Quarterly Journal of Medicine最新文献

We assessed the use of a standardized antineutrophil cytoplasm antibody (ANCA) test in diagnosing Wegener's granulomatosis (WG), microscopic polyarteritis (mPA) and systemic vasculitis (SV). All samples (n = 779) tested for ANCA at our laboratory were identified, and clinical information was obtained for 783/779 patients by questionnaire, and by visits where necessary. The combined prevalence of WG/mPA/SV was 123/738 (17%). The ANCA test was positive in 48/68 WG patients (71%; 38 cANCA, 10 pANCA), 22/43 mPA patients (51%; 12 cANCA, 10 pANCA) and 3/12 SV patients (25%). WG and mPA patients in remission had similar frequencies of positive ANCA to those with active disease. The sensitivity and specificity for WG (71% and 80%) and mPA (51% and 80%) were lower than previously reported. In this high-prevalence population, the overall (WG/mPA/SV) positive predictive value was only 40%, and the sensitivity 59%. Only 29% of positive tests were from patients with active disease. Overall, 78% of test results gave a 'true' prediction. On this basis, a diagnosis of necrotizing vasculitis (WG/mPA/SV) can be neither made nor refuted by ANCA test alone.

Cyclosporin is an immunosuppressant that acts by selectively inhibiting the activation of T lymphocytes. Its effects on monocytes and neutrophils are not well explored. We investigated the in vitro effects of cyclosporin on these cells, harvested from venous blood from nine healthy, non-smoking volunteers. In vitro incubation of monocytes with increasing concentrations of cyclosporin (5, 25 and 625 micrograms) depressed their phagocytosis by 22%, 32% and 49%, respectively, compared to the control values. The intracellular killing capacity of monocytes decreased by 26%, 31% and 43% with these doses, and neutrophil phagocytosis was depressed in a similar manner (16%, 30% and 40%). Patients receiving cyclosporin are susceptible to infections, and inhibition of these phagocytic cells by cyclosporin may be partly responsible for this. Neutrophil chemotaxis is reduced in patients with impaired renal function. Treating these patients with cyclosporin may in addition suppress the phagocytic function of these cells.

From January 1981 to December 1992, of 6250 cases of salmonellosis treated at the Christian Medical College and Hospital, Vellore, India, 100 patients with focal pyogenic infection caused by salmonellae required surgical intervention in addition to medical therapy. Thirty-one had involvement of the hepatobiliary system, and 10 more had other intra-abdominal infections. Involvement of bone and joint as well as soft tissue constituted 15% each. The site of infection in patients with soft tissue abscesses included skin (7), parotid (2), thyroid (2), breast (1) inguinal node (1), branchial sinus (1) and injection site (1). Three patients had arterial infections. Noteworthy among the cases of genital infections was one case of salmonella infection in a pre-existing hydrocele, and one case of epididymo-orchitis with a loculated salmonella infection. Salmonella infection in a pre-existing ovarian cyst was seen in a patient with endometriosis. The salmonella serotypes most frequently encountered were S. typhi (36) and S. typhimurium (36), followed by S. paratyphi A (15). The importance of recognition of these protean manifestations of salmonellosis in an endemic setting is discussed. The microbiological evaluation of properly obtained specimens is mandatory in such unusual pyogenic infections.