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The article presents a study aimed at evaluating whether perceived stress in the workplace can be considered as a risk factor for change in blood counts in male and female outdoor workers of municipal police, showing that stress induces a drop in white blood cells.

Introduction: The patients who undergo intermittent catheterization are at high risk of urinary tract infection. A prophylaxis method for this infection can be represented by the lubrication of urethral catheters with 0.1% gentamycin cream. This study compared the lubrication of urethral catheters with 0.1% gentamycin cream and 2% lidocaine jelly in relation to the quantitative results of the urine culture and incidence of symptomatic urinary tract infection and asymptomatic bacteriuria., Material and Methods: Sixteen patients, divided in groups A and B, were studied. Patients in Group A were directed to lubricate the urethral catheter with 0.1% gentamicin cream, whereas in Group B with 2% lidocaine jelly. Urine cultures and urine analysis were carried out every three weeks, for four months, for a total of 5 samples. The presence or absence of bacteria or fungi, the number of colonies and the isolated types, and the leukocyturia were evaluated., Results: No significant differences in the presence of significant bacteriuria, symptomatic urinary tract infection and asymptomatic bacteriuria were found between the two groups. Escherichia coli was the most common isolated bacterium in both groups., Conclusions: The results of this study, in line with previous works, showed that the lubrication of urethral catheters with 0.1% gentamicin cream is not an effective alternative to reduce significant bacteriuria and prevent urinary infection in patients who undergo clean intermittent catheterization.

Aim: Human Cytomegalovirus (HCMV) is a relevant pathogen in transplant recipients, particularly in the first three months post-transplantation. The use of antiviral prophylaxis and pre-emptive therapy is able to reduce incidence of HCMV infection and disease. The incidence of HCMV infection and disease in renal transplant recipients in the first 100 days post-transplantation was investigated, in relation with HCMV serological matching and therapeutic management., Methods: Incidence of HCMV infection in the first 100 days post-transplantation was evaluated by pp65-antigenemia in 165 patients on a total number of 1241 clinical samples. Patients were divided in four groups according to donor/recipient serological matching: D(-)/R(-) (low risk of HCMV disease), D(-)/R+ and D+/R+ (intermediate risk) and D+/R(-) (high risk). Antiviral strategy (prophylaxis in high risk group; pre-emptive therapy in intermediate risk group, no therapy in low risk group) and immunosuppressive protocol were recorded., Results: Incidence of antigenemia-positivity was as follows: 0/3 D(-)/R(-) patients; 59/130 (45.4%) D+/R+; 5/16 (31.3%) D(-)/R+; 4/16 D+/R(-). No significative difference was found between the four groups in terms of incidence of antigenemia-positivity in the first 100 days following transplantation. Antigenemia values >50 pp65-positive/2x10(5) peripheral blood leukocytes (used to start pre-emptive therapy) were present in 18/130 (13.8%) D+/R+; 1/16 (6.2%) D+/R(-); 0/16 D(-)/R+. Viral kinetics in patients with HCMV infection was described., Conclusion: No significative difference was found in terms of incidence of HCMV infection in the first 100 days post-transplantation in relation to immunosuppressive protocol and serological matching, suggesting the appropriateness of antiviral strategies and viral monitoring adopted in this setting.

Aims: To analyze clinical and laboratory features at presentation in correlation to treatment response and overall survival; evaluation of different treatment approaches., Methods: The data of 151 consecutive HCL patients observed between 1982 and 2005 were retrospectively analyzed., Results: The following data at presentation were analyzed and compared to response, DFS, PFS and OS: Hb < 10 g/dl (observed in 27% of patients); Plt < 100,000/microl (72%); WBC > 10,000/microl (15%); Splenomegaly (75%); Bone marrow involvement > 70% (27%). At univariate analysis only WBC > 10,000/microl resulted significantly correlated to reduced PFS. 88 Pts received as first line treatment alpha2-interferon (IFN) alone, 49 purine analogues (PA) alone or in combination with IFN, 5 were treated with splenectomy. Among IFN treated patients CR, PR and SD were obtained in 21.6%, 73.8%, 4.5% respectively of the patients; while among PA treated patients in: 26.5%, 71.4%, 2.0% respectively. DFS was significantly prolonged in patients treated with PA with respect to IFN. No significant difference in OS was observed. Median PFS was 27.6 months, median OS is projected at 238 months after a median follow up of 131 months., Conclusions: Among the routine clinical and hematochemical baseline features only the presence of WBC > 10,000/microl was correlated to a lower PFS. First line treatment with purine analogues is correlated to prolonged PFS and DFS with respect to IFN; nevertheless no difference is observed in OS.

