[Soluble P-selectin levels in synovial fluid and serum from patients with psoriatic arthritis]. / Livelli di P-selettina solubile nel liquido sinoviale e nel siero di pazienti con artrite psoriasica.

OBJECTIVE: P-selectin is an adhesion molecule expressed by activated endothelial cells and platelets favouring the leukocyte adherence to microvascular endothelium. A soluble form of this molecule has been described, whose serum levels were found to be elevated and correlate with disease activity in rheumatoid arthritis (RA) patients. Aim of this study was to determine soluble P-selectin levels in synovial fluid (SF) and serum from patients with psoriatic arthritis (PsA), where it has never been investigated, to define its involvement in PsA synovial damage. METHODS: we analysed, by ELISA, soluble P-selectin serum and SF levels in 100 patients presenting a knee joint effusion: 38 of them presented PsA, 40 RA and 22 osteoarthritis (OA). We examined the main clinical and laboratory parameters of these patients. Soluble P-selectin serum levels were also detected in 15 healthy subjects. RESULTS: soluble P-selectin SF levels were significantly higher in PsA and RA patients respect to OA subjects. Soluble P-selectin SF levels were lower than those found in serum and the SF/serum ratio was higher in PsA and RA patients respect to OA. Soluble P-selectin serum levels were not significantly different among patients and controls. No correlation was found between SF and serum levels of soluble P-selectin and the main clinical parameters. CONCLUSIONS: our study of soluble P-selectin in PsA reveals a prominent local role of this molecule, with no differences respect to RA. Histological findings may be of help in understanding the role of this adhesion molecule in PsA.

Ménière's disease and anxiety disorders.

Diagnosis of Menière's Disease is based upon the wellknown labyrinthic syndrome (hypoacusia, tinnitus and dizziness) which manifests with the typical abscessual, recurrent and unforeseeable course. Many Menière patients also report panic attacks, agoraphobia and anxiety which make evaluation of labyrinthic symptoms difficult, affect the onset and maintenance of vestibular compensation and require specific treatments which are very different from those for the control of endolymphatic hydrops. In order to analyse the nature and the meaning of the association of the vestibular and psychiatric symptoms, a comparison has been made between patients presenting Menière's disease, and a group of patients with dizziness resulting from other vestibular diseases. Socio-demographic data were collected and anxiety tests were used to evaluate, the depression and phobia. An interview ad hoc was also programmed for the psychiatric diagnosis. A previous psychiatric history, age, sex, marital status as well as education appear to have a variable effect upon the onset and evolution of panic-phobic symptoms, following onset of Menière's disease. These conclusions, which require confirmation with further studies, allow early characterisation of Menière's disease patients of great predictive usefulness as far as concerns the development of psychiatric sequelae of a panic-phobic nature. This evolution is far more frequent in females being enhanced by middle age, low level of education, long-standing Menière's disease and large number of attacks of dizziness. Onset of panic-phobic attacks is more rare in males in whom the condition is associated with young age, high level of education, lack of setting up of a family nucleus with children.

Allergic rhinitis in Italy: epidemiology and definition of most commonly used diagnostic and therapeutic modalities.

Allergic rhinitis is classically defined as an IgE-mediated inflammation of nasal mucosa, characterised by nasal obstruction, rhinorrhea, sneezing and nasal itching. It is certainly a high-prevalence disease and an important social and medical problem in many industrialised Countries, affecting about 20% of the general population; moreover, it is diagnosed with increasing frequency, both in adults and children in many developing countries. In view of the high medical and social costs, a correct diagnostic approach to allergic rhinitis is a fundamental need for the otorhinolaryngologist, also considering the severe complications (asthma, rhinosinusitis, rhino-otitis, rhinosinusal polyposis) which could develop if this disease is not recognised and adequately treated in its early phases. In order to evaluate not only the present epidemiological characteristics of allergic rhinitis in Italy but also the most commonly used diagnostic and therapeutic approaches in the management of this disease, 145 Italian otorhinolaringologists were selected to take part in the investigation. Each was invited to complete a questionnaire, divided into 8 different sections, to be answered according to their daily clinical practice. The significance of the results has been compared with those of the international samples comprised in the ARIA Document and in the epidemiologic survey of the Standing Committee on Rhinology and Allergy of the International Federation of Otorhinolaryngological Societies. A critical analysis of these data leads to some interesting epidemiological and therapeutic considerations.

