Intraarterial prednisolone infusion therapy in ulcerative colitis

Thirty-seven patients with ulcerative colitis who had shown inadequate response to conventional medical therapies were given intraarterial infusions of prednisolone via the superior and inferior mesenteric arteries. The therapy was effective in 31 (57%) of 54 infusions, including three of five cases of toxic megacolon. The effectiveness of the therapy correlated well with the clinical assessment of disease activity. There was also a positive correlation between the caliber of the inferior mesenteric artery and the effectiveness of the therapy. Intraarterial infusion of prednisolone can lead to improvement of ulcerative colitis, and this mode of therapy should be considered particularly in severe cases.

Microangiographic findings of massive intestinal bleeding in a patient with Crohn's disease: a case report

A 16 year old man with complaints of abdominal pain, diarrhea, high fever and loss of body weight was made a diagnosis of Crohn's disease. During the administration, he had intestinal obstruction and several episodes of massive intestinal bleeding. Selective angiography of the superior mesenteric artery demonstrated the bleeding site in the ileum. Microangiography of the surgical specimens revealed abrupt interruptions of arteriae rectae in the submucosa indicating the bleeding site from the diseased intestine.

[Effect of iron concentrations on the DNA-degradation reaction by bleomycin]

DNA-degradation reaction by bleomycin was conducted with form I of SV40 DNA as the substrate under "iron-limited conditions" and "iron-sufficient conditions". For "iron-limited conditions", the iron ions in reaction mixtures were derived from contaminant iron in the bleomycin preparation, the molar ratio of bleomycin/iron being 1/0.05. For "iron-sufficient conditions", Fe(II) was added to reaction mixtures to attain the molar ratio of bleomycin/iron at 1/1 to 1/29. DNA-degradation reaction by Fe(II) without bleomycin, or "Fe(II) alone", was also run for comparison. In any case, the reaction was allowed to proceed at such low rates that other products than form II and form III, due to further fragmentation, were negligible. The mass of DNA in each form was quantitatively determined by spectrofluorometry after agarose gel electrophoresis and staining with ethidium bromide. "Iron-limited conditions" and "iron-sufficient conditions" showed similar reaction characteristics as follows. As form I decreased with incubation time, form II increased faster than form III, hit a plateau (ca. 65% of total DNA) and decreased gradually thereafter. Form III kept increasing throughout the incubation. The reaction was dependent on incubation time and on doses of both bleomycin and Fe(II) but rather independent of temperature. The reaction was inhibited by acidic pH, Tiron (a specific chelator of iron) and Cu(II) but not EDTA. Octanucleotides with specific base sequence inhibited the reaction. DNA-degradation reaction by "Fe(II) alone" showed different characteristics as follows. The reaction proceeded rapidly at first, but ceased within 2 minutes. The extent of reaction was dependent on dose of Fe(II). The reaction product was form II accompanied by little amount of form III. The reaction was highly dependent on temperature, inhibited by EDTA, and not inhibited by Cu(II) and acidic pH. Octanucleotides, irrespective of their base sequences, inhibited the reaction.

Induction of impaired activation of lymphocytes by suppressive factor in Crohn's disease patients

Lymphocyte proliferative response to phytohemagglutinin (PHA) and relevance of serum factors to the response were studied in 12 patients with Crohn's disease (CD). The lymphocyte proliferative response was markedly reduced in patients with Crohn's disease (S.I. = 38.8 +/- 36.8) (mean +/- SD), as compared with normal controls (S.I. = 100.6 +/- 28.6) (p less than 0.01). In addition, the effect of sera from patients with CD or 10 patients with ulcerative colitis (UC) who had extremely impaired lymphocyte responsiveness to PHA on the proliferative response of normal lymphocytes to PHA was also measured. Sera from CD patients had a marked suppressive effect on the blastogenesis of normal lymphocytes (S.I. = 46.4 +/- 28.5), as compared with normal sera (S.I. = 126.2 +/- 14.7) (p less than 0.001). On the other hand, UC sera did not suppress the blastogenesis of normal lymphocytes (S.I. = 114.9 +/- 27.7). Moreover, serum immunosuppressive acidic protein (IAP) levels in patients' sera were measured by single radial immunodiffusion assay. A marked increase in serum IAP levels was revealed both in CD patients (780 +/- 470 micrograms/ml) and in UC patients (601 +/- 278 micrograms/ml), as compared with normal controls (376 +/- 92 micrograms/ml) (p less than 0.001). But there was no precise correlation between the suppressive effect of sera and serum IAP levels in patients with CD. Thus, we demonstrated an impairment of the lymphocyte responsiveness to PHA in CD patients and the possible existence of immunosuppressive factors which is not identical with IAP in the sera from patients with CD.

