Is the clinical picture of Schnitzler syndrome always Schnitzler syndrome?

Here we present two cases, a female and a male patient with Schnitzler-like syndrome. Both patients had two major (monoclonal gammopathy and chronic urticaria) and almost all minor symptoms (e.g. arthralgia, bone pain, fever, etc.) of Schnitzler syndrome. It is considered that interleukine (IL)-1 has important influence on immunopathogenesis of Schnitzler syndrome. However, when looked at the immune response in our two patients, we found significant differences between them. In the sera of the female patient, IL-1beta was increased. However, the highest increase was found for granulocyte- colony stimulating factor (G-CSF), IL-32 alpha and IL-17E (IL-25). The male patient had a significant increase in the percentage of NK-cells, a decrease in CD4+ helper cells and no increase in cytokine levels. In both patients an increase in CD40L (CD154) was found. Our statement is that, besides clinical symptoms and signs, additional immune parameters should be tested before diagnosis of Schnitzler syndrome is established.

Electrocardiographic changes and myocarditis in trichinellosis: a retrospective study of 154 patients.

The frequencies of electrocardiographic (ECG) abnormalities and myocarditis were determined, retrospectively, among 154 cases of trichinellosis [101 males and 53 females, with a mean (S.D.) age of 35.60 (14.64) years] who were hospitalized at the University Hospital for Infectious Diseases in Zagreb, Croatia, over a 5-year period. Eighty-seven (56%) of the patients, most of them in the invasive phase of infection with Trichinella spiralis, were found to have abnormalities when examined by 12-lead, resting electrocardiography. The ECG disorder most frequently observed was a non-specific ventricular repolarization disturbance (with ST-T wave changes), followed by bundle-branch conduction disturbances, and sinus tachycardia. The other ECG disorders recorded, during various phases of the infection, were sinus bradycardia, right bundle-branch block, supraventricular and ventricular extrasystoles, low-voltage QRS complexes in standard limb leads, first-degree atrio-ventricular block, and atrial fibrillation. Eighteen (12%) of the patients were identified as cases of myocarditis (13 in the invasive phase and five in the convalescent) and two (1.3%) as cases of myopericarditis. One patient developed acute myocardial infarction 28 days after the onset of disease and died soon thereafter; an autopsy revealed multiple necroses and fibroses of the myocardium and thrombus of a coronary artery. Although ECG abnormalities appear to be a common feature of trichinellosis, especially during the invasive phase of the disease, they are rarely associated with a poor prognosis. A transient, non-specific, ventricular-repolarization disturbance is the abnormality most commonly observed.

Duration of clinical symptoms in female patients with acute urethral syndrome caused by Chlamydia trachomatis treated with azithromycin or doxycycline.

One hundred fifty-one female patients with acute urethral syndrome caused by Chlamydia trachomatis were examined. First, patients were divided into two groups, those with clinical symptoms present < 3 weeks before the start of treatment, and those with clinical symptoms > or = 3 weeks prior to the beginning of therapy. Then patients were further divided into groups and randomized to receive azithromycin once daily in a single dose of 1.0 g or 500 mg once daily for 6 days, or to receive doxycycline 100 mg b.i.d. for 14 days or 100 mg b.i.d. for 7 days (8 study groups in all). Clinical and bacteriological efficacy was evaluated 3 weeks after the end of therapy. In the group of patients with disease symptoms lasting for 3 weeks or longer, the eradication and clinical cure rates were significantly higher after administration of azithromycin in a dose of 1x500 mg/6 days than after a single dose of 1.0 g (p<0.01), and after administration of doxycycline 2x100 mg/14 days than by using doxycycline 2x100 mg/7 days (p<0.05).

[Cholera threatens again]. / Kolera ponovno prijeti.

The etiology, epidemiology, pathogenesis, clinical manifestations and treatment procedures of cholera with the point to new experience are presented. This work was motivated by the intensifying interest for this old disease which has reappeared in Europe in epidemic form.

