Clinical aspects of systemic and localized scleroderma

After the skin, the gastrointestinal tract is the most frequently affected organ in systemic sclerosis. Gastrointestinal symptoms already may be present early in the course of the disease and do not necessarily correlate with objective findings. Esophageal dysmotility is not specific for systemic sclerosis but occurs in other connective tissue diseases as well. Peripheral macrovascular disease was shown to be increased in patients with limited cutaneous sclerosis; signs of autonomic dysfunction were found in patients with the CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) variant. Pulmonary involvement was shown to be moderately or severely decreased in 40% of a large cohort of scleroderma patients. In one study, no support was found for the association between pulmonary involvement and gastroesophageal reflux. Peripheral nerve involvement is often subclinical and might be associated with anti-U1-RNP and anti-topoisomerase I antibodies. Internal organs are seldomly affected in localized scleroderma. When occurring in childhood and involving an extremity, localized scleroderma can cause growth failure, resulting in long-term functional disability.     

Control of fibrosis in systemic scleroderma

Scleroderma is characterized by an excessive deposition of collagen in all involved organs. This is due to an overproduction of extracellular matrix (ECM) molecules following induction of gene expression, whereas there is no evidence that the composition of the connective tissue matrix is altered. Several in vivo studies and in vitro experiments suggest that a close interaction between inflammatory cells and fibroblasts is required for the initial activation of fibroblasts. TGF-beta presumably plays an important role, but other cytokines, e.g., PDGF or FGF, may also be involved. Many of the ECM molecules have been shown to interact closely with fibroblasts and provide signals that regulate fibroblast metabolism. The cellular response towards those signals is a further aspect of fibrosis that has attracted attention during recent years. The altered expression of receptor proteins on the cell surface of scleroderma fibroblasts for example might explain in part the lack of down-regulation of collagen synthesis in late phases of the disease. This review summarizes the alterations of connective tissue in scleroderma, and discusses the role of cytokines as well as the ECM for the regulation of fibroblast function and their implication for the development of fibrosis.     

The pathoanatomical,diagnosis of progressive forms of pulmonary tuberculosis in relation to the new clinical classification

This communication is a letter of information that gives for postmortem diagnosis a brief account of tuberculous inflammation and major types of pulmonary tuberculosis during their progression to death and an approximate outline of pathoanatomical diagnosis. Terminal tuberculosis is shown to be now complicated by miliary and caseous pneumonias. Caseous pneumonia may appear as an independent nosological entity and as a complication of acute progression, more frequently, of fibrocavernous tuberculosis. Caseous pneumonia as a tuberculosis type is an irreversible process that calls for emergency surgical treatment. It has been found that there are primarily impairments in lung connective tissue function, acute mesenchymopathy with high blood barrier permeability in caseous pneumonia. Terminal bronchiolar lesion is a later stage in the pathogenesis of caseous pneumonia.     

A lineal equation for the classification of progressive and hyperactive spermatozoa

Capacitation of spermatozoa, a complex sequence of events that render them able to fertilize the egg, is generally associated with a switch from lineal, progressive movement to a vigorous, non-progressive pattern characterized by starlike tracks, a process known as hyperactivation. Development of a method for the analysis of progressive and hyperactive tracks is thus important for the assessment of capacitation in biochemical, physiological and clinical studies. In this study, we have applied a two-step heuristic model to deduce a lineal equation that discriminates hyperactive from progressive spermatozoa. The kinetic parameters (curvilinear velocity (VCL), linearity (LIN), amplitude of lateral head displacement (ALH), straightness (STR), wobble (WOB), mean 'dance' (DAN) and velocity of the average path (VAP)) of ram spermatozoa were evaluated with a computerized motility analyzer, and classified one by one as progressive or hyperactive by the appearance of their tracks. In a first step, a discriminating plane was defined by minimizing the number of misclassified spermatozoa ('conflicting points'); then, the plane was adjusted by an iterative process to minimize the distance from conflicting points to it. The resulting plane showed a discriminating capacity of over 95% for both classes, higher than that achieved by setting a threshold value for the parameters taken separately or in group. When included in a standard semen analysis, application of the equation allowed a rapid assessment of the percentage of hyperactive spermatozoa. The method described, developed in ram spermatozoa, can be applied to different species for a variety of purposes.     

