Identification of 45 kD antigen in immune complexes of patients of allergic bronchopulmonary aspergillosis

The hippocampus is a major target of alpha-bungarotoxin (alpha-BTX) binding. This ligand binds to the alpha 7 nicotinic, cholinergic receptor, which has been implicated in hippocampal habituation to repetitive auditory stimulation, a phenomenon thought to involve inhibitory neurons. This study examined whether alpha-BTX binds to neurons containing nitric oxide synthase (NOS), a marker of one subgroup of inhibitory hippocampal neurons. Rat hippocampal sections were processed for NOS immunohistochemistry, photographed and then processed for [125I]alpha-BTX autoradiography. Comparison between the distribution of neurons immunoreactive for NOS and those positive for alpha-BTX binding in the same regions of the hippocampal formation revealed a variable degree of colocalization of NOS and alpha-BTX. Of the cells labeled with alpha-BTX, 2% in the dentate gyrus and 40% in the hippocampus proper were also immunoreactive for NOS. These NOS/alpha-BTX neurons were most prevalent in CA1 stratum oriens. The results suggest a possible role for NOS-containing neurons in alpha 7-mediated inhibition to repetitive auditory stimulation in rat hippocampus.     

Comparative study of carbohydrate antigen 195 and carcinoembryonic antigen for the diagnosis of pancreatic carcinoma

The expression CA195 in serum, defined by monoclonal antibody CC3C195 (IgM), was studied in 67 patients with pancreatic cancer and in 138 patients with biliary or pancreatic benign disease. The results were compared with carcinoembryonic antigen (CEA) expression. The overall sensitivity of the CA195 assay (> 12 U/ml) was higher than that for CEA (89.5% vs. 53.7%) (p < 0.001). Sensitivity was increased to 92.5% with the simultaneous use of the two antigens, but the difference was statistically significant only with CEA (p < 0.001). The specificity of CA195 calculated from all patients with benign diseases was lower than that of CEA (73.1% vs. 89.8%). However, using a cutoff value of 100 U/ml for CA195, the specificity of this antigen (82%) was higher than that of CEA. These results demonstrate that marked elevations of tumor antigen CA195 are relatively specific for pancreatic carcinoma, and that this antigen is superior to CEA for diagnosing pancreatic cancer by virtue of its higher sensitivity.     

A 25-week placebo-controlled study of eptastigmine in patients with Alzheimer disease

Studies of Pneumocystis carinii have been limited by our inability to propagate it in continuous culture. In this context, studies of P. carinii antigens have provided significant insight into the biology of this organism. The mannose-rich surface major surface glycoprotein of P. carinii termed glycoprotein A (gpA) is the best studied of these P. carinii antigens. Significant genetic and immunologic diversity exists between the gpA molecules expressed by P. carinii derived from different mammalian sources. The molecular and biochemical nature of gpA and other P. carinii antigens including p55 are reviewed. In addition, available information concerning the role of P. carinii gpA and other antigens in host-organism interactions are also discussed.     

Immunoglobulin content in the bronchial washings of patients with benign and malignant pulmonary disease

The bronchial washings of 58 patients with benign and neoplastic conditions involving the lungs were evaluated for immunoglobulin content. Levels in the washings from the diseased lung were compared with those from the normal contralateral lung. In normal patients and those with either bilateral inflammatory diseases or unilateral bronchiectasis or tuberculosis, the mean variation in igA/K and igG/K ratios between diseased and uninvolved lungs was minimal. In unilateral pneumonitis, however, igG/K was markedly elevated (P less than 0.01). Significant changes in the igA/K occurred on the affected side in patients with cancer. In the group with squamous-cell cancer. the mean elevation was 4.6 times that of contralateral lung (P less than 0.005), whereas with adenocarcinoma and undifferentiated carcinoma, the rise was 6.4 and 2.8 times, respecitvely (P less than 0.01 and P less than 0.01). Thus, carcinoma appears to alter local immunoglobulin production in the affected lung as compared to its normal counterpart. (N Engl J Med 295:694-698, 1976).     

Classical conditioning in patients with Alzheimer's disease: A multiday study.

