СРАВНИТЕЛЬНАЯ ЭФФЕКТИВНОСТЬ РАЗНЫХ МЕТОДОВ АЛЛЕРГЕН-СПЕЦИФИЧЕСКОЙ ИММУНОТЕРАПИИ У ПАЦИЕНТОВ С ПОЛЛИНОЗОМ: ОТКРЫТОЕ РАНДОМИЗИРОВАННОЕ ИСПЫТАНИЕ

2019 ◽  
pp. 35-45
Author(s):  
A.Y. Nasunova ◽  
N.M. Nenasheva
Keyword(s):  
Pollen Season ◽  
Biological Fluids ◽  
Clinical Manifestations ◽  
Allergic Rhinoconjunctivitis ◽  
Nasal Lavage ◽  
Subcutaneous Immunotherapy ◽  
Immune Reactivity ◽  
Cationic Protein ◽  
New Findings ◽  
Study Results

Аллергенспецифическая иммунотерапия (АСИТ) является единственным методом, способным влиять на все патогенетически значимые звенья аллергического процесса, на раннюю и позднюю фазы IgEопосредованной аллергической реакции и тем самым видоизменять характер иммунного ответа организма на аллерген. В настоящее время в клинической практике наиболее часто используют подкожный (ПКИТ) и сублингвальный методы (СЛИТ) АСИТ. Несмотря на доказанную эффективность подкожной и сублингвальной аллергенспецифической иммунотерапии, остаются нерешенными вопросы предпочтительного метода сравнительной эффективности АСИТ посредством измерения биомаркеров в сыворотке крови и в других биологических жидкостях у пациентов с аллергическим ринитом (с/без астмы). Цель. Провести сравнительный анализ эффективности разных методов АСИТ (ПКИТ и СЛИТ экстрактами аллергенов) на основании клинических и иммунологических параметров. Материалы и методы. В исследование включены 60 пациентов с аллергическим ринитом (с/без астмы) в возрасте от 18 до 50 лет. Все пациенты случайным способом были распределены на 3 группы в зависимости от метода проведения АСИТ: группа 1 пациенты, получавшие сублингвальную АСИТ экстрактами аллергенов группа 2 пациенты, получавшие подкожную АСИТ экстрактами аллергенов группа 3 пациенты, получавшие подкожную АСИТ модифицированными аллергенами (аллергоидами). Результаты. Продемонстрирована эффективность предсезонной АСИТ (ПКИТ и СЛИТ) экстрактами аллергенов и аллергоидами в контроле симптомов аллергического риноконъюнктивита (с/без астмы). Анализ данных шкал (Total Symptom Scove TSS, Mediacation Scove MS) после окончания 1го курса предсезонной АСИТ выявил статистически значимые различия между группами пациентов, получавших ПКИТ аллергоидами, и пациентами, получавшими СЛИТ аллергенами: по шкалам TSS (р0,023), MS (р0,002). Кроме того, у пациентов, получавших ПКИТ аллергоидами, к концу поддерживающей фазы АСИТ уровень эозинофильного катионного протеина (ECP) в назальном лаваже снизился на 22 (p0,012), секреторного иммуноглобулина А (sIgA) в назальном лаваже увеличился на 70 (p0,001), интерлейкина10 (ИЛ10) в сыворотке крови увеличился на 126 (p0,006), аллергенспецифического IgG4 увеличился на 42 (p0,01) от исходных значений, что коррелирует с уменьшением выраженности клинических проявлений. В сезон естественной экспозиции аллергенов уровень ECP в назальном лаваже статистически значимо (p0,007) ниже в группе больных, получавших ПКИТ аллергоидами, по сравнению со СЛИТ аллергенами. Статистически значимо более высокие показатели сывороточного уровня ИЛ10 в сезон цветения также отмечены в группе больных, получавших ПКИТ аллергоидами, по сравнению с группами, получавшими СЛИТ (p0,013) и ПКИТ (p0,001) экстрактами аллергенов. Заключение. Результаты исследования углубляют имеющиеся представления о механизмах ПКИТ и СЛИТ. Они позволяют разработать схему комплексной оценки эффективности данной терапии, базирующейся на мониторинге клинических параметров, а также локальных (ECP, sIgA) и системных биомаркеров (ИЛ10, аллергенспецифический IgG4).Background. Allergenspecific immunotherapy (ASIT) is viewed as the only treatment that influences all pathogenetically significant parts of the allergic process in the initial and late phases of the IgEmediated allergic reaction and modifies the abnormal immune reactivity to a specific allergen. Currently, sublingual (SLIT) and subcutaneous (SCIT) immunotherapy are most commonly used in clinical practice. Despite long experience of sublingual and subcutaneous immunotherapy application, questions remain about the preferred ASIT method and comparative effectiveness of different ASIT methods. This article evaluates the efficacy, benefits of SCIT and SLIT and highlights new findings related mechanisms and potential biomarkers. The aim of the study. To evaluate the comparative efficacy of different methods of ASIT (subcutaneous and sublingual) based on clinical data and biomarkers in the blood serum and other biological fluids in adult patients with allergic rhinoconjunctivitis (with/without asthma). Materials and methods. 60 patients with allergic rhinoconjunctivitis (with/without asthma) aged 18 to 50 were randomly assigned to 3 groups treated by sublingual immunotherapy with extracts of allergens, subcutaneous immunotherapy with extracts of allergens and subcutaneous with modified allergens (allergoids) respectively. Results. The efficiency of the first course of preseason ASIT (SCIT and SLIT) with extracts of allergens and allergoids in the control of symptoms of allergic rhinoconjunctivitis (with/without asthma) was demonstrated. After the end of the first year preseason ASIT data analysis scales (Total Symptom Score TSS, Medircation Score MS) revealed the best performance in the group of patients receiving SCIT with allergoids compared with patients receiving the SLIT with extracts of allergens: the scales of the TSS (p0.023), MS (p0.002). In addition, at the end of the maintenance phase of ASIT in patients treated with SCIT with allergoids the level of eosinophilic cationic protein (ECP) in the nasal lavage decreased by 22 (p0.012), secretory immunoglobulin A (sIgA) in the nasal lavage increased by 70 (p0.001), interleukin10 (IL10) in serum increased by 126 (p0.006), allergenspecific IgG4 increased by 42 (p0.01) from the initial values, that correlates with a decrease in the severity of clinical manifestations. In pollen season ECP level in nasal lavage was significantly (p0.007) lower in a group of patients who received SCIT with allergoids compared with patients who received the SLIT with extracts of allergens. The most significant changes of serum level of IL10 in the pollen season occurred in a group of patients receiving SCIT with allergoids compared with patients who received SLIT (p0.013) and SCIT (p0.001) with extracts of allergens. Conclusion. The study results deepen the existing understanding of the mechanisms of SCIT and SLIT. They allow to develop a comprehensive assessment of the therapy efficacy scheme based on clinical parameters and on monitoring of local (ECP, sIgA) and systemic biomarkers (IL10, allergenspecific IgG4) as well.

scholarly journals A comparison of different methods of the allergen-specific immunotherapy in patients with pollinosis: the results of open randomized study

2019 ◽  
Vol 16 (3) ◽  
pp. 35-45
Author(s):  
A Y Nasunova ◽  
N M Nenasheva
Keyword(s):  
Pollen Season ◽  
Specific Immunotherapy ◽  
Allergic Rhinoconjunctivitis ◽  
Nasal Lavage ◽  
Subcutaneous Immunotherapy ◽  
Immune Reactivity ◽  
Allergen Specific Immunotherapy ◽  
New Findings ◽  
Study Results ◽  
Specific Igg4

