Respiratory health and immunological profile of poultry workers

OBJECTIVES: To examine work-related respiratory symptoms in poultry workers, and to test for immunologically mediated responses to poultry-related agents. DESIGN: A cross-sectional survey of differentially exposed poultry workers and unexposed blue-collar workers. SETTING: Three poultry farms and a poultry plant in Gauteng (exposed workers) and a municipal workers' clinic in Johannesburg (controls). PARTICIPANTS: 134 poultry workers (85.4% of all eligible workers) and 122 controls (> 95% response rate). OUTCOME MEASURES: Respiratory symptoms plus allergy and hypersensitivity to poultry agents identified by skin-prick tests, and by the presence of specific IgE and IgG enzyme-linked immunoflow assay and nonspecific (radial immunodiffusion) antibodies. RESULTS: Smoking habits and atopic status were similar in the poultry workers and the controls. Symptoms were very common in poultry workers, for example work-related cough in 32% and work-related wheeze in 23% of highly exposed workers. Significantly more poultry workers than controls complained of chest symptoms (increasing with increasing exposure), and of eye, skin and nose irritation at work. More poultry workers than controls had symptoms consistent with asthma (e.g. 3%, 4%, 13% and 11% in controls and subjects with low, medium and high exposure, respectively), and symptom complexes associated with organic dust exposure. Five poultry workers had positive skin-prick test reactions to poultry-specific antigens, but none of the unexposed controls reacted. More poultry workers than controls had positive immunodiffusion test reactions to chicken feed, feathers and serum, and IgE to chicken faeces. There was no association between immunological status and respiratory symptoms. CONCLUSION: We found a very high prevalence of exposure-related symptoms in poultry workers; improved hazard control is strongly indicated. Tests of allergy and hypersensitivity were associated with exposure, but not with disease. The possibility of useful tests of sensitisation has not been excluded; a prospective study design is likely to be more rewarding than cross-sectional approaches such as in this study.     

Clinical and immunological analysis of Birch pollenosis

In recent years, the number of cases Birch pollenosis has increased, but there have been very few reports, and therefore we decided to carry on this clinical and immunological analysis as follows. (1) Statistical analysis of Birch pollenosis patients who visited the Department of Otorhinolaryngology of Hokkaido University School of Medicine, Sapporo. (2) Study of atmospheric birch pollen counts and investigation of the relationship between the incidence of pollenosis and pollen count. (3) Allergen analysis of Japanese Birch pollen using Western blotting method. (1) From 1990 to 1992, 392 cases of nasal allergy visited our hospital and 74 cases (18.9% of all cases) were birch pollenosis. There was a significant increase in the number of cases birch pollenosis, compared with previous reports. (2) Atmospheric pollen grains of birch pollen were collected by Durham's pollen trap at Hokkaido University School of Medicine, Sapporo from 1990 to 1992. In this study, birch pollen was collected from the beginning of April to the middle of June. The first day when birch pollen was collected in this study was about one month earlier than previously reported. We suspected that the mean temperature rise of Sapporo city in April is one of the factors that lead to the increase of incidence of birch pollenosis. (3) Allergens in birch pollens from Betula platyphylla Sukatchev var. japonica and Betula Ermanii Cham in Japan were identified by Western blotting, following separation by SDS-PAGE, transfer to PVDF membranes and incubation with sera from 35 birch pollenosis patients. In almost all cases, 17kd molecular from B. platyphylla and B. Ermanii pollen proteins were detected as the major IgE binding components.     

Hypothalamic hamartoma: report of a case with unusual histologic features

A rare case of hypothalamic hamartoma with unusual radiologic and histopathological features is described, possibly the first of its type in English literature. A 1.5-year-old female child presented with precocious puberty. MR scan of the brain revealed a pedunculated hypothalamic mass, most of which was isointense with normal brain on T1- and T2-weighted images. However, a sizeable component of the lesion was hyperintense on T1-weighted images, suggestive of adipose tissue. Microscopically, the lesion was a hamartoma composed of an admixture of neuroectodermal elements, namely glial cells, neurons, and nerve bundles along with mesenchymal elements in the form of fibroadipose tissue.     

