Endobronchial tuberculosis--is corticosteroid treatment useful? A report of 8 cases and review of the literature

Eight patients with endobronchial tuberculosis diagnosed on bronchoscopy were treated with antituberculosis drugs and a course of prednisone. The progress of the endobronchial lesions was assessed on repeated examinations. The course of the disease was variable and the endobronchial narrowing improved in two patients only. Hypersensitivity reactions associated with initiation of antituberculosis treatment may constitute a special group where corticosteroid is indicated. In other situations, the usefulness of corticosteroid for treatment of endobronchial tuberculosis is not well documented.

HLA-DR and DQ antigens in Chinese patients with oral lichen planus

A study of HLA-DR and DQ typing in 44 patients with oral lichen planus (OLP) (28 women and 16 men) and in 107 normal controls of both sexes was performed by using Terasaki's oriental tray. Twenty-eight patients had erosive forms of lichen planus (OLPe). Serologic typing revealed a highly significant increase of HLA-DR 9 and Te 22 antigens in the patient group. Considering our findings and those in other autoimmune diseases, it is hypothesized that OLP is a localized autoimmune disease and the HLA-DR9 in Chinese takes the place of HLA-DR3 in Caucasians in carrying the genes which predispose to the development of autoimmune disease.

Na(+)-H+ antiporter and Na(+)-(HCO3-)n symporter regulate intracellular pH in mouse medullary thick limbs of Henle

To determine mechanisms of intracellular pH (pHi) regulation in mouse medullary thick limbs (MTAL), pHi was measured in MTAL suspensions and in the isolated perfused MTAL by use of 2',7'-bis(carboxyethyl)-5(6)carboxyfluorescein (BCECF). A method to obtain MTAL suspensions from the mouse outer medulla is reported. Characterization of suspensions with microscopy, anti-Tamm-Horsfall antibody labeling, measurement of O2 consumption, and adenosine 3',5'-cyclic monophosphate responses to antidiuretic hormone indicated that these suspensions were highly purified for viable MTAL tubules. The resting pHi was 7.41 +/- 0.02 (means +/- SE) in N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid-buffered media and 7.23 +/- 0.02 in CO2- HCO3(-)-buffered media, both at extracellular pH 7.4. MTAL tubules exhibited rapid pHi recovery from intracellular acidification. Recovery of pHi was dependent on luminal Na+ (apparent Km = 13.2 +/- 3.2 mM) and was inhibited by amiloride (apparent Ki = 10.6 microM), consistent with the activity of an apical Na(+)-H+ antiporter. Antiporter activity was enhanced by acidification and was diminished at the resting pHi. Recovery from intracellular alkalinization (rapid withdrawal of CO2- HCO3-) was sensitive to the stilbene anion transport inhibitor 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid, Cl(-)-insensitive, and Na(+)-sensitive, consistent with the activity of a Na(+)-(HCO3-)n symporter. Both transporters were significantly involved in steady-state pHi regulation in the presence of CO2- HCO3-. In contrast, the Na(+)-H+ antiporter played the dominant role in steady-state pHi regulation in the absence of CO2- HCO3-.

Rapid hypertonic cell volume regulation in the perfused inner medullary collecting duct

