Background
Tubulointerstitial nephritis (TIN) is an inflammatory disease of unknown pathogenesis. To evaluate a possible role of regulatory T cells (Tregs) in the pathophysiology of TIN with (TINU) ...and without uveitis, we investigated the presence and quantity of FOXP3
+
T regulatory lymphocytes in diagnostic kidney biopsies from pediatric patients.
Methods
A total of 33 patients (14 TIN and 19 TINU) were enrolled. The quantity of CD4
+
, FOXP3
+
and double-positive T cells in formalin-fixed kidney biopsies was determined using double label immunohistochemistry with anti-human CD4 and FOXP3 antibodies.
Results
FOXP3 staining was successful in all 33 patients. In patients with chronic uveitis, the density of FOXP3
+
cells was significantly lower (
p
= 0.046) than in TIN patients without uveitis or with uveitis lasting <3 months. CD4
+
staining was successful in 23 patients. The density of all lymphocytes (CD4
+
, CD4
+
FOXP3
+
and FOXP3
+
cells) was significantly lower (
p
= 0.023) in patients with chronic uveitis than in other patients.
Conclusions
FOXP3
+
T cells are present in kidney biopsy samples from TIN and TINU patients. In patients with chronic uveitis, the density of FOXP3
+
T cells is significantly lower than in other patients, suggesting a different pathomechanism for these clinical conditions.
To examine the interobserver variability in measuring the abdominal aorta by ultrasound (US) and computed tomography (CT).
A prospective clinical study in a university hospital.
Thirty-three patients ...whose abdominal aortas were scanned both with CT and US as a part of aneurysm investigation or for a variety of other reasons.
Three radiologists measured abdominal aortic diameters by US and CT. The interobserver differences (IOD) in US and CT and intraobserver differences for CT-US-pairs were analysed by various statistical methods. A new concept of “clinically acceptable difference” (CAD) was adopted denoting differences of less than 5mm.
The IOD in US was 2mm or less in 65% of the anteroposterior and 61% of the transverse measurements and 5mm or more in 11% of the anteroposterior and 14% in the transverse measurements in 102 observer pairs for all aortas. The IODs were significantly larger in measuring the aneurysmal aortas compared with normal aortas (
p < 0.001). The CAD-value for the aneurysmal aortas was 84% in the anteroposterior and 82% in the transverse directions. In CT the IODs were 2mm or less in 62% of the anteroposterior and 66% of the transverse measurements and 5mm or more in 12% of both anteroposterior and transverse measurements in 94 observer pairs for all aortas. The CAD-value in the aneurysmal aortas was 91% in the anteroposterior and 85% in the transverse directions. There was no significant difference between the US and CT CAD-levels. The absolute CT-US difference of an individual observer was 2mm or less in 54%, 5mm or more in 17% and 10mm or more in 2% of the anteroposterior measurements in the 95 CT-US pairs. In the transverse direction the corresponding figures were: 2mm or less in 63%, 5mm or more 13% and 10mm or more in 2% of the pairs. The diameters obtained by US were smaller in 84% of the cases compared with those of CT in measuring the maximum aortic diameter in anteroposterior direction, whereas the same figure for the transverse measurements was 59%.
Both US and CT measurements are subject to significant interobserver variability that must be taken into account in the clinical follow-up of small abdominal aortic aneurysms and in screening studies. Neither of these methods can be considered as a ‘gold standard’.
Tubulointerstitial nephritis (TIN) is an inflammatory disease of unknown pathogenesis. To evaluate a possible role of regulatory T cells (Tregs) in the pathophysiology of TIN with (TINU) and without ...uveitis, we investigated the presence and quantity of FOXP3.sup.+ T regulatory lymphocytes in diagnostic kidney biopsies from pediatric patients. A total of 33 patients (14 TIN and 19 TINU) were enrolled. The quantity of CD4.sup.+, FOXP3.sup.+ and double-positive T cells in formalin-fixed kidney biopsies was determined using double label immunohistochemistry with anti-human CD4 and FOXP3 antibodies. FOXP3 staining was successful in all 33 patients. In patients with chronic uveitis, the density of FOXP3.sup.+ cells was significantly lower (p = 0.046) than in TIN patients without uveitis or with uveitis lasting <3 months. CD4.sup.+ staining was successful in 23 patients. The density of all lymphocytes (CD4.sup.+, CD4.sup.+FOXP3.sup.+ and FOXP3.sup.+ cells) was significantly lower (p = 0.023) in patients with chronic uveitis than in other patients. FOXP3.sup.+ T cells are present in kidney biopsy samples from TIN and TINU patients. In patients with chronic uveitis, the density of FOXP3.sup.+ T cells is significantly lower than in other patients, suggesting a different pathomechanism for these clinical conditions.
The work ability of 961 construction workers, aged 40yr and over, was followed in two consecutive interviews in 1991 and 1995. A total of 736 (77%) construction workers participated in the follow-up ...interview. A work ability index was calculated for each respondent at baseline and at follow-up. Information on disability pensions was obtained from the registries of the LEL Employment Pension Fund. The actual working status was followed in the pension insurance register. Due to the recession during the early 1990s, nearly half of the respondents were unemployed for at least some period during the study. The work ability declined, especially in the age-group 50yr and older. The work ability index was highly predictive of disability pensions during the follow-up.
