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Notes: : Two patients with clear-cell acanthoma with multiple lesions are reported; histologic and histochemical findings are similar to previous descriptions. The ultrastructural study confirms the overload of glycogen in keratinocytes, associated with an increase of mitochondria and nuclear deformations. The abundance of Langerhans’ cells is emphasized. Extrusion of glycogen by keratinocytes and its phagocytosis by Langerhans’ cells is suggested.

Notes: La morphologie de la grégarine Didymophyes gigantea, au cours de la croissance et de l'évolution du trophozoïte et de la syzygie, est étudiée en microscopie photonique et en microscopie électronique à balayage. Certaines observations sont également illustrées par quelques micrographies en microscopie électronique à transmission.Les premiers stades de développement de cette grégarine polycystidée ne possèdant cependant pas de septum; celui-ci n'apparaîtra qu'au cours de la croissance du jeune trophozoïte. Plus tard, les trophozoïte se détachent de la cellule-hôte pour s'as-socier en syzygies généralement constituées de 2 gamontes. Des syzygies multiples, c'est-à-dire à plus de 2 individus sont fréquemment observées. Immédiatement après l'association de 2 trophozoïtes, le satellite, dont le septum se résorbe, semble pénétrer quelque peu dans l'extrémité postérieure du primite, tandis que le protomérite de ce dernier va voir son apex se transformer en une sorte de coiffe sillonnée radialement. L'epicyte de cette grégarine est différencié en un système régulier de plis longitudinaux. Au niveau du deutomérite les plis sont animés de mouvements ondulatoires permettant des mouvements de glissement du parasite. Les plis du protomérite, qui ne semblent pas intervenir dans le déplacement par translation du parasite, sont rectilignes. Lorsque le septum proto-deutoméritique du satellite disparaît, les plis initialement rectilignes du protomérite deviennent également ondulatoires. Des excroissances des plis épicytaires apparaissent au niveau de l'etranglement marquant la limite proto-deutomérite et de la cloison primite-satellite. Plus tard, en fin d'évolution, il s'en forme également sur tout le deutomérite. Aucun noyau n'a jamais été observé, in vivo, dans la grégarine adulte, le jeune trophozoïte, ou même les 2 gamontes d'une syzygie. Cependant sur coupes fines en microscopie électronique à transmission, une grande quantité de très petits noyaux ont été découverts.La motilité de cette grégarine semble donc être due à 3 systèmes différents: (a) les plis ondulatoires de l'épicyte; (b) les myonèmes annulaires ectoplasmiques; (c) l'important flux cytoplasmique.Les relations entre les cycles de l'hôte et du parasite, les divisions nucléaires progamiques, l'origine du déplacement par translation de la grégarine et des contractions péristaltiques, font également l'objet d'une discussion.〈section xml:id="abs1-2"〉〈title type="main"〉SYNOPSISStructure of the gregarine Didymophyes gigantea during syzygy and growth and development of the trophozoite, was studied by light microscopy and scanning electron microscopy. Some observations are illustrated also by a few micrographs obtained by transmission electron microscopy.The first developmental stages of this cephaline gregarine do not have a septum, which appears only during growth of the young trophozoite. Later, the trophozoites detach themselves from the host cell to become associated in syzygy which usually involves 2 gamonts. Multiple syzygies, i.e. those involving more than 2 animals are frequently observed. Immediately after association of 2 trophozoites the satellite, whose septum is resorbed, appears to penetrate the posterior extremity of the primite for some distance, while the latter's protomerite has its apex transformed into a kind of radially furrowed cap. The epicyte (surface) of this gregarine is differentiated into a system of regular longitudinal folds. At the level of the deutomerite the folds exhibit undulatory movements which allow gliding movements of the parasite. The folds of the protomerite, which does not participate in the movement of the parasite, are rectilinear. When the proto-deutomeritic septum of the satellite disappears, the initially rectilinear folds of the protomerite also become undulatory. Excrescences of the epicytic folds appear at the level of the narrowed areas marking the proto-deutomerite junction and the primite-satellite septum. Toward the end of development they form over the entire deutomerite. No nucleus has ever been observed in living mature gregarines, young trophozoites, or in 2 gamonts in syzygy. A large number of very small nuclei was discovered, however, in thin sections examined by transmission electron microscopy.Motility of the gregarine appears to depend upon 3 different systems: (a) the undulating epicytic folds; (b) the ectoplasmic annular myonemes; (c) the cytoplasmic streaming.The relationships between the host and parasite cycles, the “progamic” nuclear divisions, and the origin of movement and peristaltic contractions of the gregarine are also discussed.

