Interferon-gamma and bacterial lipopolysaccharide act synergistically on human neutrophils enhancing interleukin-8, interleukin-1beta, tumor necrosis factor-alpha, and interleukin-12 p70 secretion and phagocytosis via upregulation of toll-like receptor 4.

In human neutrophils, interferon (IFN)-gamma enhanced the expression of toll-like receptor 4 (TLR4), a crucial component of the signaling receptor complex for bacterial lipopolysaccharide (LPS). Lipopolysaccharide alone did not affect TLR4 expression, but costimulation with IFN-gamma and LPS induced higher levels of TLR4 expression than stimulation with IFN-gamma alone. Using the protein synthesis inhibitor cycloheximide and measuring the expression of CD35 in neutrophils stimulated with IFN-gamma and LPS alone or in combination, we could demonstrate that IFN-gamma enhances TLR4 by de novo protein synthesis, whereas the addition of LPS acts synergistically by enhancing vesicular mobilization to the cell surface. Costimulation with IFN-gamma and LPS induced neutrophil activation and enhanced secretion of the cytokines, interleukin (IL)-8, IL-1beta, tumor necrosis factor-alpha, and IL-12 p70, and phagocytosis of latex beads, processes that were blocked by a monoclonal antibody specific for TLR4. These data suggest that IFN-gamma primes neutrophils to respond to LPS.

Epstein-Barr virus-associated pericarditis and pericardial effusion: case report and diagnostic aspects.

We report the case of a 39-year-old patient suffering from acute pericarditis accompanied by considerable pericardial effusion, most probably secondary to acute Epstein-Barr virus infection, an etiology uncommonly reported with pericardial inflammation and effusion. Diagnostic aspects and the approach to etiologic evaluation are discussed.

[Incidence of influenza among patients admitted to the department of internal medicine during the winter season].

BACKGROUND: Influenza is a common disease, especially in the winter season. Influenza virus causes symptoms of acute viral illness, development of complications and worsening of chronic diseases. Vaccination may prevent influenza illness. OBJECTIVES: 1. To determine the rate of vaccination against influenza. Furthermore, in the immunized patients--the study aimed to determine the efficiency of the vaccination. 2. To determine the incidence of influenza illness among patients admitted to a Department of Internal Medicine during the winter season. METHODS: We performed a prospective screening of 124 consecutive patients hospitalized in the Department of Internal Medicine during February 1998. Demographic parameters (age, sex) and admission diagnosis were collected. All patients were asked about influenza vaccination in the last fall. Blood samples were collected on admission and 10-30 days later. Three relevant virus subtypes were examined. Virus subtype was determined in all patients with evidence of influenza illness. RESULTS: Eleven patients (8.9%) were found with evidence of acute influenza illness at the time of hospitalization. The rate of patients with chronic pulmonary disease was higher in this group than in the group without evidence of influenza (p = 0.03). Forty-four out of 124 patients (35.5%) had been vaccinated against influenza. In the vaccinated patients, the protective antibody level for all 3 subtypes developed in 27.3% of cases and for one or two subtypes in 50% of cases. In 22.7% of patients no protective level of antibody was detected for any subtype. CONCLUSIONS: It is necessary to encourage vaccination in the high-risk group patient, especially those with chronic pulmonary disease. It is essential to develop new vaccination strategies and prophylactic antiviral medications.

[Unilateral diaphragmatic paralysis in a diabetes patient].

Bilateral or unilateral diaphragmatic paralysis may be caused by motor neuron or muscle disease. Diabetic neuropathy, which is a common complication in diabetic patients, has a wide range of clinical manifestations. This is a case history of a 52 year old diabetic woman hospitalized with new paralysis of the right diaphragm. A thorough evaluation revealed no reason for diaphragmatic paralysis, other than diabetic neuropathy. A six month follow-up revealed significant clinical improvement. This article includes a summary of the literature, discussing the relationship between diabetes mellitus and diaphragmatic paralysis.

[Levels of INR in patients admitted to the department of internal medicine].

We reviewed the records of 282 patients admitted to the Department of Internal Medicine who had been treated at home with warfarin. In 181 patients INR was measured on the day of admission. Less than 20% of the 44 patients treated with warfarin for artificial valves had INR levels within the therapeutic range--3-4. Among the 138 patients treated with warfarin for atrial fibrillation only 31.9 were in the therapeutic range of 2-3. Seven patients in the atrial fibrillation group had very high values of INR--above 7. These patients were older (mean age 82 years) compared to 69.4 years in the rest of the group. Four patients with INR's above 7 had mild hemorrhagic events. Our data show that most patients treated with warfarin were not in the therapeutic range.

[Extensive subcutaneous hemorrhage complicating primary amyloidosis].

Bleeding manifestations are common in patients with primary as well as secondary amyloidosis and have been attributed to different mechanical and metabolic causes. Factor X deficiency has been described in patients with primary amyloidosis, although severe bleeding is not common in these patients. We describe a patient with extensive subcutaneous hematoma, a sign that served as the major indicator assisting us in establishing the diagnosis of primary amyloidosis.