Hepatitis C virus infection of salivary gland epithelial cells. Lack of evidence.

BACKGROUND: Hepatitis C virus genome (HCV-RNA) has been detected in whole salivary gland tissue of chronically infected patients. However, contamination of the tissue by plasma or blood cells was not excluded by the previous reports. AIMS: To assess whether HCV infects the salivary gland epithelial cells in patients with chronic HCV liver disease. METHODS: Twenty unselected patients with chronic active hepatitis (11 cases) or active cirrhosis (nine cases) were examined. Serum and saliva samples were obtained from all patients, 12 of whom (seven, chronic active hepatitis; five, active cirrhosis) underwent salivary gland biopsy. PCR for HCV-RNA was performed on RNA extracted from serum, saliva and salivary gland epithelial cells collected by isokinetic gradient separation after trypsin digestion of whole salivary gland tissue. Saliva samples were also examined for the presence of secretory IgA anti-HCV by gel chromatography and ELISA testing. RESULTS: HCV-RNA was detected in all sera with titers ranging from 5.42 x 10(5) genome equivalents/ml to 123.2 x 10(5) genome equivalents/ml. Thirteen patients were infected with genotype 1b, four patients had genotype 1a, two patients had genotype 2a and one patient was unclassifiable. Low titer HCV-RNA (<2 x 10(5) genome equivalents/ml) was detected in 3/20 saliva samples (15%) from highly viremic patients infected with 1b genotype. RNA extracted from salivary gland epithelial cells consistently tested negative for HCV-RNA. In addition, all saliva specimens tested negative for secretory-IgA (S-IgA) anti-HCV, even after a 10-fold concentration of the samples. CONCLUSIONS: There was no evidence that HCV infects the salivary gland epithelial cells in our viremic patients with HCV chronic liver disease. Low level HCV-RNA in saliva is most probably due to virus spillover from blood.

[Initial symptoms in Meniere's disease]. / I sintomi precoci della malattia di Menire.

Menière's disease appears with the classic triad of symptoms in about 1/3 of cases so that, on the whole, diagnosis is delayed until full symptomatology develops. Spontaneous reversibility and effective control, if any, of the disease mechanism are limited to the beginning phases and thus it seems appropriate focus attention on the earliest symptoms. Unfortunately, the pre-diagnosis period is poorly known and, for this reason, we decided to investigate it in our series. The purposes of this research were: 1) to estimate the prevalence of isolated symptoms in subjects successively found to be menieric; 2) to make a clinical outline of the pre-diagnosis period; 3) to investigate the relationship between the pre-diagnosis period and the post-diagnosis disease course. From a group of 216 Menière's patients (diagnosed according to the 1985 AAOO criteria), 170 were selected on the basis of availability of audiometric and clinical data pertaining to the pre- and post-diagnosis disease course. Isolated symptoms in the pre-diagnosis period were found in 107/170 subjects (63%). The nature of the symptoms was cochlear (71.9%), vestibular (22.4%) and mixed (5.6%). In the largest group of patients (41 cases), the pre-diagnosis period lasted from 2 to 5 years. This period was shorter in the cases with mixed symptoms in comparison with patients suffering from either cochlear or vestibular symptoms. Between the 2nd and 5th year following diagnosis, hearing was seen to deteriorate more significantly in patients with a history of isolated cochlear symptoms. Furthermore, patients whose first disturbances were of cochlear origin suffer significantly shorter vertigo attacks.(ABSTRACT TRUNCATED AT 250 WORDS)

[Recovery from Meniere's disease]. / La guarigione della malattia di Ménière.

