Spontaneous bacterial peritonitis in patients with hepatitis B-related cirrhosis and hepatocellular carcinoma

To delineate the natural clinical course of spontaneous bacterial peritonitis in hepatitis B-related cirrhosis and to determine if it occurs in hepatocellular carcinoma, a prospective survey was conducted in 262 patients over 2 1/2 years. The in-hospital incidence and mortality rates of spontaneous bacterial peritonitis were 21.6% and 36.4%, respectively, in cirrhosis and 7.3% and 50% in hepatocellular carcinoma. In cirrhosis, the cumulative probability of annual recurrence of spontaneous bacterial peritonitis was 47.3%, which was significantly higher than the annual probability of occurrence of 11.3% in those with no previous attack (P less than 0.0001). The cumulative probability of annual survival was 27.6% in the spontaneous bacterial peritonitis patients, significantly lower than the probability of 64.0% in the control group (P = 0.0001). A univariate analysis, with Kaplan-Meier curves compared by the Mantel-Cox test, and subsequent multivariate analysis by stepwise Cox regression procedure were used to evaluate 37 variables recorded immediately after admission. Blood urea nitrogen concentration greater than 10.5 mmol/L urea (greater than 30 mg/dL) and ascitic fluid protein concentration less than 7.35 g/L (less than 735 mg/dL) were found to be the only significant predictors of lower annual survival; ascitic fluid protein concentration less than 7.50 g/L (less than 750 mg/dL) was the only significant predictor of higher annual recurrence. The authors conclude that spontaneous bacterial peritonitis has a high risk of recurrence in hepatitis B-related cirrhosis and that the same disease occurring in patients with hepatocellular carcinoma is related to the underlying cirrhosis rather than the hepatocellular carcinoma.

Peripheral blood neutrophils in inflammatory bowel disease: morphological evidence of in vivo activation in active disease

Morphological evidence of activation in vivo of circulating neutrophils in patients with inflammatory bowel disease (IBD) was sought by quantitative light microscope examination of toluidine blue-stained preparations made from peripheral venous bloods that had been fixed immediately ex vivo. The proportion of spherical (unactivated) circulating neutrophils was reduced in active Crohn's disease (73%; 46-96 (median; range), n = 11) compared with inactive Crohn's (90%; 45-99; n = 18, P less than 0.01) and normal subjects (94%; 44-98; n = 13, P less than 0.05). There tended to be fewer spherical neutrophils in active ulcerative colitis (77%; 13-96; n = 17) than in quiescent colitis (88%; 57-99, n = 13, P less than 0.1) or normal subjects (P less than 0.05). Activated neutrophils occur in the circulating pool of patients with active IBD and can be detected by light microscopy of peripheral venous blood leucocyte preparations.

Mineral-associated hepatic injury: a report of seven cases with X-ray microanalysis

The patterns of hepatic injury associated with various minerals were studied in seven patients. The subjects included one patient who was a sandblaster (silica by inhalation), one patient who was a dental laboratory technician (silica and chromium-cobalt alloy by inhalation), one patient with inhalational talcum powder abuse, and four chronic intravenous (IV) drug abusers (talc by IV injection). In all cases, the liver was examined by light and polarizing microscopy, and by scanning electron microscopy with energy-dispersive x-ray microanalysis. In the two patients with silica exposure, silica-containing sclerohyaline nodules were diffusely present in portal tracts and lobules. Both chromium-cobalt alloy and silica were present in the dental technician. In contrast, in all cases of talc exposure, aggregates of talc-laden macrophages were present in portal and centrilobular areas. Three IV drug abusers and the talcum powder abuser had histologic evidence of chronic hepatitis, most probably of viral etiology. We conclude that mineral type plays an important role in the pathogenesis and fibrogenesis of hepatic lesions. Compared with silica, talc primarily elicits a macrophage response without granuloma formation or fibrosis. Hepatic silicosis is a rare complication in dental laboratory technicians, and chromium-cobalt alloy may contribute to hepatic injury and fibrosis in this setting.

Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients

Septic metastatic endophthalmitis from Klebsiella pneumoniae liver abscess, first reported in seven cases treated at the Veterans General Hospital, Taipei, Taiwan, between 1981 and 1985, was seen in six similar cases at the same hospital in the subsequent 2 years. We conducted a retrospective search for factors that might be associated with these complications of pyogenic liver abscess. A total of 23 cases with septic metastatic lesions from pyogenic liver abscess were found between 1981 and 1987, and 164 cases of pyogenic liver abscess without septic metastatic lesions were identified as a comparison group. Klebsiella pneumoniae liver abscess, bacteremia, and the underlying diabetes mellitus were significantly more common in the study group than in the comparison group. Of the 23 patients with septic metastatic lesions, there were 14 cases (60.8%) of endophthalmitis or uveitis, 10 cases (43.4%) of pulmonary abscess and/or emboli, six cases (26.0%) of brain abscess and/or purulent meningitis, five cases (21.7%) of bacteriuria and/or prostate abscess, two cases (8.6%) of osteomyelitis and/or pyogenic arthritis, and one case (4.3%) of psoas abscess.

Maintenance of erection of penile glans, but not penile body, after transection of rat cavernous nerves

Two experiments tested the widely held assumption that the cavernous nerves (CN) are essential not only to erection of the penile body, via the corpora cavernosa, but also to erection of the glans penis, via the corpus spongiosum. In Experiment 1, the copulatory behavior and reflexive erections of male rats were studied before and after the CN were transected bilaterally (n = 8), unilaterally (n = 6), or sham-operated (n = 6). In postoperative tests, bilaterally operated males were severely impaired in their attempts to effect intromission, and they had the expected deficits in reflexive erections of the penile body, but their capacity for erection of the glans penis was only minimally impaired. Sham-operated males were unaffected by surgery, and unilaterally transected males had intermediate values. Experiment 2 tested the hypothesis that activity of the bulbospongiosus muscles was responsible for the residual erectile capacity of the glans after CN transection in Experiment 1. Males had bilateral sections of the CN (n = 9), or of the nerves innervating the bulbospongiosus muscles (n = 10), or of both of these nerves (n = 8), or sham surgery (n = 10). Relative to CN transection alone, the combined denervation further reduced glans penis erections, but did not eliminate them. These results suggest that the cavernous nerves of the rat are not the only peripheral nerves facilitating vascular engorgement of the corpus spongiosum.

[Effects of phencyclidine on rabbit basilar artery in vitro and rabbit cerebral blood flow in vivo]

The effect of phencyclidine [1-(1-phenylcyclohexyl)piperidine, PCP] on rabbit basilar arteries was studied with an in vitro model of ring segment arteries. PCP 0.05-500 mumol.L-1 caused vasoconstriction of basilar arteries in a concentration-dependent manner. Its maximal effect (Emax) was 94 +/- 21 mg and the concentration causing half maximal effect (EC50) was 25 +/- 18 mumol.L-1. PCP 0.01-10 mumol.L-1 also concentration-dependently augmented the vasoconstriction induced by electric stimulation in rabbit basilar arteries. Its Emax was 91 +/- 18 mg and EC50 was 0.27 +/- 0.17 mumol.L-1. The effects of PCP on mean arterial blood pressure (MABP) and heart rate (HR) of rabbits were observed. PCP iv 4 mg.kg-1 reduced MABP from 14.3 +/- 0.8 to 12.2 +/- 1.0 kPa and HR from 300 +/- 0 to 278 +/- 5 bpm in 5 min. Using the technique of radionuclide imaging in rabbit brain in vivo, we studied the effect of PCP on cerebral blood flow. After iv PCP 4 mg.kg-1, the tp of radiocerebrogram was increased from 4.5 +/- 1.1 to 6.1 +/- 1.0 s, the tg of radiocerebrogram was increased from 11.7 +/- 0.6 to 18.2 +/- 3.3 s and the rate of clearance was decreased. After iv PCP 2 mg.kg-1, only tg increased from 12.6 +/- 2.1 to 15.9 +/- 0.6 s. Hence PCP increased the transit time of nondiffusible indicators (99mTc) through the cerebral circulation. These results suggest that PCP causes constriction of basilar artery and slows down the cerebral blood flow.

