Sjögren's syndrome salivary gland immunopathology: increased laminin expression precedes lymphocytic infiltration.

Previous studies have demonstrated increased expression of a laminin-like protein in labial salivary glands from Sjögren's syndrome (SS) patients. The objective of the present study was to verify the identity of this protein and to compare lymphocytic infiltration and laminin expression in minor salivary gland ductal epithelium. This was carried out by comparing laminin protein and laminin mRNA expression in 13 SS patients, 11 normal controls, and 12 patients with non-specific sialoadenitis. Laminin protein and laminin mRNA expression was determined using immunoperoxidase (IP) and in situ hybridization (ISH) techniques, respectively. In addition, the relationship between lymphocytic infiltration and laminin expression was evaluated on adjacent serial salivary gland sections from SS patients, using routine histological methods and IP immunohistochemistry. Biopsies from SS patients showed significant increases in staining for both laminin protein and laminin mRNA compared to normal controls. On seven of the eight SS samples that showed significant laminin protein staining, the ductal epithelial staining occurred in the absence of periductal lymphocytic foci. Results of the ISH assay strongly suggest that the increased expression of the laminin-like protein is laminin, since the cDNA probe was specific for the B1 chain of laminin. In addition, this increased expression in ductal epithelial cells occurs without significant lymphocytic infiltration. These studies provide further evidence that altered laminin expression is an early event associated with salivary gland pathology in SS, since these data demonstrate a potential pathologic event prior to the arrival of lymphocytes. Further studies are underway to examine the relationship between laminin and lymphocytic infiltration in salivary gland pathology.

Salvage from cardiogenic shock by atherectomy after failed emergency coronary artery angioplasty.

In this case report of a patient undergoing angioplasty for cardiogenic shock during acute myocardial infarction, recurrent occlusion resulted in recurrence of shock. Atherectomy reestablished lasting patency and reversed the patient's hemodynamic collapse. Atherectomy deserves further investigation as a means to salvage vessel patency during unsuccessful coronary angioplasty.

Blood pressure in four remote populations in the INTERSALT Study.

Four remote population samples (Yanomamo and Xingu Indians of Brazil and rural populations in Kenya and Papua New Guinea) had the lowest average blood pressures among all 52 populations studied in INTERSALT, an international cooperative investigation of electrolytes and blood pressure. Average systolic blood pressure was 103 versus 120 mm Hg in the remaining INTERSALT centers; diastolic blood pressure in these four population samples averaged 63 versus 74 mm Hg in the 48 other centers. There was little or no upward slope of blood pressure with age; hypertension was present in only 5% of the rural Kenyan sample and virtually absent in the other three centers. Also in marked contrast with the rest of the centers was level of daily salt intake, as estimated by 24-hour urinary sodium excretion. Median salt intake ranged from under 1 g to 3 g daily versus more than 9 g in the rest of INTERSALT populations. Average body weight was also low in these four centers, with no or low average alcohol intake, again unlike the other centers. The association within these four centers between the above variables and blood pressure was low, possibly reflecting their limited variability. While several other INTERSALT centers also had low average body weight or low prevalence of alcohol drinking, when this was accompanied by much higher salt intake (7-12 g salt or 120-210 mmol sodium daily), hypertension prevalence ranged from 8% to 19%. These findings confirm previous reports that in populations with a low salt intake, there is little or no hypertension or rise of blood pressure with age.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation in Papua New Guinea of a urine coagglutination test and a Widal slide agglutination test for rapid diagnosis of typhoid fever.

Two simple rapid tests for the laboratory diagnosis of typhoid fever were evaluated, a coagglutination test for detecting Salmonella typhi antigens in urine and a Widal slide agglutination for detecting serum antibodies. Ninety-two culture-confirmed typhoid cases were compared with 64 non-typhoid fever patients, 50 close contacts of typhoid patients, 30 vaccinated staff and 72 healthy community members. A strong urine Vi coagglutination was found to be 86.5% sensitive and 91.8% specific for typhoid, but was not always easy to read. The slide Widal H was found to be 99% sensitive and 95% specific whereas the slide Widal O was 98% sensitive and 98% specific. These data suggest that a single slide Widal O, at a reciprocal titre of 40, is the most suitable rapid test for the diagnosis of typhoid in a population with low typhoid antibody levels in the community, few other cross-reacting Salmonella infections, and a tendency for patients to present late in the infection.

