Epidemiology of tuberculosis in immigrant patients hospitalised in Infectious Diseases Units in Italy: multicentric study

In order to retrospectively evaluate the prevalence of immigrant patients affected by active tuberculosis, we analysed the clinical data of 2255 immigrant patients hospitalised during 2002 in ordinary admission or in Day Hospital in 48 Clinics of Infectious Diseases. In all, 303 patients were affected by active tuberculosis (13.4% of the total immigrant hospitalised patients); 30 patients (9.9%) were also HIV-positive. There was a considerable male gender bias (62.5%); the mean age was 29.7 years; 144 patients were from Africa (47.5%), 72 (23.7%) from Asia, 47 (15.5%) from eastern Europe and 40 (13.2%) from South America. The clinical variants were: pulmonary (57.7%), lymph node (15.8%), meningitis (13.8%), intestinal (4.2%), bone (3.3%), pleurical (2.3%), peritoneal (2.3%) and renal (0.6%). We conclude that tuberculosis is a very frequent disease among immigrants, especially of African origin. The high percentage is due to several factors, such as no vaccine prophylaxis and poor, overcrowded living conditions. It is fundamental to focus on the need to provide better health support for all subjects by setting up screening plans to estimate the real incidence of this pathology and ensure medical treatment to prevent the spread of this infection among immigrants and the local host population.     

The CTLA-4 gene region of chromosome 2q33 is linked to, and associated with, type 1 diabetes. Belgian Diabetes Registry

Susceptibility to autoimmune insulin-dependent (type 1) diabetes mellitus is determined by a combination of environmental and genetic factors, which include variation in MHC genes on chromosome 6p21 (IDDM1) and the insulin gene on chromosome 11p15 (IDDM2). However, linkage to IDDM1 and IDDM2 cannot explain the clustering of type 1 diabetes in families, and a role for other genes is inferred. In the present report we describe linkage and association of type 1 diabetes to the CTLA-4 gene (cytotoxic T lymphocyte associated-4) on chromosome 2q33 (designated IDDM12). CTLA-4 is a strong candidate gene for T cell- mediated autoimmune disease because it encodes a T cell receptor that mediates T cell apoptosis and is a vital negative regulator of T cell activation. In addition, we provide supporting evidence that CTLA-4 is associated with susceptibility to Graves' disease, another organ- specific autoimmune disease.      

A mathematical model of optimized radioiodine-131 therapy of Graves' hyperthyroidism

Background

The current status of radioiodine-131 (RaI) dosimetry for Graves' hyperthyroidism is not clear. Recurrent hyperthyroidism and iatrogenic hypothyroidism are two problems which interact such that trying to solve one leads to exacerbation of the other. Optimized RaI therapy has therefore begun to be defined just in terms of early hypothyroidism (ablative therapy) as physicians have given up on reducing hypothyroidism.

Methods

Optimized therapy is evaluated both in terms of the greatest separation of cure rate from hypothyroidism rate (non-ablative therapy) or in terms of early hypothyroidism (ablative therapy) by mathematical modeling of outcome after radioiodine and critically discussing the three common methods of RaI dosing for Graves' disease.

Results

Cure follows a logarithmic relationship to activity administered or absorbed dose, while hypothyroidism follows a linear relationship. The effect of including or omitting factors in the calculation of the administered I–131 activity such as the measured thyroid uptake and effective half-life of RaI or giving extra compensation for gland size is discussed.

Conclusions

Very little benefit can be gained by employing complicated methods of RaI dose selection for non-ablative therapy since the standard activity model shows the best potential for cure and prolonged euthyroidism. For ablative therapy, a standard MBq/g dosing provides the best outcome in terms of cure and early hypothyroidism.     

Interpolymer association between poly(vinylpyridines) and poly(mono-n-alkyl itaconates). Effect of the n-alkyl substituent

The binary polymeric systems formed by some poly(mono-n-alkyl itaconates) and poly(2-vinylpyridine) or poly(4-vinylpyridine) are studied. Depending on the solvent, two different types of material have been synthesized. On the one hand, using methanol as common solvent, we have obtained solid polymer-polymer complexes the composition of which is determined by the initial mixing conditions. On the other hand, pyridine avoids the complexation process, allowing to obtain a true solution of both polymers and, therefore, a solid polymer blend of known composition by solvent casting. Yields of the complexation and stoichiometries of the polymer-polymer complexes have been analysed. In this way, a favoured composition in the range from 3:2 to 1:1 for the mole ratio (referring to repeating units) ratio poly(mono-n-alkyl itaconate):poly(vinylpyridine) was observed depending on the poly-(mono-n-alkyl itaconate used). Differential Scanning Calorimetry and thermogravimetry have been employed to study the thermal behaviour of complexes and blends. Viscometry measurements have been performed to analyse the interactions in solution. One of the aims of this work has been to analyse the effect of the side group of the poly-(mono-n-alkyl itaconate) in the mixing process as well as in the characteristics of the final products. In this way, higher complexation yields have been obtained using poly-(mono-n-alkyl itoconates) with longer n-alkyl side groups due to the additional stabilisation by solvophobic interactions. On the other hand, the poly(mono-n-alkyl itaconates) with longer n-alkyl groups form polymer-polymer complexes with a higher proportion of poly(4-vinylpyridine), presumably due to their slower kinetics of complexation.     