Background. Allergen-specific immunotherapy (ASIT) is viewed as the only treatment that influences all patho-genetically significant parts of the allergic process in the initial and late phases of the IgE-mediated allergic reaction and modifies the abnormal immune reactivity to a specific allergen. Currently, sublingual (SLIT) and subcutaneous (SCIT) immunotherapy are most commonly used in clinical practice. Despite long experience of sublingual and subcutaneous immunotherapy application, questions remain about the preferred ASIT method and comparative effectiveness of different ASIT methods. This article evaluates the efficacy, benefits of SCIT and SLIT and highlights new findings related mechanisms and potential biomarkers. The aim of the study. To evaluate the comparative efficacy of different methods of ASIT (subcutaneous and sublingual) based on clinical data and biomarkers in the blood serum and other biological fluids in adult patients with allergic rhinoconjunctivitis (with/without asthma). Materials and methods. 60 patients with allergic rhinoconjunctivitis (with/without asthma) aged 18 to 50 were randomly assigned to 3 groups treated by sublingual immunotherapy with extracts of allergens, subcutaneous immunotherapy with extracts of allergens and subcutaneous with modified allergens (allergoids) respectively. Results. The efficiency of the first course of preseason ASIT (SCIT and SLIT) with extracts of allergens and aller-goids in the control of symptoms of allergic rhinoconjunctivitis (with/without asthma) was demonstrated. After the end of the first year pre-season ASIT data analysis scales (Total Symptom Score -TSS, Medircation Score -MS) revealed the best performance in the group of patients receiving SCIT with allergoids compared with patients receiving the SLIT with extracts of allergens: the scales of the TSS (p=0.023), MS (p=0.002). In addition, at the end of the maintenance phase of ASIT in patients treated with SCIT with allergoids the level of eosinophilic cationic protein (ECP) in the nasal lavage decreased by 22% (p=0.012), secretory immunoglobulin A (sIgA) in the nasal lavage increased by 70% (p=0.001), interleukin-10 (IL-10) in serum increased by 126% (p=0.006), allergen-specific IgG4 increased by 42% (p=0.01) from the initial values, that correlates with a decrease in the severity of clinical manifestations. In pollen season ECP level in nasal lavage was significantly (p=0.007) lower in a group of patients who received SCIT with allergoids compared with patients who received the SLIT with extracts of allergens. The most significant changes of serum level of IL-10 in the pollen season occurred in a group of patients receiving SCIT with allergoids compared with patients who received SLIT (p=0.013) and SCIT (p=0.001) with extracts of allergens. Conclusion. The study results deepen the existing understanding of the mechanisms of SCIT and SLIT. They allow to develop a comprehensive assessment of the therapy efficacy scheme based on clinical parameters and on monitoring of local (ECP, sIgA) and systemic biomarkers (IL-10, allergen-specific IgG4) as well.

Pathophysiological mechanisms of hepatic immune reactivity in prolonged experimental exposure of the body to sodium fluoride

2019 ◽  
pp. 64-72
Author(s):  
А.С. Казицкая ◽  
Т.К. Ядыкина ◽  
М.С. Бугаева ◽  
А.Г. Жукова ◽  
Н.Н. Михайлова ◽  
...  
Keyword(s):  
Sodium Fluoride ◽  
Histological Study ◽  
The Body ◽  
Male Rats ◽  
Free Access ◽  
Immune Reactivity ◽  
Organ Protection ◽  
Pathophysiological Mechanisms ◽  
Subchronic Exposure ◽  
Study Results