Differential interference contrast microscopic images were used to assess the cell volume regulatory increase (VRI) response of rat IMCD segments isolated from the mid-inner medullary region of pathogen-free Sprague-Dawley rats and perfused in vitro at 37 degrees C. In the absence of ADH. IMCD cells behaved in an osmometric fashion over the range of extracellular osmolalities 290 to 386 mOsm/kg H2O and had an osmotic space equal to 54.2% of total geometric volume. After initial shrinkage in hypertonic perfusing and bathing solutions (340 mOsm/kg H2O using sucrose), cell volume increased rapidly to the isotonic value only in tubules preincubated in ADH (100 microU/ml). The rates of VIR were: (-ADH) 0.0142 +/- 0.0046 nl.min-1.cm-1 or 0.30 +/- 0.10%/min and (+ADH) 0.7225 +/- 0.1278 nl.min-1.cm-1 or 15.42 +/- 2.31%/min (N = 4; P less than 0.01). An overshoot in cell volume was observed on return to isotonic media only in the ADH exposed tubules showing a hypertonic VRI response, indicating that IMCD cells accumulated solute during hypertonic VRI. In the absence of ADH, one mM dibutyryl cyclic AMP mimicked the effect of hormone on hypertonic VRI. This ADH-dependent VRI process required Na+ and (CO2 + HCO3-) in external media and was reduced or abolished by 0.1 mM amiloride, 0.1 mM 4,4'-diisothiocyanatostilbene-2,2-'-disulfonic acid (DIDS) in peritubular solutions. These data suggest that ADH-dependent, rapid hypertonic cell volume regulation in rat inner medullary collecting duct depends on NA+ uptake, which may be mediated by parallel Na+-H+ and an HCO3(-)-dependent. DIDS-sensitive pathway (such as, Cl+-HCO3- exchanger) in basolateral cell membrane. In addition, a luminal amiloride-sensitive pathway (most likely the cation-selective channel) may contribute to cell volume regulation in the rat IMCD.

Cell membranes impermeable to NH3

Classically, there is a direct correlation between the lipophilic nature of a molecule and its rate of permeation across a biological membrane, so cell membranes should be more permeable to small, neutral molecules than they are to charged molecular species of similar size. Consequently, the distribution of NH+4 in biological systems is generally believed to be due to the rapid diffusion and equilibration of lipophilic NH3 across cell membranes and the accumulation of NH+4 to be governed by pH differences between compartments. Here we report that renal tubule cells from the medullary thick ascending limb of Henle have an apical membrane which is not only virtually impermeable to NH3, but is also highly permeable to NH+4. These remarkable properties have been incorporated into a model which explains how this renal epithelium can mediate vectorial movement of NH+4 between compartments of equal pH.

Anti-mucosal antibodies in recurrent aphthous ulcers

Using indirect immunofluorescent antibody technique, anti-mucosal antibodies were evaluated in single or sequentially multiple sera from 21 patients with recurrent aphthous ulcers (RAU), 41 age/sex-matched healthy subjects, and 40 patients with miscellaneous oral mucosal diseases. Although anti-mucosal antibodies were found widely distributed in patients having oral mucosal diseases, there were significantly higher rates of positive anti-mucosal antibodies (15/21, 71%) and circulating intercellular substance (ICS) antibodies (14/21, 67%) in RAU patients as compared with either the healthy subjects or patients with miscellaneous oral mucosal diseases. Circulating ICS antibodies of IgG class were found to be significantly predominant in the active phase of 67% (14/21) RAU patients. The percentage decreased in the order of 25% (4/16) in the remission phase of one week, and to 10% (1/10) in the remission phase of two weeks. The presence of pemphigus-like antibodies might be elicited by the epidermal occult antigens released from damaged tissue and/or due to the transient immunoregulatory dysfunction caused by certain infectious agents.

Hypotonic cell volume regulation in mouse medullary thick ascending limb: effects of ADH

Differential interference contrast microscopy was used in combination with standard electrophysiological techniques in the in vitro perfused mouse medullary thick ascending limb of Henle's loop (MAL) to evaluate the cell volume responses of this nephron segment during and following exposure to hypotonic media and to assess the role of antidiuretic hormone (ADH) and net salt absorption on the associated volume regulatory processes. Reductions in extracellular osmolality by 50 mosmol resulted in rapid increases in cell volume of approximately 20% with or without exposure to ADH. Cell volume recovery (volume-regulatory decrease, VRD) was much slower in the presence, than in the absence, of ADH. This hormone-mediated impairment of the VRD response could be overcome by the abolishment of net salt absorption with luminal 10(-4) M furosemide. An inverse linear relationship was observed between the rates of net salt absorption and VRD, indicating a finite ability of this nephron segment to enhance solute exit mechanisms whether induced by increases in transcellular traffic or by hypotonic cell swelling. Finally, returning to the isotonic media resulted in cell shrinkage under all conditions [+/- ADH and +(ADH and furosemide)] consistent with cell solute loss mediating VRD. However, recovery of cell volume back to the initial isotonic control value [post-VRD volume regulatory increase (VRI)] was only observed in ADH-treated tubules and was independent of net salt absorption. The post-VRD VRI response could be abolished by isohydric CO2-HCO3- removal or by addition of 10(-4) M amiloride to the peritubular medium. The latter results suggest that parallel Na+-H+ and Cl- -HCO3- exchangers located in basolateral membranes mediate the post-VRD VRI response.

