Differences in stress response between patients undergoing transurethral resection versus endoscopic laser ablation of the prostate for benign prostatic hyperplasia.

The objective of the study was to determine the differences in systemic stress response in patients undergoing transurethral resection of the prostate (TURP) versus endoscopic laser ablation of the prostate (ELAP) for benign prostatic hyperplasia (BPH). The study included 48 patients with BPH (24 treated by TURP and 24 by ELAP). Blood samples were taken from each patient before and immediately after the procedure and on postoperative days 1, 6, and 20, respectively. TURP caused more intense acute-phase response during 24 h after the procedure considering the serum c-reactive protein (CRP) level (p < 0,001) and absolute leukocyte (p = 0.001) and neutrophil number (p = 0.003) in peripheral blood. ELAP caused more decrease in the number of natural killer cells immediately after the procedure (p = 0.048). There were no statistically significant differences between TURP and ELAP procedures in protein and creatine kinase (CK) levels, adrenocorticotropic hormone, and cortisol as well as other immunological parameters. TURP causes more intense acute-phase response than ELAP.

Clinical usefulness of cellular antigen stimulation test in detection of aspirin allergy.

Acetylsalicylic acid, commonly known as aspirin, can induce some hypersensitive reactions with clinical symptoms such as urticaria, angioedema, acute bronchospasm, and rarely anaphylactic shock. At present, detection of aspirin allergy is still rather difficult and requires an adequate clinical history and sensitive in vivo and in vitro tests. The aim of the study was to evaluate the diagnostic utility of cellular antigen stimulation test (CAST) in the detection of allergic reaction mediated by aspirin. Fifty patients (39 women and 11 men) with a history of hypersensitivity reaction to aspirin were included in the study. Positive scratch test to aspirin was found in 72% (36/50) and positive CAST in 58% (29/50) of patients. Both skin scratch test and CAST positive results were recorded in 48% (24/50%) and negative results in 20% (9/45) of patients. The level of agreement between skin scratch test and CAST was fair with Cohen's kappa of 0.269 (0.95% CI 0.004-0.533). The observed between-test agreement was 66%. It is concluded that CAST-ELISA might be of value as an additional test for the detection of aspirin nonallergic hypersensitivity in suspected individuals.

Antineutrophil cytoplasmic antibodies (ANCA): diagnostic utility and potential role in the pathogenesis of vasculitis.

Antineutrophil cytoplasmic antibodies (ANCA) are a heterogeneous group of circulating antibodies directed toward the cytoplasmic constituents of neutrophils and monocytes. ANCA have been described in various diseases including idiopathic systemic vasculitides, connective tissue diseases, inflammatory bowel diseases, autoimmune liver diseases, infectious diseases, and some drugs. ANCA recognize different target antigens such as proteinase 3 (PR3-ANCA), myeloperoxidase (MPO-ANCA), cathepsin G, lactoferrin, bactericidal/permeability-increasing protein (BPI), and some others. However, only PR3-ANCA and MPO-ANCA are closely associated with systemic vasculitides, in particular Wegener's granulomatosis, microscopic polyangiitis and its renal limited manifestation, and Churg-Strauss syndrome. Both in vitro and in vivo experimental data strongly support a pathogenic role for ANCA in vasculitis and glomerulonephritis.

Cellular and humoral immunity to purified protein derivative (PPD) in PPD skin reactive and nonreactive patients with pulmonary tuberculosis: comparative analysis of antigen-specific lymphocyte proliferation and IgG antibodies.

AIM: To evaluate in vitro reactivity against tuberculin purified protein derivative (PPD) in patients with active pulmonary tuberculosis scoring either positive or negative upon intradermal PPD application (PPD-DTH). METHOD: Two groups of patients with pulmonary tuberculosis, 22 PPD+ and 22 PPD-, were studied. Peripheral blood mononuclear cells (PBMC) were assayed for in vitro proliferation to PPD antigen, phytohaemagglutin, concanavalin A, and pokeweed mitogens. In the proliferation assay PBMC were incubated in a medium supplemented with serum (20% concentration) from healthy donors, autologous serum, or allogenic serum. Anti-PPD IgG concentration in patients sera were analyzed by ELISA. CD3+ lymphocytes from 10 patients in each group were tested for the expression of surface activation markers (HLA-DR and CD25/IL-2 receptors) by flow cytometry. RESULTS: PPD- patients showed clinically and radiologically more advanced forms of pulmonary tuberculosis as compared with PPD+ patients. PBMC from both groups of patients proliferated in response to PPD effectively, but significantly higher de novo DNA synthesis was observed in PPD+ patients (p<0.001). Proliferative activity was not affected by the type of the serum supplement (autologous or allogenic) in the culture medium. Mitogen stimulation elicited similar proliferative responses in both groups. Similar percentages of T-lymphocytes and T-lymphocytes expressing CD25 activation markers were observed in both groups of patients. There was a borderline difference in the percentage of CD3+HLA-DR+ lymphocytes between these two groups of patients (p=0.05). At 1:1000 serum dilution a significant difference (p=0.002) in anti-PPD IgG concentrations was found between PPD- and PPD+ patients. CONCLUSION: Patients with active pulmonary tuberculosis with a more favorable clinical course have a more potent specific cell-mediated immunity to PPD (positive skin reactivity in vivo and significantly greater lymphocyte proliferative response in vitro) than patients with a clinically more severe form of the disease. The concentration of PPD specific IgG in the serum appears to be higher in patients with relatively more severe forms of the disease.