Isolated cryptococcosis of the adrenal gland

A case of isolated adrenal cryptococcosis is reported. A patient with a history of diabetes mellitus had symptoms of left flank pain. Roentgenological and sonographic findings of the adrenal gland were indicative of a malignant tumour. Tissue obtained from surgery showed fungal granuloma and a poorly encapsulated cryptococcal organism was identified by special stains. A post-operative serum cryptococcal antigen test was positive, and the patient was successfully treated with surgery and a course of amphotericin B. After a 7-month follow-up period, there is no evidence of recurrence or dissemination.

Membrane-microfilament interactions in ascites tumor cell microvilli. Identification and isolation of a large microfilament-associated membrane glycoprotein complex

[14C]Glucosamine metabolic labeling and concanavalin A blots were used to identify four major glycoprotein species associated with ascites tumor cell microvillar microfilament cores and with a transmembrane complex containing actin. Phalloidin shift analysis of glucosamine-labeled microvilli showed that glycoproteins of 110-120, 80, 65, and 55 kDa are stably associated with the microfilament cores. Analysis of large (greater than 10(6) kDa) transmembrane complexes from microvillar membranes made under microfilament-depolymerizing conditions (Carraway, C. A. C., Jung, G., and Carraway, K. L. (1983) Proc. Natl. Acad. Sci. U. S. A. 80, 430-434) revealed glycoproteins of the same Mr values, showing the same relative staining or labeling patterns as those observed with the microfilament cores. Gel filtration of high salt, high pH extracts of intact microvilli, microfilament cores, or transmembrane complexes showed that in all of these fractions the glycoproteins are associated in a very large, stable complex. The glycoprotein multimer was isolated essentially free of actin and other components by Sephacryl S-1000 chromatography of microvilli, microvillar membranes prepared at pH 11, microfilament cores, or transmembrane complex fractions in Triton X-100, 1 M KCl, glycine, pH 9.5. Purified glycoprotein complex bound actin when incubated under polymerizing conditions. The presence of the glycoprotein heteromultimer in both microfilament cores and transmembrane complex from isolated membranes and the association of the purified glycoprotein complex with actin are consistent with our hypothesis that the glycoprotein-containing transmembrane complex is an association site for microfilaments at the plasma membrane.

Generation of monoclonal antibodies to bovine follicle-stimulating hormone and application in an enzyme immunoassay

Twenty monoclonal antibodies (MAbs) to bovine follicle-stimulating hormone (bFSH) were generated by using the hybridoma technique. Twelve of the MAbs have been shown to bind specifically to bFSH and seven of them were purified from the respective ascitic fluids with the methods of caprylic acid precipitation and hydroxylapatite column chromatography. The purity of the MAbs was in the range of 86-95%. Three of the purified MAbs have been coupled to horseradish peroxidase (HRP). By using a matrix cross-matching procedure, two MAbs reacted with discrete antigenic determinants are selected for a double antibody sandwich enzyme-linked immunosorbent assay (DAS-ELISA). The designed ELISA procedure could be performed within 60 min in a two-stage incubation and has a minimum sensitivity of 1ngFSH/ml. For serum samples, its mean intra- and inter-assay coefficients of variation were 3.4% and 7.3% respectively. The DAS-ELISA can be used to establish a complete FSH profile in the field of in vitro diagnosis.

Studies on bio-antioxidants--prooxidation of vitamin E on the autoxidation of linoleic acid in sodium dodecyl sulfate micelles

The reaction of vitamin E (alpha-tocopherol) with linoleic acid containing peroxidized linoleic acid has been studied. No significant reaction was found in ethanol solution, whereas in sodium dodecyl sulfate micelles vitamin E reacted rapidly with peroxidized linoleic acid, and thereby induced the peroxidation of linoleic acid, leading to oxygen absorption. The reaction kinetics was studied in detail by u.v. spectroscopy, HPLC and ESR spectroscopy. It was found that the main product was alpha-tocopherone with alpha-tocopheroxy radical as the reaction intermediate. A mechanism involving two consecutive bimolecular reactions between peroxidized linoleic acid and alpha-tocopherol and between peroxidized linoleic acid and alpha-tocopheroxy radical, with rate constant 2.93 and 6.21 mol/L-1s-1 respectively is proposed. The micellar effect on the reaction is discussed.

