Dendritic cells co-localize with activated CD4+ T cells in giant cell arteritis.

OBJECTIVE: Giant cell arteritis (GCA) is a vasculitis predominantly affecting medium- and large-sized arteries. Recent data show the co-localization of dendritic cells and Chlamydia pneumoniae in vascular biopsies from GCA patients. Here we define the topographical relation of dendritic cells and these activated T-cells to determine the antigen presenting cell in GCA, and to examine several auxiliary biochemical and genetic aspects relating to the role of bacteria such as C. pneumoniae in eliciting GCA. METHODS: 18 paraffin-embedded temporal artery biopsy specimens from 14 patients with GCA that were PCR-positive for C. pneumoniae were examined by two-color immunohistochemistry for the topographical relationship between dendritic cells and activated T-cells. In addition the presence of GTP-binding proteins. Tumor necrosis factor alpha (TNF alpha), and Toll-like receptor 4 (TLR4) was investigated. 15 temporal artery specimens from 10 patients without GCA served as controls. RESULTS: In all GCA specimens, dendritic cells co-localized in the immediate vicinity of activated CD4+ Talin-expressing T cells, and these were predominantly found in granulomatous infiltrates. Confocal microscopy confirmed the cell-cell contact of dendritic cells with activated T cells. Results further showed that RhoA and Rac1 were predominantly present in the region of granulomatous infiltrates. TNF alpha production and expression was found in dendritic cells and macrophages, predominantly in granulomatous infiltrates and in endothelial cells of the vasa vasorum dispersed in the adventitial and medial layers of the temporal artery. No control specimens showed TNF alpha expression. More than 95% of dendritic cells were positive for TLR4; macrophages and endothelial cells localized in the adventitia showed TLR4 production. CONCLUSIONS: The immediate co-localization of dendritic cells and activated T cells indicate a high probability that the former represent the antigen presenting cells in GCA. In addition, because of the presence of Rho A and Rac1 in the granulomatous infiltrates, we speculate that they provide the right environment for cell-cell contact and adhesion, and that they may promote the internalization of bacteria. TNF alpha is expressed at high levels in the granulomatous infiltrates of temporal artery specimens from patients with GCA. Since TLR4 is produced in the same cell types, and predominantly in the adventitial layer of the temporal artery, we suggest that these receptors are coupled to signal transduction pathways that control TNF alpha expression.

Involvement of peripheral arteries in giant cell arteritis: a color Doppler sonography study.

OBJECTIVE: To investigate the involvement of arteries other than the temporal arteries in active giant cell arteritis using color Doppler sonography. METHODS: The occipital, facial, vertebral, carotid, subclavian, axillary, brachial, ulnar radial, femoral, popliteal, posterior tibial, and dorsal pedal arteries, and the abdominal aorta of 33 consecutive patients with acute giant cell arteritis and 33 age- and sex-matched controls were investigated. RESULTS: In 10 patients (30%), but in none of the controls, a characteristic inflammatory mural thickening (halo) could be demonstrated in these arteries. The subclavian, external carotid, and/or facial arteries were involved in 4 patients, the occipital and/or axillary arteries in 3 patients, the brachial and/or ulnar arteries in 2 patients, and the common carotid, vertebral, popliteal, and/or radial arteries in 1 patient each. Two patients had symptomatic large vessel giant cell arteritis with arm claudication. The other patients were asymptomatic concerning the involved arteries. Furthermore the ulnar artery was occluded in 3 cases, the posterior tibial artery in 2 cases, and the dorsal pedal and the vertebral artery in 1 case each. No occlusions were found in the controls. Occlusion of the temporal arteries occurred more frequently in patients with peripheral artery involvement than in those without peripheral involvement (60% versus 26%). In most of the non-stenotic, small arteries the halo disappeared within 9 to 21 days. Mural thickening remained in large, stenotic arteries. CONCLUSION: Peripheral artery involvement occurs more frequently in acute temporal arteritis than has been assumed up to now. Color Doppler sonography offers a new method to evaluate this peripheral involvement.

Color duplex ultrasonography in the diagnosis of temporal arteritis.

BACKGROUND: The diagnosis of temporal arteritis usually requires a biopsy of the temporal artery. We examined the usefulness of color duplex ultrasonography in patients suspected of having temporal arteritis. METHODS: In this prospective study, all patients seen in the departments of rheumatology and ophthalmology from January 1994 to October 1996 who had clinically suspected active temporal arteritis or polymyalgia rheumatica were examined by duplex ultrasonography. The final diagnoses, made according to standard criteria, were temporal arteritis in 30 patients, 21 with biopsy-confirmed disease; polymyalgia rheumatica in 37; and negative histologic findings and a diagnosis other than temporal arteritis or polymyalgia rheumatica in 15. We also studied 30 control patients matched for age and sex to the patients with arteritis. Two ultrasound studies were performed and read before the biopsies; one ultrasonographer was unaware of the clinical information. RESULTS: In 22 (73 percent) of the 30 patients with temporal arteritis, ultrasonography showed a dark halo around the lumen of the temporal arteries. The halos disappeared after a mean of 16 days (range, 7 to 56) of treatment with corticosteroids. Twenty-four patients (80 percent) had stenoses or occlusions of temporal-artery segments, and 28 patients (93 percent) had stenoses, occlusions, or a halo. No halos were identified in the 82 patients without temporal arteritis; 6 (7 percent) had stenoses or occlusions. For each of the three types of abnormalities identified by ultrasonography, the interrater agreement was > or =95 percent. CONCLUSIONS: There are characteristic signs of temporal arteritis that can be visualized by color duplex ultrasonography. The most specific sign is a dark halo, which may be due to edema of the artery wall. In patients with typical clinical signs and a halo on ultrasonography, it may be possible to make a diagnosis of temporal arteritis and begin treatment without performing a temporal-artery biopsy.