Regeneration of long spinal axons in the rat

Summary To investigate regeneration of long spinal axons, the right lateral column of the rat spinal cord was cut at high cervical, low cervical, midthoracic or lumbar level, and one end of an autologous sciatic nerve segment was grafted to the spinal cord at the site of incision. Three to six months after operation, the origin of axons in the grafts was traced retrogradely with horseradish peroxidase injected into the grafts and, in some cases, anterogradely with radioautography of tritiated amino acids injected into the brainstem. Axons from each of the major lateral spinal tracts arising in the brainstem as well as axons ascending from the lower spinal cord succeeded in growing into low cervical grafts. However, long descending axons rarely regenerated after midthoracic or lumbar injury; axons ascending from lumbar segments of the spinal cord usually failed to enter high cervical grafts. Differences in axonal regrowth at the four segmental levels were not simply attributable to dwindling of axonal number in fibre tracts. Axonal regeneration from Clarke's column or the red nucleus was observed only with lesions causing atrophy of many neurons.There was no obvious example of a fibre tract in the lateral spinal columns from which axons failed to regenerate nor from which axons regenerated exceptionally well. Under the conditions of these experiments, the distance from cell body to injury appeared to be an important determinant of axonal regeneration.     

Enteroid cyst of the spleen: a new entity? Apropos of 2 cases

The authors describe two cases of non parasitic cyst of the spleen of "enteroid" origin on histological examination. No similar cases have yet seen described in the medical literature that we consulted. The histology of these two cases is quite unusual in that cysts are multilocular and mucoid with a cylindrical mucus secreting epithelium similar to cystic tumours of the ovary. The outcome of the first case remains favorable four years after surgery. As in the case of mucoid or enteroid cyst of the ovary, a disembryological origin seems the most likely explanation of these cyst of the spleen.     

In vivo imaging of rat lymphocytes with an indium 111-labelled anti-T cell monoclonal antibody: a comparison with indium 111-labelled lymphocytes

An indium 111-labelled mouse anti-rat T cell monoclonal antibody, MRC OX-19, was injected intravenously into rats to establish the usefulness of radiolabelled anti-lymphocyte antibodies in imaging lymphoid tissues. Antibody binding in vivo, measured by immunofluorescence analysis of cell suspensions made from lymphoid tissues, was detectable on lymphocytes in blood, spleen and lymph nodes. The extent of binding was time and antibody-dose dependent. Doses of antibody above 80 g/kg body weight resulted in modulation, i.e. loss of CD 5 (T 1) molecules from the cell surface, although the cells remained in the circulation. Modulation was demonstrable within 2 h and for at least 24 h after a single injection of antibody. Intravenous injection of¹¹¹In-MRC OX-19 resulted in levels of in vivo binding comparable with those seen with unlabelled antibody. Scintillation imaging showed early splenic localisation persisting over 48h, a more gradual localisation in the lymph nodes seen clearly at 24 h and a steady background. Comparison of the in vivo distribution of labelled antibody and¹¹¹In-tropolone-labelled lymphocytes showed that both could be used for external imaging of lymphocytes by scintillation camera.     

Clinical features and management of anterior intraurethral prostatic cyst

We report on a symptomatic anterior intraurethral prostatic cyst in a 46-year-old man without clinical evidence of benign prostatic hyperplasia. The anterior location of this cyst makes it unique to all previously reported cases of prostatic cysts which are located posteriorly. Transurethral resection of the cyst with limited resection of the anterior prostatic tissue at the base of the cyst was performed with successful resolution of voiding symptoms. In the absence of lateral lobe hypertrophy, standard transurethral resection of the prostate should be avoided to ensure preservation of erectile and ejaculatory function.     

Transurethral Needle Ablation of the Prostate: Report of Initial United States Clinical Trial

Purpose

We studied the efficacy and safety of transurethral needle ablation of the prostate for treatment of symptomatic benign prostatic hyperplasia (BPH).

Materials and Methods

A total of 12 patients with symptomatic BPH underwent transurethral needle ablation of the prostate. Voiding outcomes, including American Urological Association symptom scores, bother scores, quality of life scores, peak urinary flow rates, residual urine volumes and urodynamic pressure flows, were measured with time, and immediate and short-term (6 months) complications were assessed.

Results

Transurethral needle ablation of the prostate was performed with local intraurethral lidocaine anesthesia in 11 patients and general anesthesia in 1. At 6 months there was a 61.7 percent improvement in American Urological Association symptom score (25.6 to 9.8, p = 0.0001), 61.1 percent improvement in bother score (18.8 to 7.3, p = 0.0002), 70.0 percent improvement in quality of life score (13.7 to 4.1, p = 0.0001), 73.0 percent increase in peak flow rate (7.8 to 13.5 cc per second, p less than 0.0001) and 54.9 percent decrease in the post-void residual (111 to 50 cc, p = 0.0457). Prostate volumes, maximum detrusor pressures and detrusor opening pressures decreased significantly. There were no intraoperative complications. Postoperatively, all 12 patients had mild dysuria for 1 to 7 days, 5 had transient urinary retention for 1 to 4 days, 3 had hematuria for 1 to 2 days and 1 had retrograde ejaculation.

Conclusions

This initial United States trial confirms previous experience, and shows that transurethral needle ablation of the prostate appears to be a simple, safe and efficacious procedure for treatment of symptomatic BPH. In addition, it can be performed in the majority of patients using topical urethral anesthesia.