Objective. To examine the usefulness of determining extended serum cytokine profiles in patients with juvenile rheumatoid arthritis (JRA), for the purpose of improving differential diagnosis and monitoring disease activity. Methods. In a 2‐year prospective study, serum levels of interleukin‐1β (IL‐1β), soluble IL‐2 receptor (sIL‐2R), IL‐6, IL‐8, tumor necrosis factor α (TNFα), and the p55 soluble TNF receptor (sTNFR) were repeatedly determined by enzyme‐linked immunosorbent assay in 40 patients with JRA, 13 patients with postinfectious arthropathies, and 30 healthy controls. The data were compared with conventional parameters of inflammation, such as C‐reactive protein (CRP), iron and hemoglobin levels, erythrocyte sedimentation rate (ESR), white blood cell (WBC) counts, and platelet counts. WBC subsets were analyzed by flow cytofluorometry. Results. At the first visit and at the peak of inflammatory activity according to CRP levels and/or ESR, serum levels of sIL‐2R, IL‐6, and sTNFR in JRA patients correlated significantly with conventional inflammation indicators, whereas IL‐1β, IL‐8, and TNFα did not. No changes in leukocyte subset distribution were noted. Among the different clinical subtypes of JRA, sIL‐2R, IL‐6, and sTNFR values at the time of the initial visit showed a pattern similar to CRP, whereby patients with systemic disease exhibited by far the highest values. TNFα and IL‐1β were variably elevated in certain JRA subtypes. Patients with postinfectious arthropathies showed elevated levels of CRP, sIL‐2R, TNFα, and sTNFR, which did not differ significantly from levels in the various JRA subtypes with the exception of systemic disease. Detailed analysis of types I and II pauciarticular JRA revealed that levels of CRP, IL‐1β, and TNFα were elevated in patients with type I disease. While these parameters were invariably normal in patients with type II disease, sTNFR and sIL‐2R were still found to be significantly elevated. Followup studies suggested that persistently high sTNFR values are a better indicator of JRA activity than are measurements of other cytokines or CRP. Conclusion. JRA is associated with significant and consistent changes in serum levels of inflammatory cytokines and soluble receptors. For the clinical monitoring of JRA, determination of levels of sTNFR, and to some extent sIL‐2R, may be particularly useful, since these determinations yield information about subtype and/or activity of disease that is not available from conventional parameters of inflammation.

The authors examined 105 proved cases of aspergillosis involving the paranasal sinuses or nasal fossa. Mycosis was always unilateral, and the maxillary sinus was infected in all cases. Early stages were manifested by an intraluminal soft-tissue mass representing the mass of mycelia. Fifty-nine patients (56%) demonstrated very dense intraluminal calcifications. Such dense concretions suggest the diagnosis of aspergillosis.

To prevent myocardial overloading, it seems to be useful to determine the HRTP, which indicate the workload where LVEF decreases.

Aspergillosis is not a rare disease of the paranasal sinuses; more than 80 cases were reported from 1976 to 1982 in the University ENT Clinic at Graz, Austria. Of 59 patients studied, 27 presented almost metal-dense x-ray shadows resembling foreign bodies in one of the sinuses. By means of light and electron microscopic investigations as well as x-ray fluorescence analysis, it can be demonstrated that these areas are equivalent to local enrichment of calcium phosphate in the center of the noninvasive fungal masses in the sinuses. A detailed description of the histopathology of Aspergillus fumigatus is given. For clinical diagnosis, the detection of almost metal-dense x-ray shadows in the absence of foreign-body history in our experience may be regarded as almost certain for aspergillosis of the paranasal sinuses.