Characterization of thymus cells in hyperplastic thymuses in patients with myasthenia gravis and ulcerative colitis with monoclonal antibodies

Recently, increasing attention has been paid to thymic relevance to pathogenesis in some autoimmune diseases. In this report, the thymus cells from 7 patients with myasthenia gravis (MG) and 6 patients with ulcerative colitis (UC), who had undergone thymectomy for complication of thymic hyperplasia, were studied. The thymus cells were characterized with monoclonal antibodies (Anti-Leu-2a and Anti-Leu-3a) which define human T-cell surface antigens. Although the control thymus consisted of 82-94% of thymocytes which were reactive with Anti-Leu-2a and 90-95% of cells reactive with Anti-Leu-3a, in UC patients both Leu-2a positive thymus cells (38-56%) and Leu-3a positive cells (68-82%) were decreased. Concerning MG thymocytes, Leu-2a positive cells were also decreased (66-81%), but the percentage of Leu-3a positive cells did not show a remarkable change (86-90%) compared with control thymocytes. Considering the above results and many reports telling functional and populational abnormalities of peripheral immunocompetent cells, the process of intra-thymic T-cell maturation may be impaired in these autoimmune diseases.

Functional differences of anti-T-cell antibody in patients with systemic lupus erythematosus and ulcerative colitis

The loss of suppressor T-cell function results in an abundant production of autoantibodies in systemic lupus erythematosus (SLE). As a cause of this suppressor T-cell defect, anti-T-cell antibody seems to be of prime importance. On the other hand, anti-T-cell antibodies can be detected in various other autoimmune diseases, but their functional characteristics have not been determined. In the present study, the functional characteristics of anti-T-cell antibody from a selected subgroup of patients with ulcerative colitis (UC) were compared with those from patients with SLE. Anti-T-cell antibody from the patients with SLE reacted with a T8 subset, resulting in a suppressor defect, whereas anti-T-cell antibody from the UC patients reacted primarily with a T4 subset. Functionally, SLE- T cells failed to proliferate in response to concanavalin A, whereas UC- T cells from UC patients failed to proliferate in response to phytohaemagglutinin. In the Ig synthesis system, both SLE- and UC- T cells increased Ig production of B cells. Since UC+ T cells did not contribute to the generation of Con-A-inducible suppressor activity, we believe that serum from the selected subgroup of patients with UC reacted with the inducer T-cell subset.

Circulating antibodies to the surface antigens on colon epithelial cells in ulcerative colitis

The fluorescence activated cell sorter (FACS) was used for detecting circulating antibodies to the surface antigens on isolated colon epithelial cells (anti-colon antibodies) by indirect immunofluorescence. Anti-colon antibodies were found in the serum of 30 of 41 (73%) patients with ulcerative colitis. This incidence is much higher than one established in earlier reports by application of indirect immunofluorescence to colon tissue using the fluorescence microscope. The results suggest that FACS analysis is very useful for detecting antibodies to colon specific antigen.

Long-term follow-up study on gastric adenoma and its relation to gastric protruded carcinoma

A total of 191 gastric adenomas in 178 patients was studied macroscopically by endoscopy and histopathologically by endoscopic biopsy. Among the lesions, 85 in 74 patients were followed-up for six months to 12 years. Gastric adenomas were found to be more frequent in the aged, with a rate of 0.1% in the third decade but 3.7% in the ninth decade, on gastroscopic examination. Gastric cancers coexistent with the gastric adenomas were seen in 14 cases (8%), and were more frequent in male than in female patients (sex ratio, 12:2). Only eight of the 85 lesions (9%) revealed macroscopic changes. Four of these showed a reduction in size, while the other four lesions showed enlargement. In 21 of the 85 lesions (25%), histologic changes were observed. Four (5%) changed from moderate dysplasia (Group III) to nondysplastic or intestinal metaplasia (Group I), eight lesions (9%) revealed histologic changes (Group III to IV, or vice versa) without malignant transformation, and nine lesions (11%) showed malignant changes. Neither submucosal invasion nor lymph node metastasis was found. These lesions consisted of carcinoma in situ with small foci in the lesions exhibiting moderate dysplasia, and a gradual transition from severe dysplasia to cancer was seen in resected lesions obtained by endoscopic polypectomy or surgical resection. In addition, a gradual increase in dysplasia of tissue from moderate to severe was revealed by repeated gastroscopic biopsy. These findings suggest that the gastric adenomas underwent malignant changes with gradual transformation from moderate through severe dysplasia.

