T and B cell deficiency associated with yellow nail syndrome.

Yellow nail syndrome (YNS) is a rare disorder of unknown aetiology that is characterized by yellow nails associated with lymphoedema and chronic respiratory manifestations. There are no detailed immunological studies in YNS. In this study, we present first extensive immunological analysis of both adaptive and innate immunity in two patients with YNS. One patient has common variable immunodeficiency, whereas second patient has specific antibody deficiency syndrome. Severe lymphopaenia, a striking deficiency of naïve CD4+ and CD8+ T cells and total B cells, and increased transitional B cells were observed. T cell proliferative response to mitogens and antigens was significantly reduced in both patients. Both patients failed to make specific antibody response to pneumococci. Complement, natural killer cell activity and neutrophil oxidative burst were normal. Immunoglobulin administration resulted in decreased frequency and severity of infections, and an impressive effect was observed on lymphoedema and on the recurrence of pleural effusion. Our data show that YNS is associated with both T and B cell defects. Furthermore, Immunoglobulin may be beneficial in clinical manifestations of lymphoedema.

Transurethral electrovaporization of the prostate: is it any better than conventional transurethral resection of the prostate?

OBJECTIVE: To evaluate transurethral electrovaporization of the prostate (TUVP), compared with transurethral resection of the prostate (TURP), as a treatment for men with symptomatic benign prostatic enlargement (BPE). PATIENTS AND METHODS: In all, 235 men with symptomatic BPE in four hospitals in the South-East of England were randomized to TUVP (115) and TURP (120). Patients were assessed using the International Prostate Symptom Score (IPSS), the Short Form-36 (SF-36), EuroQol and sexual function questionnaire, uroflowmetry, ultrasonographic measurement of residual urine volume, pressure-flow urodynamics and transrectal ultrasonography. RESULTS: There was no statistically significant difference in the objective and subjective outcome after TURP and TUVP. The latter was associated with a lower transfusion rate than TURP but this did not result in an overall reduction in complications. There was no difference in the length of hospital stay. Overall, the two operations produced equivalent results and equivalent complication rates. CONCLUSION: TUVP is an effective treatment for symptomatic BPE, with results equivalent to TURP. TUVP has not led to the expected reduction in early postoperative morbidity or shorter hospital stays.

Leptospirosis in pregnancy and its effect on the fetus: case report and review.

We report the case of a pregnant woman with leptospirosis who gave birth to a healthy baby. We also review 15 previously reported cases of leptospirosis in pregnancy. Of these 15 cases, eight women had abortions, two delivered healthy babies, and four delivered babies who had signs of active leptospirosis; in one case, the fate of the fetus was not stated. It appears that women are more likely to spontaneously abort if leptospirosis occurs in the early months of pregnancy. Since congenital infection is rare, leptospirosis should not necessarily be considered an indication to terminate pregnancy. Increased awareness of the possibility of leptospirosis for pregnant women who live in areas where the disease is endemic is of utmost importance for early detection and treatment of the disease and, thus, for the safety of the fetus.

Long-term follow-up after leptospirosis.

Human leptospirosis is an infectious disease that is a substantial problem in the Third World, but it can occur in developed countries as well. Survivors of the acute disease are considered to recover without sequelae, though little literature exists on long-term follow-up among these patients. Eleven patients, at an average of 22 years after acute leptospirosis, were reevaluated for possible delayed sequelae. Results showed that liver and renal disease had resolved, but headache and ophthalmic sequelae persisted. Even though the number of patients involved in this study is small, it appears that the eyes, particularly the anterior chambers, may be the site of continuing morbidity after acute human leptospirosis. The pathogenesis for persistent headache is not known.

Acute myocardial infarction in pregnancy and puerperium.

Myocardial infarction during pregnancy and puerperium is very rare. Increased awareness of its possible occurrence is important for diagnosis. A young woman who developed acute myocardial infarction 14 days after labor is described. She had no coronary risk factors; coronary angiography was not done, but ergometric test involving maximal stress done 22 months after confinement did not reveal signs or symptoms of disease. An additional 62 women with myocardial infarction, 51 during pregnancy and 11 in puerperium, reported in the literature were reviewed. The following points were observed: (1) Hypertension was present in 25% of cases. (2) Four out of 6 coronary angiograms performed after the infarct were normal. (3) Fifteen patients died (24% mortality). (4) Coronary atherosclerosis was the main finding in 7 out of 9 post-mortem examinations.

Inherited progressive cone--rod dystrophy and alopecia.

Two young sisters of Yemenite Jewish family with progressive cone-rod dystrophy accompanied with progressive alopecia of the scalp in one patient and with alopecia of the scalp and eyelashes in the other patient are presented. This rare disease seems to be autosomal recessively inherited since the patient's parents are first cousins and the family history is positive for a paternal grandmother and great-aunt having the same condition.

Scintigraphic assessment of ectopic splenic tissue localization and function following splenectomy for trauma.

Twenty-three subjects who had a splenectomy as a result of trauma underwent scintigraphic evaluation with a sensitive heat-denatured 99mTc-labeled red blood cells (DRBC). This method enabled detection of ectopic splenic tissue foci (ESTF) as small as 1 X 1 cm in diameter. ESTF splenosis or accessory spleen was detected in 15 cases (65%), a higher incidence than previously reported. The size of the ESTF ranged from 1 X 1 to 5 X 10 cm (0.8-40 cm2), and 53% were less than 2 X 2 cma (3 cm2). A new multiparametric scintigraphic evaluating technique is described, which estimates the quantity of ESTF and its grade of activity, relative to that of the liver. The technique is a highly efficient assessor of ESTF function. Good correlation was found between the size and activity of the ESTF and the presence of Howell-Jolly bodies (HJB), but with a low sensitivity for detecting small ESTF. Correlation was low between residual splenic tissue and concentrations of IgM, IgA and IgG immunoglobulins. The 99mTc-DRBC method described is recommended for verification of ESTF existence, localization, and function.

Passive immunization in experimental Herpesvirus hominis infection of newborn mice.

Infection of newborn mice with Herpesvirus hominis type 2(HVH-2) was used as an experimental model of disseminated HVH infection in newborn humans. Mice were challenged with 103 plaque-forming units of HVH-2 intranasally and were given 0.2 ml of rabbit serum intraperitoneally. Passive immunizations with rabbit anti-HVH-2 serum resulted in a significant decrease in mortality and prolongation of survival time. This effect correlated with the neutralizing antibody titer of the serum against HVH-2 and was more pronounced when immune serum was administered 1 h after infection as compared with 24 h. These results suggest that administration of high-titer anti-HVH-2 immunoglobulins shortly after delivery could afford significant protection to the newborn of a mother with genital HVH-2 infection.