The purpose of this investigation was to study myocardial function at rest, during three phases of energy supply, and during recovery. Radionuclide angiography was performed during the aerobic phase (phase I, rest-first lactate increase), the aerobic-anaerobic transition phase (phase II, first lactate increase-second lactate increase), the anaerobic phase (phase III, second lactate increase-maximal work performance (Pmax)), and during recovery. Thirty-eight male patients (59 +/- 7 d after myocardial infarction) were compared with 19 healthy control subjects and 21 sport students of comparable age. Left ventricular ejection fraction (LVEF) increased from rest to phase I and from phase I to phase II in sports students and control subjects. During phase III, LVEF did not change significantly in sports students, but it decreased significantly in control subjects. This is in contrast to the patients, who showed an increase of LVEF from resting values (47 +/- 3%) to phase I (50 +/- 1%), no change during phase II (51 +/- 2%), and a decrease to resting values (45 +/- 2) during phase III. All subjects showed an increase in stroke volume (SV) during phase I and II, reaching a maximum at phase II. This was evidenced by an improvement of the systolic function with a constant left ventricular end-diastolic volume (EDV) in control subjects and sports students. In contrast, an improved SV in patients was achieved through an increase in EDV and a less distinct increase in the left ventricular end-systolic volume (ESV). Maximal LVEF values were measured during the first 90 s of recovery in all subjects. Values during recovery are not representative of load dependent myocardial function. This increase in LVEF does not cause an increase in cardiac output but is a consequence of changes in the EDV and ESV, which decrease again immediately after the end of exercise performance.

In about 10% of patients who are operated on for chronic sinusitis, an aspergilloma is found in the affected paranasal sinus. In order to detect possible underlying immune defects, 25 patients with aspergillomas were subjected to an immunological screening program. The data obtained were compared with those of patients with non-mycotic chronic sinusitis and healthy controls. Total lymphocyte counts and immunoglobulin levels were normal in both groups with sinusitis. However, leukocyte subset analyses using membrane fluorescence revealed a significant decrease of CD11+ cells (macrophages, monocytes and natural killer-cells) in both types of sinusitis. Furthermore, a markedly enhanced frequency of CD25+ cells (interleukin 2-receptor-bearing cells), was observed in patients with the aspergillomas. Additionally, peripheral blood lymphocytes in both groups of patients showed a significant reduction in the proliferative response to both T- and B-cell mitogens, with the values for the mitogens ConA and PHA being significantly lower in the aspergilloma patients as compared to those with non-mycotic sinusitis. This lack of lymphocyte stimulation in the aspergilloma group was also manifest in skin tests to recall antigens. These first data suggest that there is an immune deficiency in patients with chronic sinusitis caused by Aspergillus fumigatus. Further studies are needed to clarify if this defect is the cause or the result of the mycotic infection.

The authors evaluated suppressed in vitro functions of peripheral blood lymphocytes (PBL) as a possible tool in the early diagnosis of human lymphoma. In 13 of 22 patients with recent onset of various types of nonleukemic lymphomas (Mb. Hodgkin and non-Hodgkin's lymphomas of B-cell and T-cell origin) the mitogen response of PBL against phytohemagglutinin (PHA) and concanavalin A (Con A), as measured by 3H-thymidine (3HTdR) uptake, was found to be significantly suppressed, whereas the response to pokeweed mitogen (PWM) was normal in 18 cases. In parallel, cytofluorimetric analysis was done with PBL after 72 hours in culture with and without PHA, using antibodies against the differentiation antigens: CD3, CD8, CD4, CD19, and CDw14 and the activation antigens: interleukin-2 (IL-2) receptor (IL-2R, CD25), human leukocyte antigen DR (HLA-DR), and transferrin receptor (TR). Compared with healthy controls and patients with other diseases, a significant reduction of the total T-cell blast response, i.e., the percentage of large T-cells bearing activation markers, was found in all lymphoma cases including those with a normal 3HTdR uptake. Furthermore, a pronounced inhibition in the expression of the activation markers Il-2R and TR, but not of HLA-DR, was detected on CD3+ cells in PHA-stimulated PBL of all lymphoma cases. Thus, polyclonal activation combined with activation antigens seems to give more accurate information about the functional defect(s) of PBL in an early state of lymphoma; these parameters may therefore be valuable diagnostically. The abnormal pattern in the expression of T-cell activation antigens after polyclonal stimulation may help in the understanding the cellular immune defects associated with lymphoma.

Out of 808 (100%) cases of endometrial carcinomas, registered at the Klinik Bad Trissl during a period of 14 years (1968-1981), over 85 cases (10,5%) of double and triple malignomas were found. 59 cases (7,3%) are correlated with a second primary breast cancer, 26 (3,2%) with other primary malignomas. 9 cases (1,1%) show triple malignomas. 5 precancerous cases (0,6%) were included in the survey. Contrary to medical literature the survey reveals a different distribution of neoplasms among the affected organs.