Patients and Methods: In a three-year prospective survey of 135 consecutive adult patients referred for fever of unknown origin often associated with a broad spectrum of constitutional signs and symptoms, 21 (15.5%) were found to have a primary Cytomegalovirus infection., Results: In the majority of cases, this syndrome was consistently associated with altered white blood cell count, abnormal T-lymphocyte subsets and hepatosplenomegaly. On the other hand, altered white blood cell differential and serum hepatic enzymes, and constitutional signs and symptoms were absent with a rate ranging from 11.1% to 27.4% of cases, and an initial laboratory cross-reaction with anti-Epstein-Barr IgM antibodies was detected in 48.1% of episodes. Non-specific signs and symptoms were the only features in 27.4% of patients, thus confirming that this disorder may be still clinically underestimated in its real frequency, until virologic assays are carried out. An extensive and varied spectrum of subjective disturbances, sometimes of duration prolonged beyond six months involved nearly 30% of subjects, and lasted for 3-15 months after recovery of acute, primary Cytomegalovirus disease., Conclusions: In a multidisciplinary (clinical, laboratory, and instrumental) workup for a fever of unknown origin, a rapid recognition of a primary Cytomegalovirus disease is useful to exclude alternative diagnoses, avoid unnecessary exposure to antimicrobial agents, and reassure patients of the benign and self-limiting course of their illness.

A cytofluorimetric method to detect antineutrophil antibodies was carried out in sixty adults suffering from chronic idiopathic neutropenia (5 patients with severe neutropenia, 16 with moderate neutropenia, 39 with mild neutropenia). Both the direct and the indirect tests were carried out using F(ab')2 goat anti-human FITC-conjugates immunoglobulins on whole blood samples. Fifteen patients (25%) were found to have antineutrophil antibodies both on the neutrophil surface and in serum. Most positive patients were suffering from severe neutropenia (4 patients) and moderate neutropenia (8 patients). Only four positive patients were suffering from infections.

Background: The diagnosis of acute appendicitis remains a critical challenge for paediatric surgeons. White Blood Cell (WBC) count, once considered a basic exam, is still routinely performed in most institutions, despite its lack of accuracy. Aim of this study is to assess the additional value of WBC count in the diagnosis of acute appendicitis., Methods: We retrospectively reviewed the charts of children who underwent appendectomy for acute appendicitis in the last two years at our institution. In the patients treated in 1999 (Group A), WBC count was assessed routinely after admission. The surgeons relied on leukocytosis as well as on clinical findings and on ultrasound abdominal scan for the diagnosis of acute appendicitis. In the patients treated in 2000 (Group B), blood cell count was not tested or deliberately ignored by the surgeons., Results: There were 65 children in Group A and 70 in Group B; the two groups of patients were similar in terms of gender (p = 0.989) and age (p = 0.758). Criteria for operation were similar in the two groups (p = 0.222). No differences were found in the number of perforated (p = 0.989) and normal (p = 0.217) appendixes in the two groups as well as in the duration of hospital stay after surgery (p = 0.849)., Conclusions: WBC count at admission has no proven additional value in the diagnosis of acute appendicitis and can be omitted without modifying diagnostic pathway and without affecting diagnostic accuracy.

