The Influence of Insulin Therapy on the Course of Acute Exacerbation of Bronchial Asthma.

Large doses of systemic corticosteroids are the basis of treatment of acute exacerbation of bronchial asthma. The hyperglycemic activity of systemic corticosteroids often leads to the loss of control of diabetes diagnosed earlier or to its first diagnosis during treatment of the exacerbation of asthma. We conducted a prospective, randomized study in a group of 24 adult patients treated for asthma exacerbation, with the blood glucose level at admission above 8.4 mmol/l. The patients were randomly divided into a group treated with intravenous insulin infusion by an electric syringe pump in doses controlling glycemia at 4.5-7.2 mmol/l (Group A) and a group of patients treated with insulin administered subcutaneously in three doses controlling glycemia at 7.2-10.0 mmol/l (Group B). A control group (Group C) consisted of patients without any disturbances in carbohydrate metabolism, treated for exacerbation of asthma. Asthma exacerbation was treated in all groups in a uniform way. We found that the average hospitalization time was 8.2 ± 2.4 days in Group A, 10.2 ± 5.2 days in Group B, and 5.8 ± 1.9 days in Group C; the last being significantly shorter than those in Groups A and B. We conclude that hyperglycemia is a significant factor increasing the risk of extending hospitalization time due to asthma exacerbation, regardless of the way of insulin therapy.

Food-dependent exercise-induced anaphylaxis: possible impact of increased basophil histamine releasability in hyperosmolar conditions.

We present a case of anaphylactic shock induced by exercise following celery ingestion. The possible mechanism of food-dependent exercise-induced anaphylaxis (FDEIA) and the laboratory tests for its diagnosis are discussed. We evaluated spontaneous, celery-allergen-induced, and anti-FcepsilonRI-antibody-induced histamine release from basophils obtained from the patient, 2 celery-allergic controls, and 3 healthy controls. Buffers of increasing osmolarity were used to mimic conditions of vigorous physical exercise. Only the patient's basophils showed an increase in spontaneous, anti-FcepsilonRI antibody-induced and allergen-induced histamine release under physiological conditions and with slightly increased medium osmolarity. To our knowledge, this is the first report on the possible role of increased histamine releasability in the pathogenic mechanism of FDEIA. We suggest that FDEIA results from increased histamine releasability triggered by physical effort after exposure to a sensitizing food allergen.

A novel polymorphism in the cytoplasmic region of the human immunoglobulin A Fc receptor gene.

The Fc receptor for immunoglobulin A (IgA), FcalphaRI, is expressed on several types of myeloid cells, and activates them upon ligand binding. However, binding of IgA to the extracellular domain of the receptor requires previous stimulation of the cell by cytokines, and the cytoplasmic tail of FcalphaRI has been shown to play a role in this. Therefore, polymorphism in this region might affect this process. However, no changes in the amino acid sequence in this region of the FcalphaRI have so far been reported. Here, we describe for the first time a single nucleotide polymorphism in exon 5 of the immunoglobulin A Fc receptor (FCAR) gene leading to a Ser-->Gly substitution at position 248 of the mature FcalphaRI protein. Prediction of structural features suggests some changes that may affect the function of the protein to some extent. However, the Gly248 variant is quite common (4% homozygotes and 38% heterozygotes) in healthy population, suggesting a weak effect, if any, on function, at least in heterozygotes.

Relevance of the selected cytokine release (TNF-alpha, IL-6, IFN-gamma, and IFN-alpha) to the exacerbation of bronchial asthma from airway mycotic infections. Predominant role of TFN-alpha?