Long-term follow-up study on gastric adenoma and its relation to gastric protruded carcinoma

A total of 191 gastric adenomas in 178 patients was studied macroscopically by endoscopy and histopathologically by endoscopic biopsy. Among the lesions, 85 in 74 patients were followed-up for six months to 12 years. Gastric adenomas were found to be more frequent in the aged, with a rate of 0.1% in the third decade but 3.7% in the ninth decade, on gastroscopic examination. Gastric cancers coexistent with the gastric adenomas were seen in 14 cases (8%), and were more frequent in male than in female patients (sex ratio, 12:2). Only eight of the 85 lesions (9%) revealed macroscopic changes. Four of these showed a reduction in size, while the other four lesions showed enlargement. In 21 of the 85 lesions (25%), histologic changes were observed. Four (5%) changed from moderate dysplasia (Group III) to nondysplastic or intestinal metaplasia (Group I), eight lesions (9%) revealed histologic changes (Group III to IV, or vice versa) without malignant transformation, and nine lesions (11%) showed malignant changes. Neither submucosal invasion nor lymph node metastasis was found. These lesions consisted of carcinoma in situ with small foci in the lesions exhibiting moderate dysplasia, and a gradual transition from severe dysplasia to cancer was seen in resected lesions obtained by endoscopic polypectomy or surgical resection. In addition, a gradual increase in dysplasia of tissue from moderate to severe was revealed by repeated gastroscopic biopsy. These findings suggest that the gastric adenomas underwent malignant changes with gradual transformation from moderate through severe dysplasia.

Long-term follow-up study on gastric adenoma and its relation to gastric protruded carcinoma

A total of 191 gastric adenomas in 178 patients was studied macroscopically by endoscopy and histopathologically by endoscopic biopsy. Among the lesions, 85 in 74 patients were followed-up for six months to 12 years. Gastric adenomas were found to be more frequent in the aged, with a rate of 0.1% in the third decade but 3.7% in the ninth decade, on gastroscopic examination. Gastric cancers coexistent with the gastric adenomas were seen in 14 cases (8%), and were more frequent in male than in female patients (sex ratio, 12:2). Only eight of the 85 lesions (9%) revealed macroscopic changes. Four of these showed a reduction in size, while the other four lesions showed enlargement. In 21 of the 85 lesions (25%), histologic changes were observed. Four (5%) changed from moderate dysplasia (Group III) to nondysplastic or intestinal metaplasia (Group I), eight lesions (9%) revealed histologic changes (Group III to IV, or vice versa) without malignant transformation, and nine lesions (11%) showed malignant changes. Neither submucosal invasion nor lymph node metastasis was found. These lesions consisted of carcinoma in situ with small foci in the lesions exhibiting moderate dysplasia, and a gradual transition from severe dysplasia to cancer was seen in resected lesions obtained by endoscopic polypectomy or surgical resection. In addition, a gradual increase in dysplasia of tissue from moderate to severe was revealed by repeated gastroscopic biopsy. These findings suggest that the gastric adenomas underwent malignant changes with gradual transformation from moderate through severe dysplasia.

Lymphatic role in the pathogenesis of fat malabsorption in liver cirrhosis in rats

Intestinal fat absorption was examined in rats with CCl4-induced liver cirrhosis. Marked lymphangiectasia of the small intestine was observed in rats after CCl4 was given subcutaneously biweekly for 10--12 weeks. Intestinal epithelial uptake of linoleic acid administered in the loop was not impaired, but accumulation of lipid droplets in the intestinal epithelial cells and disturbed lymphatic transport of absorbed fat were observed in these rats. These data suggest that lymphostasis of the intestine may play an important role in fat malabsorption in liver cirrhosis.

Anti-colon antibody and lymphocytophilic antibody in ulcerative colitis

The presence of anti-colon antibody in the sera from patients with ulcerative colitis was demonstrated by antibody-dependent cell-mediated cytotoxicity (ADCC) assay. In addition, the high prevalence of lymphocytophilic antibody in the sera from patients with ulcerative colitis was obtained by fluorescence activated cell sorter (FACS) analysis. This lymphocytophilic antibody was absorbed by rat colon epithelial cells. Moreover the lymphocytes from ulcerative colitis showed lower binding capacity to this antibody, but acquired higher binding capacity after 20 hr incubation at 37 degrees C in vitro. These data suggest that ADCC may have some role in the pathogenesis of ulcerative colitis.

Changes in intestinal alkaline phosphatase activity in cholera toxin-treated rats

It is conceivable that brush border enzyme activities of the intestinal mucosa will change when bacterial toxins are exposed to the intestinal microvillous membranes. The effect of cholera toxin on the activity of intestinal alkaline phosphatase in rats was therefore determined in the intestinal mucosa by the histochemical method as well as in intestinal lymph by using lymph fistulated-rats. Activity of intestinal alkaline phosphatase in the intestinal mucosa and lymphatics changed biphasically after the oral administration of cholera toxin to rats. For the first three hours after the administration of cholera toxin it was depressed; it then increased and at eight hours reached a maximum. These changes in the activity of intestinal alkaline phosphatase were prevented by the administration of chlorpromazine, a known inhibitor of adenylate cyclase activity.