Clinical features, immunological changes and mortality in a cohort of HIV-2-infected individuals in Bissau, Guinea-Bissau

Techniques currently available to obtain anti-idiotypic reagents reactive with a single chain of a lymphocyte antigen receptor rely on immunization with intact soluble or cell-bound Ig or T-cell receptors. Ready recovery of single-chain-specific monoclonal antibodies (MAbs) depends on the presence of an immunodominant epitope on the desired chain and chance recovery of the responding clone. Here we present a method to maximize recovery of an Ig heavy-chain-specific anti-idiotypic Ig, using sequential immunization with MAbs expressing the H chain V region in combination with different H chain isotypes and with different light chains. The latter was produced by in vitro transfection of an H-chain-loss variant myeloma cell line with a transgene construct expressing the Ig H chain V region of interest. Sequential immunization may be a useful strategy to enhance selection of anti-Id reagents reactive with single chain-specific epitopes.     

Clinical immunological classification of tuberculous uveitis

Clinical and immunological studies carried out in 251 patients with tuberculous uveitis (TU) revealed three types of inflammatory reactions in the uveal tract in this patient population: productive, exudative, and productive-exudative (mixed), differing by the type of immune disorders. The findings helped develop a clinical immunological classification of TU, taking account of the clinical form of uveitis, type of inflammatory reaction of the uveal tract, disease pattern, involvement of one or both eyes, complications, and the immunopathological variants of TU course.     

Tumour of the pancreas with unusual clinicopathological features

Antihistamines are frequently administered to psychiatric patients for a variety of purposes. Several large studies of schizophrenics have revealed an extremely high prevalence of Alzheimer's disease neuropathology compared with that in the general population. The neuroleptic treatment of schizophrenia appears to be implicated in this phenomenon. Many of the neuroleptics have anticholinergic effects, some being antihistamines as well, including chlorpromazine. It is proposed here that anticholinergics, including many antihistamines, either exacerbate the Alzheimer process or possibly contribute to its etiology/pathogenesis through their effects on cerebral cholinergic systems. Parsimony in the use of antihistamines thus appears to be warranted both for non-patients and schizophrenics pending the resolution of this issue.     

Parathyroid crisis of unusual features in a child

BACKGROUND: A case of familial parathyroid crisis resulting from presumptive cancer in a 14-year-old boy impressed the authors with its rarity and need for recognition. METHODS: The authors performed a retrospective review of the relevant literature and described the case. RESULTS: The case report cited is the eighth example of parathyroid cancer occurring in a child younger than 16 years of age. It represents the first example of malignant parathyroid crisis because of familial hyperparathyroidism and illustrates the demand for appropriate diagnosis and methods of management in parathyroid cancer. CONCLUSIONS: Familial hyperparathyroidism may become manifest in young patients, which justifies screening among affected families to avoid serious sequelae of disease. Parathyroid cancer is an example of a malignant neoplasm in the young and is managed best by en bloc resection of primary disease, appropriate neck dissection for nodal involvement, and aggressive resection for recurrence, if possible, to control the lethal effects of hypercalcemia; this permits prolonged survival even in discouraging situations.     

Cytogenetic profile of lymphoma of follicle mantle lineage: correlation with clinicobiologic features

Conventional chromosome analysis (CCA) and interphase fluorescence in situ hybridization (FISH) was performed in 42 patients with mantle-cell lymphoma (MCL), with BCL1 rearrangement. The t(11;14)(q13;q32) or 11q abnormalities were detected by CCA in 34 cases, 20 of which had additional aberrations. A normal karyotype was observed in 8 cases. Probes detecting the chromosome aberrations that were observed in at least 3 cases by CCA, ie, +12, 13q14 deletion, and 17p deletion, were used for interphase FISH analysis. FISH detected total or partial +12, 13q14 deletion and 17p- in 28.5%, 52.4%, and 26% of the cases, respectively. The presence of these anomalies was not a function of karyotype complexity. Based on the results of CCA/FISH, three groups of increasing karyotype complexity were recognized: group 1, including 11 patients without detectable aberrations in addition to BCL1 rearrangement; group 2, including 14 patients with 1 to 2 additional anomalies; and group 3, including 17 patients with three or more additional anomalies. Clinical parameters associated with shorter survival were male sex (P =.006) and primary lymph-node involvement compared with primary bone marrow involvement (P =.015). Trisomy 12 was the only single cytogenetic parameter predictive of a poor prognosis (P =.006) and the best prognostic indicator was the derived measure of karyotype complexity (P <.0001), which maintained statistical significance in multivariate analysis (P<.0001). We arrived at the following conclusions: 13q14 deletion occurs at a high incidence in MCL; 17p deletion and total/partial +12 are relatively frequent events in MCL, the latter aberration being associated with a shorter survival; and the degree of karyotype complexity has a strong impact on prognosis in this neoplasia.     

