Prevalence of latex allergy among greenhouse workers.
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Adult↗
Biomedical subjects
R Castillo
Publications and source records attributed to R Castillo.
Uraemic medium causes endothelial cell dysfunction characterized by an alteration of the properties of its subendothelial matrix.
Uraemic patients suffer from haemorrhagic disorders and accelerated atherosclerosis. To evaluate the possible role of the vessel wall in these haemostatic alterations associated with uraemia, we investigated the effect of a uraemic milieu on human endothelial cell (EC) cultures and the reactivity of the extracellular matrices (ECM) generated by these cells towards platelets. EC cultures were exposed to a pool of sera (20% in the culture medium) obtained either from uraemic patients or from normal donors, and the following parameters were evaluated: (1) EC viability (trypan blue exclusion test); (2) von Willebrand factor (vWF) levels in supernatants and associated with ECM; (3) the reactivity of EC and EC-derived ECM towards platelets, measured 'ex vivo' under flow conditions (5 min, wall shear rate 800 s-1); and (4) ultrastructure of the ECM. The viability of EC cultured in the presence of uraemic sera was similar to controls. Platelet interaction with ECM generated by EC exposed to uraemic sera was significantly reduced (P < 0.05). This decrease was mainly related to a reduction in platelet adhesion (9.8 +/- 1.9% vs 16.7 +/- 1.8% in controls, P < 0.02). VWF levels in supernatants and associated with ECM were similar to controls. Ultrastructural analysis of the ECM generated by EC exposed to uraemic sera revealed a deficient matrix. An increased removal of EC was observed in experiments in which EC cultured in the presence of uraemic sera were perfused with citrated blood. These results indicate that a uraemic milieu induces quantitative and qualitative changes in the vascular subendothelium, characterized by a less intrincate network of fibrils, as well as a decreased attachment of EC and reduced thrombogenicity to the ECM. These changes may represent another mechanism which contributes to the haemostatic dysfunction observed in uraemic patients.
Blood Platelets↗
Caroli's disease complicating pregnancy.
We describe two pregnancies in the same patient with Caroli's disease (congenital dilatation of the intrahepatic bile ducts). The first pregnancy was uneventful concerning the maternal Caroli's disease. The second pregnancy highlights the serious and potentially lethal complications of an acute episode to both the fetus and mother. The patient had acute ascending cholangitis, disseminated intravascular coagulopathy, and septic shock. Fetal distress necessitated delivery by cesarean section. The mother's postoperative course required prolonged critical care and interdisciplinary consultation. Both mother and neonate survived. We present the first report of Caroli's disease in pregnancy and review implications to the pregnant patient.
Adult↗
Occupational rhinoconjunctivitis and bronchial asthma due to Phoenix canariensis pollen allergy.
We report a case of occupational bronchial asthma and rhinoconjunctivitis caused by Phoenix canariensis (PC) pollen. The canary palm is a type of palm tree, belonging to the Arecaceae family, which is widely distributed in frost-free regions as an ornamental tree. Our patient was referred because he suffered symptoms of bronchial asthma, rhinoconjunctivitis, and contact urticaria when pruning dried leaves from PC during the pollination months. The skin prick test (SPT) with a PC pollen extract was positive, as was the specific IgE to PC pollen determined by Phadezym RAST, indicating an IgE-mediated sensitization. The nonspecific bronchial provocation test (BPT) performed with methacholine disclosed a mild bronchial hyperreactivity, and specific BPT with PC pollen elicited an immediate fall of 25% in FEV1 with respect to baseline. On RAST inhibition studies, a significant cross-reactivity was found between PC pollen and date palm (P. dactylifera) pollen. These results suggest that PC pollen could be a potential allergen in PC-growing areas.
Asthma↗
Summary of panel discussion: is traditional dental education in conflict with faculty development in the university setting?
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Education, Dental↗
[Expression of von Willebrand's disease in endothelial cord cell from a type 1 patient. Discrepancies between clinical manifestations and laboratory tests].