Karyotypes in 90 human gliomas.

Cytogenetic studies were performed on 90 human gliomas including 26 astrocytomas, 12 oligodendrogliomas, three oligo-astrocytomas, seven ependymomas, eight pilocytic astrocytomas, and 33 malignant gliomas (anaplastic astrocytomas and glioblastomas). The most common abnormalities were trisomy 7 in 23 cases, monosomy 22 in 15 cases, losses of the Y chromosome in 19 of 50 male cases, and losses of the X chromosome in 10 of 39 female cases. There are evident differences between the particular subgroups of gliomas. Monosomy 10 and double minutes are typical for malignant gliomas. The 58 determined chromosomal breakpoints were located on 45 different sites. Chromosomes 1, 9, 6, 3, 10, and 17 were predominantly involved.

Experimental studies on caustic burns of the stomach by aggressive chemicals.

The treatment of caustic burns of the stomach in childhood by acids, alkalis and especially soldering fluids has remained without any clear concept so far. Surgical treatment consists of therapy of acute complications or late sequelae. Early endoscopy enables one to decide between conservative treatment and early laparotomy. Animal experiments were performed in albino rats for the development of a therapeutic concept. Because of its amphoteric and aggressive nature, soldering fluid zinc dissolved in 33-50 M saline) was used as the caustic substance. Clear demarcation and tissue changes can be recognized after 6-8 h, at the earliest. Laparotomy aiming at protective plication or atypical gastric resection should be performed at that time, if endoscopy reveals a third-degree caustic burn of the stomach.

Clinical symptoms and therapy of lung separation.

This paper refers to the different terminology used in so-called lung separation/sequestration and to the standpoint of the pathologist. Theories of development are discussed. Clinical symptoms, diagnosis, indications for operation and operative technique are described, and nine cases of lung separation (six with extralobar and three with intralobar forms) tabulated analysed. Among them there is a 5-month-old female infant with extralobar lung separation in the right hemithorax resulting in recurrent pleural effusions with severe respiratory insufficiency. There was evidence of aeration in the pathohistological preparation. Pleural effusion and the origin of the aeration in the separated lung are discussed.

[Neurosurgical aspects of the treatment of esthesioneuroblastoma]. / Neurochirurgische Aspekte bei der Behandlung des Esthesioneuroblastoms.

On the basis of the example of two observations by the author the diagnostic and therapeutical problems of the esthesioneuroblastoma are discussed. Neurosurgical problems result from the growing of the tumor into the inner space of the skull or the destruction of the anterior base of the skull with subsequent inflammatory consequences.

[Aneurysmal bone cysts of the base of the skull]. / Uber aneurysmatische Knochenzysten der Schädelbasis.

On the basis of two observation of aneurysmatic bone cysts in the region of the skull, the diagnostic and therapeutic problems of this clinical picture are discussed. The highest diagnostic value is offered by computed tomography. The operation with a total extirpation to be aimed at is recommended.

[Contribution to the epithelial tumors of the ciliary body (clinical, histopathological and electronmicroscopical observation) (author's transl)]. / Uber epitheliale Tumoren des Ziliakörpers--klinische, histologische und elektronenmikroskopische Beobachtungen.

An adenoma of the non pigmented epithelium of the ciliary body was supposed to be an irisciliary body melanoma (32P-test positive) and was treated by irido-cyclectomy. Vision acuity remained 0,4 one year after operation. The tumor formed adenoid tubes lined with a cubical or cylindrical epithelium. The cytoplasm of all tumorcells was threaded with compactly arranged tonofilaments. The histopathological examination showed unequivocal the benignant character of this tumor. Nevertheless the tumorcells were infiltrating the deep scleral layer in one place. Also the lens was deformed by the tumor and developed a local opacity in the periphery. It is refered to the difficulty of a clear histopathological distinction between adenomas, adenocarcinomas and pseudo-adenomatous hyperplasia of the ciliary body (Fuchs adenoma).

Chrome alloy welding fume study.

Breathing zone samples obtained at a production arc welding operation employing approximately 90 welders demonstrated excessive exposure to chromium from the welding of high chromium alloy steel. Breathing zone samples were collected inside welding helmets. Methods considered for reducing employee exposure included local exhaust ventilation and the use of air-supplied helmets. Air-supplied helmets were chosen as best suited for the production scheme and suitable devices were subsequently developed that reduced breathing zone contaminant levels well below applicable standards.

Health hazards from oil, soot and metals at a hot forging operation.

An extensive study of a hot forging operation was performed to characterize and quantitate worker exposures to the aerosol formed by an oil-based die lubricant and it's decomposition products. Total particulate breathing zone levels up to 65 mg/m3 and benzo (a) pyrene levels up to 2.9 mug/m3 were measured.

Environmental health hazards from high-powered, infrared, laser devices.

The potential health hazards associated with high-power laser systems are not limited to the direct beam. In addition to the obvious hazards of direct beam exposure of personnel, environmental problems may arise from electrically-energized equipment, excessive noise from the laser itself, and from hazardous fumes, gases, and vapors originating from components of the laser or from the target material.