[Association of autoimmune chronic active hepatitis and acquired erythroblastopenia cured by cyclophosphamide]

To the best of our knowledge this is the reported first case of the successive occurrence in the same patient of chronic active hepatitis and acquired pure red cell aplasia, both probably of autoimmune origin. The diagnosis of autoimmune hepatitis was based on the presence of characteristic lesions at the examination of the liver biopsy specimen, high titer of anti-smooth muscle antibodies in the serum, and remission obtained by steroid therapy. Erythroid aplasia, which appeared during the course of this treatment, was revealed by a regenerative anemia (4.4 g Hb/100 ml) and proved by bone marrow aspiration and biopsy. In vitro bone marrow culture was normal, suggesting the in vivo presence of an inhibitor of erythroblastic differentiation. Red cell aplasia was cured by cyclophosphamide (100 mg/day during 56 days). No recurrence was noted until the death of the patient, which occurred one year later, due to hepatic cholangiocarcinoma. Action of cyclophosphamide on the pure red cell aplasia suggested the immune origin of this disease. The liver and the bone marrow erythroid lineage have probably been the successive targets of immunologic dyscrasia.

Drug-induced hepatitis associated with anticytoplasmic organelle autoantibodies

A study from five hepatology units documenting 157 cases of drug-induced hepatitis and a second study from a laboratory of immunology which tested more than 100,000 sera permitted us to establish the frequency of antiorganelle antibodies and their diagnostic value in drug-induced hepatitis. In drug-induced hepatitis caused by a heterogenous group of drugs consisting of ajmaline, aminopterine, isaxonine, isoniazid, perhexiline, phenylbutazone and troleandromycine, antiorganelle antibodies were absent or rare. In drug-induced hepatitis caused by another heterogenous group of drugs, including clometacin, fenofibrate, oxyphenisatin and papaverine, antismooth muscle, antinucleus and antimitochondria antibodies were found in isolation or in different combinations in 70% of cases. From the presence of antismooth muscle antibodies in sera, we could trace 30 cases of clometacin-induced hepatitis. The third group included drug-induced hepatitis with special antibody:iproniazid-induced hepatitis with antimitochondrial antibody 6 and tienilic acid (ticrynafen)-induced hepatitis with antiliver/kidney microsome antibody 2 (anti-LKM2). These two antibodies are rare in routine sera and were absent in patients who received the drug and had no liver damage. From the presence of corresponding antibodies, we detected six cases of iproniazid-induced hepatitis and 67 cases of tienilic acid-induced hepatitis. Antiorganelle antibodies found in high titers disappeared in 2 to 24 months following withdrawal of the offending drug. The fourth group was represented by halothane-induced hepatitis; antiliver/kidney microsome antibody 1 was weak and infrequent. Similarities between drug-induced hepatitis of the second group and lupoïd hepatitis suggest that drugs may reveal this spontaneous disorder.(ABSTRACT TRUNCATED AT 250 WORDS)

A preliminary survey of the relative abundance of fecal coliform bacteria in water and sediment and in the fresh water bivalve,Lamellidens marginalis, of the Buriganga river, Bangladesh

Studies on the concentration of fecal coliforms in freshwater bivalves were carried out using a spread plate method and membrane fecal coliform medium. Water, sediment, and bivalves collected from the Buriganga River at Dhaka, Bangladesh, were examined. As demonstrated in many previous studies, fecal coliform counts were consistently higher for the bivalve tissue than those for water and sediment samples; in the bivalveLamellidens marginalis, they were ∼10.0- to 87.0-fold higher than those in water, and 2.0- to 11.0-fold higher than those in sediment.

Fasting serum bile acid level in cirrhosis. A semi-quantitative index of hepatic function

We examined the roles of the factors which influence bile acid levels in order to define to what extent fasting serum total bile acid (FSTBA) level might reflect hepatic function and/or anatomy of the portal circulation in patients with cirrhosis. In a first group of 13 patients having mild to moderately advanced cirrhosis we determined the apparent oral clearance (CLo) of chenodeoxycholic acid (764 mumol) and their FSTBA levels. In a second group of 15 similar patients we measured FSTBA levels and by hepatic vein catheterization the intrinsic clearance (CLi) of ICG as well as total hepatic blood flow (Q). We found a significant inverse log-log relationship (r = 0.752, P less than 0.01) between the FSTBA and the CLo on the one hand and significant inverse log-log relationship (r = 0.707, P less than 0.01) between the FSTBA and CLi on the other hand. Q was not found to bear any significant relation to FSTBA (r = 0.120, P greater than 0.1). To conclude, in view of the observed relationship between CLi and CLo vs FSTBA, the latter might serve as a simple non-invasive semiquantitative index of hepatic function and/or anatomy of portal circulation in cirrhosis.