PURPOSE: The reactivity of subendothelium generated by endothelial cells attained from the umbilical cord of a newborn girl from a patient with type I von Willebrand's disease was evaluated. MATERIAL AND METHODS: Platelet adhesiveness was assessed by means of "ex vivo" blood perfusion systems (shearing coefficients from 300 to 1,300 s-1), on umbilical artery subendothelium and over the extracellular matrix (ECM) generated by cultured endothelial cells attained from the umbilical cord of a newborn baby from a type I von Willebrand mother. RESULTS: By means of an ELISA technique, a significant reduction of both the vWF secreted into the culture (p < 0.05) and of that associated with ECM (p < 0.05) was noticed. The two subendothelial surfaces examined supported a lesser extent of platelet adhesion than the control surfaces from healthy individuals in the perfusion tests at 1,300 s-1 (p < 0.05). The experimental results did not agree with the lack of clinical manifestations and laboratory abnormalities in the propositus at age 3. CONCLUSIONS: These findings suggest that the endothelial cells cultured from the tissues of a newborn baby from a type I von Willebrand woman expressed less vWF, at the same time confirming the importance of vWF bound to connective tissue in sustaining platelet adhesion. The data attained here illustrate the complex model of inheritance of moderate von Willebrand's disease, along with the technical limitations of cell culture studies. Such observations must be borne in mind whenever any experimental approach is performed with material attained from ill-differentiated tissues such as the umbilical cord vein.
Endothelium, Vascular↗
Von Willebrand factor availability in platelet concentrates stored for 5 days.
Von Willebrand factor (vWF) availability was assessed in platelet concentrates (PCs). After 5 days of storage, 82 +/- 9% of basal levels of ristocetin cofactor activity (vWF:RCo) remained in PCs. vWF antigen (vWF:Ag) increased up to 166 +/- 38% (P < 0.05) in the same period. Autoradiograph pattern of vW:Ag showed an increase in low molecular weight multimers, and fast migrating multimeric forms were visualized by crossed immunoelectrophoresis on day 5. Studies carried out in platelet free plasma stored as PCs showed similar changes in vWF:RCo but increments in vWF:Ag were not detected. These data indicate that PCs maintain vWF:RCo levels of clinical value even after 5 days of storage and suggest that vWF comes out from platelets to plasma during storage.
Blood Platelets↗
The role of the Baumgartner technique in transfusion medicine: research and clinical applications.
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Blood Transfusion↗
Specific skin tests in subjects with chronic bronchitis exposed to pigeons.
We have studied the diagnostic reliability of the specific skin tests done in 30 subjects who presented with chronic bronchitis (CB) as the only clinical manifestation related to exposure to pigeons and in 21 subjects with CB and known risk factors. Additionally, two control groups were included (24 asymptomatic subjects exposed and sensitized to pigeons and 10 subjects not exposed and not sensitized to pigeons). The skin prick tests with pigeon serum were negative in all the subjects tested. The intradermal skin tests showed an immediate positive reaction in 16 of the 30 CB-affected patients and in six of the control group of exposed asymptomatic subjects (chi square: 3.376) (P < 0.1; nearly significant); after 6 h, a positive reaction was recorded in 14 of the CB-affected patients and in three subjects of the control group (chi square: 5.187) (P < 0.005). A delayed reaction was seen in 10/30 CB patients and in only three of the 24 subjects of the control group (chi square: 2.218) (nonsignificant). In the group of the 21 CB patients with known risk factors and not sensitized to pigeons, only two patients showed immediate skin reactivity; the remaining readings were negative. Lastly, in the control group of 10 unexposed, nonsensitized subjects, the intradermal skin tests in the different readings were negative. Our results show that although the skin tests with pigeon serum have low sensitivity, they can be a useful supplement in distinguishing cases of CB attributable to chronic pigeon exposure from those cases attributable to another cause, especially in the consideration of immediate and late readings.
Adolescent↗
Avocado hypersensitivity.