Background: The aim of this study was to determine the course of the main inflammatory and fibrinolytic markers in patients undergoing primary elective coronary artery bypass graft with extracorporeal circulation., Methods: One hundred and thirteen patients (105 males, 8 females) undergoing primary isolated coronary artery bypass with normo- (37 degrees C) or hypothermic (26 degrees C) systemic perfusion were prospectively studied. The clinical course of the patients was recorded and inflammatory and fibrinolytic markers (C-reactive protein, fibrinogen, interleukin-6, plasminogen activator inhibitor-1, prothrombin time, activated partial thromboplastin time, platelets and white blood cell counts) were determined before surgery, 24, 48 and 72 hours thereafter, and at hospital discharge., Results: Two patients died (mortality 1.7%) and 6 had a major complication (event free survival > 94%). Interleukin-6, lymphocyte, neutrophil and monocyte levels increased after surgery but returned to normal at hospital discharge. C-reactive protein levels increased after 24 hours and remained high at hospital discharge. Plasminogen activator inhibitor-1, prothrombin time, and activated partial thromboplastin time increased from few hours postoperatively and returned to normal before discharge. Platelets decreased immediately after surgery and normalized only at hospital discharge. Fibrinogen decreased in the first 24 postoperative hours, raised later and remained elevated at hospital discharge., Conclusions: Cardiopulmonary bypass activates inflammatory response and hemostatic/fibrinolytic balance in patients undergoing primary isolated coronary artery bypass.

Background: Acute appendicitis is the most frequent cause of surgical emergency in pediatric age. The aim of this study has been to evaluate the diagnostic accuracy of a scoring system, retrospectively applied, to the clinical and laboratory parameters in patients with acute appendicitis., Methods: A group of 156 patients admitted for acute abdominal pain and operated for appendectomy, in the last 3 years, has been included in the study. The mean age was 8.4 years. The modified Alvarado score has been used as scoring system: white count, neutrophil count, fibrinogen level, body temperature, resistance in the right iliac fossa, length of symptoms, nausea/vomiting. The score has been calculated for each patient. They were subdivided into 3 groups. Group I (score 1-4), no admission; Group II (5-6), admission and observation; Group III (7-10), surgery. This subdivision was then compared with the intraoperative notes., Results: Patients were divided into 3 groups. Group I, 24 patients (15%); Group II, 34 patients (22%); Group III, 98 patients (63%). On the basis of the intraoperative notes 61 patients had acute appendicitis and 95 complicated acute appendicitis. In this last subgroup the score gave a percentage of patients to operate of 90.5%., Conclusions: With the present work we confirm the utility of a scoring system in the preoperative diagnosis of acute appendicitis and in our opinion it is a useful system for a first, rapid and economic evaluation in the pediatric emergency department.

Background: Even though the diagnosis of acute pancreatitis has become easier by the measurement of specific pancreatic enzymes, early assessment of the prognosis still remains a clinical challenge at an early stage of the disease. The imaging procedures and the elevated mediators, are not widely available at the beginning. The aim of this study is to analyze the blood concentration of lipase, glucose, calcium and leucocytes (Simplified Prognostic Test). The values of these markers in the prognostic evaluation of acute pancreatitis are described., Methods: A total of 45 patients with acute pancreatitis were evaluated; 38 patients developed a mild acute pancreatitis and 7 patients developed a severe acute pancreatitis. The values of serum markers at cut-offs of 160 mg/100 ml for glucose, 10.000 U/L for lipase, 13.000 leucocytes/100 ml and 8.5 mg/ml for calcium were monitored., Results: On admission to hospital, concentration of glucose, lipase, calcium and leucocytes were significantly higher in the second group (severe acute pancreatitis) than in the first one (p<0.01 for glucose, leucocytes and calcium; p<0.05 for lipase). The test was considered positive if 3 out of 4 markers were significant., Conclusions: At an early stage the SPT was positive in patients who developed severe disease. SPT had sensitivity of 71.4% and specificity of 75.5%. The preliminary results indicate that there is no significant difference between the Ranson score and SPT in evaluating acute pancreatitis. SPT is simple and quick to perform and unlike the recently introduced laboratory markers can easily be adopted in emergency clinical practice. Definite proof may however only be obtained by a prospective, randomized clinical trial.

Background: An adverse effect of leukocytospermia in seminal fluid on motility and fertilizing power of spermatozoa has been described. This detrimental effect could be mediated by radical oxygen species (ROS). Recently, a direct effect on nuclear DNA of sperm induced by ROS has been described, although the chance of fertilization did not seem altered during ICSI procedure. Aim of this prospective case-control study was to compare the outcome of results in term of fertilization rate and embryo quality in patients with and without idiopathic leukocytospermia during IVF and ICSI cycles., Methods: Seventy-two patients selected for a program of IVF and ICSI were admitted in the study. Fourty-two patients underwent IVF procedure, 14 with idiopathic leukocytospermia and 28 without, and thirty underwent ICSI procedure, 16 with leukocytospermia and 14 without leukocytospermia., Results: Statistical significant differences on cleavage rate of embryos between leukocytospermia and control group in IVF cycles were observed. In ICSI procedure a low fertilization, cleavage rate and percentage of good embyros in the presence of leukocytospermia were evidenced., Conclusions: The presence of a significant number of leukocytes in semen, even in idiopathic condition, could affect the results of IVF and ICSI procedure. An adverse effect of lipoperoxidation process of plasma membrane and damage of nuclear chromatin of sperm, as result of leukocyte contamination could be hypothesized and future studies needed in order to verify the role of ROS on sperm functions.