В условиях непрерывного воздействия неблагоприятных факторов окружающей и производственной среды на человека особую актуальность приобретает изучение механизмов, поддерживающих гомеостаз организма. Длительное поступление фторидов в организм приводит к формированию хронической фтористой интоксикации, патогенез которой вызывает многочисленные споры и дискуссии. До сих пор недостаточно внимания уделяется изучению висцеральной патологии, обусловленной нарушениями иммунного статуса в условиях воздействия на организм соединений фтора. Практически отсутствуют исследования по изучению иммунной реактивности, определяющей морфофункциональный характер ответной реакции печени на ранних стадиях развития фтористой интоксикации. Цель работы - изучение действий патофизиологических механизмов иммунной реактивности печени при субхроническом действии на организм соединений фтора. Методика. Опыты проведены на 210 лабораторных крысах-самцах массой 180-220 г., разделенных на 2 группы: контрольную (n=80) и группу животных с субхроническим действием фторида натрия (n=130). Экспериментальные животные в течение 12 нед имели свободный доступ к водному раствору фторида натрия (концентрация 10 мг/л, что составляет суточную дозу фтора 1,2 мг/кг массы тела). Для изучения иммунологических и биохимических показателей забирали кровь из хвостовой вены через 1, 3, 6, 9, 12 нед от начала эксперимента. Для оценки состояния гуморального звена иммунитета определяли уровень сывороточных иммуноглобулинов (IgA, IgG, IgM) иммуноферментным анализом с помощью наборов реактивов ЗАО «Вектор-Бест» (Новосибирск). Уровень сывороточных цитокинов: TNF-α, IL-1β, 2, 4, 6, 10 определяли на анализаторе Multiskan EX методом иммуноферментного анализа с использованием наборов «Вектор Бест» (Новосибирск). Подсчет общего количества лейкоцитов произведен классическим способом в камере Горяева, анализ лейкоцитарной формулы - в окрашенных мазках периферической крови. Метаболические изменения оценивали по активности ферментов в ткани печени: щелочной фосфатазы (ЩФ), аланин- и аспартатаминотрансфераз (АЛТ, АСТ), лактатдегидрогеназы (ЛДГ), гаммаглутамилтранспептидазы (γ-ГТ). Активность ферментов определяли унифицированными методами с помощью наборов реактивов ЗАО «Вектор-Бест» (Новосибирск) на фотометре PM-750 (Германия). Гистологические исследования печени осуществляли после декапитации крыс, проводимой под эфирным наркозом. Результаты. Показано, что субхроническое воздействие фторида натрия сопровождается формированием внутриклеточных и внутрисосудистых повреждений печени. Активация медиаторов воспаления и развитие иммунологических нарушений в динамике эксперимента способствуют формированию системной воспалительной реакции, которая приводит к появлению стойких морфологических нарушений в печени и изменению активности ферментов основных метаболических путей. Заключение. Полученные результаты могут быть использованы при разработке и проведении профилактических мероприятий в условиях воздействия на организм высоких концентраций фтора с последовательным применением детоксикационной, иммуномодуляторной и органопротекторной коррекции. Studying mechanisms, which maintain the body homeostasis, is particularly important in the conditions of continuous impact of adverse environmental and manufacturing factors. Long-term exposure to fluorides leads to chronic fluoric intoxication, the pathogenesis of which is a subject of multiple controversy and discussions. Not enough attention is still paid to elucidating the visceral pathology associated with fluorine-induced immune disorders. There are virtually no studies of immune reactions that define the morphofunctional nature of the liver response to early stages of fluoric intoxication. Aim. To study pathophysiological mechanisms of hepatic immune reactivity in subchronic exposure of the body to fluorine compounds. Methods. Experiments were performed on 210 male rats weighing 180-220 g. The animals were divided into two groups: 1) control (n=80) and 2) subchronic exposure to sodium fluoride (n=130). The rats had free access to a 10 mg/l aqueous solution of sodium fluoride (daily dose, 1.2 mg/kg body weight) for 12 weeks. Blood was withdrawn from the caudal vein at 1, 3, 6, 9, and 12 weeks of the experiment for immunological and biochemical tests. Histological study of the liver was performed after decapitation of rats under ether anesthesia. Results. The subchronic exposure to sodium fluoride was associated with intracellular and intravascular damage of the liver. Activation of inflammatory mediators and development of immunological disorders during the experiment contributed to a systemic inflammatory reaction, which resulted in persistent morphological injuries of the liver and changes in enzyme activities in major metabolic pathways. Conclusion. The study results can be used for development and implementation of preventive measures against the effects of high fluorine concentrations, which would include a successive use of detoxification, immunomodulation and organ protection.

