaginal levels of secretory leukocyte protease inhibitor in both groups were significantly lower in women with any sexually transmitted disease than in those without infection (P<.0001). Patients with bacterial vaginosis and those with bacterial vaginosis with yeast vaginitis also had decreased levels (P<.025). CONCLUSIONS: Levels of secretory leukocyte protease inhibitor in vaginal fluid are decreased in women with lower genital tract infection. This may represent a common mechanism of increasing susceptibility to infection with human immunodeficiency virus.     

Necrosis correlates with high vascular density and focal macrophage infiltration in invasive carcinoma of the breast

Necrosis is a common feature of invasive carcinoma of the breast and is caused by chronic ischaemia leading to infarction. Although necrosis was previously assumed to be due to a generally poor blood supply in the tumour, in this study we show that it is present in tumours with focal areas of high vascular density situated away from the actual sites of necrosis. This may account, in part, for the previous observation that necrosis is linked to poor prognosis in this disease. Highly angiogenic tumours often display blood vessel shunting from one tumour area to another, which further exacerbates ischaemia and the formation of tumour necrosis. We have recently demonstrated that high focal microphage infiltration into breast tumours is significantly associated with increased tumour angiogenesis and poor prognosis and that the macrophages accumulate in poorly vascularized, hypoxic areas within breast tumours. In order to investigate the interactions of macrophages with chronic ischaemia (as reflected by the presence of necrosis) and angiogenesis in breast tumours, we quantified the levels of these three biological parameters in a series of 109 consecutive invasive breast carcinomas. We found that the degree of tumour necrosis was correlated with both microphage infiltration (Mann-Whitney U, P-value = 0.0009; chi-square, P-value = 0.01) and angiogenesis (Mann-Whitney U P-value = 0.0008, chi square P-value = 0.03). It was also observed that necrosis was a feature of tumours possessing an aggressive phenotype, i.e. high tumour grade (chi-square, P-value < 0.001), larger size (Mann-Whitney U, P-value = 0.003) and low oestrogen receptor status (Mann-Whitney U, P-value = 0.008; chi-square, P-value < 0.008). We suggest, therefore, that aggressive tumours rapidly outgrow their vascular supply in certain areas, leading to areas of prolonged hypoxia within the tumour and, subsequently, to necrosis. This, in turn, may attract macrophages into the tumour, which then contribute to the angiogenic process, giving rise to an association between high levels of angiogenesis and extensive necrosis.