Disease due to enterotoxigenic Escherichia coli in Bangladeshi adults: clinical aspects and a controlled trial of tetracycline

The clinical characteristics of disease due to enterotoxigenic Escherichia coli (ETEC) were determined in 88 adult males admitted to a hospital in Dacca, Bangladesh, with moderate to severe dehydration. Persons infected with ETEC strains producing both heat-labile toxin (LT) and heat-stable (ST) toxin had more dehydration and acidosis, longer duration of illness, and greater stool volume than persons infected with strains producing only ST. Tetracycline therapy, evaluated in 63 cases, resulted in slightly earlier termination of illness in patients with LT-ST strains but had no effect on illness in the patients with ST strains. In both groups of patients tetracycline shortened the duration of excretion of organisms. Because of its limited effectiveness and the generally excellent response of ETEC diarrhea to rehydration therapy alone, tetracycline is not warranted for use in treatment of ETEC diarrhea in adults in this population.

Randomized trial of high- and low-dose ampicillin therapy for treatment of severe dysentery due to Shigella dysenteriae type 1

To establish optimal therapy for severe dysentery due to Shigella dysenteriae type 1 and Shigella flexneri, we compared in a prospective randomized trial two oral ampicillin doses (50 and 150 mg/kg per day) in 57 children and 39 adults in Dacca, Bangladesh. Clinical failure did not occur in either group, indicating that conventional doses need not be increased even in severe disease. Among children 3 years of age or under, bacteriological relapses tended to be more frequent in the low-dose group and were not related to serum levels of ampicillin, nutritional status, or the severity of colitis on admission. Therefore, we recommend that younger children be treated with 100 mg/kg per day of oral ampicillin.

Oral therapy in children with cholera: a comparison of sucrose and glucose electrolyte solutions

We performed a double-blind trial comparing sucrose electrolyte oral solution with glucose electrolyte oral solution in children less than 5 years of age with severe cholera-like diarrhea. Of 111 patients studied (102 with bacteriologically confirmed cholera), 55 received sucrose solution and 56 received glucose solution. The success rates, as defined by the absence of the need to give unscheduled intravenous therapy, were similar in the two groups (73% and 77% in the sucrose and glucose groups, respectively). There was no difference in purging rates between the two groups. The primary determinant of success for oral fluid regardless of the sugar was the purging rate. Sucrose malabsorption was responsible for oral therapy failure in one child. This study demonstrates that sucrose is an effective alternative to glucose in the oral therapy solution, but either must be used in conjunction with intravenous solution when treating severe dehydrating diarrhea.

Severe conditioned taste aversion elicited by venom of Russell's viper

Conditioned taste aversion (CTA) established in rats by associating saccharin drinking with subsequent poisoning by Russell's viper venom. Retention test revealed 76 and 56% reduction of saccharin intake in venom and antivenom-venom groups. No CTA was observed in antivenom and control groups.

Identification of gallbladder typhoid carriers by a string device

The efficiency of a gelatin capsule containing a nylon string for collection of duodenal specimens was investigated in carriers of Salmonella typhosa (typhi). Cultures of duodenal specimens obtained by means of the string capsule were compared with cultures of duodenal specimens obtained by a conventional duodenal tube and with stool cultures Duodenal contents obtained with either the string or tube were more often positive for S. typhosa than were stool cultures. The string, which is as efficient as tube collection but simpler and more comfortable, may be useful in identifying carriers of S. typhosa.

Eliciting conditioned taste aversion by cobra venom neurotoxin in rats

An attempt is made to study conditioned taste aversion (CTA) using cobra venom antivenom or lithium chloride as the Unconditioned Stimulus (US). Twenty-four hour water deprived rats were habituated for two consecutive days to drinking tap water in the drinking box for 15 minutes daily. On 3rd day they were allowed to drink 0.1% sodium saccharin. Thirty minutes later, they were injected with cobra venom (45 micrograms), antivenom (0.022 microliter), antivenom followed by venom, lithium chloride (0.15 M, 4% body weight) or physiological saline. After two days of recovery the animals were water deprived for twenty four hours and water intake was measured on the 7th and 8th day. Retention test on the 9th day shows reduced saccharin consumption in the lithium chloride and venom groups. CTA was significantly reduced in the antivenom-venom group and absent in the antivenom and control group. It is concluded cobra venom can induce clear-cut CTA in rats.

Single-dose doxycycline for cholera

To determine the efficacy of single-dose doxycycline in the treatment of cholera, we carried out a randomized prospective trial in 65 patients. Treatment consisted of either a single dose of 200 mg of doxycycline (or 4 mg/kg in patients less than 15 years old) or multiple doses of doxycycline, 500 mg over 4 days (or 10 mg/kg in patients less than 15 years old). There were no differences between the groups in the volumes of intravenous fluid required, volumes of diarrheal stool, or durations of diarrhea. The mean duration of positive stool cultures for Vibrio cholerae was similar for the two groups, although in both groups several patients continued to excrete Vibrios in the stool for more than 3 days. Blood levels of antibiotic demonstrated that the doxycycline was absorbed in spite of the rapid transit time associated with severe diarrhea. These results suggest that although tetracycline remains the drug of choice for cholera, doxycycline is a reasonable alternative, and that a single dose of 200 mg (4 mg/kg in children) is effective clinically.