Tropheryma whipplei, Immunosuppression and Whipple's Disease: From a Low-Pathogenic, Environmental Infectious Organism to a Rare, Multifaceted Inflammatory Complex

2015 ◽  
Vol 33 (2) ◽  
pp. 190-199 ◽  
Author(s):  
Thomas Marth
Keyword(s):  
Heart Valves ◽  
Clinical Manifestations ◽  
Systemic Infection ◽  
Tropheryma Whipplei ◽  
Molecular Techniques ◽  
Whipple’S Disease ◽  
Whipple's Disease ◽  
New Findings ◽  
The Central Nervous System ◽  
Body Compartments

Background: The actinobacterium Tropheryma whipplei was detected 20 years ago by molecular techniques, and following its culture has been characterized as the cause of a systemic infection known as Whipple's disease (WD). T. whipplei occurs in the environment, is prevalent only in humans, is believed to be transmitted via oral routes and to be host dependent. Key Messages: The classical form of T. whipplei infection, i.e. classical WD (CWD), is rare. It is well defined as slowly progressing chronic infection with arthralgia, diarrhea and weight loss, mostly in middle-aged men. However, current research revealed a much broader spectrum of clinical features associated with T. whipplei infection. Thus, T. whipplei may cause acute and transient infections (observed primarily in children) and the bacterium, which is found in soil and water, occurs in asymptomatic carriers as well as in CWD patients in clinical remission. In addition, T. whipplei affects isolated and localized body compartments such as heart valves or the central nervous system. Subtle immune defects and HLA associations have been described. New findings indicate that the progression of asymptomatic T. whipplei infection to clinical WD may be associated with medical immunosuppression and with immunomodulatory conditions. This explains that there is a discrepancy between the widespread occurrence of T. whipplei and the rareness of WD, and that T. whipplei infection triggered by immunosuppression presents with protean clinical manifestations. Conclusions: This review highlights recent findings and the clinical spectrum of infection with T. whipplei and WD, focusing specifically on the role of host immunity and immunosuppression. Current concepts of the pathogenesis, diagnosis and therapy are discussed.

Estimation of Na\K - ATPase Enzyme Activity and Endogenous Digitalis in Patients with Diabetic Neuropathy

2021 ◽  
Vol 19 (5) ◽  
pp. 95-103
Author(s):  
Eman Hameed Al-Rikabi ◽  
Mazin J. Mousa ◽  
Oda M. Yasser
Keyword(s):  
Enzyme Activity ◽  
Diabetic Neuropathy ◽  
Inhibitory Activity ◽  
Strong Association ◽  
Clinical Manifestations ◽  
Gradual Loss ◽  
Study Results ◽  
Healthy Control ◽  
The Mean ◽  
Age Range