Previous studies demonstrated that patients with Alzheimer's disease (AD) do not acquire the classically conditioned eyeblink response. These studies, however, were only tested over a single conditioning session and, hence, raise the question of whether AD patients are capable of acquiring the response if sufficient training is given. This question may be of some importance because whether AD patients can ultimately acquire the response has implications for the underlying neurobiological deficit in disrupted conditioning in AD. This study tested AD patients and age-matched controls over 4 days. As in previous studies, AD patients performed significantly worse than controls on Day 1, but by Day 4, they were not significantly different from controls. Subsequent testing indicated that these effects were not due to nonassociative variables such as changes in sensitivity to stimuli or disruption of the motor response. Also, it was reported that neither AD patients nor controls showed any evidence of acquisition in an explicitly unpaired paradigm, suggesting that neither pseudoconditioning nor sensitization is contributory. Data are discussed in terms of the possible role of the hippocampus in mediating conditioning deficits in AD patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of disease progression in patients with atherosclerotic renal artery stenosis

The natural history of renal artery stenosis (RAS) has been difficult to document because serial arteriography is rarely justified. Duplex scanning is a noninvasive technique that is ideally suited for both screening and follow-up of RAS. In this approach, renal arteries are classified as normal, < 60% stenosis, > or = 60% stenosis, or occluded, and disease progression is defined as a change in the duplex classification. The purpose of this study was to determine the rate of disease progression in atherosclerotic RAS by serial duplex scanning. At least one abnormal renal artery was identified in each of 76 patients being screened for RAS. Of the 152 renal arteries, 20 were excluded (14 prior interventions, 5 occlusions, 1 technically inadequate duplex scan), leaving 132 for the natural history follow-up protocol. The patient group included 36 men and 40 women, with a mean age of 67 years, who were followed for a mean of 32 months (maximum 55 months). The initial status of the 132 renal arteries was normal in 36, < 60% stenosis in 35, and > or = 60% stenosis in 61. The cumulative incidence of progression from normal to > or = 60% RAS was 0% at 1 year, 0% at 2 years, and 8% at 3 years. The cumulative incidence of progression from < 60% to > or = 60% RAS was 30% at 1 year, 44% at 2 years, and 48% at 3 years. All 4 renal arteries that progressed to occlusion had > or = 60% stenoses at the initial visit, and for those arteries with a > or = 60% stenosis, the cumulative incidence of progression to occlusion was 4% at 1 year, 4% at 2 years, and 7% at 3 years. Progression of RAS occurred at an average rate of 7% per year for all categories of baseline disease combined. Progression of atherosclerotic RAS is relatively common, particularly from < 60% to > or = 60% stenosis.     

Effect of transurethral resection on serum free/total prostate-specific antigen levels in patients with benign prostatic hyperplasia

Endotoxin-induced early inflammatory reactions may inhibit the function and survival of isolated cells or cell aggregates after transplantation. By the chromogenic Limulus amebocyte lysate assay we found rather high but variable endotoxin concentrations in the chemicals used for islet isolation, i.e. collagenase and Ficoll. Liberase, a special collagenase preparation from Boehringer, was nearly endotoxin-free. Correlating to the endotoxin content, collagenase and Ficoll had the capacity to induce interleukin-1beta release from human peripheral blood mononuclear cells. Because collagenase and density gradient media are needed in most cell isolation procedures from solid organs, each lot of these chemicals should be tested for endotoxin contamination. In pancreatic islet transplantation, the use of endotoxin-free chemicals may diminish early local inflammatory reactions at the graft site and thereby reduce the number of islets needed for successful islet transplantation.     