Authors evaluated the correlation between immune system and metal ions release in blood of 17 subjects with Cr/Co/Ni joint prostheses. For the purpose Chromium (Cr), Cobalt (Co) and Nickel (Ni) serum levels were measured and, at the same time some immunological parameters (Leukocytes, Lymphocytes and Lymphocytes T, B and Natural Killer cells sub-populations) were evaluated. The results showed a significant decrease of Leukocytes, Lymphocytes and of T Lymphocytes sub-populations. At the same time it was demonstrated a significant increase of Chromium, Cobalt and Nickel levels in patients with joint prostheses as compared to control population (23 patients). In conclusion, ions release from metallic surface of the prostheses is correlated with a depression of immune system. This correlation could depend on a toxic action on immune system caused by the products released by the implant. It could also depend on a lymphocytes compartimentalization in periprosthetic tissues as a consequence of a cell-mediated hypersensitivity reaction towards implants corrosion products.

Spontaneous bacterial perionitis (SBP) is a relatively frequent complication of liver cirrhosis and is associated with a high mortality if not early recognized and immediately treated. The text-books of Medicine available in Italy suggest the use of traditional laboratory tests (gravity, total protein concentration, Rivalta's test) to whom add white blood cell count for the assessment of the nature transudative (not infected) or exudative (infected) of ascitic fluid; nevertheless, in every day clinical practice, the association between total protein concentration and type of ascitic fluid may be misleading with respect to the diagnosis of SPB. The aim of this retrospective study, undertaken on 86 patients with liver cirrhosis consecutively admitted and separated in two groups, one without and the other with PSB (white blood cell count > 500/mm3), was to identify criteria for diagnosis of PSB. The traditional laboratory tests were significantly different in the two groups but Rivalta's test. Yet, none of them showed a diagnostic measurement sufficient for the use in the diagnosis of PSB (positive predittive value: gravity 41%, Rivalta's test 36%, total protein concentration 40%). The results of this work show the traditional laboratory tests unable to define the nature of the ascitic fluid. For the diagnosis of PSB the only reliable parameter is the white blood cell count.

Basophil granulocytes and their mediators are involved in the pathogenesis of allergic inflammation. We evaluated basophil count, blood histamine content, eosinophil count and serum total IgE levels in one hundred-thirteen healthy newborns at birth. 108 children were prospectively studied with a follow-up to 18 months of age for development of topic disorders. No difference was found in newborns with biparental family history of atopy (FHA) in comparison with newborns with monoparental FHA and with newborns without FHA. Children who developed atopic disorders had neonatal basophil count higher than those who did not develop atopic symptoms (p = 0.03). No significant correlation was found between basophil and eosinophil counts (r = 0.013), between basophil count and serum total IgE levels (r = 0.012) and between basophil count and blood histamine content. Positive predictive value and sensitivity of basophil count for allergy up to 18 months of age was respectively only 33% and 27%. Our data indicate that an increased basophil count at birth is not associated with FHA and is not a good predictive marker of atopy.

An asympthomatic case of toxocariasis is described in a 9 years boy, who had been under follow-up observation for 24 months. He showed only a marked eosinophilia (42%) without any clinical alterations. The IgG antitoxocara dosage, performed by immunoenzymatic method, allowed to formulate the diagnosis. The oculistic checks, together with EEG carried out the time of diagnosis as well as at the end of follow-up did not show any alterations. No therapy was practised and the number of eosinophilis in to circulation went progressively down. At the end of follow-up the percentage of eosinophilis is 7%.