When vertigo attacks and balance disorders stop, menieric patients are generally considered recovered although they complain of more or less severe sensorineural hearing loss. As far as a true clinical recovery is concerned, the Authors think that it should correspond not only to absence of vertiginous spells but even to a long lasting normal and stable hearing level. On the basics of this presumption, they select the files of 7/207 patients showing complete recovery since not less than 8 years. Age at the onset of the disease, associated disease, isolated symptoms before the appearance of the classic triade, age at the first attack, total number of crises, length of active period of the disease, maximum hearing loss, shape of audiometric tracing are all analyzed. Healed patients are characterized by a smooth evolution, which reverses in the very first phases of the disease, as well as by the following: 1) absence of head injury and viral labyrinthitis in clinical history; 2) onset of disease with complete symptomatology; 3) slight hearing loss and up-sloping audiometric configuration; 4) few attacks of vertigo (less than 30) lasting no longer than 12 hours; 5) active period of disease not exceeding 18 months. Recovery from Ménière's disease seems possible as long as labyrinth lesions are not stabilized.

Hepatitis C virus infection in chronic liver disease in Somalia.

To assess the role of hepatitis C virus (HCV) in liver disease in Somalia, antibody to HCV (anti-HCV) was studied by enzyme-linked immunosorbent assay (ELISA) and recombinant immunoblot assay (RIBA) in 110 patients with chronic liver diseases, in 309 healthy adults, in 179 institutionalized subjects with a high prevalence of intestinal parasites and Schistosoma haematobium, and in 287 children with diseases other than hepatitis. According to the RIBA test, anti-HCV was present in three healthy adults (0.97%), in four institutionalized individuals (2.2%), but in none of the children. The prevalence of anti-HCV was 4.8% in patients with hepatitis B surface antigen (HBsAg)-positive chronic liver diseases and 20.6% in patients with HBsAg-negative chronic liver diseases. Thus, HCV infection appears to play a minor role in HBsAg-positive liver disease in Somalia but may be an important factor in HBsAg-negative chronic liver disease. The low anti-HCV prevalence in individuals with no hepatic disorders is consistent with the fact that HCV does not spread by nonpercutaneous transfer. We found also a large proportion of both patients with hepatic disease and institutionalized individuals who tested positive by ELISA but not confirmed by RIBA. However, the likelihood of a true positive result increases proportionally with the ELISA value; thus, in most cases a low ELISA value probably represents a false-positive reaction, while a high ELISA value probably represents a true positive reaction.

IgG subclasses in human hydatid disease: prominence of the IgG4 response.

To assess the participation of the four subclasses of IgG in the humoral response to Echinococcus granulosus infection, we determined total and parasite-specific IgG1, IgG2, IgG3 and IgG4 in sera from 46 patients with hydatid disease using an enzyme-linked immunosorbent assay (ELISA). Parasite-specific IgG subclass antibodies were quantitatively measured by means of standard curves obtained by affinity chromatography. Sera from 35 healthy individuals served as controls. The total component of IgG1, IgG2, and IgG3 showed a slight increase in patients with hydatidosis in comparison to normal control subjects with no significant differences. For the IgG4 subclass, however, a marked elevation was found in the patients group (p = 0.001 by analysis of variance). IgG1 and IgG4 subclasses showed a high anti-echinococcus antibody response, whereas there was a low parasite-specific IgG2 and IgG3 response. Indeed IgG-specific antibodies were found to belong mainly to IgG1 (63%) and to IgG4 (30%) and to a lesser extent to IgG2 (5%) and IgG3 (2%). The percentage of the total serum IgG4 antibodies that were specific for hydatid antigen reached a mean level of 18%, significantly higher than that of any of the other three IgG subclasses (p < 0.001 by Student's t test). Thus, the continuous antigenic stimulation of hydatidosis may result in an enhanced IgG4 subclass response.

[The circulation of the hepatitis A and B viruses in the Somali population]. / Ricerche sulla circolazione del virus A e del virus B dell'epatite nella popolazione somala.

We report the results of a study carried out to evaluate the extent of hepatitis A virus (HAV) and hepatitis B virus (HBV) circulation in Somalia. Serum samples were collected from 593 subjects (age range 0-83 years) and tested for anti-hepatitis A (HAV) and anti-HAV IgM. Serum samples taken from 1272 individuals (age range 0-83 years) were tested for HBsAg, anti-HBsAg, anti-HBcAg, HBeAg and anti-HBeAg. We confirmed a very high rate of HAV exposure (about 90% of the subjects tested had circulating anti-HAV) as is typical of fecal-orally transmitted infectious agents. The age-specific anti-HAV IgM prevalence suggests that HAV infection is acquired very early in life. Our data also indicate a high rate of HBsAg carriers (range: 10.5%-27.4%) in the Somalian population. When all markers are considered, 60% of the adult population showed evidence of HBV exposure. HBV spreads very subtly: in fact, it is generally transmitted via non-overtly percutaneous routes. In Somalia, hepatitis A virus infection is highly endemic and occurs very early in life. Hepatitis B virus infection is also widespread in this country.

