AllergoOncology: Opposite outcomes of immune tolerance in allergy and cancer.

While desired for the cure of allergy, regulatory immune cell subsets and nonclassical Th2-biased inflammatory mediators in the tumour microenvironment can contribute to immune suppression and escape of tumours from immunological detection and clearance. A key aim in the cancer field is therefore to design interventions that can break immunological tolerance and halt cancer progression, whereas on the contrary allergen immunotherapy exactly aims to induce tolerance. In this position paper, we review insights on immune tolerance derived from allergy and from cancer inflammation, focusing on what is known about the roles of key immune cells and mediators. We propose that research in the field of AllergoOncology that aims to delineate these immunological mechanisms with juxtaposed clinical consequences in allergy and cancer may point to novel avenues for therapeutic interventions that stand to benefit both disciplines.

"Single step" PCR with a sensitivity similar to nested PCR for the detection of hepatitis C virus RNA.

OBJECTIVE: Evaluation of the performance of different HCV PCR detection systems for HCV RNA: A nested PCR, considered the reference assay, was compared with two single-step methods (ss-PCR): the first is based on the detection of PCR products by liquid hybridization with a 32P end-labelled probe (isotopic ss-PCR), while the second assay is a colorimetric method (colorimetric ss-PCR) using microwell plate hybridization with a specific nucleic acid probe (Amplicor HCV PCR, Roche Diagnostics Systems). METHODS: Sera from 56 patients with suspected hepatitis C infection based on reactive serology or altered liver parameters, and sera from 15 blood donors were tested for HCV RNA: After RNA extraction, the synthesized HCV cDNA was amplified in parallel using isotopic ss-PCR, colorimetric ss-PCR and nested PCR. The products were detected by autoradiography, color development and ethidium bromide fluorescence, respectively. RESULTS: In order to assess the analytical sensitivity of ss-PCR versus that of nested of PCR, experiments included serial dilutions of positive control samples. Results showed that both methods had an extinction signal at the 1:512 dilution. A comparative analysis of 71 clinical sera samples was obtained using the three protocols and the results clearly documented 100% concordance. CONCLUSIONS: Single step PCR methods for HCV RNA have a sensitivity equal to that of nested PCR and appear more suitable for diagnostic applications. Ss-PCR is safer than nested PCR in terms of both specificity and contamination problems. In particular, the Roche Amplicor HCV PCR assay minimizes sample exposure and management problems.

The effect of thymic substances on T circulating cells of patients treated for Hodgkin's disease.

Forty-one patients with Hodgkin's disease staged as IA(4), IIA/B(4/6) IIIA/B(6/9) and IVA/B(3/9) who had had radiotherapy (subtotal nodal irradiation (STNI) or total nodal irradiation (TNI), or combined one (STNI/TNI plus chemotherapy MOPP or MOPP/ABVD) have been enrolled consequently and randomized to receive thymic hormone (17 patients) or pentapeptide treatment (14 patients) for 3-6 months at the end of the therapeutic regimens. In all patients severe immunodeficiency evaluated either as leukopenia (WBC less than 4000/mm3) or lymphocytopenia (lymphocytes less than 1500/mm3) or CD3 and CD2 cell reduction, or imbalance of helper/suppressor (H/S) ratio have been documented before starting thymic therapy. Different results by immunorestorative therapy have been registered according to the entity of immunodeficiency. In fact in the group of 15 patients with severe lymphopenia (lymphocytes less than 1000/mm3) either the thymic hormone or the synthetic drug produced a significant increase of all subsets examined: CD3-CD2-CD4-CD8 without or with minimal influence on H/S ratio, due to the increase of absolute lymphocytes count. In the remaining patients with mild or no lymphopenia the two drugs resulted ineffective on T cells. Comparing the overall group of patients who received thymic therapy with a control group of patients who did not, an advantage in terms of recruitment of T cell compartment has been observed in the former group when mean values are compared. According to the clinical impact of the immunotherapy with thymic substances on these patients, a significant decrease in incidence of herpes virus infection (HVI) has been observed in patients who had had thymic therapy compared with the incidence of HVI in the control group (18% versus 53.8%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative clinical study of a new imidazole molecule (fluconazole) and ketaconazole in the treatment of Candida albicans vulvovaginitis]. / Studio clinico comparato tra una nuova molecola imidazolica (fluconazolo) e il ketoconazolo nella terapia della vulvovaginite da Candida albicans.

A multicentre trial was carried out in Italy with the aim of comparing the efficacy, safety and tolerability of the oral administration of fluconazole with the oral administration of ketoconazole in the treatment of patients affected by Candida vulvovaginitis. A total of 174 patients with symptomatic Candida vulvovaginitis were identified both by objective examination and cell culture tests: of these 87 were treated using a single oral administration of fluconazole (150 mg) whereas the other 87 received 2 200 mg capsules of ketoconazole daily for 5 days. Tests to assess the efficacy, safety and tolerability of both treatments were carried out approximately 7 days and 5-6 weeks from the start of therapy. The results obtained showed a success rate of 92% for fluconazole-treated patients and 83% for those treated with ketoconazole. In addition to the rapid and safe efficacy of treatment, the most important findings which emerged from this study were the extreme simplicity of use, excellent patient compliance and the complete absence of collateral effects of variations in the hematochemical and urine parameters taken into consideration caused by fluconazole.

Reversal of sterilization by microsurgical technique.