Eosinophilic gastroenteritis is an uncommon disease of unknown aetiology, whose distinctive features are eosinophilia in peripheral blood and eosinophilic infiltration of the bowel wall. Its clinical course shows recurrent crises, even after a period of years, of symptoms that underline the predominant involvement of mucosal, muscular or subserosal layers of the bowel wall. The prognosis of the disease is essentially benign and pharmacologic therapy is not always necessary. A case with predominant involvement of both muscular and mucosal layers is described.

In June 1981 a new clinical syndrome, now called acquired immunodeficiency syndrome (AIDS) was first reported by the CDC. This entity has grown to be a pandemic disease with major socioeconomics, political and medical consequences. HIV-induced immunodeficiency infection typically occurs gradually over several years and leads to secondary opportunistic infections and malignancies. Similar features are observed in transplant recipients; the same clinical and diagnostic management is mandatory, but only in transplant complications an effective cure is possible.

We describe the eosinophil granulocyte's immunobiology and pediatric management implications. Moreover, we review our results about eosinophil count in newborn as a predictive marker of atopy.

Considering that in the HIV infection there is a precocious deterioration of humoral immunity with rapid turn-over of cellular B clones, we have evaluated the conduct of serum lactate-dehydrogenase activity (LD, EC 1.1.1.27) and its isoenzymes in 21 children born from HIV-positive mother respect to a control group (30 subjects). Furthermore we have checked the existence of a probable correlation between those and other clinical and immunologic parameters (total lymphocytes, CD4/CD8, immunoglobulins, classification according to the Atlanta CDC). In seropositive children we saw, respect to those evolved towards P3 stage, a significantly raising of LD4 (also vs. control group) for likely pulmonary parenchyma's damage, LD3 for B immature lymphocytes' increase and a reduction of LD1 (also vs. control group) for mature clones' decrement. Furthermore in seropositive subjects there was the existence of a direct correlation between LD1 and CD4/CD8 values. As such, the evaluation of LD isoenzymes can establish an useful element in the clinical monitoring of seropositive children.

A flow-cytometric analysis of ascitic fluid (AF) and peripheral blood lymphocyte subpopulations (LS) was performed on 16 patients with ovarian malignancy (OM) and 5 with metastatic peritoneal carcinomatosis (MPC). AF lymphocytes are 58% of total leukocytes in OM patients, 37% in MPC patients, while blood lymphocytes are 14% and 17%, respectively. AF absolute lymphocyte count (total and individual LS) is higher in OM patients. OM patients AF lymphocytes are: T = 70%, CD4+ = -37%, CD8+ = 32% (CD4/CD8 = 1.39), B = 5%, NK cells = 4-10%, CD25+ = 20%, CD69+ = 15%, CD71+ = 3%. In MPC patients the values are generally similar, though CD4+ cells are +7%, CD8+ cells = -14% (CD4/CD8 = 3.17), CD69+ cells = -8%. Untreated OM patients have a AF total and percent lymphocyte count higher than treated ones. Among the latter, however, the CD4/CD8 ratio as well as the number of CD4+, inducer, CD25+ and CD71+ cells are higher. In terms of percent values, the most striking differences involve total T and B lymphocytes (81-87% vs 56-62%, and 10% vs 2%, respectively). With the only exception of absolute NK cell count, OM patients show no correlation between AF and peripheral blood LS pattern. These results agree only partially with data from the literature. Pathophysiologic and clinical considerations support the practical usefulness of LS analysis in AF from OM patients.

