Predominance of type 1 CD4+ T cells in human abdominal aortic aneurysm.

The functional repertoire of T cells in abdominal aortic aneurysm (AAA) and the exact nature of aortic wall adaptive cellular immune responses still remains a matter of debate. In this study, we sought to determine whether type 1 or type 2 responses occur predominantly in human aneurysmal aortic lesions. We first examined the phenotype and cytokine secretion profile of T lymphocytes freshly isolated from aneurysmal aortic wall for comparison with their circulating counterparts using flow cytometry. We found that both populations of infiltrating CD4(+) and CD8(+)T cells displayed a unique activated memory phenotype. In addition, we identified the presence in human aneurysmal aortic lesion of CD4(+)T cells producing high levels of interferon (IFN)-gamma but not interleukin (IL)-4, reflecting their type 1 nature. Quantitative analysis of cytokine gene expression confirmed increased IFN-gamma transcript levels in infiltrating cells compared to controls. We next analysed aortic wall responses using LightCycler-based quantitative real-time reverse transcription-polymerase chain reaction. Compared to control non-diseased aortic samples, we demonstrated that whole AAA tissues exhibited high mRNA levels of IFN-gamma but not IL-4. Overexpression of the transcription factor T-bet in the absence of significant GATA-3 expression further assessed the type 1 polarization of aortic wall immune responses. These findings indicate that type 1 CD4(+)T cells predominate in human AAA lesions. This study has important implications for the pathogenesis of aneurysm disease. Through the production of IFN-gamma, T cells may indeed contribute to orchestrate extracellular matrix remodelling.

Rehabilitation of high-frequency hearing loss with the RetroX auditory implant.

The RetroX is a new semi-implantable hearing aid which does not occlude the external ear canal. It consists of an electronic unit that plugs into a titanium tube which is implanted under the pinna so as to connect the retroauricular sulcus with the inside lumen of the external ear canal. Implantation requires minor surgery which can be performed under local anesthesia. Moreover, a pre-implant simulator exists and allows patients to try the device before deciding on definite implantation. The RetroX auditory implant is indicated in case of high-frequency sensorineural hearing loss with a steep slope (ski-slope audiogram). We implanted 25 adults suffering from such a hearing loss, and we report their hearing measured after 2.5 to 15 months of use. Four patients developed a persistent granulomatous reaction which disappeared after explantation. Two patients complained of acoustic feedback and needed supplementary fitting. Twenty three of our 25 subjects are satisfied or even extremely satisfied with the hearing improvement provided by the RetroX; they wear the implant daily, from morning until evening. Audiometrically, we observed a statistically significant improvement of the pure-tone thresholds at 1, 2, 4 and 8 kHz. In quiet, the speech reception thresholds decreased by 10 dB SPL and in noise, speech intelligibility increased by 15% for signal-to-noise ratios between -5 dB and +5 dB. Up till now, our patients were implanted monaurally because of financial considerations and our initial inexperience with this new implant. The overall results, however, are promising and nowadays, we advise bilateral implantation for patients who tolerate the first implant. By doing so, we hope to improve hearing in noise and spatial sound perception.

Severe atherosclerosis of the aorta and development of peripheral T-cell lymphoma in an adolescent with angiolymphoid hyperplasia with eosinophilia.

We report an adolescent girl with a history of angiolymphoid hyperplasia with eosinophilia (ALHE) diagnosed at the age of 10 years. The patient also suffered from chronic persistent multiresistant herpes simplex virus infection. Atherosclerotic occlusive disease of the abdominal aorta and its major branches was observed at the age of 17 years, necessitating vascular surgical intervention 1 year later because of disease progression. Histological examination of the aorta disclosed widespread atherosclerosis and high levels of gene expression of both T-helper cell type (Th) 1- and Th2-derived cytokines. This suggests that a highly stimulated systemic immune response including increased production of both Th1- and Th2-derived cytokines such as interferon-gamma and interleukin-4 may result in severe atherosclerotic lesions at a very young age. In addition, the patient developed a peripheral T-cell lymphoma at the age of 18 years. Neither systemic atherosclerosis nor T-cell lymphoma has been reported in association with ALHE. It is suggested that a highly stimulated dysfunctional immune response may play a key role in persistent inflammatory disease and premature development of atherosclerosis as well as malignant transformation of T cells.

The RetroX auditory implant for high-frequency hearing loss.