Lymphocyte function in patients with recurrent aphthous ulcers

Lymphocyte proliferation (LP) responses to mitogens: phytohemagglutinin (PHA), concanavalin A (ConA) and pokeweed mitogens (PWM) were studied in 17 patients with recurrent aphthous ulcers (RAU) of minor type (MiAU) and 20 age/sex-matched healthy subjects. RAU patients elicited normal T-cell and B-cell responses to mitogens in comparison with healthy subjects. Proliferative responses were neither enhanced during active episodes of oral ulceration nor suppressed during periods of remission. It seems unlikely that non-specific lymphocyte dysfunction plays a major role in the pathogenesis of RAU.

Lack of effect of beta-endorphin on basal or glucagon-stimulated hepatic glucose production in vitro

beta-Endorphin appears to have effects on hepatic glucose production in vivo. In order to determine whether beta-endorphin modulates glucose production directly, the effects of beta-endorphin on isolated rat hepatocytes were investigated. This permitted isolation of the effects of beta-endorphin from hormonal and/or neuronal influences. A significant dose-related stimulatory effect of glucagon (10(-10) to 10(-6) mol/L) on both hepatic glucose production and glycogen phosphorylase a activity was demonstrated. No effect of either physiologic (10(-11) to 10(-9) mol/L) or supraphysiologic (10(-6) mol/L) concentrations of beta-endorphin on these parameters, under basal or glucagon-stimulated conditions, could be detected. These results suggest that reported in vivo effects of beta-endorphin to inhibit hepatic glucose production were either indirect or centrally mediated.

Serum immunoglobulins, complements and circulating immune complexes in oral lichen planus

Serum IgG, IgM, IgA, C3, C4 concentrations and circulating immune complexes (CIC) were measured in a series of 46 patients with oral lichen planus (LP). This investigation revealed a significant increase in the level of serum IgG in patients with oral LP as compared with 36 healthy subjects. In erosive LP, serum IgM was also elevated as compared with healthy subjects and patients with the non-erosive type. The results of this study did not support the suggestion that a humoral immunodeficiency underlies oral LP. Elevated serum level of IgM may be considered to represent secondary oral infection during mucosal erosion. The study also demonstrated a significant reduction in serum C4 in both variants of oral LP, but the C3 level was normal. A 3% polyethylene glycol precipitation (PEG-ppt) method was used, no significant amount of CIC could be detected in the patients. It is tempting to speculate that oral LP reflects an immunologic disorder in which serum IgG and C4 is disturbed. However, further investigation is needed to clarify the pathogenesis of oral LP.

Feasibility of computer screening of blood films for the detection of malaria parasites

This paper considers the feasibility of automatic screening procedures for detecting malaria parasites in blood smears prepared in the field. A simple programme for pattern recognition by computer has been developed for thin blood films that identifies parasites as densely stained particles within an erythrocyte. The parasites are detected correctly, but platelets falling accidentally within the outline of an erythrocyte and perhaps reticulocytes may be wrongly classified as parasites. The results indicate that automated detection of parasites is technically feasible but that the technique needs to be refined to reduce the incidence of false positives. A substantial increase in processing speed is required if the automatic procedure is to be economically feasible in screening programmes. The complexity of the equipment and the need for well prepared blood smears point to a possible use of the technique in laboratory checks but not under usual field conditions.