The aim of this retrospective study is to evaluate the correlation between T-cell immunity and pulmonary disorders in a group of Italian subjects with HIV infection. HIV-infected patients seen at the Institute of Infectious Diseases, University of Verona, were included in this study if they had a specific acute pneumonia, a CD4+ cell count and a CD4+/CD8+ ratio during the 60 days immediately before the onset of pulmonary disease. Cases receiving any antimicrobial prophylaxis were excluded. Pneumonia was recognized by usual clinical and radiologic abnormalities. The diagnostic procedure included sputum examination, bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. The specimens were processed for bacterial, mycobacterial and fungal stains and cultures. Ziehl-Neelsen, periodic acid-Schiff and silver methenamine stains were performed on the transbronchial biopsy specimens in addition to usual pathologic examinations mononuclear. Determination of percentage of peripheral blood mononuclear cells bearing CD4+ and CD8+ markers was done by conventional fluorescent antibody cell-sorter analysis of the mononuclear cell population. Absolute number of CD4+ lymphocytes was determined by multiplying the total lymphocyte count by the percent of mononuclear cells bearing CD4+ marker. From October 1987 to August 1991, 61 patients, 50 males and 11 females, had 65 episodes of specific pneumonia. The average age of patients was 31.4 years (range 29-59 years). The risk factors for HIV infection included intravenous drug abuse (47 patients), homosexuality (6 patients), bisexuality (3 patients) and heterosexual contact (5 patients). Before the onset of pulmonary disorders, patients were classified in the following clinical HIV-related stages: asymptomatic state (22 episodes), ARC (22 episodes) and AIDS (21 episodes). In decreasing order of frequency diagnosis of pneumonias were PCP (29 episodes), community-acquired bacterial pneumonia (16 episodes), pulmonary tuberculosis (8 episodes), nonspecific interstitial pneumonia (4 episodes), PCP and pulmonary tuberculosis (3 episodes), cytomegalovirus pneumonia (2 episodes), and one of each episode of PCP and pulmonary cryptococcosis, pulmonary candidiasis, pulmonary Kaposi's sarcoma. The mean and the standard deviation of immunologic values regarding the four primary diagnostic groups were: PCP CD4+/CD8+ 0.50 +/- 0.42, CD4+/mm3 196 +/- 190; bacterial pneumonia CD4+/CD8+ 0.53 +/- 0.44, CD4+/mm3 247 +/- 139; pulmonary tuberculosis CD4+/CD8+ 0.62 +/- 0.38, CD4+/mm3 260 +/- 170; nonspecific interstitial pneumonia CD4+/CD8 + 0.57 +/- 0.48, CD4+/mm3 240 +/- 189. No significant statistical differences with respect to CD4+/CD8 ratios and CD4+ cell counts among these diagnostic groups were found by standard analysis of variance.(ABSTRACT TRUNCATED AT 400 WORDS)

In order to understand the significance of presence of HIV-1 in saliva, we searched for by PCR HIV-1 proviral sequences in the saliva cells of 49 HIV-1 infected patients. Seven out 49 specimens resulted positive, 4 of which were from patients with PGL, 1 with ARC and 2 with AIDS. Four patients had a CD4+ lymphocyte counts < 200/cmm and in 3 patients the CD4+ lymphocyte count ranged from 200 to 400/cmm. Two patients were treated with AZT, 1 with DDI and 4 had no antiretroviral treatment. In conclusion, although HIV-1 proviral sequences have been found in saliva of HIV-1 infected patients, a larger group of patients should be investigated to define more precisely the role of HIV-1 in saliva.

An absolute and relative increase of circulating CD56+ (NKH1, Leu19) natural killer cells has been found in a patient with systemic sclerosis. The expanded natural killer cells exhibited reduced natural killer activity and antibody-dependent cell-mediated cytotoxicity. Furthermore, the limiting dilution analysis of spontaneous in vitro immunoglobulin synthesis demonstrated that the precursor frequency of immunoglobulin-secreting cells and the "single-hit" kinetics of the titration curve were similar to healthy controls, but strongly different from previously reported patients in whom CD16+NK cell subset was expanded. Thus, our findings might suggest that expanded CD56+ natural killer cells exhibit unique regulatory properties on B cell function in systemic sclerosis.

The nutritional and immunological status have been evaluated in 28 consecutive patients with esophageal cancer. Patients (21 male and 7 female), had a mean age of 61 years, ranging from 34 to 84 years. The tumor histological type was squamous in 25 patients. A melanoma, an oat cell carcinoma and a adenocarcinoma were observed in the remaining cases. The nutritional status was assessed by means of weight loss, triceps skinfold, midarm muscle circumference and serum levels of albumin and transferrin. On the basis of this data the patients were divided into two groups: A, 19 patients (68%), normal nourished group (or with a mild malnutrition) and B, 9 patients (32%) with a severe malnutrition. The immunological status was assessed by determining the lymphocyte absolute number (H-6000-Technicon), the T-Lymphocyte sub-populations (flow-cytometry with monoclonal antibodies--Ortho Diagnostic System) and the patient's response to intradermally placed recall antigens (Multitest Merieux). Significative immunological abnormalities were found only in malnourished patients, group B (p less than 0.05). Moreover a reduction of OKT4 helper (less than 30%) and the inversion of OKT4/OKT8 ratio (less than 0.9%) were also observed only in the malnourished group (p less than 0.01). Therefore, we conclude that acquired immunodeficiency, when present in patients with esophageal cancer, is due to the severe malnutrition rather than to the cancer itself.