The avocado (Av) is a fruit that belongs to the Lauraceae family. We report 17 patients with immediate hypersensitivity to avocado. Clinical manifestations in relation to avocado ingestion were as follows: systemic anaphylaxis in seven patients, angioedema/urticaria in six, vomiting in two, bronchial asthma in one, and rhinoconjunctivitis in one. Skin prick test (SPT) with fresh avocado was positive in all patients with the Strong avocado variety (SAv) and in 14 patients with the Hass avocado variety (HAv). Our patient-associated sensitizations were as follows: 10 to latex, eight to chestnut, eight to banana, four to kiwi, and four to walnut. Avocado-sensitized patients with latex allergy were typically middle-aged women, professionally exposed to latex, who also exhibited frequent associated sensitizations to chestnut, banana, and other fruits. Specific IgE against avocado was demonstrated in 11 of our patients, by both commercial CAP and RAST with avocado extract coupled to nitrocellulose disks. Despite its lower protein content, SAv seems to be more allergenic than HAv, both in vivo and in vitro. On incubating a pool of sera from our patients with avocado, latex, chestnut, and banana extracts, a progressive RAST inhibition was obtained, with SAv- and chestnut-marked disks. This suggests the existence of common antigenic determinants among these allergens.
Adolescent↗
[Cyto-histologic evaluation of parametrial involvement in cervico-uterine cancer using aspiration puncture guided by transvaginal echography].
Vaginal tact is not sufficient for staging the extension of cervical Ca in its adnexal compromise. The use of transvaginal echography with a cytological hystological parametrial biopsy allow the diagnosis to be certified. In 23 cases studied, 21 epidermoid carcinoma and one adenocarcinoma related with of original cervical tumor were revealed. The clinical staging had a 8.3% error margin.
Adenocarcinoma↗
Characterization of partial gene deletions in type III von Willebrand disease with alloantibody inhibitors.
von Willebrand factor gene deletions were characterized in four patients with severe type III von Wilebrand disease and alloantibodies to von Willebrand factor. A PCR-based strategy was used to characterize the boundaries of the deletions. Identical 30 kb von Willebrand factor gene deletions which include exons 33 through 38 were identified in two siblings of one family by this method. A small 5 base pair insertion (CCTGG) was sequenced at the deletion breakpoint. PCR analysis was used to detect the deletion in three generations of the family, including two family members who are heterozygous for the deletion. In a second family, two type III vWD patients, who are distant cousins, share an approximately 56 kb deletion of exons 22 through 43. The identification and characterization of large vWF gene deletions in these type III vWD patients provides further support for the association between large deletions in both von Willebrand factor alleles and the development of inhibitory alloantibodies.
Base Sequence↗
Latex allergy: clinical features and cross-reactivity with fruits.
BACKGROUND: Latex IgE-mediated allergy is an important medical problem, but its clinical characteristics and association with food allergies are not well defined. OBJECTIVE: Our objectives were to determine the clinical features of latex-allergic patients, and latex-associated food hypersensitivities. METHODS: A prospective study was performed in our outpatient clinic. It consisted of a clinical questionnaire, skin prick tests with aeroallergens and foods, skin test with a latex extract, determination of total and specific IgE by CAP/RAST methods, and RAST inhibition. Latex and food allergies were diagnosed on the basis of a suggestive clinical history and a positive skin test with the corresponding allergen. RESULTS: Twenty-five patients were diagnosed as having latex allergy. Their mean age was 33 +/- 9.0 years, with female predominance (23:2). There were nine greenhouse and six hospital workers. Latex-induced reactions included systemic anaphylaxis in nine patients (36%). Average total IgE was 161 kU/L, and it was within normal limits in 16 cases. Latex skin prick tests had excellent diagnostic precision with no adverse reactions, and CAP for latex diagnostic sensitivity was 80%. Forty-two food allergies were diagnosed in 13 of our patients (52%), and 23 of these consisted of systemic anaphylaxis. The most frequent food hypersensitivities were to avocado (9), chestnut (9), banana (7), kiwi (5) and papaya (3). Through RAST-inhibition, cross-reactivity among latex, avocado, chestnut, and banana was demonstrated. CONCLUSIONS: In our experience, latex allergy affects middle-aged women in certain professions at increased risk. Our data suggest the existence of a "latex-fruit syndrome," because 52% of our latex allergic patients had allergies to certain fruits.
Adolescent↗
Anaphylaxis due to limpet ingestion.
