[Diagnosis of drug allergy. Role of specific IgE and IgG determination]. / Diagnosi di allergia ai farmaci. Ruolo del dosaggio di IgE e IgG specifiche.

In the diagnosis of drug allergies, the anamnesis and, in some cases, prick tests are without doubt indispensable approaches but they are not always able to provide optimal prognostic levels. Moreover, prick tests are sometimes contraindicated owing to their potential danger. This study evaluated the diagnostic efficacy of a test in vitro--the assay of IgE- and IgG-specific (RAST)--for a group of 16 drugs in 88 patients referred for allergological consultancy after clinical manifestations attributable to the administration of a drug (30/88 cases) or more than one drug (58/88). Disorders had appeared at least one week after the start of drug treatment, an interval that is compatible with the development of an immune response. In 17/88 (19.3%) patients the in vitro test confirmed the presence of IGe and/or IgG against at least one of the drugs suspected in the anamnesis. In this series it was also found that there was a higher incidence of ADR in females (60/88) compared to males (28/88). Reactions to several drugs were more frequent than reactions to a single drug (58 cases vs 30). The association of ADR and the presence of other allergies in a particular individual was relatively rare (13/88 = 14.7%). These results confirm the value of RAST as a useful aid to improve the overall diagnosis of drug allergies and to make it safer.

Extrathoracic and intrathoracic airway responsiveness in sinusitis.

BACKGROUND: Asthma associated with sinusitis is supposed to be sustained by bronchoconstrictive reflexes originating in extrathoracic airway (EA) receptors. OBJECTIVE: The study was designed to evaluate the relationship between EA responsiveness and bronchial responsiveness in sinusitis. METHODS: We performed histamine inhalation challenge in 106 patients with chronic sinusitis, during disease exacerbation and after treatment with antimicrobials and nasal flunisolide (100 micrograms daily) for 2 weeks. Forced expiratory volume in 1 second (FEV1) and maximal mid-inspiratory flow (MIF50) were the respective indexes of bronchial and EA narrowing; the histamine concentrations causing a 20% fall in FEV1 (PC20) and 25% drop in MIF50 (PC25MIF50) were used as thresholds of bronchial and EA responsiveness. Thresholds of 8 mg/ml or less were assumed to indicate bronchial hyperresponsiveness (B-HR) or EA hyperresponsiveness (EA-HR). RESULTS: During sinusitis exacerbation 76 patients had EA-HR, which in 46 was associated with B-HR. The values of PC20 were closely related with those of PC25MIF50 (p < 0.001). EA-HR and B-HR were strongly associated with pharyngitis. After treatment, mean PC25MIF50 and PC20 were significantly increased (p < 0.001). The improvement of PC25MIF50 was closely related to that of PC20 (p < 0.001) and to the decrease in neutrophils in nasal lavage (p < 0.05). EA-HR reversed in 58 patients and improved in 10; B-HR reversed in 29 and improved in 12. CONCLUSIONS: Our findings suggest that in sinusitis, B-HR may be sustained by constrictive reflexes originating in pharyngeal receptors, made hypersensitive by seeding of the inflammatory process.

Serum thyroid hormone changes in head and neck cancer patients treated with microwave hyperthermia on lymph node metastasis.

Eleven patients with head and neck cancer (ten men, one woman; mean age, 65 years) (larynx, six; oropharynx, two; tongue, one; skin, one; thyroid, one) with regional lymph node enlargements either in contiguity or firmly adherent to the vascular structures of the neck have been treated by means of external microwaves (915, 434 MHz) applicators. All patients were treated by hyperthermia (42-45 degrees C) alone (ten sessions, twice a week, each lasting 30 minutes). Thyroid hormones (T4, T3, FT4, FT3, rT3, thyroid stimulating hormone less than obTSH]) were evaluated during sessions 1, 2, 3, and 8, just before the session (time [t] = 0) and at 10-minute intervals during the heating (t = 10, t = 20, t = 30). Blood was also taken 10 (t = 40) and 30 minutes (t = 60) after the end of each session. T4 showed a decreasing trend; T3 decreased significantly from t = 10 and reached the lowest values at t = 40 and t = 60; FT4 decreased at t = 40 and t = 60 at all sessions; FT3 and rT3 showed no change; TSH decreased at t = 10 until t = 40.