Relationship between C4 null genes, HLA-D region antigens, and genetic susceptibility to systemic lupus erythematosus in Caucasian and black Americans.

The complement components C4A, C4B, and factor B, and the HLA-A, B, C, DR, DQ, and DRw antigens were analyzed in 103 patients (66 Caucasian, 37 black) with systemic lupus erythematosus (SLE) and 98 control subjects (63 Caucasian, 35 black). Only the C4A null (silent) allele was significantly increased in SLE (0.254 versus 0.095 in Caucasians, p = 0.033; 0.200 versus 0.071 in blacks, p = 0.046). The absence of any detectable C4A gene products (homozygous C4A null or C4A*Q0,Q0) was found in 11.1 percent of Caucasian patients but in no control subjects (p = 0.006 with relative risk of 16.86). HLA-DR2 was significantly associated with Caucasian SLE (R2 = 0.63, p less than 0.0012). Multivariate analysis demonstrated that the HLA-DR2 antigen and C4A null allele contributed independently to the risk of SLE (relative risk 3.0 and 3.2, respectively); when HLA-DR2 and the homozygous C4A null phenotype were present together, the relative risk of SLE was 24.9. Both HLA-B8 and HLA-DR3 were increased in SLE, but these antigens are in linkage disequilibrium with the C4A null allele; the presence of HLA-B8 or DR3 did not contribute further to the risk of SLE. It is concluded that the HLA-DR2 antigen and the C4A null allele are independent and additive risk factors for development of SLE.

Diagnosis of disseminated coccidioidomycosis by liver biopsy.

The liver is commonly involved at autopsy in disseminated coccidioidomycosis, but it is distinctly unusual to diagnose disseminated coccidioidal disease by a liver biopsy. We describe three patients with hepatic coccidioidomycosis diagnosed by liver biopsy in addition to the four previously reported cases in the literature. Most patients had a hepatitislike illness with pulmonary infiltrates of short duration. Hepatomegaly and/or abnormal liver function test results were present in six of seven patients. All patients had an abnormal chest roentgenogram. Eosinophilia was found in five patients. Every biopsy specimen showed evidence of granulomas containing readily identifiable coccidioidallike spherules. The condition of six of seven patients improved following therapy and only one died. Hepatic coccidioidomycosis is an unusual manifestation of dissemination that is commonly a hepatic-pulmonary syndrome with eosinophilia. The diagnosis is readily made with liver biopsy, and the outcome may be more favorable than other forms of dissemination.

The echocardiographic diagnosis of calcified mitral annulus.

Echocardiograms were recorded in six patients with calcification of the mitral annulus. Echocardiographic sweep from the aorta to the left ventricular cavity revealed dense echoes, representing annulus calcification, posterior to the mitral valve. Characteristic calcium deposits in the region of the mitral annulus were detected on the chest roentgenogram of only a single subject. Cardiac fluoroscopy fluoroscopy demonstrated calcified mitral annulus in all patients. In one patient, coexisting calcified mitral annulus and proven pericardial effusion were diagnosed echocardiographically. It is concluded that the echocardiogram represents a useful noninvasive technic for the diagnosis of calcified mitral annulus.

Correlation of electrocardiogram and vectorcardiogram with coronary occlusion and myocardial contraction abnormality.

Electrocardiograms and Frank vectorcardiograms were recorded in 156 consecutive patients with total occlusion of at least one coronary artery (on arteriography) and associated left ventricular contraction abnormality (on ventriculography). The angiograms and cardiograms were independently reviewed. In the presence of single vessel occlusion, appropriate vectorcardiographic diagnosis of myocardial infarction was determined in 118 of 156 cases (76 percent) compared with a lower electrocardiographic detection rate in 77 of 156 cases (49 percent). Findings diagnostic of two coexisting infarctions were observed in 71 percent of vectorcardiograms and 37 percent of electrocardiograms in 51 patients with double vessel occlusion and two areas of left ventricular dyskinesia. The vectorcardiographic detection rate was similarly superior to the electrocardiographic rate in the presence of subtotal coronary occlusion and myocardial asynergy in single (73 percent versus 53 percent) and double (53 percent versus 28 percent) vessel disease. The incidence rate of false positive diagnoses was 3 percent for electrocardiography and 4 percent for vectorcardiography. It is concluded that the vectorcardiogram is superior to the electrocardiogram in the diagnosis of obstructive coronary artery disease and left ventricular contraction abnormality.