Retrospective analysis of the Beijing family of Mycobacterium tuberculosis in preserved lung tissues.

Direct repeat spoligotyping of 85 paraffin-embedded lung biopsies was used to investigated the occurrence around Beijing of the Beijing family of Mycobacterium tuberculosis. Samples ranged in time from 1956 to 1990. Hybridization patterns were found with 49 (58%) samples, and 45 (92%) produced typical Beijing family patterns extending over the 34-year period.

Simultaneous detection and strain differentiation of Mycobacterium tuberculosis complex in paraffin wax embedded tissues and in stained microscopic preparations.

AIMS: To detect and differentiate Mycobacterium tuberculosis simultaneously by polymerase chain reaction (PCR) in clinical samples prepared for histopathological analysis and for microscopic detection of acid fast bacteria. METHODS: Paraffin wax embedded tissue samples and Ziehl-Neelsen (ZN) and auramine stained microscopic preparations from culture positive tuberculosis patients were subjected to DNA extraction and amplification by PCR. PCR was performed with primers specific for direct repeats and the product was detected by hybridisation to a set of 43 different oligonucleotides, a procedure designated as "spoligotyping". RESULTS: Mycobacterium tuberculosis complex DNA was detected in all of the 23 paraffin wax embedded tissues analysed. Strain differentiation was possible in 20 of the 23 paraffin wax embedded tissues. Mycobacterium tuberculosis complex DNA was also detected and typed in eight of 10 ZN stained microscopic preparations. The hybridisation patterns obtained from virtually all of these samples were identical to those obtained from DNA extracted from cultures. CONCLUSION: Simultaneous detection and strain differentiation of M. tuberculosis complex bacteria is possible in clinical samples prepared by current methods for microscopic and histopathological analysis, without the need to culture. The methodology described opens the way to rapid disclosure of outbreaks in high risk settings, such as hospitals and prisons, where dissemination of tuberculosis might be very fast as a result of a high prevalence of human immunodeficiency virus infected patients.

Hidradenitis suppurativa or acne inversa. A clinicopathological study of early lesions.

The pathogenesis of hidradenitis suppurativa (HS) has given rise to controversy about whether the central pathogenetic feature is an apocrine follicular occlusion (with subsequent bacterial infection) or it is a folliculitis with secondary involvement of both apocrine and eccrine sweat glands. Most previous concepts have focused on apocrine gland involvement. A prospective study of 27 consecutive patients (39 biopsies) was performed to investigate the immune-histological findings in early, newly formed lesions. Most of them were examined within 3 days of clinical onset. Histopathological findings showed that the initial lesion is an occluding spongiform infundibulo-folliculitis. Furthermore, it was found that T cells predominated in the lymphocytic cell population. A high percentage of HLA-DR positive lymphocytes was found in an inverse relationship with Leu-8 positive lymphocytes. Additionally, a sharp decline in the T-helper/suppressor ratio was observed after the initiation. These results reveal that the primary event in HS is an infundibulofolliculitis with secondary involvement of apocrine glands. Acne inversa would be a more appropriate name.

Metastatic malignant melanoma to the gastrointestinal tract.

Two cases of gastrointestinal metastasis of malignant melanoma are reported. We describe diagnosis and treatment of these metastases.

Computed tomography of pleural hyaloserositis.

Pleural hyaloserositis is an uncommon finding on routine chest X-rays. The images may simulate metastatic lesions. Four cases of pleural hyaloserositis are described in which computed tomography (CT) demonstrated calcified pleural pseudotumors.

Pulmonary defence mechanisms: damage and repair. Opportunities for intervention.

In this article pulmonary defence mechanisms and factors causing (progressive) tissue damage in some common settings of lower respiratory tract infections are dealt with. Opportunities for intervention are different, considering the proper cause. Passive immunization is appropriate in case of immune deficiency and active immunization applies to a series of clinical conditions in which the immune system for the greater part is intact but other defence mechanisms are impaired. Besides antibiotic treatment, anti-inflammatory therapy is considered beneficial, anticipating progressive tissue damage.

IgE deposition in normal skin of patients with rheumatoid arthritis in relation to clinical and laboratory findings.

Biopsy specimens from apparently normal skin of 28 patients with classical or definite rheumatoid arthritis (RA) were examined for the presence of IgE deposition by a direct immunofluorescence technique. IgE deposition was found in 12 patients (43%) and in none of the 10 controls. This deposition was mainly localised on mast cells, and in three patients perivascular IgE staining was also noted. The skin from nine of the 12 patients also showed deposition of IgM and complement C3 or C4 factor, or both. All 12 patients with skin IgE deposition had raised levels of IgM rheumatoid factor (RF) in the serum. Nine of these also had IgE RF. IgE-containing circulating immune complexes (IgE CIC), raised serum IgE levels, and extra-articular (EA) manifestations were present in respectively 10, nine, and eight skin IgE positive patients. It is suggested that IgE and IgE CIC may be involved in the pathogenesis of RA and its EA manifestations.

Veiled cells in the gastrointestinal tract.