Expression of a neuromodulin-beta-galactosidase fusion protein in primary cultured neurons and its accumulation in growth cones

Cultured embryonic neurons share a number of characteristic morphological and physiological properties with their counterparts in vivo. For example, differentiating hippocampal neurons in culture develop two distinct classes of processes that serve as dendrites and axons. It has also been shown that the microtubule organization and composition in axons differs from those in dendrites, which may contribute to differential transport of macromolecules into axons or dendrites. We have expressed a neuromodulin-beta-galactosidase fusion gene in cultured mesencephalic neurons in order to study the transport of the neurospecific protein neuromodulin into neurite growth cones. When beta-galactosidase alone was expressed in neurons, it was found in the cell bodies with diffuse neurite staining. In marked contrast, the neuromodulin-beta-galactosidase fusion protein was rapidly transported into neurites and was concentrated in the growth cones. This system may provide a useful model for studying the structural domain(s) of neuromodulin that are required for transport and accumulation of neuromodulin in the growth cones of neurons.

Targeting of neuromodulin (GAP-43) fusion proteins to growth cones in cultured rat embryonic neurons

Neuromodulin (GAP-43) is a membrane protein that is transported to neuronal growth cones. Zuber and co-workers have proposed that the N-terminal 10 amino acid sequence of neuromodulin is sufficient to target proteins to growth cones. We demonstrate that a neuromodulin-beta-galactosidase fusion protein is transported to growth cones of cultured rat neurons, whereas a fusion protein containing the N-terminal 10 amino acids of neuromodulin and beta-galactosidase is not. A mutant neuromodulin lacking cysteines 3 and 4, the palmitylation sites required for membrane attachment, does not target beta-galactosidase to growth cones. We conclude that membrane attachment is required for growth cone accumulation and that structural elements, in addition to the first 10 amino acids of neuromodulin, may be required for growth cone targeting.

Stopped-flow ESR study on the reactivity of vitamin E, vitamin C and its lipophilic derivatives towards Fremy's salt in micellar systems

The reaction between Fremy's salt and alpha-tocopherol (VE), ascorbic acid (VC) and its lipophilic derivatives ascorbyl-6-caprylate (VC-8), 6-laurate (VC-12) and 6-palmitate (VC-16) were studied by stopped-flow ESR spectroscopy in cetyl trimethylammonium bromide (CTAB) and sodium dodecyl sulfate (SDS) micelles, as a model reaction of these antioxidants with alkyl peroxy radicals in biological systems. The second order rate constants for the reaction of Fremy's salt with VE in CTAB and SDS micelles were found to be 7.9 x 10(3) and 2.2 M-1 s-1, respectively, with as high as a 3600-fold variation. Rate constants for VC, VC-8, VC-12 and VC-16 are 4.3, 35, 53 and 56 x 10(3) M-1 s-1 and 3.3, 2.7, 1.2 and 0.86 x 10(3) M-1 s-1 in CTAB and SDS micelles, respectively. The results demonstrate remarkable effects of the charge type of the micelles and the side-chain of the antioxidants on the antioxidation reactivity in the micelles. It reveals that the inter-micellar diffusion may be the rate-limiting step for antioxidation carried out in micelles.

[Renal involvement in amyloidosis: analysis of 14 cases]

14 cases were investigated between 1963 to 1988. Age ranging from 25-66 (mean 48.2). 9 cases (64%) were over age 50. Diagnosis was established by renal biopsy or autopsy. 11 cases (79%) were primary. 3 cases (21%) were secondary with chronic infection. Besides renal involvement, primary amyloidosis principally affected the heart, gastrointestinal tract and tongue. Hepatosplenomegaly and anemia were found in secondary cases. Proteinuria was found in 14 cases. Nephrotic Syndrome (NS) found in 8 cases, both renal insufficiency and hypertension were 21% respectively. In 3 cases performed renal venography, 2 cases showed renal vein thrombosis. 9 cases (64%) showed kidneys were enlarged. Congo red test showed positive reaction were 100% in secondary and 50% in primary. By light microscopy stained with congo red there was a specific protein deposited in glomeruli and mesangium, by electron microscopy. There was fine amyloid fibrils. These findings are characteristic and to have diagnostic value.