Relevance to industry
Reduced work ability and early retirement due to disabilities is commonplace in physically demanding jobs. There are few methods to forecast and monitor the risk of disability. This paper presents an easy to administer questionnaire, the work ability index, which is suitable for description and prediction of work ability in a group of ageing workers in physically demanding tasks, such as construction work.
We evaluated the long-term outcome of farmer's lung (FL) patients and matched control farmers using high-resolution computed tomography (HRCT). The study population consisted of 88 FL patients and 83 ...control farmers, matched by age, sex, and smoking habits. The mean time after the first diagnosed episode of FL was 14 yr. The great majority, 82%, of the studied subjects were nonsmokers. Clinical studies included HRCT, spirometry, and pulmonary diffusing capacity. Emphysema was found significantly more often (23%) in FL patients than in control farmers (7%) (p = 0.006). The presence of emphysema was 18% in nonsmoking and 44% in smoking FL patients, the respective values being 4% and 20% in control farmers. Patients with recurrent attacks of FL tended to have emphysema more often (p = 0. 08) than patients who had experienced only a single attack. Fibrosis was observed in 17% of the FL patients and in 10% of the control farmers (p = 0.2). Miliary changes were found in 12% of the FL patients compared with 4% of the control farmers (p = 0.07). Both emphysematous and fibrotic but not miliary changes correlated significantly with impaired pulmonary function. In conclusion, farmer's lung disease seems to be associated with an increased risk of developing emphysema.
The aim of this study was to compare high-resolution computed tomography (HRCT) findings of long-term farmer's lung (FL) patients and control farmers. We studied 88 FL patients and 83 matched control ...farmers with a mean follow-up time of 14 years. Emphysematous, fibrotic, and miliary changes were recorded by HRCT. The pattern of emphysema and location and distribution of other findings were evaluated in detail. Emphysema was found in 20 (23%) FL patients and in 6 (7%) controls (p=0.005). Recurrences of FL attacks increased (p=0.021) the risk of emphysema. Prevalence of fibrosis (17 vs 10%, p=0.16) and miliary changes (11 vs 4%, p=0.06) did not differ significantly in patients and controls. Among FL patients, emphysematous, fibrous, and miliary changes were more pronounced at the base than in the upper parts of the lung (p<0.02). In slice analysis, the pattern of emphysema was more polymorphous (p=0.001) and the distribution of fibrotic and miliary changes was more variable among FL patients than controls. Emphysema in HRCT is more common in FL patients than matched control farmers, and the occurrence is increased by recurrences of FL. Emphysematous, fibrous, and miliary changes in FL patients HRCT are multiform and predominate in the lower parts of the lung.
Photofluorography with a large image intensifier, which provides an image field of 40 x 40 cm, reduces both the radiation dose and the imaging costs in chest radiography as compared with the ...film-screen technique. The two techniques were evaluated in a clinical study of 135 patients with suspected chest abnormalities. Photofluorographs and film-screen chest radiographs were interpreted independently by three radiologists. The diagnoses were confirmed by CT, follow-up radiographs, and clinical records. Among the 135 patients, 75 had primary lung cancer, 39 had pulmonary nodules, 52 had hilar or mediastinal abnormalities, 17 had pleural fluid, and 45 had pneumonic or atelectatic changes. Twenty-three normal subjects were included. Differences in diagnostic accuracy, measured by sensitivity and specificity, were not statistically significant. A larger number of true-positive cases (65%) with peripheral lung nodules were found by photofluorography than by film-screen radiography (54%) (p less than .05). The results suggest that the diagnostic accuracy of chest images made by photofluorography is sufficient to warrant using it instead of the film-screen technique in routine chest radiography, especially to detect lung tumors and metastases.
Large-screen image intensifier (II) photofluorography was compared with full-size screen-film chest radiography in the diagnosis of pulmonary emphysema in 84 patients. Photospot films and ...conventional radiographs were interpreted independently by three radiologists. Computed tomography (CT) was used as an independent reference technique, and diagnostic performance of chest radiography in various CT patterns of emphysema was evaluated. The difference in diagnostic sensitivity for emphysema in favor of conventional chest radiography over photofluorography (0.65 versus 0.56) was statistically significant (p less than 0.05). Specificity of the imaging modalities was equal: 0.78 in full-size films and 0.77 in photospot films. All CT patterns of emphysema had great false negative response rates in chest radiography, which is an inaccurate technique for the diagnosis of emphysema. CT is required for reliable radiologic evaluation of emphysema.
An anatomical compensation filter for improving the radiographic demonstration of the mediastinal and retrocardiac areas of a chest radiograph has been evaluated. The filter, made of a transparent, ...light-weight lead-plastic material was attached to the X-ray collimator housing. The device reliably improved the visibility of normally underpenetrated areas without producing detectable artefacts, provided the patient was correctly positioned. Hilar structures were also slightly better visualised. At the same time there was no statistically significant deterioration in visualisation of peripheral pulmonary vessels or parenchymal structures. Rib details and pleural calcifications were less well seen, however, a result that was to be expected because of the X-ray beam hardening.
We present a case of intraperitoneal seeding in a 36-year-old woman with a large primary hepatocellular carcinoma located superfically in the left lobe of the otherwise normal liver. The patient was ...treated with percutaneous ethanol ablation therapy. Eight months after the treatment computed tomography and ultrasonography (US) revealed an intraperitoneal seeding that was confirmed with US-guided percutaneous biopsy.
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