Notes: A search for IgE antibodies was performed in 224 children, aged 0–15 yr, with symptoms compatible with IgE-mediated allergy, employing total IgE. RAST with up to 17 allergens and the Phadiatop® test. Fiftysix of 113 children (50%), aged 0–3 yr, and 80 of 111 children (72%) aged 4–15 yr had specific IgE antibodies. The most common allergens during the first 4 yr were egg white, a mixture of nuts (hazel nut, peanut, almond, coconut and Brazil nut) and milk. During the 2nd yr of life inhalant allergens became more important. From the 3rd yr they became more common than food allergens as sensitizers. Among the children aged 4–15 yr timothy, cat and nut mix were the most common allergens. Among the children with specific IgE antibodies Phadiatop was positive in 58% of the children younger than 4 yr, and in 91% of the children over that age. Fifty-three of the children with IgE antibodies against nut mix were further investigated for antibodies against hazel nut, peanut and almond, and 48 (91%) were positive against at least one of them. The parents of 41 of these patients answered a questionnaire about adverse symptoms against nuts, and 26 (63%) were aware of clinical sensitivity. In conclusion, IgE antibodies against food allergens dominated in children under 2 yr, and thereafter antibodies against inhalants became more important. An unexpectedly high prevalence of IgE antibodies against nut mixture was found. Phadiatop was a good screening method for identification of children 4 yr or older with IgE antibodies against inhalants.

Notes: Background Intranasal budesonide is an efficacious treatment for perennial allergic rhinitis. Long-term effects on safety, particularly in children, need further investigation.Objective To investigate the long-term safety of intranasal budesonide in children.Methods In an open trial, 78 children (5–15 years) with perennial rhinitis were treated with intranasal budesonide pressurized metered dose inhaler 200 µg twice daily (delivered daily dose 256 µg) for 12 months; 43 children stayed in the study for 12 additional months and were switched to aqueous suspension (400 µg delivered daily dose) for 6 months. Statural growth, bone age, ophthalmologic and rhinoscopic status, cortisol and biochemical analyses in blood and urine were monitored during the first and second years, and adverse events (AEs) were continuously recorded.Results No significant effects on statural growth and bone age, compared with reference values, were observed. Morning plasma cortisol and 24-h urinary cortisol were not changed during treatment. Patients reported 195 AEs, most commonly nasal dryness (30%), blood-tinged secretions (21%) and, among non-nasal AEs, headache (13%). Rhinoscopy revealed no signs of mucosal atrophy, ulceration, or candidiasis but some nasal dryness. No treatment-related ophthalmological or biochemical aberrations were found. Reduction of blood eosinophils and nasal symptom scores, compared with pre-treatment values, indicated the efficacy of budesonide treatment.Conclusion Long-term treatment for 1–2 years with intranasal budesonide 256–400 µg daily in children with perennial rhinitis revealed no negative effects on growth or endogenous cortisol production. Local side-effects were mild and patient symptoms decreased.

Notes: Zusammenfassung Es wird berichtet über die histologische Untersuchung der SinusknotenRegion bei 35 Herzen, davon 22 Herzen mit chronischer absoluter Arrhythmie. Der Sinusknoten war bei den primären Arrhythmie-Herzen (14 Fälle), das sind Arrhythmie-Herzen ohne wesentliches anderes Herzgrundleiden, über doppelt so häufig pathologisch verändert wie bei den sekundären Arrhythmie-Herzen mit anderen vorausgegangenen Herzleiden, wie z.B. Hypertonie, Herzfehler (8 Fälle). Bei diesen bestehen Beziehungen zwischen Vorhofsweite und -Schädigung einerseits und Sinusknotenveränderung andererseits. Es wird daher vermutet, daß die initiale Schädigung bei den primären Arrhythmie-Herzen meistens am Sinusknoten ansetzt, bei den sekundären Arrhythmie-Herzen dagegen meistens an den Vorhöfen, vor allem am rechten. Arrhythmie-Patienten erreichen ein hohes Alter, die mit primärem Arrhythmie-Herz ein durchschnittlich noch höheres als die anderen. Das Alter scheint ein wesentlicher Faktor bei der Entwicklung einer Arrhythmie zu sein. Wesentliche Bedeutung bei der Entstehung einer Arrhythmie kommt anscheinend rezidivierenden Hämorrhagien in die Sinusknotenregion zu, nervale — also auch psychische — Einflüsse spielen höchstwahrscheinlich eine große Rolle. Der Befund am Sinusknoten allein erlaubt keine sicheren Schlüsse, daß Arrhythmie bestanden hat. Wie auch sonst bei im wesentlichen funktionellen Störungen, kann bei Arrhythmie der morphologische Befund höchstens einen Hinweis auf die Disposition zur Entwicklung einer Arrhythmie geben.