A gastric acid secretion model.

A theory of gastric acid production and self-protection is formulated mathematically and examined for clinical and experimental correlations, implications, and predictions using analytic and numerical techniques. In our model, gastric acid secretion in the stomach, as represented by an archetypal gastron, consists of two chambers, circulatory and luminal, connected by two different regions of ion exchange. The capillary circulation of the gastric mucosa is arranged in arterial-venous arcades which pass from the gastric glands up to the surface epithelial lining of the lumen; therefore the upstream region of the capillary chamber communicates with oxyntic cells, while the downstream region communicates with epithelial cells. Both cell types abut the gastric lumen. Ion currents across the upstream region are calculated from a steady-state oxyntic cell model with active ion transport, while the downstream ion fluxes are (facilitated) diffusion driven or secondarily active. Water transport is considered iso-osmotic. The steady-state model is solved in closed form for low gastric lumen pH. A wide variety of previously performed static and dynamic experiments on ion and CO2 transport in the gastric lumen and gastric blood supply are for the first time correlated with each other for an (at least) semiquantitative test of current concepts of gastric acid secretion and for the purpose of model verification. Agreement with the data is reported with a few outstanding and instructive exceptions. Model predictions and implications are also discussed.

Modulation of lateral transport of membrane components by spatial variations in diffusivity and solubility.

The effect of spatially varying diffusivity and solubility on the efficiency of intramembrane transport is investigated by obtaining solutions to the generalized lateral diffusion equation in which both the diffusion coefficient, D(r), and the partition coefficient, K(r), are functions of position. The mean-time-to-capture by a sink, tc, of particles diffusing in a plane is obtained analytically for the case of a sink surrounded by gradients in D(r) and K(r) with radially symmetrical geometry. It is shown that for particles originating at random locations, tc is shortened dramatically, if in an annular region around the sink, D and K are significantly greater than in the remainder of the plane. Similarly, a viscous boundary layer surrounding a sink is demonstrated to represent a significant barrier for diffusing particles. To investigate more complex geometries, a finite difference numerical integration method is used and is shown to provide comparable results for tc with modest computational power. The same method is used to calculate the tc for particles originating at a source that is joined to the sink by a channel. The increase in the rate with which particles travel from a source to a sink when they are joined by a high diffusivity and/or solubility channel is illustrated by several numerical examples and by graphical representations that show the equilibrium particle density (and hence the effective particle flow) in the presence of different sink, source, and channel combinations. These results are discussed in terms of fluidity domains and other membrane heterogeneities.

Resonance energy transfer from a cylindrical distribution of donors to a plane of acceptors. Location of apo-B100 protein on the human low-density lipoprotein particle.

The resonance energy transfer (RET) from a cylindrical assembly of donors to acceptors in a plane was investigated, and the dependence the average RET rate (kT) on the cylinder's size, shape, and proximity to the acceptor plane was determined. This geometry provides a model for the RET from a donor-containing protein to acceptors embedded in an associated phospholipid mono- or bilayer. The determination of kT for a series of acceptors at different levels in the phospholipid layer is shown to provide information on the protein's relationship to the phospholipid layer. Two models for the donor (D) and acceptor (A) distributions are employed: (a) The D's and A's are uniformly distributed in the cylinder and the plane, respectively, and analytical expressions for kT in terms of experimental parameters are derived. (b) The RET rates between all D, A pairs within the cylinder and in the plane are calculated and averaged for a large number of random D and A distributions. The average transfer rates obtained by the two approaches are in agreement and the width of the frequency distribution of kT for the latter provides an estimate of the error to be expected when, as is usually the case, the true D and A locations are unknown. This methodology is illustrated by analyzing RET from the 37 tryptophan residues of the apo-B100 protein to a series of pyrenylphosphatidylcholine acceptors inserted in the phospholipid monolayer of the human low-density lipoprotein particle, and it is concluded that significant portions of the protein penetrate the phospholipid layer.