Lymphocytary subpopulations have been determined, by means of monoclonal antibodies, in 24 patients afflicted with iron deficient anaemia, repeating the determination in 15 of the patients after an adequate iron therapy. In iron deficient patients a significant reduction of the percentage of lymphocytes T (OKT3+) has been observed, in comparison with normal controls, as well as a significant reduction of the percentage of cells OKT8+, with a significant increase of the OKT4+/OKT8+ ratio. In the 10 patients who at the moment of the revaluation did not present any longer either anaemia or iron deficiency, the percentage of lymphocytes OKT3+ and OKT8+ had returned to normal values, as well as the OKT4+/OKT8+ ratio. The 5 patients still resulting anaemic in course of control presented, on the contrary, a significant reduction of cells OKT3+ and OKT8+, while the OKT4+/OKT8+ ratio resulted lightly increased, however not significantly.

The paper studies the distribution of circulating lymphocytic phenotypes in 20 cases of recurrent aphthous stomatitis. The statistical analysis of data, together with that found in 40 normal subjects, reveals the selective immunoactivation of cytotoxic T lymphocytes and NK cells similar to that found during the course of acute viral diseases. In etiopathogenetic terms, results should therefore be considered as a possible demonstration of the viropathic genesis of this disease.

A case of Wiskott-Aldrich syndrome is reported. At 2 months of age the infant was hospitalized because of petechiae, and a low platelet count was noted (range 30.000/90.000/mmc). During his stay in the Hospital he developed pneumonia, which lasted several weeks in spite of therapy. Subsequently he presented eczema and a defect of cell-mediated immunity, and the Wiskott-Aldrich syndrome was diagnosed. A short review of clinical and functional findings in this syndrome is reported.

In previous studies we have demonstrated that human normal pancreata were populated by interstitial mononuclear cells constituted by dendritic cells (70%), macrophages (30%) and few B cells (less than 1%). Furthermore, the endocrine parenchyma and the centroacinar cells appeared negative for the detection of HLA-A,B,C molecules. In the present report, 15 pancreata from cadaver donors were studied by means of immunohistochemical methods. 5 out of 15 organs were found to contain a larger amount of interstitial hematic cells that were constituted mainly by macrophages and B cells, together with a small percentage of granulocytes and T cells. In such "infiltrated" pancreata both endocrine parenchyma and centroacinar cells displayed a positivity for HLA-A,B,C antigens. As HLA-class I antigens have importance in allo-recognition and rejection responses, our data suggest that pre-transplant biopsies may be useful for a better evaluation of the pancreatic tissue immunogenicity.

Individuals who are infected with human immunodeficiency virus (HIV) are at high risk of developing tuberculosis, probably due to the reactivation of latent infection associated with HIV-induced immunosuppression. Tuberculin skin test is the best diagnostic means to assess a previous tuberculous infection, but this test may be falsely negative in HIV seropositive subjects. To assess the validity of a non-reactive tuberculin skin test in asymptomatic HIV seropositive subject, we performed Mantoux test 5 TU, chest x-ray, HIV serologic tests on 141 asymptomatic prisoners. Determination of lymphocyte subsets in HIV seropositive carriers had already been performed. Chest x-ray film showed no pleuro-pulmonary lesion in any subject. We found 101 HIV seronegative subjects (89 men and 12 women; 30 +/- 6 yrs with 18-39 range; 34 Mantoux reactive and 67 non-reactive) and 40 HIV seropositive individuals (30 men and 10 women; 29 +/- 6 yrs with 21-39 range; 7 Mantoux reactive and 33 non-reactive). By subdividing HIV seropositive subjects in two groups (reactive and non-reactive to tuberculin test) a significant decrease of CD 4 lymphocytes and CD 4/CD 8 ratio was found in HIV seropositive/Mantoux non-reactive group, without changes in total lymphocytes and CD 8 subset. We conclude that: 1) a non-reactive tuberculin skin test cannot be confidently explained in asymptomatic HIV seropositive subjects with a T helper lymphocyte count decrease; 2) T helper cells are important to keep alive delayed hypersensitivity reaction.