CONCLUSION

(1) Renal amyloidosis is not very rare in China. (2) Proteinuria and NS were major clinical manifestations. (3) Renal biopsy and autopsy have diagnostic value, congo red test does not prove the absence of primary amyloidosis.

Fungemia: analysis of 43 cases

This report reviews the cases of 43 patients with 48 episodes of fungemia, and examines the clinical significance of fungemia and the results of treatment. All episodes were nosocomial infections. Candida albicans (60.4%), Candida parapsilosis (16.7%), and Candida tropicals (14.6%) were the most common fungal pathogens isolated from blood cultures. Patients with Candida albicans had a better survival rate than those with other species (p = 0.011). Polymicrobial fungemia was noted in 5 patients (11.6%). Most patients had underlying diseases and predisposing factors. Intravascular catheters (100%), broad-spectrum antibiotics administration (100%), surgical procedures (46.5%) and total parental alimentation (41.9%) were the most common predisposing factors. The clinical manifestations were not characteristic and consisted of nonspecific signs of sepsis. The overall mortality rate was 79%. We did not find any improvement in the mortality rate of our patients treated with amphotericin B. Early recognization, immediate removal of predisposing factors, and correction of underlying conditions is most important for patients with fungemia. We also suggest that fungal infection should be considered early when a febrile patient at high risk dose not improve with broad-spectrum antibacterial therapy.

Inflammatory pseudotumor of the liver with occlusive endophlebitis: report of a case

Inflammatory pseudotumor (IPT) of the liver is an extremely rare benign tumor. Only 12 cases have so far been reported in the English literature. The etiology and pathogenesis of IPT remain obscure. We herein present an additional case of IPT of the liver with occlusive endophlebitis in a 36-year-old female. Immunohistochemical studies demonstrated the polyclonal nature of the plasma cells in the tumor, including IgA, IgM, IgG, kappa and lambda. The inflammatory pseudotumor should be kept in mind in the differential diagnosis of hepatic space-occupying malignant lesions.

Pyogenic liver abscess: clinical manifestations and value of percutaneous catheter drainage treatment

One hundred and sixty-two patients with solitary or multiple pyogenic liver abscesses received surgical or medical treatment in the past 8 years. Fifty-seven patients were treated medically (medical group), 62 patients received medical treatment plus sonogram-guided percutaneous drainage (PCD group), and 43 patients received surgical drainage (surgical group). Aerobic gram-negative rods were the predominant causative microorganisms. Klebsiella pneumoniae was the most common microorganism, occurring in 46.9% (76/162) of the cases. Anaerobes occurred in 16.7% (27/162) of the cases. In the evaluation of treatment, the success rates for these three groups were: medical group, 59.6% (34/57); PCD group, 90.3% (56/62); and surgical group, 83.7% (36/43). This retrospective study confirms evidence from a small series that medical treatment plus percutaneous catheter drainage is efficient and more convenient than conventional surgical drainage for pyogenic liver abscesses. The frequent severe septic emboli to distant organs noted in this series (11.1%; 18/162) are quite unusual and should be anticipated in the future.

[Dose-response relationships of propofol in Chinese]