Oral hydration rotavirus diarrhoea: a double blind comparison of sucrose with glucose electrolyte solution

Of 57 male children, aged 5 months to 2 1/2 years with rotavirus diarrhoea, 28 were given oral therapy with sucrose electrolyte solution and 29 were given glucose electrolyte solution in a randomised double-blind trial. All were rehydrated and remained so on oral therapy alone. These patients were compared with 44 children, also with rotavirus, who were treated only with intravenous hydration. The oral therapy and intravenous therapy groups did not differ clinically in the rate of rehydration or the rate of purging. Vomiting did not prevent the giving of oral therapy during hospital admission. Bangladeshi children with rotavirus diarrhoea have a defect of carbohydrate digestion but this defect does not prevent the use of a sugar electrolyte solution for oral hydration.

Hemolytic-uremic syndrome after shigellosis. Relation to endotoxemia and circulating immune complexes

To investigate three possible causes of the acute hemolysis in the hemolytic-uremic syndrome, we studied prospectively 207 children and 34 adults with shigellosis in Bangladesh. Nineteen children showed acute hemolytic anemia, a leukemoid reaction, thrombocytopenia and oliguria; nine other had, in addition, a serum urea nitrogen level of over 100 mg per diciliter. Eight of the nine had pseudomembranous colitis, and six of the nine died. The frequency of bacteremia was similar in all grades of shigellosis. Circulating immune complexes were found in 10 of 20 patients with uncomplicated shigellosis and in four of six with severe hemolytic-uremic syndrome. Limulus assay for endotoxemia was positive in nine of 18 patients with hemolysis (50 per cent) and three of 61 with uncomplicated shigellosis (5 per cent) (P less than 0.001). These data support the hypothesis that severe colitis in shigellosis is associated with circulating endotoxin from the colon producing coagulopathy, renal microangiopathy and hemolytic anemia.

Interaction between the activity of an epileptic focus and discrete skilled movements in rats

Sixteen male hooded rats were trained to reach into a narrow feeding tube for small food pellets. The paw movements were photoelectrically detected. An epileptic focus established by local application of 1% picrotoxin on the exposed motor cortex increased the frequency of reaching with the ipsilateral paw and impaired reaching with the contralateral paw. Interictal discharge rate of all ipsilateral foci was increased by reaching in the same way as the slow activity (less than 0.5/sec) of contralateral foci. On the other hand, fast activity (greater than 0.5/sec) of contralateral foci was decreased by reaching. Computer analysis of interictal discharge indicence during 512 msec before and after reaching onset showed that the brief facilitation of discharge (50 msec) during the actual movement was often preceded and followed by more prolonged inhibition (200 msec). The inhibition was better expressed in the contralateral hemisphere. The results are interpreted as due to changes of cortical excitability associated with reaching and to interference of the epileptic focus with the cortical elaboration of the skilled movement.

Interhemispheric transfer of extinction of the active avoidance reaction in rats

Cortical spreading depression (CSD) was employed in rats to study the lateralization of extinction of a jumping avoidance reaction. Under unilateral CSD, 181 nonreinforced trials were needed to extinguish the avoidance reaction acquired in three 100-trial sessions of intact-brain training. During a second extinction session, either with the same or with the contralateral hemisphere depressed, the mean number of trials to the extinction criterion (9/10) was 39 (n = 12) or 186 (n = 15), respectively. Five extinction trials performed with the brain intact 1 hr before extinction with contralateral CSD decreased the number of trials to extinction of 98 (n = 11). Thus, extinction of active avoidance can be lateralized and interhemispherically transferred in the same way as acquisition of this habit.

Epidemiologic investigation of an outbreak of Shiga bacillus dysentery in an island population

An epidemic of dysentery broke out in St. Martin island during May through July 1973. The epidemic was caused by Shigella dysenteriae type 1. The dysentery could not be controlled by conventional antibiotics and other antidysenteric drugs. The average attack rate was 32.9%. The age specific attack rate was highest in the age group 1-4 years (52.2%). The attack rates were higher in smaller families. The rates were not greatly different amongst people using different sources of water. The overall death rate was 2.1%. The overall infection-to-death rate was 6.4% but amongst children less than a year old, it was 41.1%. A common source outbreak was unlikely. The higher attack rate in smaller families suggested limited possibility of person to person spread. No particular water source could be implicated with higher attack rate. Flies may have played an active role in transmission.