A long-term follow-up study of patients with ischaemic heart disease versus patients with nonspecific chest pain

Ninety consecutive patients who were admitted to hospital with acute chest pain were followed-up five years later. At the time of the original admission, all of the patients received a detailed physical and psychiatric evaluation. Seventy-one patients were diagnosed as having ischaemic heart disease, and 19 were diagnosed as having nonspecific chest pain. Patients with nonspecific pain were younger, consumed greater amounts of alcohol, smoked more than their organic counterparts, and were more likely to suffer from psychiatric disorder. The five-year assessment was carried out using a self-report questionnaire. Of the original 71 patients with ischaemic heart disease, 14 had died; 43 questionnaires were returned, 80.2% of the original sample. Sixteen (84.9%) of the patients with nonspecific pain were followed up; none had died. Both groups were predominantly male. The patients with nonspecific pain still smoked more than the patients with ischaemic heart disease, and they had significantly more symptoms of anxiety. The overall prevalence of psychiatric morbidity remained high, however, in both groups. Patients who had psychiatric illness at the time of the original assessment were more anxious at follow-up and more likely to complain of chest pain than those who had been well. Patients with nonspecific chest pain continued to seek treatment on a regular basis from their general practitioners either for chest pain or for other symptoms, but few were in frequent contact with hospital services. The possible preventive effects of psychiatric intervention at an earlier stage in both groups of patients needs to be investigated.     

Motor impersistence in patients with unilateral cerebral disease: A cross-validational study.

Evaluated 8 simple motor tasks comprising a motor impersistence test battery both individually and in combination as indicators of unilateral cerebral disease. Previously developed scoring criteria were applied to the performances of 32 right-handed brain-damaged and 32 control patients. Classificatory efficiency provided by overall performance on 6 of the tasks (70%) approached the level achieved by overall performance on the full battery of 8 tests. Side of lesion was found to be unrelated to performance within the brain-damaged group. Further study of an unselected patient sample is indicated in order to evaluate the incremental validity of the test battery in the neuropsychological examination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sensitivity of monoclonal antibodies to carcinoembryonic antigen, tissue polypeptide antigen, alpha-fetoprotein, carbohydrate antigen 50, and carbohydrate antigen 19-9 in the diagnosis of colorectal adenocarcinoma

PURPOSE: This study was designed to establish the sensitivity of monoclonal antibodies to carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), tissue polypeptide antigen (TPA), carbohydrate antigen 50 (CA 50), and carbohydrate antigen 19-9 (CA 19-9) and the efficacy of the joint determination of several tumor markers, as well as the dynamics of postoperative normalization of each marker in the absence of recurrence. MATERIALS AND METHODS: A prospective study was carried out in 100 patients subjected to surgical resection of colon adenocarcinoma. Serum concentrations of these markers were determined the day before surgery and seven days, two months, and six months after surgery. RESULTS: The results demonstrate that sensitivity increased as the disease spread and that CA 19-9 was the most sensitive tumor marker. The rate of false negatives was 40 percent for Dukes Stage A lesions, 19 percent for Dukes Stage B, 7 percent for Dukes Stage C, and 0 percent for Dukes Stage D. Determination of two markers (CA 19-9 and CEA) provided the greatest sensitivity in Stages A and D tumors (60 percent and 100 percent, respectively); the incidence did not change when measurements of other antigens were associated. For Stages B and C, determination of at least three markers was necessary, the association of CEA, TPA, and CA 19-9 being that which showed the greatest sensitivity, 78 percent and 91 percent, respectively. CONCLUSIONS: It would be advisable to include monoclonal antibody determination of CEA, TPA, and CA 19-9 in the diagnosis of adenocarcinoma, despite the fact that ultimate sensitivity will depend on the degree of tumor extension or on the presence of metastasis.     

Serum squamous cell carcinoma antigen: a potential marker for benign vulval disease?

Benign vulval disease comprises a variety of disorders and can affect women of all ages. To date, the optimal management of these conditions has been uncertain and not subjected to a systemic prospective approach. It is recognized that benign vulval disease has a potential premalignant potential. Squamous cell carcinoma antigen (SCCA) has shown in different studies to be an effective means of monitoring the course of the disease in cervical carcinoma. Elevated levels of SCCA have been found in the skin. In addition, raised SCCA levels have been found in non-carcinomatous inflammatory dermatoses, and the levels observed correlated with the extent of the disease and the response to therapy. It was thought that SCCA might prove to be a useful marker for benign vulval disease, and in our pilot study the objectives were to determine if levels of SCCA are elevated in patients with that disease and to assess whether there is an association between SCCA and clinical response to treatment.     

