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INTRODUCTION: Infections are the leading cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Invasive fungal infections (IFI) comprise a group of diseases caused by Cryptococcus, Histoplasma, Aspergillus and Candida. Few studies of IFI have been published in patients with SLE and associated factors have not been completely defined. OBJECTIVES: The objectives of this paper are to estimate the frequency of IFI in admitted patients with SLE in our hospital, to determine the risk factors associated with IFI in our patients with SLE, and to compare IFI group with a control group (SLE without IFI). METHODS: The medical charts of patients with IFI (EORTC/MSG, 2008) and SLE (ACR, 1997) admitted to our hospital from June 2001 until June 2012 were reviewed. To identify factors associated with IFI, we developed a case-control study (SLE + IFI vs SLE alone) in a one to three ratio adjusted for sex and age and hospitalization for other reasons. Comparison was made of demographic characteristics, duration of disease and disease activity previous to IFI diagnosis, especially three months before fungal infection. We defined severe activity as SLEDAI ≥ 8. Infection by fungi of the genus Candida was considered only in its disseminated form. RESULTS: Ten cases of IFI were identified in 208 patients with SLE admitted between June 2001 and June 2012. We included 40 patients with SLE (10 with IFI and 30 controls). Of the SLE-IFI patients, eight were women and the average age was 27.5 years (range, 19-42 years). Fungal isolation: eight Cryptococcus neoformans, one Histoplasma capsulatum and one Candida albicans. Sites affected: five in peripheral blood, five in central nervous system (CNS), four in skin/soft tissue and one in pleura. Mortality was 40% (p = 0.002), with Cryptococcus neoformans being the most common fungus. The SLE disease activity was severe in 70% of infected patients and no significant difference with the control group was found (p = 0.195). We also found no association with leukopenia, lymphopenia, hypocomplementemia, hypogammaglobulinemia or anti-DNA positivity; neither with meprednisone doses >20 mg/day or intravenous methylprednisolone pulse therapy before fungal infection. The use of immunosuppressive therapy with azathioprine showed a significant association (p = 0.017). Cyclophosphamide (p = 0.100) or mycophenolate mofetil (p = 0.256) did not show similar results. CONCLUSION: The frequency of IFI in hospitalized SLE patients in our hospital was 4.8%. Cryptococcus neoformans was the most common etiologic agent and was primarily responsible for the deaths in this cohort. These data are consistent with publications in East Asia rather than North America where Candida spp. is more common. Unlike other publications, previous immunosuppression with azathioprine was the only risk factor associated with the development of the infection. Invasive fungal infection should be suspected in hospitalized patients with SLE and immunosuppression with CNS or atypical cutaneous manifestation of SLE in order to start appropriate treatment early and obtain better outcome.

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Patient doses for a few common fluoroscopy-guided procedures in interventional radiology (IR) (excluding cardiology) were collected from a few radiological departments in 13 European countries. The major aim was to evaluate patient doses for the basis of the reference levels. In total, data for 20 procedures for about 1300 patients were collected. There were many-fold variations in the number of IR equipment and procedures per population, in the entrance dose rates, and in the patient dose data (total dose area product or DAP, fluoroscopy time and number of frames). There was no clear correlation between the total DAP and entrance dose rate, or between the total DAP and fluoroscopy time, indicating that a number of parameters affect the differences. Because of the limited number of patients, preliminary reference levels were proposed only for a few procedures. There is a need to improve the optimisation of IR procedures and their definitions and grouping, in order to account for their different complexities.

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Decree of Ministry of Health for the enforcement of the Act on Atomic Energy has put special emphasis on the regulation of monitoring for internal exposure in Hungary. The necessarily general prescription of the Decree called for a guidance to assist the work of the competent authority. The Guide was elaborated on the basis of the IAEA Safety Guide No. RS-G-1.2. According to the IAEA Safety Guide the decision factor shall first be determined for the potential radionuclides and practice applied. For routine monitoring the required frequency, method and MDA values, moreover for special monitoring the method and MDA values were derived for over 50 radionuclides considering two basic assumptions: the activity remaining in or excreted from the body could be determined by the given measurement method and the possible underestimation of intake shall be less than a factor of 3 within the monitoring interval.