Airway fungal infections are often associated in asthmatics with the exacerbation of asthma symptoms. However, the pathomechanism of this phenomenon has not been fully understood. The aim of our study was to assess whether antimycotic treatment can influence the capacity of bronchoalveolar (BAL) leukocytes to release proinflammatory cytokines, which could contribute to increase in asthma severity. Ten patients with bronchial asthma complicated by airway fungal infections (Candida albicans and/or Aspergillus fumigatus) were included in the study. Seven asthmatics were treated with systemic and inhaled corticosteroids, whereas the remaining three with inhaled ones only. All subjects underwent several courses of therapy with antibiotics due to respiratory infections. BAL leukocytes obtained from the patients were cultured in the absence or presence of lipopolysaccharide E.coli (LPS) or Newcastle disease virus (NDV). The BAL procedure and measurement of the levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (II-6), interferon-gamma (IFN-gamma), and interferon-alpha (IFN-alpha) by specific bioassays were performed twice: before antimycotic treatment and after 3 weeks of therapy with 8 mg of nebulized fluoconazole and 400 mg of oral ketoconazole per day. The elimination of fungi from respiratory tract resulted in an apparent clinical improvement. This coincided with diminished production of TNF-alpha in response to LPS and the production of IFN-alpha in response to NDV, which were initially high and subsided significantly after antimycotic therapy (p = 0.035, and 0.011, respectively). Such changes were not observed in the case of IFN-gamma and IL-6. This may suggest that TNF-alpha as well as IFN-alpha are secreted by fungi-prestimulated leukocytes from the lower respiratory tract and may be involved in the processes of exacerbation of asthma complicated by fungal infections. Further analyses of relationships between changes in cytokine levels and clinical parameters indicated that IFN-alpha seems to be of particular interest in fungal stimulation of asthma.

[Chylomicronemia syndrome in 45 years old man]. / Zespól chylomikronemii u 45-letniego mezczyzny.

The case of chylomicronemia syndrome in 45 year old man, previously misdiagnosed as hypercholesterolemia is described. Secondary causes of hyperlipoproteinemia were excluded. No symptoms, characteristic of familial lipoprotein lipase deficiency were observed. We concluded that the diagnosis of hyperlipoproteinemia has to be based on determination of all plasma lipids concentrations (total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol). Otherwise a false diagnosis is quite possible. In rare cases additional laboratory tests are needed.

[Allergy to nickel, chromium and cobalt after osteosynthesis]. / Alergia na nikiel, chrom i kobalt po zespoleniu kosci za pomoca laczników metalowych.

Metals are known as a common cause of contact allergies. The prevalence of sensitisation to the composite metals makes for a potential risk of osteosynthesis complications in patients suffering from long bones fractures. In the study the prevalence of delayed allergy to nickel sulphate, potassium dichromate and cobalt was estimated as well as the relation to the osteosynthesis complications. The atopy prevalence was estimated too. Persons under examination were divided into 3 groups. I--treated with osteosynthesis without complications (n = 20), II--treated with osteosynthesis with synostosis complications (n = 16) and III--negative controls (n = 34). We estimated 5% prevalence of delayed allergy to nickel in group I, 6.25% in group II and 5.8% in group III. In patients exposed to chromium we observed delayed allergy prevalence of 5.8% in group I and 3% in group III. No allergy to chromium in group II was revealed. No allergy to cobalt in all groups was revealed. The prevalence of atopy in group II was rare (6.35%) when in group I it was 45% and in controls 32%. The more frequent occurrence of type IV allergy to metals in atopic patients was not confirmed. There was no difference between the prevalence of delayed allergy to metals in groups I and II. Only one case of secondary allergy to chromium was observed.

[Secondary hypertension during a course of phaeochromocytoma in a 71-year old woman]. / Nadcisnienie wtórne w przebiegu guza chromochlonnego u 71-letniej chorej.

The case of secondary hypertension to pheochromocytoma in 71 year old woman is described. This woman has been made a false diagnosis of primary hypertension 10 years earlier. The primary objective of this paper was to call practitioners' attention to the necessity of penetrating diagnosis of arterial hypertension, also in elderly patients. Over-hasty diagnosis of primary arterial hypertension hampers the possibility of proper and causal treatment. Labile and paroxysmal hypertension with headache, tachycardia and sweating should alert the clinician to tumor of the adrenal medulla as well as the extra-adrenal paraganglion system (pheochromocytoma is the cause of arterial hypertension in 0.1-1.0% of all cases). Twenty four hours excretion level of vanillylmandelic acid in urine is of diagnostic relevance for patients with pheochromocytoma. The measurement which is done after elevation of blood pressure is more sensitive.