Managing patients with benign prostatic hyperplasia

Benign prostatic hyperplasia is the usual cause of prostatism--irritative and obstructive urinary symptoms. Steps in making the diagnosis include a focused neurologic examination, urinalysis, serum creatinine determination and, possibly, catheterization to detect urinary retention. It is difficult to predict the likelihood of future complications, such as complete urinary obstruction, even for patients with severe symptoms. The natural course of prostatism is a waxing and waning of symptoms. Treatment options are watchful waiting, medication, transurethral prostatectomy, and newer surgical treatments such as microwave thermopathy and laser ablation. The family physician can counsel patients about the potential side effects of these treatments as well as the problems incurred by simply adjusting to the disabilities associated with benign prostatic hyperplasia.     

Risk factors for septic arthritis in patients with joint disease. A prospective study

OBJECTIVE: To quantify potential risk factors for septic arthritis, in order to identify a basis for prevention. METHODS: The occurrence of potential risk factors for septic arthritis in patients with joint diseases attending a rheumatic disease clinic was prospectively monitored at 3-month intervals over a period of 3 years. Potential risk factors investigated were type of joint disease, comorbidity, medication, joint prosthesis, infections, and invasive procedures. The frequencies of risk factors in patients with and those without septic arthritis were compared using multiple logistic regression analysis. RESULTS: There were 37 patients with and 4,870 without septic arthritis. Risk factors for developing septic arthritis were age > or = 80 years (odds ratio [OR] = 3.5, 95% confidence interval [95% CI] 1.4-8.6), diabetes mellitus (OR = 3.3, 95% CI 1.1-10.1), rheumatoid arthritis (OR = 4.0, 95% CI 1.9-8.3), hip and/or knee prosthesis (OR = 15, 95% CI 4.1-54.3), joint surgery (OR = 5.1, 95% CI 2.2-11.9), and skin infection (OR = 27.2, 95% CI 7.6-97.1). CONCLUSION: These findings indicate that preventive measures against septic arthritis in patients with joint diseases should mainly be directed at those with joint prostheses and/or skin infection.     

Controversies in benign breast disease

Breast health means more than breast cancer. At least 50% of patients seen at a multidisciplinary breast center have benign conditions. Pain, nipple discharge, and a question of a mass are the usual chief complaints. This article provides contemporary information and management guidelines for the common breast conditions associated with these complaints.     

Bladder compliance in patients with benign prostatic hyperplasia

Factors influencing bladder compliance were examined in 116 patients with benign prostatic hyperplasia (BPH), by evaluating patients' histories, response of isolated bladder strips to acetylcholine, and the effect of prostatic urethral anesthesia. Patients' age, frequency of micturition, and duration of voiding difficulty were not correlated with bladder compliance. Bladder compliance was significantly low in patients within 30 days after urinary retention, as compared with bladder compliance in patients without an episode of retention. More than 30 days after retention, however, there was a tendency toward increased bladder compliance. Restricted to patients without an episode of retention, bladder compliance in the overactive detrusor group was found to be significantly lower than in the normal group. The responses to acetylcholine of bladder strips were compared between patients with low and normal-compliance bladders. The dose-response curve of patients with low-compliance bladders did not differ from that of those with normal compliance bladders, even when patients with an episode of retention were excluded. After prostatic urethral anesthesia, a significant increase of bladder compliance was observed in patients with an overactive detrusor, while the increase was not significant in patients with a normal detrusor. Our results strongly suggest that easy irritability of the anatomically altered prostatic urethra, as well as bladder over-distension caused by urinary retention, are important factors affecting bladder compliance in BPH patients.     

A multi-center prospective study of the CD Spinal System in patients with degenerative disc disease

This paper reports on 41 patients available for 24 months' follow-up who were entered into a prospective, multi-center study of the safety and efficacy of using the CD Spinal System (Sofamor Danek) containing pedicle screws and rods to treat adult patients with degenerative disc disease. All of these patients were implanted with only the CD Spinal System in an attempt at fusing four levels or less with autogenous bone graft only. At 24 months the results were compared to literature controls in regard to fusion, pain, function, neurological status, and complications. For function and neurological status, the CD Spinal System results were found to be statistically equal to and for fusion, pain, and complications, found to be statistically better than the noninstrumented literature controls with the same disease condition and demographics.     