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Escherichia coli hemolysin (HlyA) inserts into target membranes producing a cation-selective pore. We approached the problem of determining which portions of this protein remain exposed on the side of attack by applying specific antibodies. Results obtained with resealed erythrocyte ghosts and planar phospholipid membranes were compared. The effects of one polyclonal and four monoclonal anti-hemolysin antibodies (mAbs) were studied. Using ghosts we found one mAb which strongly reduced the ion-permeability through the preinserted HlyA channels and one which clearly increased it. Experiments with planar bilayers corroborated these results by showing that the former mAb effectively promoted the closed state of the channel whereas the latter forced the HlyA channel into an open configuration. Anti-hemolysin polyclonal antibodies initially stimulated but then prevented channel opening, indicating they contained clones able to act on both these channel determinants. They were effective only when applied on the same side as the hemolysin indicating that the epitopes were exposed to that side. Finally, the antigenic epitopes of three of the mAbs were localised on the HlyA molecule by using different mutants (amber and frame shift mutants and hemolysin gene hybrids).

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The application of antibiotics in the preservation of allograft and xenograft skin is controversial. The penicillin-streptomycin combination that is commonly used in reports in the literature was ineffective in our practice. Our Tissue Bank has tested different antibiotic combinations and found a more effective and suitable combination. After aseptic retrieval of pig and cadaver split skin, the skin strips were incubated in Eagle's MEM containing different antibiotic combinations. From frozen and fresh allogeneic and xenegeneic skin, 1-cm2 pieces were incubated in bacterial growth media, then tested. The antibiotic effect on skin samples of the highest antibiotic concentrations was assessed by growth inhibition around the skin discs. We followed up the clinical results after skin transplantation. The best results were obtained using the following antibiotic combination: 1000 mg/l ceftazidime, 1000 mg/l ampicillin and 80 mg/l amphotericin. The skin retained its antimicrobial effect after freezing and thawing. In 1992, 5 m2 cadaver and 50 m2 pig split skin were supplied to the Hungarian burn centres to cover deep partial and full skin thickness burned patients. There has not been a graft-originated infection during this period.

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In a multi-centre European trial we have assessed the radiation dose to those accompanying patients undergoing nuclear medicine investigations. Dosemeters were first calibrated against each other and then used to measure the radiation dose to the nurse or relative while they were in the waiting room. In departments where there was one waiting room the median radiation dose was 13 microSv, and the corresponding figures for where there were two waiting rooms and where the patients were allowed to leave the department with their nurse or relative were 12 and 11 microSv, respectively. These figures are not significantly different. However, we found that the median radiation dose to relatives was 13 microSv while that to nurses was 3 microSv (P < 0.01), although the waiting times were not significantly different. The reasons for these differences are discussed. Our data do not support the need for a second waiting room for injected patients in a nuclear medicine department.

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Escherichia coli hemolysin (HlyA) is a major cause of E. coli virulence. It lyses erythrocytes by a colloid osmotic shock due to the formation of hydrophilic pores in the cell wall. The size of these channels can be estimated using osmotic protectant of increasing dimensions. To show that the formation of pores does not depend critically on the osmotic swelling we prepared resealed human erythrocyte ghosts loaded with a fluorescent marker. When attacked by HlyA the internal marker was released, indicating the formation of toxin channels so large as to let it through. The channels can be directly demonstrated also in purely lipidic model systems such as planar membranes and unilamellar vesicles, which lack any putative protein receptor. HlyA has been recognised as a member of a large family of exotoxins elaborated by Gram-negative organisms including Proteus, Bordetella, Morganella, Pasteurella and Actinobacillus. These toxins have quite different target cell specificity and in many cases are leukocidal. When tried on planar membranes however, even specific leukotoxins open channels not dissimilar from those formed by HlyA, suggesting this might be a common step in their action. Comparison of the hydrophobic properties of six members of the toxin family indicates the presence of a conserved cluster of ten contiguous amphipathic helixes, located in the N-terminal half of the molecule, which might be involved in channel formation.

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The development of flexible, gas permeable, contact lenses, has permitted their introduction into clinical practice for the long term correction of aphakia. This study groups together the cases reported, by ophthalmologists in the area of Grenoble. Statistical analysis of the results have allowed us to establish a protocol and to define the place of this technique among already existing methods for the correction of the aphakic eye. The follow up was 20 months. There was non preoperative selection in our choice of patients for implantation, which probably explains the 10% failure rate. The protocol is described in detail based on our first 222 results.

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The effects of parent endotoxin and radiodetoxified endotoxin on human peripheral lymphocytes were compared in experiments in vitro. Radiodetoxified endotoxin is able to exceed the degree of the stimulation induced by parent endotoxin and its stimulatory effect. At the same time, no change was observed in the presence of autologous serum. Radiodetoxified endotoxin did not inhibit the phytohaemagglutinin-induced proliferative response.

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