BACKGROUND: The limpet, phylum Mollusca, is one of the most frequent sea mollusks in the Canary Islands. Limpet IgE hypersensitivity reactions have been described. OBJECTIVE: To describe six patients with anaphylactic reactions due to limpet ingestion and to demonstrate by in vivo methods and by in vitro techniques specific IgE responses. METHODS: Six subjects who developed severe bronchospasm 30 to 120 minutes after eating limpets were included in the present study. The antigenic material for the in vivo and in vitro studies was an extract of cooked limpet prepared in our laboratory. Skin prick tests were performed in all patients using commercially available aeroallergens, mollusk, and crustacean extracts; the same skin tests were performed using the extracts prepared in our laboratory. Specific IgE by CAP and RAST and CAP inhibition studies were also performed. Limpet contamination by mites was excluded through a commercial ELISA using monoclonal antibodies. RESULTS: All patients had positive skin prick tests to D. pteronyssinus and cooked limpet extract and weak reactivity to cockroach and raw limpet extract. Specific IgE to mites and cooked limpet extract was also found using CAP and RAST techniques, respectively. The possible existence of common epitopes between limpet and D. pteronyssinus was excluded by CAP inhibition studies. Finally, no significant mite concentration was detected in the cooked limpet extract analyzed by a commercially available ELISA. CONCLUSIONS: Limpet is a potentially dangerous allergen specially in patients sensitized to D. pteronyssinus.
Adolescent↗
Relationships between characteristics of exposure to pigeon antigens. Clinical manifestations and humoral immune response.
An extensive clinical study has been performed on pigeon breeders in the Canary Islands. Three hundred forty-three subjects have participated in this study through the filling of a clinical and epidemiologic questionnaire. A venous blood sample was also taken from each fancier for a further serologic analysis. Detection of specific IgG antibodies was made by an indirect enzyme-linked immunosorbent assay (ELISA) using pigeon serum as antigenic material. Twenty-nine (8 percent) breeders fulfilled the "classic" pigeon breeders' disease (PBD) criteria. One hundred six (31 percent) had rhinitis, 62 (19 percent) had immediate bronchial symptoms, and 51 (15 percent) suffered from chronic bronchitis. A significant level of specific IgG was detected in 139 (40 percent) cases. Rates were correlated with pneumonitis symptomatology (p < 0.001) and with chronic bronchitis (p < 0.05). There was a significant association between the number of pigeons and the level of sensitization (p < 0.001). Finally, a statistical relationship between the intensity of exposure and specific IgG response was also found (p < 0.001). Titers of specific IgE could not be related either to the reported symptomatology in the questionnaire or to any of the exposure parameters analyzed.
Adolescent↗
Abnormal cytoskeletal assembly in platelets from uremic patients.
The mechanisms involved in the hemostatic abnormality of uremic patients remain obscure. We have explored the response of normal and uremic platelets to surface activation at the ultrastructural level and analyzed changes in the composition of proteins associated with normal and uremic platelet cytoskeletons after stimulation with thrombin (0.01 and 0.1 U/ml). Cytoskeletons were obtained by extraction with Triton X-100, processed by sodium dodecylsulfate-polyacrylamide gel electrophoresis, and the presence of cytoskeletal proteins analyzed by densitometry. Under static conditions, uremic platelets spread with difficulty on formvar-coated grids. The percentage of platelets that spread fully on this polymer surface was statistically reduced compared with that of control platelets (11 +/- 1.4 vs. 21 +/- 1.6; P < 0.05). An impairment of cytoskeletal organization was observed in resting uremic platelets but abnormalities were more evident after thrombin activation. The incorporation of actin into the cytoskeletons of thrombin-stimulated uremic platelets was significantly reduced with respect to controls (6 +/- 3% vs. 29 +/- 5%; P < 0.01 after 0.01 U/ml and 28 +/- 9% vs. 59 +/- 10%; P < 0.05 after 0.1 U/ml). Decreased associations of actin-binding protein (P < 0.01), alpha-actinin (P < 0.05), and tropomyosin (P < 0.05) with the cytoskeletons of uremic platelets were also noted. No difference was observed for the incorporation of myosin into the cytoskeletons of activated uremic platelets. These results suggest functional and biochemical alterations of the platelet cytoskeleton in uremia, which may contribute to the impairment of platelet function observed in uremic patients.
Adult↗
Differential responsiveness of human neutrophils to the autocrine actions of 1-O-alkyl-homologs and 1-acyl analogs of platelet-activating factor.