Quality of life in patients with benign anorectal disorders

BACKGROUND: Benign proctological conditions are very common in Western civilization. However, to date quality of life in these patients has not been evaluated comprehensively. The aim of this study was to investigate whether the Gastrointestinal Quality of Life Index (GIQLI) is a useful instrument for measuring quality of life in these patients, and subsequently to establish baseline values for different anorectal disorders. METHODS: The questionnaire was completed by 325 consecutive patients (182 men; mean age 49 years) seen at the proctology outpatient clinic. For further analysis patients were classified into nine subgroups according to the primary diagnosis: group 1, haemorrhoids (n=96); group 2, anal fissure (n=38); group 3, fistula in ano (n=22); group 4, severe constipation (n=14); group 5, faecal incontinence (n=35); group 6, symptomatic anterior rectocele (n=12); group 7, perianal abscess (n=7); group 8, perianal thrombosis (n=7); and group 9, miscellaneous conditions (e.g. skin tags, anal papillomas, mild constipation, rectal polyps) (n=94). The GIQLI scores were compared between the subgroups. In addition the GIQLI scores of age-matched healthy controls, derived from data in the literature, were compared with the patients' scores. RESULTS: The mean GIQLI score for all patients was 113 (78.5 per cent of the maximum score of 144). Mean scores for the nine diagnostic subgroups were: group 1, 120; group 2, 104; group 3, 119; group 4, 94; group 5, 93; group 6, 112; group 7, 115; group 8, 129; and group 9, 117. Age-matched controls from a series published previously had a significantly higher GIQLI score compared with all patients (P < 0.0001). However, only the subgroups of patients with miscellaneous conditions, fissures, severe constipation and faecal incontinence had a significantly poorer quality of life than age-matched healthy individuals. CONCLUSION: The GIQLI is a valuable instrument for measuring quality of life in patients with benign anorectal disorders. Although certain diseases do not seem to affect quality of life profoundly, certain subgroups of patients, most notably those with incontinence and severe constipation, are extremely compromised. Severely constipated individuals exhibit the same poor quality of life as patients with faecal incontinence.     

Prevalence of allergic bronchopulmonary aspergillosis and atopy in adult patients with cystic fibrosis

BACKGROUND: Underestimation of allergic bronchopulmonary aspergillosis (ABPA) prevalence in the cystic fibrosis (CF) population is suspected due to nonuniform diagnostic criteria, nonspecific signs and symptoms, assessment during asymptomatic intervals, and physician nonaggressiveness in making the diagnosis. OBJECTIVE: To define the prevalence of ABPA in adult patients with CF, as the increased duration of bronchiectasis may increase the probability of Aspergillus fumigatus (Af) colonization. We also sought to determine whether atopy increases the prevalence of ABPA in adults with CF. METHODS: We examined a cross-sectional population of adult patients with CF at the University of Washington for 1 year. RESULTS: Information was collected on 53 of 65 (82%) patients. Fifteen of 51 (29%) had an immediate skin test reaction to Af, and 30 of 51 (59%) had at least one positive skin test. Increased total serum IgE (>450 IU/mL) was present in 0 of 53; increased IgE-Af and IgG-Af were found in 12 of 53 (23%) and 9 of 53 (17%), respectively; 24 of 53 (45%) had Af-precipitins. Peripheral blood eosinophilia was present in one patient. Eight of 49 (16%) patients' sputum cultures grew Af. ABPA-CB (ABPA-central bronchiectasis) was present in one patient and ABPA-S (ABPA-seropositive) in no patients. Atopy was present in 20 of 51 (39%). CONCLUSION: There was a low prevalence of ABPA in the adult CF population despite frequent immunologic responses to Af. The prevalence of ABPA was too small to determine an association with atopy.