Clinical features of halothane and enflurane

This is a brief review of some of the salient clinical features of halothane and enflurane, the two most widely used volatile anesthetics in clinical practice today. Although, halothane has an excellent safety record and comes close to being the ideal inhalational anesthetic it does have some undesirable effects, including incompatibility with adrenaline and the possibility of causing disturbed hepatic function when given repeatedly. Enflurane is now established as a satisfactory volatile anesthetic which has considerably less metabolic breakdown than many other agents; if this is reflected in terms of minimal organ toxicity it should continue to have considerable clinical value. The risks of damage to the kidney and cerebral irritability are uncommon but undesirable features of enflurane. In the search of the perfect inhalational anesthetic the most promising compounds will be those with least biotransformation, suitable pharmacokinetics with minimal cardiovascular or respiratory depression and without toxic effects on the liver, kidney or foetus.     

SLE: mechanisms of vascular injury

The chronic elevation of complement split products seen in many patients with systemic lupus erythematosus should be regarded as equivalent to silent hypertension, or hyperglycemia in a patient with incipient diabetes mellitus. Although the consequences may not be immediately evident, such patients should be monitored and perhaps even treated.     

Clinical and bronchoscopic features of endobronchial tuberculosis

A mobile educator unit is a cost-effective teaching tool that can be easily implemented in an acute hospital setting to assist in teaching patients, visitors, and personnel about health and wellness. The educator unit cannot replace the face-to-face interactions between professional and patient or visitor, but it can supplement and make information more readily available than a stationary display.     

Clinical and demographic features of Meige's syndrome

Fifty five patients with Meige's syndrome were examined for clinical and demographic features. The mean age of onset was 52.3 years. The peak age of onset was in the sixth decade with a male to female ratio of 1.11:1. The mean duration of illness was 3.7 years. Commonest initial symptom was increased blinking, seen in 30 cases (54.5%). Twenty five patients (45.4%) had complete syndrome of blepharospasm with oromandibular dystonia, whereas 24 patients (43.6%) had blepharospasm alone and the rest (6 patients, 10.9%) had oromandibular dystonia. The extension of spasm beyond cranial muscles was observed in 10 patients (18.1%). Eleven patients had family history of dystonia or other extrapyramidal disorders. Incidence of depression was high in these cases.     

An unusual, recurring breast tumor with features of eccrine spiradenoma: a case report

PURPOSE: We have previously demonstrated that spontaneous bacterial translocation (BT) occurs in newborn rabbits and correlates strongly with small bowel colonization (BC). Birth stress, specifically hypoxia, is believed to increase this pathologic process and thus lead to sepsis. This study investigated the relationship between BT and acute hypoxia in newborn rabbits. METHODS: Four hundred seventeen rabbit pups (aged 0, 2 to 4, 6, and 28 days) were divided into four groups according to the type of hypoxic stress: 9% O(2) for 1 hour, 9% O(2) + 12% CO(2) for 1 or 4 hours, and 21% O(2) (control animals). The animals were killed 1.5 or 20 hours after the stress. Sterile specimens of mesenteric lymph nodes (MIN), spleen, liver, small bowel, and large bowel were incubated aerobically at 37 degrees C for 24 hours in thioglycolate broth, and subsequently plated on both MacConkey and Colistin Naladixic Acid media. After 24 hours, the growth on both plates was recorded. X(2) analysis was used, and P values of less than .05 were considered significant. RESULTS: BC of the small bowel and BT to the MLN were low in the first 4 days of life in the hypoxic groups (range, 0% to 21% BC, 0% to 6% BT) and the control group (range, 4% to 30% BC, 3% to 12% BT). After an increase in BC at 6 days of age, the rate of BT increased to 25% to 29% in control animals. The rate of BT in the hypoxic groups (25%) did not differ significantly from that of the controls (P > .05). Additionally, killing at 20 hours (v 1.5 hours) was not associated with an increase in the incidence of BT. None of the stress groups had a significant increase in BT compared with the controls. Importantly, although 4 hours of 9% O(2) + 12% CO(2) resulted in a 30% mortality rate, the incidence of BT was no higher than that of the control animals (13% v 29%; P > .05). CONCLUSION: Severe hypoxic stress in newborn rabbits does not increase the incidence of BT. Because the incidence of BT correlates with that of BC, and because BC is the same in the control and hypoxic animals, the sepsis observed in hypoxic newborns probably is not related to an increased incidence of BT.