Design optimization of a prosthesis stem reinforcing shell in total hip arthroplasty.

The use of a perforated, titanium funicular shell to support the proximal femoral cortex in total hip arthroplasty was evaluated with the aid of both analytical and numerical techniques. The principal interactions between the femoral cortex, the metal shell, the implant stem and the acrylic bone cement were modeled using beam on elastic foundations theory and two-dimensional elasticity theory. Subsequent formulation of this model as a nonlinear design optimization problem enabled the determination of the dimensions of the implant and reinforcing shell which minimized an objective function based on a simplified material failure criterion. Two cases were examined, each with two cervico-diaphyseal angles: case A: with a rigid contact between a proximal prosthesis collar and the calcar femorale and case B: no collar contact (a collarless prosthesis or post-operative loosening). Case A achieved an optimal solution at a stem diameter 11-23 percent of the cortex inner diameter, a stem length to diameter ratio of 12-40, shell diameter 22-53 percent and thickness 0.2-7.2 percent of the cortex inner diameter and thickness, respectively. Case B achieved an optimal solution at a stem diameter 67-92 percent of the cortex inner diameter, length to diameter ratio of 4-6, and no shell. In case A the collar support makes the type of internal fixation unimportant, while in the more realistic case B, the shell is not recommended.

[Clinical and epidemiologic characteristics of hemorrhagic fever with renal syndrome]. / Klinicke i epidemioloske znacajke hemoragijske groznice s bubreznim sindromom (HGBS).

Clinical and epidemiological data on 16 patients with HFRS admitted to the University Hospital of Infectious Diseases in Zagreb during the past 10 years (1977-1986) are reported. In 13 of them, the diagnosis was confirmed serologically by indirect fluorescent method. All but two were men between 20 and 45 years of age (80% of patients). The disease appeared sporadically only. According to the domicile, way of living and working all the patients but three mentioned the contact with rodents in the fields or in other places (mill, storehouse). Three patients live in Zagreb and there was no possibility to get infected out of the town. The disease had moderate course, more rarely severe course when shock and acute renal failure developed. General symptoms with fever and algias dominated (febrile stage). Some of the patients had ophthalmic disturbances. Patients with a pronounced gastroenteritis developed shock the most frequently. In some of the patients back and abdominal pains followed by obstipation appeared. HFRS was incriminated disease because of febrile stage followed by the acute renal failure, oliguria, azotemia, polyuria and low urine osmolity. One female patient with active rheumatoid arthritis died after two-week staying in hospital due to irreversible shock followed by cardiopulmonary and renal failure.

[Comparative study of thiabendazole and mebendazole in strongyloidiasis]. / Poredbeno ispitivanje tiabendazola i mebendazola u strongiloidozi.

Taking into consideration some statements about better efficacy and good tolerability of mebendazole and since thiabendazole has not been produced in our country the past few years we have conducted a study evaluating mebendazole, in comparison with thiabendazole in the treatment of patients with strongyloidiasis. Strongyloidiasis is a disease that should be treated with an effective and active drug since it can rapidly progress and be fatal in patients with disturbed immunocompetence. One hundred and ten patients with strongyloidiasis were treated with oral thiabendazole in a dosage of 50 mg/kg daily for two days; the other group of 41 patients was given mebendazole in a dosage of 10 mg/kg/day orally for five days. Clinical evaluations, parasitologic and hematologic tests were performed within three months after the therapy. Patients were considered to have been cured if parasitologic findings were negative and abnormal blood eosinophilia decreased below 0.09 (733/microliters). According to these criteria thiabendazole was effective in 96.4% of patients and mebendazole in 44% of patients only. We conclude that thiabendazole has still to be regarded the drug of choice in treating patients with strongyloidiasis. Mebendazole is far less effective in patients with this helminthiasis and very probably only suppresses the infection. The reports of other studies on the effect of some of the newer benzimidazole antihelmintics as cambendazole, albendazole and flubendazole have shown that they are toxic or less effective in the treatment of strongyloidiasis.