Propofol is a new intravenous anesthetic which possesses the rapid induction and recovery of anesthesia. It has been approved to be used in clinical anesthesia and critical care medicine since 1989. From the dose-response study of propofol, we can get the ED50 and induction dose of propofol and compare those with other anesthetics. Sixty young patients, ASA I-II, both sexes, were allocated into six groups of ten patients. All of patients did not receive premedicants. Groups I-VI were given intravenously over 25 sec 1.0 mg/kg, 1.2 mg/kg, 1.4 mg/kg, 1.6 mg/kg, 1.8 mg/kg and 2.0 mg/kg, respectively. Blood pressure and heart rate were monitored and recorded before and 1 min, 3 min, 5 min after the injection of propofol. Induction of anesthesia by propofol is considered to be successful as a patient closes his eyes and does not response to simple command. As a patient obeys the order to open his eyes, he is judged to emerge from anesthesia. Induction and recovery times were recorded in each successfully-induced patient. Data were analyzed using Litchfield and Wilcoxon, and Student's t tests. The ED50 of propofol was found to be 1.46 mg/kg (95% confidence interval: 1.35 mg/kg to 1.58 mg/kg). Induction and recovery times at 1.0 mg/kg, 1.2 mg/kg, 1.4 mg/kg, 1.6 mg/kg, 1.8 mg/kg and 2.0 mg/kg were 40 sec and 5.6 min, 38 sec and 6.0 min, 38 sec and 6.2 min, 36.8 sec and 6.7 min, 36.3 sec and 7.2 min, 35.5 sec and 7.2 min, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

A rapid preparation technique for leucocytes

A procedure is described for making leucocyte preparations from blood samples fixed ex vivo. Briefly, blood is treated with buffered formaldehyde and the erythrocytes and platelets removed subsequently by lysis and differential centrifugation. The fixed leucocyte preparations can then be processed or fixed further for various types of microscopy as required. In stained preparations examined by light microscopy, the different leucocytes, i.e. lymphocytes, polymorphonuclear leucocytes (PMN) and monocytes, can readily be identified by their characteristic nuclear morphology, and polarized PMN can easily be recognized by their non-spherical shape. Experiments with chemotaxins in vitro indicated that the procedure could be used to determine whether polarized PMN circulate in the blood of normal individuals and patients with inflammatory disease. A study of the blood from eleven normal subjects showed that 84.0 +/- 10.8% (mean +/- 2 SEM) of circulating PMN were spherical, while the majority of the remainder (14.3 +/- 10.5%) were only 'slightly' polarized.

Regulation of free calmodulin levels by neuromodulin: neuron growth and regeneration

Neuromodulin is a neurospecific calmodulin binding protein that is implicated in neurite extension, axonal elongation and long-term potentiation. Yuechueng Liu and Daniel Storm propose that neuromodulin binds and concentrates calmodulin on growth cone membranes and that stimulation of protein kinase C releases high local concentrations of calmodulin in the growth cone. Interactions between released calmodulin and cytoskeleton proteins may affect the polymerization, crosslinking and membrane attachment of cytoskeleton polymers. This local 'softening' of the membrane may be an initial event in filopodia formation and extension.

[Treatment of congenital cataract with McIntyre co-axial I.A. cannula]

Thirty seven eyes with congenital cataract in with there a lot of transparent cortex were treated with McIntyre co-axial cannula. Primary posterior capsuloctomy after removing the cortex was performed on patients aged less 3 years; for patients over 3 years, their posterior capsule remained intact. After the operation, all cases got transparent pupillary space more than 5 mm in diameter. The visual acuities improved in 32 eyes and remained unchanged in 5 eyes. This procedure not only received satisfactory results, but also avoided side effects caused by capsuloctomy and reduced the possibility of general anesthesia accident and operation fee.

Preparation of diazotized polystyrene latex and its use in agglutination assays

The preparation of this immunological latex consisted of the following steps: the synthesis of polystyrene, polynitrostyrene, polyaminostyrene and polystyrene diazonium salt latex. The quantities of emulsifier and initiator used in the synthesis of the polystyrene latex were much larger than those used in the conventional method. Reduction of the polynitrostyrene latex involved adding latex dropwise to a large excess of 6% sodium hydrosulphite-2 N potassium hydroxide solution with sodium lauryl benzene sulphonate as an emulsifier. When the mixture was heated at 70 degrees C for 4 h, the emulsion of polyaminostyrene was diazotized. The polystyrene diazonium salt latex obtained was capable of combining with 20-40% by weight of antibody protein. The immunopolystyrene diazonium latex reagents showed a positive agglutination reaction of 78-91% when mixed with serum from patients with leptospirosis and two other infectious diseases. The test, which can be completed within 3 min has been used to assay over 1200 patient samples.