The phlogistic actions of six molecular species of platelet-activating factor (PAF) (1-O-alkyl-PAF homologs, 16:0-, 18:0- and 18:1-alkyl-PAF, 1-O-alkyl-2-acetyl-sn-glycero-3-phosphocholine (AGEPC) and their respective 1-acyl-PAF analog counterparts, 16:0-, 18:0- and 18:1-acyl-PAF, 1-acyl-2-acetyl-sn-glycero-3-phosphocholine (AGPC)) were assessed relative to five human neutrophilic polymorphonuclear leukocyte (PMN) functional responses: 1) lysosomal enzyme secretion; 2) specific desensitization to 16:0-AGEPC-induced lysosomal enzyme secretion; 3) O2- production; 4) chemotaxis; and 5) priming for enhanced O2- production. With respect to inducing lysozyme secretion, 18:0-AGEPC was 30- and 75-fold less potent than 16:0-AGEPC and 18:1-AGEPC, respectively, and was 25- and 40-fold less potent for inducing beta-glucuronidase secretion. 18:0-AGEPC was also 10-fold less active than 18:1- and 16:0-AGEPC for inducing O2- production. Thus, the rank order of potency of the alkyl-PAF homologs for inducing both lysosomal enzyme secretion and O2- production was 18:1- greater than or equal to 16:0- much greater than 18:0-AGEPC. In contrast, these three alkyl-PAF homologs had the same potency for desensitizing PMN to subsequent 16:0-AGEPC-induced lysosomal enzyme secretion and for priming PMN for augmented O2- production in response to FMLP or human recombinant C5a. Paradoxically, however, the rank order of potency of the alkyl-PAF homologs for effecting PMN chemotaxis was 18:0- greater than 18:1- much greater than 16:0-AGEPC. At concentrations as high as 1.0 microM, the acyl-PAF analogs did not initiate PMN lysosomal enzyme secretion, O2- production, or chemotaxis. However, the acyl-PAF analogs induced partial PMN desensitization to 16:0-AGEPC. A novel finding of potential (patho)-physiologic significance was the ability of acyl-PAF at nM concentrations to prime PMN for significantly enhanced O2- production after stimulation with FMLP or human recombinant C5a. The priming action of acyl-PAF was due to an increase in the rate as opposed to a prolongation of O2- production. The differing rank orders of potency of the alkyl-PAF homologs and acyl-PAF analogs for stimulating several physiologic responses of the same target cell, the human PMN, support the premise that there may be more than one PAF receptor subtype on the PMN and/or that differences in the biophysical properties of the various molecular species of PAF modulate their interaction with PAF receptor(s) linked to stimulus-response coupling.
Acylation↗
Recombinant human erythropoietin treatment improves platelet function in uremic patients.
The effect of recombinant human erythropoietin (rHuEPO) on primary hemostasis was tested in 19 hemodialyzed patients. Bleeding time, platelet aggregation and platelet interaction with vessel subendothelium (SE) under flow conditions were determined before treatment and after patients reached hematocrits greater than or equal to 30%. Two thrombotic events (an acute myocardial infarction and an AV fistula clotting) were recorded during the early stages of treatment. A shortening of average bleeding times (P less than 0.01), an increase in platelet count (P less than 0.01) and an improvement of platelet aggregation (P less than 0.01) and of platelet-SE interaction (P less than 0.01) were observed. A low correlation index was found between hematocrit and bleeding time (r = -0.351, P less than 0.05). To assess a possible effect of rHuEPO on platelet function, the same parameters were evaluated before and after receiving three doses of rHuEPO (40 U/kg i.v. post-hemodialysis) in 14 of the patients. No changes in platelet or erythrocyte counts were observed, the mean bleeding time remained unchanged, but platelet aggregation induced by arachidonic acid (P less than 0.05), ADP (P less than 0.01) and ristocetin (P less than 0.05) improved. Perfusion studies confirmed moderate but significant increases in the parameters that quantify platelet-SE interaction (P less than 0.05). Improvement of ADP-induced aggregation correlated with the increase of platelet adhesion to SE (r = 0.675, P less than 0.05). We conclude that rHuEPO treatment improves primary hemostasis in uremia through an increase of red cell mass but also through a beneficial effect on platelet function, which is independent of the hematocrit rise.
Adult↗