Lately it has become known that for the initiation of an immune response an antigen presenting cell is needed. In the skin the antigen presenting cell system has been studied and is extensively supposed to consist of Langerhans' cells in the epidermis and dermis, veiled cells in the skin lymph, and interdigitating cells in the skin lymph nodes. These cells are considered to belong to the mononuclear phagocyte system which is in principle composed of cells stemming from the promonocyte/monocyte. To detect whether an antigen presenting cell system is present in the gut, we studied cell suspensions of gut tissues. Monoclonal cells with long actively moving cytoplasmic veils were found in cell suspensions from small intestinal villi of guinea pig and pig, but not of rat. These veiled cells appeared to be strongly Ia positive, as are the cells from the skin antigen presenting system. They share several ultrastructural and enzyme cytochemical characteristics with these skin cells. Gut veiled cells localize within the lympho-epithelium of Peyer's patches of the rat, just underneath this lympho-epithelium and in the T-dependent interfollicular area, according to Ia stainings on frozen tissue sections and to ultrastructural observations. From stainings with anti-IgA, -IgE, -IgG, -IgM and anti-T lymphocyte sera it is concluded that these cells do not belong to the lymphocyte series. It is suggested that these gut veiled cells belong to the monocyte/macrophage family and form an antigen presenting cell system in mucosa-associated lymphoid tissue, similar to the antigen presenting cell system in the skin.

Mononuclear phagocyte function in head and neck cancer. Chemotactic responsiveness of blood monocytes in correlation between histologic grade of the tumor and infiltration of these cells into the tumor area.

The chemotactic responsiveness of peripheral monocytes and the acid-phosphatase activity of tumor-infiltrating macrophages, as well as the ultrastructural appearance, were studied in 40 patients with squamous cell carcinoma of the head and neck. The chemotactic responsiveness was found to be decreased in carcinoma patients, and this value appeared to be positively correlated in individual patients with the number of tumor-infiltrating macrophages, as well as with the histologic grade of the tumor. Patients with poorly differentiated malignancies showed impaired monocyte chemotactic responsiveness and low numbers of tumor-infiltrating macrophages. Macrophages present in the parenchyma of the tumor showed a weak and diffuse pattern of acid phosphatase activity. The acid phosphatase activity of stromal macrophages was much stronger and distributed in foci. Electron microscopic examination of the parenchymal macrophages revealed low numbers of lysosomes and the presence of tumor cell debris in the cytoplasm of the cell, without any sign of a surrounding phagosomal membrane. Together with the weak cytochemical reactivity, this probably indicates the poor functional state of the phagocyte when infiltrated in the parenchyma of the tumor. Low molecular weight factors derived from the tumor are known to decrease chemotactic responsiveness of peripheral monocytes. The poor functional state of the macrophages infiltrated within tumor parenchyma might be explained by assuming that a high concentration of such factors in the near vicinity of malignant cells causes toxic effects in macrophages.

Large mononuclear Ia-positive veiled cells in Peyer's patches. II. Localization in rat Peyer's patches.

Dendritic Ia-positive veiled cells were seen in frozen sections of rat Peyer's patches within the lymphoepithelium, in the reticular area just underneath and in the T-dependent interfollicular area. From immunohistochemical stainings with anti-IgA, IgE, IgG, IgM and monoclonal anti T lymphocyte sera it is concluded that these Ia-positive cells do not belong to lymphocyte series. The ultrastructure of these Ia-positive veiled cells resembled the morphology of the veiled cells found in Peyer's patch cell suspensions and in skin lymph. It is suggested that these cells form an antigen presenting cell system in mucosa-associated lymphoid tissue, similar to the antigen presenting cell system in the skin.

Large mononuclear Ia-positive veiled cells in Peyer's patches. I. Isolation and characterization in rat, guinea-pig and pig.

The antigen presenting cell system in the skin is extensively studied, and is supposed to consist of Langerhans cells in epidermis and dermis, veiled cells in skin lymph and interdigitating cells in skin lymph nodes. In order to detect whether a similar cell system is present in the gut, we studied Peyer's patch cell suspensions. Mononuclear cells with long actively moving cytoplasmic veils were found in cell suspensions from Peyer's patches of rat, guinea-pig, and pig, and in cell suspensions from small intestinal villi of guinea-pig and pig, but not of rat. These veiled cells are strongly Ia-positive. Because of their Ia positivity, their enzyme cytochemical staining pattern, and their ultrastructure, these cells resemble the antigen presenting cells of the skin, skin lymph and lymph node.

Kartagener's syndrome: clinical symptoms and laboratory studies.

The purpose of this study was to develop a research program for the detection of congenital malfunction of cilia in the respiratory tract of selected patients with chronic respiratory infection. A clear difference was found between patients with Kartagener's syndrome and patients with respiratory tract infections of unknown etiology by studying patients employing this program, including examination of mucociliary clearance, ciliary motility and ciliary ultrastructure. The name "primary ciliary dyskinesia" is appropriate for emcompassing several ciliary abnormalities.