Background: Among the most common complications of diabetes is diabetic neuropathy (DN). Diabetic neuropathy is a heterogeneous group of disorders, which involves a different part of somatic and autonomic nervous systems, with a gradual loss of neural conductivity. Some studies have shown that they reduce the activity of the Na/K ATPase, however, elevated levels of endogenous sodium pump inhibitor in diabetic individuals, including those with neuropathy. Changes in this transfer enzyme are believed to be due to several diabetes complications. Objective: The study had designed to evaluate the Na/K ATPase enzymatic activity in the erythrocyte-membrane among three groups. The first group had represented the patients with type 2 diabetes mellitus (DM2) and neuropathy. The second group is diabetics without neuropathy. The third group was a healthy subject. As well, the study had estimated the inhibitory activity of endogenous digitalis among patient groups. Furthermore, the aim of this research was to see whether there was a connection between red blood cell membrane Na-K ATPase activity and the medical facts of the analysis subjects. Design and Methods: One-hundred fifty subjects had enrolled in this case-control study; 80 patients complained of diabetic neuropathy of both sexes, the mean age 59.3 years with an age range of 40-81, 40 DM2 without neuropathy (53.9 years), (35 – 70), and 30 healthy controls (30 years, 25 to 45). Patients in the first group were selected carefully according to their clinical manifestations and the nerve conduction study results. The evaluations of both inhibitory activities of endogenous digitalis and Na/K ATPase had completed using a spectrophotometer. Enzyme activity had expressed in micrograms of phosphate concentration per grams of red cell ghost total protein concentration. Results: The mean enzyme activity of Na/K ATPase was significantly lower (p<0.001) in patients with diabetic neuropathy (381±17.9) compared with the diabetic group without neuropathy (498±22.9) and the normal controls (837±61.43). There was a significant inhibitory activity of endogenous digitals (17.87±2.15) in patients with DNP, compared with the diabetics without neuropathy (8.78±0.89) and healthy control (5.3±1.33). There was a significant association of enzyme activity with the following parameters: duration of diabetes, age, level of glycated hemoglobin and endogenous digitalis with the respective p-values (0.000, 0.000, 0.000 and 0.021). Gender showed no significant relationship with enzyme activity (p 0.43). Conclusions: In DM2 with neuropathy, hyperglycemia can much reduce the activity of erythrocyte Na/K ATPase. In addition, it may enhance the inhibitory activity of endogenous digitals. The timedependent increase in diabetic complications can be due to a strong association between diabetes duration and erythrocyte Na/K-ATPase activities.

scholarly journals Clinical manifestations of connective tissue systemic injury in women of early reproductive age having small pelvis varicosis

2006 ◽  
Vol 5 (1) ◽  
pp. 87-90
Author(s):  
V. G. Mozes ◽  
K. B. Mozes
Keyword(s):  
Connective Tissue ◽  
Clinical Examination ◽  
Clinical Manifestations ◽  
Sialic Acids ◽  
Reproductive Age ◽  
Severe Dysplasia ◽  
Study Results ◽  
Connective Tissue Dysplasia ◽  
Tissue Metabolites

The aim of the study was to define manifestations of non-differentiate forms of connective tissue dysplasia in women of early reproductive age having small pelvis varicosis. The study results showed that patients having small pelvis varicosis revealed more often phenotype manifestations of non-differentiate forms which were seen in clinical examination. Increased level of serum sialic acids and increasing excretion of connective tissue metabolites (free oxyproline and glycosaminoglycanes) with urine were consequence of connective tissue systemic injury in these patients which is in accordance with data of non-severe dysplasia process. The study performed allowed to conclude that the small pelvis varicosis in women of early reproductive age is a manifestation of systemic injury of connective tissue.

scholarly journals Clinical manifestations of chronic subdural hematoma in the elderly: Literature Review

2021 ◽  
Author(s):  
Gabriela Ferreira Kalkmann ◽  
Carlos Umberto Pereira ◽  
Francisco de Assis Pereira ◽  
Débora Moura da Paixão Oliveira ◽  
Nicollas Nunes Rabelo
Keyword(s):  
Early Diagnosis ◽  
Literature Review ◽  
Subdural Hematoma ◽  
Elderly Population ◽  
Clinical Presentation ◽  
Clinical Manifestations ◽  
Chronic Subdural Hematoma ◽  
Signs And Symptoms ◽  
The Elderly ◽  
Study Results

