Actinomycosis mimicking urachal cancer / Urachustumort utánzó hasi actinomycosis

Összefoglaló. Az urachus tumorai és egyéb betegségei ritkák. A 67 éves férfi anamnézisében ismétlodo húgyúti fertozés szerepelt ciprofloxacinterápiával. Cisztoszkópia során a húgyhólyag felso részének másodlagos érintettségére utaló bullosus nyálkahártya képe mutatkozott. Az ezt követo CT-felvételek alapján az alsó medián hasfallal, húgyhólyaggal, belekkel összefüggo tumor iránydiagnózisát állították fel. A kivizsgálás során kialakuló ileus miatt Hartmann-mutétet végeztek, a tumoros jellegu elváltozás teljes és az érintett szervek részleges eltávolításával. A kórszövettani vizsgálat daganatos elváltozást nem talált, hasi, vélhetoen urachuseredetu actinomycosist igazolt: erre az eredetre a lokalizáció és a tünetek közt szereplo köldökváladékozás alapján lehetett gondolni, annak ellenére, hogy urachusmaradványt szövettanilag nem sikerült igazolni a mikroabszcedáló gyulladás által érintett szövetekben. A betegnél amoxicillinterápia indult. Átmeneti, hólyag melletti vizeletcsorgást követoen a beteg tünet- és panaszmentesen távozott a kórházból, de 13 nappal késobb a hasfali seb sterilnek véleményezett szétválása miatt ismét hospitalizálni kellett. Negatív nyomású sebkezelést követoen sikerült a hasat ismét zárni. A beteg ismét tünetmentessé vált, és fenntartott antibiotikumkezelés mellett hagyta el a kórházat. Az urachuskörnyéki tumorszeru elváltozások között az actinomycosis lehetoségét is szem elott kell tartani a differenciáldiagnosztikában. Orv Hetil. 2022; 163(4): 157-160. Summary. Tumours and other diseases of the urachus are rare. A 67-year-old male presented with a history of recurrent urinary tract infection and ciprofloxacin therapy. Cystoscopy suggested secondary involvement of the bullous upper bladder wall. The subsequent CT-based diagnosis was of a tumour infiltrating the lower median abdominal wall, the urinary bladder and bowels. Bowel obstruction developed and this led to partial resection of the involved organs along with a Hartmann's procedure. Histology revealed no neoplastic conditions, but proved abdominal actinomycosis of probable urachal origin based on the location of the tumour-like lesion and umbilical discharge among the symptoms. Urachal remnants were not identified in the perivesical tissues involved by the microabscess forming inflammation. Amoxicillin therapy was initiated. After a temporary urine leakage from the bladder, the patient became symptomless and was emitted from hospital. After 13 days, he was readmitted because of abdominal wound disruption, which was treated with negative-pressure wound therapy before the abdomen could be closed. At the time of reporting, he is still on amoxicillin, and has become symptomless again. Actinomycosis should be considered in the differential diagnosis of mass lesions of the urachal region. Orv Hetil. 2022; 163(4): 157-160.

[Significance of neutralizing antibodies to immunomodulatory therapy and their laboratory analysis in multiple sclerosis]. / Immunmoduláló terápia következtében kialakuló neutralizáló antitestek jelentosége es laboratóriumi meghatározása sclerosis multiplexben.

Interferon-alpha, -beta, and -gamma have been used for the management of several diseases with varying clinical effects. Like many other proteins, all interferon species are potentially immunogenic, especially those produced by recombinant gene technologies. A reliable screening assay for anti-interferon-beta antibodies is suggested for patients with multiple sclerosis receiving interferon-beta therapy. Natural interferon-beta is a glycosylated 166 amino acid 25 kDa protein, recombinant interferon-beta is available for therapy as 1a and 1b products. Both preparations induce anti-interferon-beta antibodies, detectable in the serum of interferon-beta-treated patients with multiple sclerosis. The question of which assay is optimal for testing for anti-interferon-beta antibodies in interferon-beta-treated patients is unsettled. Two types of antibody assays are generally used: those measuring binding antibodies and those measuring neutralizing antibodies. The findings suggest that high titers of both binding and neutralizing antibodies reduce the clinical efficacy of interferon-beta in relapsing-remitting multiple sclerosis, which is important for the long-term efficacy of these drugs. Treatment with glatiramer acetate has also been shown to induce the development of "reactive antibodies" in patients with multiple sclerosis. This article briefly describes some of the findings concerning anti-interferon binding and neutralizing antibodies.

A genome-wide screen for association in Hungarian multiple sclerosis.

Although the pathogenesis of multiple sclerosis (MS) is not fully understood, substantial evidence points to the involvement of genetic factors. We report on a genome-wide screen for disease association in the Hungarian population using 5532 microsatellite markers. These markers were typed in DNA pools that consisted of 88 MS patients (cases), and 128 unrelated controls. Based on a stringent selection criterion, we obtained 33 markers suggesting association with the disease.

Quality assurance for cerebrospinal fluid protein analysis: international consensus by an Internet-based group discussion.

A group of neurologists and clinical neurochemists representing twelve countries worked towards a consensus on laboratory techniques to improve the quality of analysis and interpretation of cerebrospinal fluid (CSF) proteins. Consensus was approached via a virtual Lotus Notes-based TeamRoom. This new approach respecting multicultural differences, common views, and minority opinions, is available in http://www.teamspace.net/ CSF, presenting the implicit, complementary version of this explicit, printed consensus. Three key recommendations were made: CSF and (appropriately diluted) serum samples should be analyzed together in one analytical run, i.e., with reference to the same calibration curve. Results are evaluated as CSF/serum quotients, taking into account the non-linear, hyperbolic relation between immunoglobulin (Ig)- and albumin-quotients rather than using the linear IgG index or IgG synthesis rate. Controls should include materials with values within the reference ranges (IgM: 0.5-1.5 mg/l; IgA: 1-3 mg/l; IgG: 10-30 mg/l and albumin: 100-300 mg/l). The physiological, methodological and clinical significance of CSF/serum quotients is reviewed. We confirmed the previous consensus on oligoclonal IgG, in particular the usefulness of the five typical interpretation patterns. The group compared current external and internal quality assurance schemes and encouraged all members to maintain national or local traditions. Values for acceptable imprecision in the CSF quality assurance are proposed.