Antibodies to the extractable nuclear antigens (ENA) in Pakistani patients with systemic rheumatic disease.

Autoantibodies to the saline extracts of cells are being used as diagnostic and prognostic markers in the investigation of patients with suspected systemic rheumatic disease. These are also called antibodies to the extractable nuclear antigens or anti ENA antibodies. We used saline extracts of human spleen cells and rabbit thymus extract to detect six subtypes of anti ENA antibodies, namely anti SSA (anti Sjogren's syndrome A), anti SSB (anti Sjogren's syndrome B), anti RNP (anti Ribonucleoprotein), anti Sm (anti Smith), anti Jo-1 (anti Jo-1) and anti Scl 70 (anti Systemic sclerosis 70) antibodies. Two hundred and thirty-seven patients' sera were screened in the department of Immunology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, over a period of 16 months. Fifty-seven were positive for auto antibodies, of which 26 had anti SSA antibodies, 12 anti SSA+ anti RNP+ anti Sm antibodies, 7 anti RNP+ anti Sm antibodies, 6 anti SSA+ anti SSB antibodies, 5 anti SSA+ anti RNP antibodies while one patient showed only anti RNP antibody. The detection of the anti ENA antibodies was specially helpful in diagnosing patients with systemic lupus erythematosis presenting with atypical features and with mixed connective tissue disease.

Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders.

BACKGROUND: Retinal ischemia induces intraocular neovascularization, which often leads to glaucoma, vitreous hemorrhage, and retinal detachment, presumably by stimulating the release of angiogenic molecules. Vascular endothelial growth factor (VEGF) is an endothelial-cell-specific angiogenic factor whose production is increased by hypoxia. METHODS: We measured the concentration of VEGF in 210 specimens of ocular fluid obtained from 164 patients undergoing intraocular surgery, using both radioimmuno-assays and radioreceptor assays. Vitreous proliferative potential was measured with in vitro assays of the growth of retinal endothelial cells and with VEGF-neutralizing antibody. RESULTS: VEGF was detected in 69 of 136 ocular-fluid samples from patients with diabetic retinopathy, 29 of 38 samples from patients with neovascularization of the iris, and 3 of 4 samples from patients with ischemic occlusion of the central retinal vein, as compared with 2 of 31 samples from patients with no neovascular disorders (P < 0.001, P < 0.001, and P = 0.006, respectively). The mean (+/- SD) VEGF concentration in 70 samples of ocular fluid from patients with active proliferative diabetic retinopathy (3.6 +/- 6.3 ng per milliliter) was higher than that in 25 samples from patients with nonproliferative diabetic retinopathy (0.1 +/- 0.1 ng per milliliter, P = 0.008), 41 samples from patients with quiescent proliferative diabetic retinopathy (0.2 +/- 0.6 ng per milliliter, P < 0.001), or 31 samples from nondiabetic patients (0.1 +/- 0.2 ng per milliliter, P = 0.003). Concentrations of VEGF in vitreous fluid (8.8 +/- 9.9 ng per milliliter) were higher than those in aqueous fluid (5.6 +/- 8.6 ng per milliliter, P = 0.033) in all 10 pairs of samples obtained simultaneously from the same patient; VEGF concentrations in vitreous fluid declined after successful laser photocoagulation. VEGF stimulated the growth of retinal endothelial cells in vitro, as did vitreous fluid containing measurable VEGF. Stimulation was inhibited by VEGF-neutralizing antibodies. CONCLUSIONS: Our data suggest that VEGF plays a major part in mediating active intraocular neovascularization in patients with ischemic retinal diseases, such as diabetic retinopathy and retinal-vein occlusion.

Anti-neutrophil cytoplasmic auto antibodies (ANCA) in Pakistani patients with systemic vasculitides.

Anti-neutrophil cytoplasmic auto antibodies are directed against antigens in the neutrophil granules. Their detection by the indirect immunofluorescence clearly divides them into two distinct types, namely c-ANCA (Classical antineutrophil cytoplasmic antibody) and the p-ANCA (Perinuclear antineutrophil cytoplasmic antibody). These antibodies have been found to be useful as non-invasive markers to help establish the diagnosis in patients with systemic vasculitides. The antibodies also help in monitoring disease activity in some patients with systemic necrotising vasculitides. This study was aimed at demonstrating the utility of these auto-antibodies in the management of our patients presenting with systemic vasculitides. Fifty-six patients presenting with features of systemic vasculitides were examined over a six month period out of whom eight were found positive for these antibodies. The detection of these antibodies helped in early diagnosis and the institution of specific treatment. Six months follow-up in one patient with Wegener's granulomatosis, the disease activity related closely with the ANCA levels.

Orofacial manifestations of Sturge-Weber syndrome. Review with a case report.

Sturge-Weber syndrome is reported in a 19 year old male. Intraoral manifestations of SWS are uncommon. Hence, the present case is reported for the presence of gingival capillary hemangioma which was surgically treated. A review from the literature pertaining to orofacial manifestations of SWS is given.

Retinal vascular reactivity to norepinephrine and angiotensin II in normals and diabetics.

Retinal arterial vasoconstriction induced by an infusion of angiotensin II or norepinephrine was investigated in eight normal controls (N), nine diabetics without retinopathy (DNR), and 10 diabetics with retinopathy (DR) by color fundus photographs taken before and after the infusions. Image analysis was done by a semiautomated computerized microdensitometer using a videoscanner. Normal controls and diabetics without retinopathy had a significant reduction in diameter compared with diabetics with retinopathy, who failed to constrict arterioles in response to either vasopressor. The mechanism of this phenomenon is unclear. Semiautomated computerized microdensitometry is reproducible and appears to be a sensitive technique to evaluate the vascular reactivity of the retinal vasculature.