OBJECTIVE: The objective of this study was to analyze the subjective satisfaction and measure the hearing gain provided by the RetroX (Auric GmbH, Rheine, Germany), an auditory implant of the external ear. STUDY DESIGN: We conducted a retrospective case review. SETTING: We conducted this study at a tertiary referral center at a university hospital. SUBJECTS: We studied 10 adults with high-frequency sensori-neural hearing loss (ski-slope audiogram). INTERVENTION: The RetroX consists of an electronic unit sited in the postaural sulcus connected to a titanium tube implanted under the auricle between the sulcus and the entrance of the external auditory canal. Implanting requires only minor surgery under local anesthesia. MAIN OUTCOME MEASURES: Main outcome measures were a satisfaction questionnaire, pure-tone audiometry in quiet, speech audiometry in quiet, speech audiometry in noise, and azimuth audiometry (hearing threshold in function of sound source location within the horizontal plane at ear level). RESULTS: : Subjectively, all 10 patients are satisfied or even extremely satisfied with the hearing improvement provided by the RetroX. They wear the implant daily, from morning to evening. We observe a statistically significant improvement of pure-tone thresholds at 1, 2, and 4 kHz. In quiet, the speech reception threshold improves by 9 dB. Speech audiometry in noise shows that intelligibility improves by 26% for a signal-to-noise ratio of -5 dB, by 18% for a signal-to-noise ratio of 0 dB, and by 13% for a signal-to-noise ratio of +5 dB. Localization audiometry indicates that the skull masks sound contralateral to the implanted ear. Of the 10 patients, one had acoustic feedback and one presented with a granulomatous reaction to the foreign body that necessitated removing the implant. CONCLUSION: The RetroX auditory implant is a semi-implantable hearing aid without occlusion of the external auditory canal. It provides a new therapeutic alternative for managing high-frequency hearing loss.

[A simple audiometry test of speech intelligibility in background noise]. / Un test audiométrique simple pour mesurer l'intelligibilité vocale dans le bruit.

We propose a new audiometric test to assess French speakers' speech discrimination in noise. This soundfield test uses a standard cocktail-party background noise superimposed on Fournier's disyllabic word lists. The background noise is CD-recorded at constant 55 dB SPL. The discrimination score is measured at a signal-to-noise ratio of -5 dB, 0, and dB. In comparison with other audiometric tests in noise, our test requires only 5 minutes and is simple for both patient and audiologist. All patients are tested using the same standard condition, one that approaches daily life and uses a noise of moderate intensity. The result is reproducible and easy to calculate and graph. We propose this test for diagnosing in-noise speech intelligibility disorders and for assisting the process of conventional or implantable hearing-aid fitting.

[The medico-surgical department of vascular disease]. / Le Service Médico-Chirurgical de Pathologie Vasculaire.

The Department of Vascular Diseases can be defined as a multidisciplinary integrated clinical entity involving internists and surgeons interested in patient care, education and research in the field of arterial, venous and lymphatic diseases. Because of the increasing medical complexity with the proliferation of treatment options available, the combined expertise of specialists from different training background is required to provide the optimal patient management. The truly integrated entity with interactions on daily basis between internists and surgeons also provides opportunities for improvement in the training of fellows in vascular medicine. Basic and clinical research is focused on thrombosis and atherosclerosis. The main topics that have been developed include: the pathophysiology of thrombosis, atherogenesis and the diagnosis and treatment of venous thromboembolic disease. The successful development of our Department demonstrates that the combined expertise of internists and surgeons has resulted in marked improvement in the efficiency of patient management.

Prediction of pulmonary embolism extent by clinical findings, D-dimer level and deep vein thrombosis shown by ultrasound.

Pulmonary embolism (PE) may encompass a wide spectrum of severity. To determine whether clinical findings, D-dimer (DD) concentration, and deep vein thrombosis (DVT) shown by lower-limb venous compression ultrasonography (US) might predict the scintigraphic extent of PE, we studied 104 hemodynamically stable consecutive outpatients with acute PE diagnosed by a high-probability ventilation-perfusion lung scan. Scintigraphic extent of PE was classified into three categories: perfusion defects corresponding to <30%, 30-50%, or >50% of the total lung area. Median respiratory and heart rates were found to be significantly related to the extent of PE. Higher median alveolar-arterial oxygen difference values were observed as the proportion of lung perfusion defects increased (>50% vs. <30%, 6.3 vs. 3.6 kPa, P <.0001). Median plasma DD concentration was 7950 microg/L in patients with >50% perfusion defects compared to 2731 microg/L in those with <30% defects (P = .0001). DD levels above 4000 microg/L were associated to more extensive perfusion defects (>50% vs. <30% defects, OR 30; 95% CI 5.8-155). Finally, a proximal DVT was more likely among patients with larger perfusion defects (>50% vs. <30% defects, OR 4.5; 95% CI 1.5-13.6). In conclusion, clinical signs such as tachypnea and tachycardia, alveolar-arterial oxygen difference, plasma DD concentration, and presence of DVT on US are predictors of a larger PE, as assessed by the extent of perfusion defects on high probability lung scans.