Spontaneous in vitro generation of histamine releasing factor from mononuclear cells of patients with hydatidosis.

We have shown that Echinococcus granulosus infection can induce an enhanced sensitivity of basophils to IgE-dependent stimuli. To determine whether a cytokine, histamine releasing factor, could account for it, we evaluated 35 patients with active hydatidosis, 5 patients with past E. granulosus infection, and 20 normal volunteers. The spontaneous production of a factor in vitro that provoked the release of histamine from basophils was observed by mononuclear cells from patients with active disease, but not by those from subjects with past infection or from normal individuals. The histamine releasing factor was found to activate basophils through surface-bound IgE. It is concluded that E. granulosus infection induces both generation of histamine releasing factor and production of IgE that can bind this cytokine.

Basophil-bound and serum immunoglobulin E directed against Helicobacter pylori in patients with chronic gastritis.

The immunoglobulin (Ig) E immune response in patients with Helicobacter pylori-associated chronic gastritis has been evaluated. Of 26 patients with H. pylori infection, 22 (84%) tested positive for basophil-bound specific IgE (determined by the histamine release test) and 18 (69%) for serum specific IgE (determined by an enzyme-linked immunosorbent assay). In contrast, only 1 of 17 persons in whom the bacterium was not detected presented cell-bound and serum specific IgE. In the 4 histamine release test--positive but enzyme-linked immunosorbent assay--negative patients, removal of antibody from the basophil surface by acid elution showed that histamine release occurred through an IgE-dependent mechanism. When normal basophils, passively sensitized with serum from IgE-positive patients, were exposed to the H. pylori antigen, a significant release was observed, confirming the class specificity of the response. Inhibition experiments with bacteria other than H. pylori showed that the IgE antibody was specifically directed against this organism. The percentage of antigen-induced histamine release did not correlate with serum specific IgE level. However, the response of basophils to antigenic challenge was proportional to IgE-dependent cellular releasability. This finding suggests that target cell sensitivity may be the most important factor in determining the entity of biological response to the antigenic challenge. The ability of H. pylori to induce a specific IgE immune response could answer key questions regarding the mechanisms inducing gastric inflammation.

The serological diagnosis of human hydatid disease by time-resolved fluoroimmunoassay.

The use of a new immunoassay, time-resolved fluoroimmunoassay (TR-FIA), in the diagnosis of human hydatid disease has been evaluated. This technique, which is based on the labelling of antibodies with europium (Eu), was compared with a well-established method, the enzyme linked immunosorbent assay (ELISA). Of 102 patients with hydatid disease, 97 (95.1%) were positive according to TR-FIA and 83 (81.4%) according to ELISA. The rate of non-specificity for other parasitic infections (n = 206) was 8.7% for TR-FIA and 17.5% for ELISA. It is concluded that TR-FIA is more sensitive and more specific than ELISA in the diagnosis of human hydatid disease.

Incidence of Menière's disease in Italy.

Numerous epidemiologic investigations have been conducted regarding the incidence of Menière's disease, but the values obtained for different countries vary greatly. This can be attributed to the fact that different criteria have been applied in defining Menière's disease. The objective of this study was to evaluate the incidence and prevalence of Menière's disease in Italy following the American Academy of Ophthalmology and Otolaryngology guidelines. A total of 111 cases with Menière's disease were diagnosed in a district of southeastern Latium over a 13-year period, with an incidence of 82 per 10(6). A figure 3.4 times greater was found in hospital personnel, thus showing that a greater availability of medical facilities increases the number of diagnoses. Sex was found not to be a determining factor. The authors suggest that the incidence reported in this paper is an underestimate and that the actual one remains undetermined, but probably higher than generally believed.