In this work we investigated the effects of malnutrition on the immune response in neoplastic patients. We studied the basal NK activity of 34 neoplastic malnourished patients and 10 neoplastic not malnourished patients and a control group of blood donors, by a standard 51 Cr release assay against K562 cells. We observed that the neoplastic malnourished patients have a defective NK activity in spite of a normal number of NK cells, as ascertained by HNK-1 monoclonal antibodies. The reduced NK activity of the neoplastic malnourished patients is only partially restored by rIFN alpha 2a but is normalized by rIL-2 stimulation. We also found that the endogenous IL-2 production from some of these patients is slightly reduced as compared to controls. On the contrary, there are no significative differences between the neoplastic not malnourished patients and blood donors, as concerns the NK activity. These results suggest that nutritional status plays a very important role in the maintenance of an efficient immune response in neoplastic patients.

Hashimoto's thyroiditis is an autoimmune disease characterized by the presence of thyroid autoantibodies and frequent coexistence of other autoimmune disorders. The object of our research was to examine the peripheral blood and fine-needle cytology modifications in patients with this disease during therapy with Timopentina. Our results suggested a possible therapeutic effect of Timopentina, as an alternative to traditional cortisone treatment.

Some markers of inflammation were monitored, and whole blood filterability was measured using a low shear positive pressure nuclepore filtration system in 21 patients at the onset of an acute bacterial infection and again after full clinical recovery 4 weeks later and compared to the filterability of 40 matched healthy controls. Impairments in whole blood filterability persisted even after convalescence.

Aim of the present study was to assess the increase of peripheral white blood cell (WBC) count and its clinical and prognostic significance in patients with cerebral ischemic infarction (CI). Thirty-six subjects (17 males, 19 females; mean age 73 +/- 10 years) with CI confirmed at CT scans were studied. A significant increase of WBC, not related to complicating infections, was observed in the early phase of CI. There was a significant linear correlation between the level of serum creatine phosphokinase and the number of circulating WBC which were higher in patients who died 6-30 days after the occurrence of CI. These data suggest that the increase in circulating WBC is dependent on the extent of the cerebral damage and should be considered as unfavourable prognostic sign.

Bacteria counts in fresh, unstained, uncentrifuged urine specimens, using a phase-contrast microscope, magnification X 400, and a hemocytometer chamber, proved to be a very useful method not only of excluding (specificity 0.92) but also identifying urinary tract infection (sensitivity 0.90) in children. The presence of greater than 5/0.1 ml bacteria in the urine was taken as the threshold value. The evaluation of leukocyturia alone did not alter the sensitivity of the method, even when it was associated with bacteriuria. When Proteus was isolated from urine cultures, the bacteria count proved negative in 60% of cases; otherwise when different bacteria were isolated in urine cultures, they were then identified during the bacteria count. The method is simple, inexpensive and rapid (it requires only a few minutes) and it may be used in a pediatric outpatient or hospital setting.

The authors have studied the relationship among HIV replicative activity, expressed by HIV isolation from peripheral blood lymphocytes and p24 antigenemia detection, and the evolution of infection, in terms of stage of disease and T4 cells absolute number, in a group of 120 infected subjects. Data presented indicate that the expression of viral gene products is related both to clinical and immunological deterioration and suggest that viral replication plays a central role in the progression of the disease.

The Authors describe a technique for the identification of the lymphocytic subpopulations of peripheral human blood. It is pointed out the importance of using iron powder, AET, 20 hours incubation. The percentages of cells forming E rosets in patients suffering of acute lymphatic leukaemias and in normal subjects is valued.

In polyglobulic subjects we have found a variable reduction of plasmatic viscosity, with an increase of total viscosity. If the increase of Ht is the first cause of the increase of total viscosity, it is less simple to find the cause of plasmatic viscosity decrease; to this end we have analysed direct and indirect factors (coagulation factors, proteinous and lipidic components). We haven't found any significant qualitative alterations. It is proposed the importance of the interventions of basic proteins of polication type. To this end it has been studied the connection between plasmatic viscosity and ESR, being both influenced by the same factors, but in a contrary way and with variable results. Then the role of plasmatic viscosity in these subjects, in substitution of ESR, is significant.