Early inflammatory response after elective abdominal aortic aneurysm repair: a comparison between endovascular procedure and conventional surgery.

OBJECTIVE: To determine the nature of and to compare the inflammatory responses induced by (1) endovascular and (2) conventional abdominal aortic aneurysm (AAA) repair. MATERIAL AND METHODS: Twelve consecutive patients undergoing elective infrarenal AAA repair were prospectively studied. Seven patients were selected for endovascular procedures (the EAAA group); five patients underwent open surgery (the OAAA group). Three control patients undergoing carotid thromboendarterectomy were also included. Serial peripheral venous blood samples were collected preoperatively, immediately after declamping or placement of the endograft, and at hours 1, 3, 6, 12, 24, 48, and 72. Acute phase response expression of peripheral T lymphocyte and monocyte activation markers and adhesion molecules (flow cytometry), soluble levels of cell adhesion molecules (enzyme-linked immunosorbent assay), cytokine (tumor necrosis factor alpha, interleukin-6, and interleukin-8) release (enzyme-linked immunosorbent assay), and liberation of complement products (nephelometry) were measured. RESULTS: Regarding acute phase response, the EAAA and OAAA groups showed significant increases in C-reactive protein (P <.001 and P =.001), body temperature (P =.035 and P =.048), and leukocyte count (P <.001 and P <.001). Similar time course patterns were observed with respect to body temperature (P =.372). Statistically significant different patterns were demonstrated for C-reactive protein (P =.032) and leukocyte count (P =.002). Regarding leukocyte activation, a significant upregulation of peripheral T lymphocyte CD38 expression was observed in the OAAA group only (P =.001). Analysis of markers such as CD69, CD40L, CD25, and CD54 revealed no perioperative fluctuations in any group. Regarding circulating cell adhesion molecules, the EAAA and OAAA groups displayed significant increases in soluble intercellular adhesion molecule-1 (P =.003 and P =.001); there was no intergroup difference (P =.193). All groups demonstrated high soluble von Willebrand factor levels (P =.018, P =. 007, and P =.027), there being no differences in the patterns (P =. 772). Otherwise, soluble vascular cell adhesion molecule-1, soluble E-selectin, and soluble P-selectin did not appear to vary in any group. Regarding cytokine release, although a tendency toward high tumor necrosis factor alpha and interleukin-8 levels was noticed in the EAAA group, global time course effects failed to reach statistical significance (P =.543 and P =.080). In contrast, interleukin-6 showed elevations in all groups (P =.058, P <.001, and P =.004). Time course patterns did not differ between the EAAA and OAAA groups (P =.840). Regarding complement activation, the C3d/C3 ratio disclosed significant postoperative elevations in the EAAA and OAAA groups (P =.013 and P =.009). This complement product release was reduced in the EAAA group (P <.001). CONCLUSIONS: The current study indicated that both endovascular and coventional AAA repair induced significant inflammatory responses. Our findings showed that there were no large differences between the procedures with respect to circulating cell adhesion molecule and cytokine release. Moreover, the endoluminal approach produced a limited response in terms of acute phase reaction, T lymphocyte activation, and complement product liberation. This might support the concept that endovascular AAA repair represents an attractive alternative to open surgery. Given the relatively small sample size, further larger studies are required for confirmation of our observations.

Adventitial cystic disease of the popliteal artery communicating with the knee joint. A case report.

We describe the case of a patient with adventitial cystic disease of the popliteal artery in which a direct anatomic communication between the cysts and the nearby knee joint was demonstrated by magnetic resonance imaging and confirmed by surgery. This unusual observation could shed some light on the much debated question of the cause, the pathogenesis, and the management of the affection. Moreover, it emphasizes the importance and the role of magnetic resonance imaging in the diagnosis of adventitial cystic disease of the popliteal artery.

[The role of season in the incidence of deep venous thrombosis]. / Rôle de la saison dans l'incidence de la thrombose veineuse profonde.