Introduction: The clinical manifestations of chronic subdural hematoma (CSDH) are often confused with other medical entities in the elderly, making their early diagnosis difficult or difficult. Early diagnosis is important, since its prognosis is directly associated with the preoperative neurological state, thus resulting in a worse vital and functional prognosis. Objectives: Report through a literature review the clinical manifestations of CSDH in the elderly population. Methods: Literature review, with the search terms: “Signs and Symptoms”, “Chronic Subdural Hematoma”, Aged, Diagnosis and Prognosis. In which PubMed, Lilacs, Scielo, Cochrane and TripDataBase data platforms were used. The inclusion criteria were: original studies published in any language. Articles in which full reading was prevented were excluded. With the application of the inclusion and exclusion criteria, 110 articles were included in the study. Results: Clinical presentation depends on the location, volume of the hematoma, rapid growth, the location of the CSDH, whether unilateral or bilateral, and the clinical conditions of the patient. Because the forms of clinical presentation of CSDH are variable, it is necessary that health professionals linked to the elderly (geriatrician, psychiatrist, general practitioner) have knowledge of this clinical entity. Conclusions: The recognition of classic forms as well as the identification of risk factors in the elderly favors the timely diagnosis and treatment of CSDH in the elderly population.

scholarly journals SUN-432 A Case of Sellar Plasmacytoma Masquerading as Pituitary Carcinoma with Hypopituitarism

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Christine Lee ◽  
Marilyn Tan
Keyword(s):  
Multiple Myeloma ◽  
Complete Blood Count ◽  
Rapid Development ◽  
Clinical Manifestations ◽  
Pituitary Carcinoma ◽  
Pituitary Hormone ◽  
Mri Brain ◽  
Imaging Characteristics ◽  
Cranial Nerve Palsies ◽  
New Findings

Abstract Background: Sellar plasmacytomas are rare tumors arising from clonal plasma cells localized to the sellar/parasellar region. They may mimic other pituitary pathology such as pituitary adenomas, chordomas, meningiomas or metastatic carcinomas in both clinical manifestations and radiographic evidence. Certain features such as predominance of cranial nerve palsies and absence of hypopituitarism appear to be more common with sellar plasmacytomas. We present an interesting case of a sellar plasmacytoma, initially mistaken for pituitary carcinoma, with rapid development of hypopituitarism and systemic multiple myeloma. Case: A 75 year old healthy male presented with sudden onset left eye diplopia and retro-orbital pain. Left eye ptosis and diplopia with left lateral and upward gaze were noted on exam. Initial MRI brain revealed a 17mm soft tissue mass involving pituitary and clivus, extending into the left superior orbital fissure, concerning for pituitary carcinoma. With the exception of low LH (1.2) and testosterone (25), baseline pituitary hormone labs, complete blood count and metabolic panel were within normal limits. Within 1 month, he acutely presented with fever, confusion, weakness, and bony pains. Repeat pituitary labs showed low ACTH &lt; 5, AM cortisol 4.3, TSH 0.07, FT4 0.5. New findings of acute renal injury, hypercalcemia, anemia with elevated Mspike, Kappa light chain 39.7 (0.3-2.0mg/dl), kappa/lamda ratio 66.2 (0.3-1.6) and beta2microglobulin 4484 were found. Repeat MRI brain noted multifocal osseous metastatic disease with left sellar and cavernous sinus lesion contiguous with clival osseous lesion displacing pituitary gland, concerning for plasmacytoma. PET/CT showed focal lytic lesions in clivus and posterior left iliac bone. Bone marrow biopsy confirmed 70% myeloma involvement with kappa monotypic plasma cell population. He was started on hydrocortisone, levothyroxine, chemotherapy and XRT. Conclusion: The rarity of plasmacytomas, combined with their clinical presentation and imaging characteristics similar to other sellar tumors, can often result in misdiagnosis. Accuracy of diagnosis is critical, as sellar plasmacytomas and underlying multiple myeloma (present in 50% of cases) require XRT and systemic chemotherapy respectively rather than surgery. Although pituitary function is usually preserved in plasmacytomas, our case shows that acute anterior pituitary dysfunction can be an early presenting sign.