Tubal sterilization techniques that spare the fimbriae and cause the least amount of tubal destruction offer the best chance for reversal of sterilization. Patients seeking reversal of sterilization should be carefully selected. Surgical technique and equipment are important factors in reversal procedures; microsurgical techniques are shown to be more effective than macroscopic techniques.

PIP: Microsurgical techniques enables successful results in tubal anastomosis for reversal of sterilization. Patients in the study had all been sterilized at the medial isthmic segment. Ideally, in this case, there was no luminal disparity and a relatively thick circular muscle coat. After the pathologic or fibrotic tissue had been removed, a series of 8/0 nylon stitches, which include only the muscular coat, was carried out under microscopy. 6 or 7 stitches usually are sufficient to make a watertight anastomosis. A 2nd layer of 8/0 nylon stitches was used to repair the gap in the mesentery and the serosa overlying the fallopian tube. The patency of the anastomosis was inspected at 1 year from the date of the procedure by celiochromoscopy. The good results obtained are the result of the careful techniques of reconstruction using microscopy and the right instrumentation. In all cases, it is most important to consider the site of sterilization. The isthmo-isthmic site is regarded as the most ideal for microsurgical reversal because it is the easiest site for an anastomosis. Silber maintains that the prospect for a normal pregnancy, after reversal, is directly proportional to the length of the remaining tube which is the only critical factor, as long as there is at least 1 cm of ampulla. The time interval that passes between sterilization and surgical reversals also needs to be considered as an influencing factor in terms of the successful results of the tubal reconstruction.

Single step immunophenotyping of acute leukemias not classifiable by standard morphology and cytochemistry: a practical approach.

BACKGROUND: Immunophenotyping is at present a useful aid and often an essential step for correct diagnosis of acute leukemia and for this purpose some investigators have proposed several immunomarker panels. This approach is particularly important in the differential diagnosis of acute leukemias not classifiable by standard morphology and cytochemistry. METHODS: We have tested peripheral blood and/or bone marrow samples from 125 patients not classifiable by FAB criteria. In all the cases, the reactivities of the same panel of 17 monoclonal antibodies were analyzed by flow cytometry, using both single and double fluorescent labeling. RESULTS: Of the 125 patients investigated, 75 (60%) were classifiable as ALL, 58 as B-lineage ALL and 17 as T-lineage ALL; 33 (26.4%) as AML, of which 2 M7; 6 (4.8%) as biphenotypic and 11 (8.8%) as immunophenotypically undifferentiated. CONCLUSIONS: From a critical analysis of our cases and a review of the literature, we suggest that a panel of 9 monoclonal antibodies (CD2, CD5, CD7, CD10, CD19, CD20, CD13, CD33, CD41), is sufficient for reliable, rapid and reasonably low cost typing of acute leukemia, useful for an immediate therapeutic decision.

[Home care for the diabetic within the limits of project--object: pilot project integrated into the health education of the diabetic. Veneto Region]. / L'assistenza domiciliare al diabetico nell'ambito del progetto-obiettivo: progetto pilota integrato per la tutela della salute del diabetico, Regione Veneto.

Twenty one district-nurses working in 13 districts were handed a questionnaire (one questionnaire for each patient), to collect data on nursing interventions and main problems of the 382 diabetic patients cared for. The diabetic patients are a very demanding population with a mean age of 78 years; 314 (82%) have a comorbidity, 272 (71%) severe limits on their physical functioning and 233 (61%) the diabetic foot; 183 patients (47%) are not capable of taking autonomous decisions. The nursing interventions for these patients are both technical (drawing blood samples, diagnostic exams) and educational on how to manage and monitor self-administration of insulin (31 patients, 10%), on self monitoring techniques (116 patients, 30%), on alimentation in general and change in food habits (289 patients, 94.1%). The role of the nurse in promoting patients' independence and in preventing complications is highlighted.

The clinical significance of the antiplatelet antibody test based on results for 265 thrombocytopenic patients.

BACKGROUND: The usefulness of measuring antiplatelet antibodies by ELISA or cytofluorimetric techniques for the diagnosis of idiopathic thrombocytopenic purpura is still uncertain. METHODS: We evaluated the clinical significance of two widely applicable antiplatelet antibody tests for a series of 265 patients evaluated consecutively in our Department for the diagnosis or follow-up of thrombocytopenia. Flow cytofluorimetry was used to measure platelet-associated immunoglobulins (PAIg) and the enzyme-linked immunosorbent assay (ELISA) was used to detect antiplatelet antibodies in patients sera (S-PBIg). The significance of antiplatelet antibody testing was addressed by studying the factors that influence test positivity, the diagnostic value of a positive test and the prognostic implication of a positive test. RESULTS: The platelet count was found to be strongly associated with positive PAIg or S-PBIg (P < 0.001), while neither splenectomy nor corticosteroid treatment affected PAIg or S-PBIg positivity. Both PAIg and S-PBIg were limited diagnostic value for the differential diagnosis of idiopathic thrombocytopenic purpura (ITP) from secondary thrombocytopenia for patients with platelet counts between 25,000 and 100,000 platelets/microliters, but the percentages of misclassified patients based on only the PAIg or S-PBIg test were 32 and 54%. We found no relationship between PAIg and/or S-PBIg at time of diagnosis and the patient's clinical response to corticosteroid therapy. CONCLUSIONS: We conclude that antiplatelet antibodies are strongly correlated with platelet counts, discriminate poorly between ITP and secondary thrombocytopenia and have negligible prognostic value. Therefore, we do not recommend performing antiplatelet antibody tests as a routine laboratory test in the diagnostic workup of thrombocytopenia.