Lack of correlation between plasma cell thymidine labelling index and serum beta-2-microglobulin in monoclonal gammopathies.

Simultaneous evaluation of bone marrow plasma cell thymidine labelling index (LI) and serum beta-2-microglobulin (SB2M) was performed in 146 patients with multiple myeloma (MM) or monoclonal gammopathy of undetermined significance (MGUS). Eighty patients had MM on diagnosis, 11 were in relapse and 12 were in remission phase; 43 patients had MGUS. All the evaluated patients had normal renal function with a creatinine level less than 1.4 mg%. Overall there was no direct correlation between LI% and SB2M. LI% best reflected the proliferative capacity of the tumor clone itself being less than or equal to 1% in MGUS and MM in remission, but greater than 2% at relapse of MM. SB2M correlated best with the stage of disease and tumor burden. These two factors therefore have different clinical utility: LI is a useful parameter to detect disease stability (e.g., MGUS) or highly proliferative disease (aggressive MM at diagnosis or early relapse). SB2M remains the best single predictor of patient tumor burden and associated survival duration.

Kinetic analysis of the response of plasma glucose, insulin, and C-peptide to glucagon injection in normal and diabetic subjects.

A compartmental model formed by plasma glucose, proinsulin, insulin, and C-peptide was proposed to allow a quantitative evaluation of the interrelationship among the different components of the system and to obtain a better discrimination between normal and pathologic subjects. In 11 control subjects, in 6 mild diabetics, and in 9 severe diabetics (insulin-dependent), the kinetics of plasma glucose, insulin, and C-peptide after an i.v. injection of glucagon (sampling for about 120 min) were fitted to the model which was solved with digital computing techniques. Since biphasic plasma insulin and C-peptide kinetics were demonstrated in many normals and mild diabetics, the effect of glucagon in the model was represented by a differential plus a proportional effect. The model (formed by 6 compartments and 14 transfer constants) takes into account the fact that insulin and C-peptide derive monomolecularly from proinsulin and that liver inactivates insulin. The values of the parameters obtained were submitted to stepwise discriminant analysis in order to obtain their relative importance in discriminating among the three groups of subjects. With respect to normal subjects, we found in diabetics an increased inflow of glucose into plasma; a decreased effect of glucagon in promoting the proinsulin response; a decreased effect of glucose in promoting the proinsulin response; a decreased glucose utilization; a lower coupling effect of insulin on glucose; and a higher disappearance rate of C-peptide. We observed a lower formation of insulin and C-peptide from proinsulin in severe diabetics.

[Insulin receptors in the HL60 human promyelocytic leukemic cells line]. / Recettori insulinici nelle cellule della linea promielocitaria umana HL60.

The insulin binding characteristics of human promyelocitic HL60 cell line was studied by the use pf I(125) insulin. The binding activity was found to increase linearily both with the number of cells and with the incubation time. The competition curve with increasing concentration of unlabeled insulin demonstrated of specific receptors. The number of receptors was estimated to be 6.36 . 10(6) per cell.

[Decrease of insulin binding to human acute leukemic cells during chemically induced differentiation]. / Modificazioni dell'attivita' legante l'insulina di cellule leucemiche umane durante la differenziazione indotta da sostanze chimiche.

The specific insulin binding activity of human promyelocitic HL 60 cell line during the myeloid and macrophagic differentiation induced by chemical compounds was investigated. Dimethyl sulfoxide (DMSO) and retinoic acid myeloid induced differentiation in HHL 60 cells was accompanied by a marked decrease of insulin receptors. In K 562 cell line, where DMS O has no effect on differentiation, the number of insulin receptors was only slightly affected. 12-0-tetradodecanoil phorbol 13-acetate (TPA) induced macrophagic differentiation of HL 60 cell line was also accompanied by a decrease of insulin binding activity. Our results support the hypothesis that during the process of terminal differentiation a decrease of insulin receptors occurs.