Recently a new type of ANA, directed against the centromere region of chromosomes, has been described.3 These antibodies were found especially in patients with the CRST syndrome, a variant of scleroderma characterised by calcinosis, Raynaud's phenomenon, sclerodactyly, and telangiectasia.4 5 Since Raynaud's phenomenon is often an early manifestation of scleroderma and especially of the CRST

Human fibroblast monolayers were applied as a nuclear substrate in indirect immunofluorescence for the detection of anti-nuclear antibodies (ANA). Comparison of the results obtained with this substrate and with conventional rat liver sections led to the conclusion that the application of human fibroblast monolayers as a substrate has the following advantages: 1) better recognition of the distinct nuclear staining patterns; 2) more convenient serum titrations, since a cryostat is not needed and twelve tests can be performed on one slide; 3) detection of significantly higher ANA titres in sera from patients with SLE and MCTD; 4) recognition of a type of ANA that was not detected on rat liver sections. These latter antibodies produced a discrete speckled pattern of fluorescence, which was completely lost after acid elution of the fibroblasts. Using HEp-2 cells in metaphase, it was shown that the antibodies were directed against the centromere regions of the chromosomes. These anti-centromere antibodies were detected in sera from patients with severe Raynaud's phenomenon. Underlying disorders were scleroderma (8 patients, 5 of them with CREST syndrome), Sjögren's syndrome (2 patients), and Raynaud's phenomenon in combination with a few symptoms of connective tissue diseases without fulfilling the criteria for a specific disease (5 patients).

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Monoclonal antibodies were used for detecting varicella-zoster virus (VZV) by immunofluorescence (IF) in clinical specimens inoculated on shell vial cultures. Vesicles of 74 patients with varicella or herpes zoster-like eruptions were tested by this method and by conventional cell culture. Further diagnostic tests were direct IF on smears (42 patients), the cytological Tzanck test (28 patients), and serology (30 patients). Both IF assays were performed with the commercial VZV-specific monoclonal antibody 3B3 (Ortho). Using the shell vial technique, we found VZV in 37 (50%) of the patients, on average after 3 days. The conventional culture method yielded 26 positives (35%), on average after 7.5 days. Twenty-nine of the shell vial IF-positive patients were also positive by direct IF on smears (30 tested), while 15 gave positive Tzanck smears (18 tested). The sensitivities of the shell vial IF test, the direct IF test, the conventional culture method, and the Tzanck test were about 95%, 97%, 70%, and 79%, respectively. For the specificities, we found at least 97% for the shell vial IF test, at least 91% for the direct IF test, and about 78% for the Tzanck test. We conclude that both VZV IF tests are much more reliable than the conventional cell culture method and the Tzanck test for the laboratory diagnosis of VZV infections.