Primary sclerosing cholangitis and low-dose oral pulse methotrexate therapy. Clinical and histologic response

Two patients with sclerosing cholangitis responded to low-dose methotrexate treatment. A 40-year-old man who had previously undergone total colectomy for ulcerative colitis presented with refractory erythroderma and sclerosing cholangitis. Both disorders were alleviated and have remained in remission on methotrexate, 5 mg every 12 hours three times each week (15 mg/wk). Liver function improved, bile duct scarring did not worsen, and repeat liver biopsy samples have shown striking improvement. A 60-year-old man with long-standing ulcerative colitis and repeated exacerbations of sclerosing cholangitis had a similar response to low-dose methotrexate, 2.5 mg every 12 hours three times each week (7.5 mg/wk), during a 6-year period. Recurrent episodes of cholangitis have disappeared, liver function has become normal, bile duct scarring has not worsened, and liver histologic findings have become normal. Because of the potential hepatotoxicity of methotrexate, we suggest that a prospective, randomized trial be done.

Cellular immune response following thermal injury in human patients

Cellular immune response was studied longitudinally for a period of 1 month in a group of 51 patients sustaining burns between 20 and 55 per cent of their body surface area. The results indicated lymphocytopenia and significant depression in the total T cells in all the patients. T cells showed a significant rise in their levels in those patients who showed clinical improvement. Further, the loss of expression of 'E' receptor correlated with the lowering of the protein-synthesizing capacity of the mononuclear cells. The functional integrity of the lymphocytes also showed an inability to recognize and stimulate normal alloantigens in an MLR reaction. Investigation of the mechanisms responsible for immunosuppression revealed the generation of T suppressor activity.

Cellular immune mechanisms in thermally injured mice

An attempt was made to establish an animal model for analysing the cellular immune alterations following thermal injury and to correlate the results with those obtained in humans. A standard burn involving 20 per cent of the body surface area was established in C57 black mice (b1). The results revealed a loss of total T cells until post-burn day 10 and an increase in B cells only during post-burn day 1. The lymphocyte proliferative response to PHA was elevated with the appearance of null cells on post-burn day 10. This observation revealed a generalized depression in the immune responses which was significant until post-burn day 10. However, the results were not comparable with the human studies.

Partial purification and some properties of a latent CO2 reductase from green potato tuber chloroplasts

We have partially purified the CO2 reductase, present in green potato tuber chloroplasts, as a latent form. Illumination of the chloroplasts in the absence of substrate, bicarbonate, activated the enzyme, which could then be obtained in soluble forms. Purification of the enzyme was achieved by (NH4)2SO4 fractionation (0-30%) and adsorption and elution from a DEAE-Sephadex A-50 column. The final preparation showed 15-fold purification and 50% recovery of the activity. The pH optimum for CO2 reductase was 8.0. Hepes and Tricine buffers showed maximum activity whereas Tris/phosphate or borate failed to show any activity. The enzyme reaction was sensitive to the presence of metal ions like Fe3+, Hg2+, Cu2+, Mo6+ and Zn2+, however, a threefold activation was observed with Fe2+. The metal requirement for CO2 reductase was evident from the observed inhibition by metal chelators like o-phenanthroline, alpha, alpha'-dipyridyl, bathocuproine, 8-hydroxyquinoline etc. Out of these o-phenanthroline was the strongest inhibitor and its concentration for 50% inhibition was 40 microM. The presence of Fe2+ ions in the reaction mixture protected the enzyme from heat denaturation upto 50 degrees C. Maximum enzyme activity was observed at 15 degrees C. The enzyme activity showed a 30-s lag period and the maximum was reached in 90 s. Supplementation of sodium dithionite in the reaction activated enzyme activity threefold, suggesting involvement of dithiol groups in the catalytic activity. There was strong inhibition by -SH inhibitors like 5,5'-dithiobis(2-nitrobenzoic acid) and N-ethylmaleimide and -SH reagents like dithiothreitol, 2-mercaptoethanol and cysteine. Various nucleotide coenzyme tried inhibited the enzyme strongly.