POLYMORPHISM OF GENE IL2-330Т>>G AND EXPRESSION OF INTERLEUKIN-2 IN PATIENTS WITH VENOUS THROMBOEMBOLIC COMPLICATIONS OF POLYTRAUMA

2017 ◽  
Author(s):  
А. Мироманов ◽  
В. Доржеев ◽  
Н. Мироманова ◽  
Ю. Витковский
Keyword(s):  
Molecular Genetic ◽  
Interleukin 2 ◽  
Clinical Manifestations ◽  
Molecular Genetic Analysis ◽  
Control Group ◽  
Thromboembolic Complications ◽  
Inclusion Criteria ◽  
Study Results ◽  
Venous Thromboembolic ◽  
Analysis Point

Введение. Политравма отличается особой тяжестью клинических проявлений, сопровождается значительным нарушением жизненно важных функций организма, трудностью диагностики и лечения, частым развитием разнообразных осложнений, длительным периодом пребывания в стационаре и высокой инвалидизацией. Тромбоэмболические осложнения при политравме встречаются в 40–77% случаев и характеризуются скрытым клиническим течением, трудностью лечения и высокой летальностью. Цель исследования. Изучить влияние полиморфизма гена IL2-330T{>{G на экспрессию интерлейкина-2 (IL-2) у пациентов с венозными тромбоэмболическими осложнениями (ВТЭО) политравмы в Забайкальском крае. Материалы и методы. В исследование включено 114 пациентов (71,9% мужчин и 28,1% женщин) в возрасте от 20 до 40 лет с политравмой. Критерий включения в исследование: политравма с индексом по шкале ISS более 9. Первая группа — 73 пациента с неосложнённым течением политравмы, вторая группа — 41 пациент с ВТЭО политравмы. Контрольную группу составили 100 практически здоровых мужчин и женщин в возрасте от 20 до 40 лет. Материалом для молекулярно-генетического анализа служили образцы ДНК, выделенные из периферической крови. Для исследования выбрана точковая мутация IL-2 в позиции 330 (Т{>{G). Результаты. У пациентов с ВТЭО политравмы регистрировали более частое носительство генотипа -330T/T гена IL2; наличие этого генотипа сопровождалось увеличением продукции IL-2. Заключение. Идентификация генов и раскрытие их влияния на экспрессию кодируемых молекул способствует более глубокому пониманию патогенетических механизмов развития осложнений. Introduction. Polytrauma is characterized by a specifi c severity of clinical manifestations, is accompanied by a signifi cant impairment of vital body functions, the diffi culty of diagnosis and treatment, frequent development of various complications, prolonged period of hospitalization and high disability. Thromboembolic complications of polytrauma occur in 40–77% of cases and characterized by latent clinical course, diffi culties in treatment and high mortality. The aim was to study the eff ect of gene IL2-330T{>{G polymorphism on the expression of interleukin-2 (IL-2) at patients with venous thromboembolic complications (VTE) of polytrauma in Zabaykalskiy Krai. Materials and methods. The study included 114 patients (71,9% men and 28,1% women) with polytrauma aged from 20 to 40 years. Inclusion criteria: polytrauma with index according ISS scale more than 9. First group — 73 patients with uncomplicated polytrauma, second group — 41 patients with VTE of polytrauma. Control group consisted of 100 practically healthy men and women aged from 20 to 40 years. DNA samples isolated from the peripheral blood were the material for molecular genetic analysis. Point mutation of IL-2 at position 330 (T{>{G) was selected for study. Results. Genotype -330T/T of IL2 gene was registered more frequently at patients with VTE of polytrauma; the presence of this genotype was accompanied by increased production of IL-2. Conclusion. Identifi cation of genes and their eff ects on the expression of encoded molecules assists more overall understanding of pathogenetic mechanisms of complications development.

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