The clinical picture and treatment of destructive pancreatitis

The results of treatment of 319 patients with acute pancreatitis are analyzed, 48 from them (15.1%)--with pancreanecrosis. Etiologic factors in destructive pancreatitis were alcohol addiction (41.67%), cholelithiasis (37.5%), hyperlipidemia (10.41%), hypercalcemia (4.17%), postoperative (4.17%). Location of the necrosis in parapancreatic fat cellular tissue was detected in 6 patients, in pancreatic head--in 8 and both in pancreatic head and corpus--in 11, in corpus and in tail--in 10; total pancreo-necrosis was observed in 5 patients. Therapeutic measures were conservative and only in cholelithiasis cholecystectomy was performed as well as drainage of the choledochus and abdominal cavity. Intensive care was aimed at blocking pancreatic and gastric secretion, inhibition of pancreatic enzymes ferments and suppressing mediators of inflammation, immunocorrection, prophylaxis of infection in the necrotic tissues. Desintoxication was carried out by combination of infusion therapy with forced diuresis, usage of extracorporeal methods and laparoscopic sanation of the abdominal cavity with subsequent lavage. Surgical interventions were carried out in far-off period only for complications of pancreanecrosis. Mortality rate in pancreanecrosis made up 20.85% and in total number of patients with acute pancreatitis--3.13%.     

Oculomotor disorders in the clinical picture of bacterial meningoencephalitis

The clinical study comprising 254 patients with bacterial meningoencephalitis (meningococcal, pneumococcal, staphylococcal, undefined, with n = 135, 76, 43, 120 respectively) permitted identifying a syndrome of oculomotor disturbances. It has been shown that assessment of changes in oculomotor disturbances enables the extent of inflammatory process, focal lesion as well as course and outcome of bacterial meningoencephalitis to be determined in a timely fashion.     

Effect of progressive systemic sclerosis on antral myoelectrical activity and gastric emptying

In patients with progressive systemic sclerosis (PSS) suffering from chronic dyspepsia the stomach may be affected by this disease. The objective of this study was to investigate both antral myoelectrical activity and gastric emptying in PSS patients. Electrogastrography (EGG) was performed in 17 PSS patients (16 female, one male, median age 58 years, range 32-74 years) with chronic dyspepsia. After an overnight fast during one hour in the fasting and one hour in the fed state after ingestion of a liquid-solid test meal (370 kcal; liquid phase labeled with 0.5 mCi 99mTc-colloid) antral electrical activity was measured by one pair of electrodes sonographically placed on the skin overlying the gastric antrum. Several EGG parameters including dominant frequency (DF), percentages of DF in the normal range (2-4 cycles per minute [cpm]), bradygastria (< 2 cpm) and tachygastria (4-10 cpm), dominant frequency instability coefficient (DFIC), and postprandial to preprandial power ratio (PR) were calculated. The data were correlated to results obtained in 20 age- and gender-matched healthy subjects. In addition, the data were compared to gastric retention of the radionuclide at 60 min measured by simultaneous scintigraphy. The PSS patients did not reveal electrical disturbances. They even exhibited a significant postprandial decrease in DFIC, bradygastria, and tachygastria (ns) compared to healthy subjects. Over 50% of the PSS patients showed a delayed gastric emptying. However, EGG did not correlate to radioscintigraphy significantly. Our results reflect an absent relationship between antral myoelectrical activity in EGG and gastric emptying. Therefore, electrogastrography is unsuitable to assess gastric involvement in PSS.