Burn sera mediated effects on the E-rosetting property of normal active T1 cells

This study investigates the suppressive effects of burn sera on normal active T1 cells. The results revealed that burn sera collected from survivors and non-survivors during the initial 'shock' phase caused varied effects on the 'E' rosetting properties of normal active T1 cells. However, unlike non-survivor sera convalescent or recovery sera failed to block the 'E' rosetting property of T1 cells. Furthermore, cold incubation in fetal calf sera (FCS) failed to abrogate the loss of T1 cells which were exposed to non-survivor (early) sera; these samples also revealed the presence of antigenic factors. Our experiments were extended to investigate the mechanisms resulting in the irreversible change, and showed that the inhibiting factors could be acting at the microtubular level of the cell cortex.

"Malignant" contracture of the eye socket

A new method for reconstruction of "malignant" contracture of the eye socket is described using a simple procedure based on the principle of epithelial inlay. The lining consists of a free skin graft. No cumbersome external appliances for the prevention of contraction of the graft are used; hence the hospitalization is minimized. The results have been satisfactory.

Fc and complement receptor integrity of polymorphonuclear (PMN) cells following thermal injury

In patients sustaining thermal injury, a sequential study was formulated to evaluate Fc and complement receptor expression of polymorphonuclear cells (PMN). Additionally, the role of factors in burn sera and maturity of PMN cells in the circulation were studied. The salient features of the study were: Marked reduction in Fc receptor expression by the 5th day of injury in both survivors and non-survivors. Thereafter levels gradually increased in survivors, though they were still below the normal range. In non-survivors, the depression was severe and persistent. In contrast to Fc receptor expression, complement receptor integrity was not grossly affected in both survivors and non-survivors. Burn sera collected from survivors on the 5th and 13th post-burn day showed reduction in Fc receptor expression of normal PMN cells, whereas sera obtained a month after the injury exhibited no inhibitory effect. Non-survivors sera inhibited Fc receptor expression of normal PMN cells on 5th, 13th and 21st post-burn days. The appearance, increase and disappearance of immature PMN cells in the circulation was correlated with the clinical progress of the patient. Mechanisms involved in the aberrations and its implications are discussed.

Intracranial venous aneurysms: vein of Galen and other similar vascular anomalies

Aneurysmal dilatation of the vein of Galen is peculiar to arteriovenous malformation around the midbrain. Similar venous aneurysms may rarely occur in other regions. This paper deals with the radiographic findings in three cases of vascular malformation associated with giant venous aneurysms. The pathophysiology resulting in aneurysmal venous dilatation is discussed based on our material and those previously reported.

Dermatosis papulosa nigra

The incidence and natural history of dermatosis papulosa nigra was assessed in eighty-two black patients. The overall incidence in the study population was 77 percent, with a predominance in women of almost 2:1. Fifty-four percent of these patients reported that other members of their families were also affected. The peak incidence and number of lesions occurred in those patients in their sixties. Fair-complexioned blacks had the lowest frequency of involvement. These findings confirm those of other investigators; however, we report a higher than average incidence of involvement in the population we studied.

Microglioma--unusual computed tomographic appearance and course of neoplasm

Microglioma accounts for 0.8-1.5% of primary brain tumors. Eight cases of primary lymphoma of brain are presented. 50% of the patients demonstrated unusual computed tomographic appearances. These patients were divided into three groups depending on clinical outcome. Survival seems to be related to treatment modality. Longest survival times were in patients treated with radiation alone or radiation following biopsy.

Epidermoid tumor of the fourth ventricle: use of metrizamide-computed tomography

This report describes two cases of epidermoid tumor of the fourth ventricle diagnosed with metrizamide computed tomography. They both presented as a low-density lesion in the region of the fourth ventricle on computed tomography. They did not show any enhancement after intravenous injection of contrast medium and had no hydrocephalus. Metrizamide-enhanced computed tomography demonstrated the irregular fourth-ventricular filling defect characteristic of epidermoid tumors.

Accidental overdose intoxication: a hazard of drug smuggling

Three patients involved in illicit drug smuggling via the swallowing of high dose, high purity drugs packed in multiple condoms are reported. Two of these patients experienced drug overdose symptoms due to leakage or rupture of the condoms in the GI tract. They were treated successfully.