INTRODUCTION: The question of the role of season as a predisposing factor for development of venous thromboembolic disease still remains a matter of debate. Actually, most reports described a higher incidence of thrombotic disorders in winter, while a recent study showed no seasonal variation in the incidence of deep vein thrombosis (DVT). These data led us to study the seasonal distribution of all outpatients with DVT admitted to our Department over a period of 14 years. METHODS: Retrospective review of the files of all outpatients with confirmed (venography or ultrasound) DVT of the legs admitted from Jan. 1st 1982 to Dec. 31st 1995 (n = 512; mean age 59.4 years; 49.4% women). RESULTS: DVT occurred in spring in 135 (26.4%), in summer in 104 (20.3%), in autumn in 142 (27.7%) and in winter in 131 (25.6%) patients. This distribution appears to be similar to an expected uniform distribution [chi 2(3) df = 6.48; p = 0.090 (NS)]. CONCLUSIONS: In our study, by investigating retrospectively 512 outpatients with confirmed DVT, no correlation was found between season and development of thrombosis, suggesting that cold seasons do not represent a predisposing factor for DVT. Further large prospective studies are needed in order to validate our data and to investigate the clinical implications and the precise role of the season in the risk of occurrence of venous thrombosis.

Pyogenic arthritis caused by streptococcus equisimilis (group-C streptococcus) in a patient with AIDS.

A patient with the Acquired ImmunoDeficiency Syndrome (AIDS) treated with a daily low dose of corticosteroids for chronic atopic dermatitis experienced a sudden episode of unilateral knee arthritis. Culture of the purulent synovial liquid yielded a pure culture of Streptococcus Equisimilis. A four week period of intravenous antibiotherapy combined with repeated drainages allowed a complete recovery of articular function.

Role of alveolar macrophages in precipitation of mineral elements inhaled as soluble aerosols.

The lysosomes of several varieties of cells such as the tubular proximal cell of the kidney and the alveolar macrophage have the ability to concentrate and precipitate several elements inhaled in water-soluble form, usually as phosphate. The mechanism involved is attributed to the high acid phosphatase activity of lysosomes and can be considered as an in vivo Gomori reaction. Among the elements studied, most of them are chemotoxic or radiotoxic (Cr; group IIIA: Al, Ga, In; rare earths: La, Ce, Tm; actinides: Th, U). In the lung macrophage, this mechanism of intralysosomal concentration and precipitation may prevent the diffusion of these toxic elements through the alveolar membrane.

Absence of aluminium in Alzheimer's disease brain tissue: electron microprobe and ion microprobe studies.

Brain tissue from the frontal cortex and hippocampal formation, taken at autopsy or biopsy from 7 patients with Alzheimer's disease, was studied by two methods of microanalysis. One case of Down's syndrome was also studied. Electron probe microanalysis of the frontal cortex and Ammon's horn of the hippocampus showed no aluminium in the various cell organelles, especially in the lysosomes, although some aluminium was found in a few contaminating dusts. Ion microscopy, a method of extremely high sensitivity, also showed the absence of an aluminium signal.

Morphologic and ultrastructural effects of Maalox TC on human gastric and duodenal mucosa.

Prostaglandins (PGs) and aluminum-containing antacids (Al.AAs) are effective in preventing gastric and duodenal lesions induced by neutralizing agents. The efficacy of Al.AAs is thought to be due to neutralizing properties and to stimulation of endogenous PGs synthesis. Liquid Maalox has the same effect as cimetidine 400 mg on postprandial duodenal acid load. In numerous prospective studies, Al.AAs have been shown to be as effective as cimetidine in the short-term treatment of duodenal ulcer (DU). Maalox TC at a dosage of 3 tablets b.i.d. provides an effective method for preventing DU relapse. Its effect is similar to that of nighttime cimetidine. Meta-analysis of prospective trials suggests that Al.AAs prevent stress ulcers more effectively than does cimetidine. It has been suggested that Al.AA acts by inducing surface epithelial cell disruption. Al-induced mucosal protection could be caused by a stimulated release of endogenous PGs, induced by Al microcrystal penetration of cells. In a recent study, we showed that small amounts of Al were absorbed by human gastric mucosa and accumulated in lysosomes; however, we did not observe any histological or ultrastructural lesions of the gastric mucosa. Prostaglandins (enprostil, misoprostol, and rioprostil) are as effective as cimetidine, but less effective than ranitidine, in healing DU. Enprostil and rioprostil have been shown to be as effective as ranitidine in treating gastric ulcer (GU). Moreover, enprostil inhibits postprandial gastrin release, whereas H2-blockers increase gastrin levels. Coadministration of misoprostol with aspirin is highly effective in healing aspirin-induced gastroduodenal lesions. Moreover, cotreatment with misoprostol was associated with a marked decrease in GU in patients with osteoarthritis receiving NSAIDs chronically.(ABSTRACT TRUNCATED AT 250 WORDS)