[Lysozyme and lactoferrin in normal and inflammatory changes of the gastric mucosa]

A total of 238 randomly selected gastric biopsies were examined with polyclonal antibodies from rabbits (antihuman-lysozyme and antihuman-lactoferrin) using the Peroxidase-Antiperoxidase-method according to Sternberger. The preparations were evaluated by comparing the intensity of the staining as well as the quantity and distribution of positive cells within the mucosa. The results show that lysozyme can be demonstrated constantly in the glandular neck zone and in the mucoid glandular body within the normal non-inflamed mucosa of the antrum, whereas in the normal corpus mucosa only a small amount of lysozyme appears focally and inconsistently in the neck area of the glands. A substantial increase in the intensity of lysozyme presentation due to inflammatory changes as related to the chronic superficial gastritis of the antrum cannot be discovered. On the contrary, the presentable amount of lysozyme decreases in line with the progressing inflammation and, in case of chronic-atrophic gastritis with intestinal metaplasia is restricted to the Paneth cells. A distinct and constant presentation of lysozyme can be achieved in the glandular neck zone, in the lower gastric pits and partially in the upper glandular body of the corpus mucosa in cases of chronic inflammatory processes. Obviously lysozyme is formed in the epithelial cells and not taken up from other cells. Furthermore it can be concluded from the findings that to a large extent lysozyme formation is linked to the proliferation activity of the epithelial cells. Lactoferrin cannot be found in normal non-inflammatory mucosa neither of the antrum nor of the corpus. But it can be found among most of the biopsy specimens with inflammatory changes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Gastrointestinal cytomegalovirus manifestations in AIDS]

Cytomegalovirus (CMV) infection is one of the most important intestinal opportunistic infections in AIDS. In severe cases ulcerations and colitis are the commonest manifestations. 184 HIV positive patients with gastrointestinal symptoms were investigated by endoscopy of the gastrointestinal tract. While culture, immunohistochemical staining and histology from biopsies were performed, the results of all three methods were compared. In one third the cases CMV associated lesions could be found by endoscopy. Erosions or ulcerations are the most frequent tissue lesions. In 95% the culture was positive. In addition, immunohistochemical staining in 75% and histology in 61.7% were positive in patients with more serious manifestations. For early diagnosis endoscopy of the gastrointestinal tract and histological, histochemical and microbiological investigations of biopsies are essential.

Aspergillus findings in AIDS patients suffering from cryptococcosis

Because of the known pathogenicity of Cryptococcus neoformans and of aspergilli depending on defined but different immunodeficiencies of the host, the evaluation of their simultaneous cultural detection in specimens of the respiratory tract of AIDS patients is of epidemiological, diagnostic, pathogenetic and therapeutic interest. In 10 out of 15 AIDS patients the following species of the genus Aspergillus could be isolated either once or repeatedly during the course of Cr. neoformans infections in specimens from the respiratory tract: A. fumigatus, A. flavus, A. nidulans, A. niger and A. glaucus. From the 10 different case reports the conclusion can be drawn that the cultural findings of aspergilli in specimens from the respiratory tract during the course of cryptococcosis were of no pathogenic significance. Rather, they should be interpreted as inhaled and not yet germinated conidia still capable of growth lacking primary pathogenicity for the AIDS patient. The significance of serodiagnosis for the evaluation of the simultaneous occurrence of Cr. neoformans and Aspergillus spp. is demonstrated and discussed.

Cryptococcus neoformans in the seminal fluid of an AIDS patient. A contribution to the clinical course of cryptococcosis

In a 33-year-old HIV-positive homosexual male suffering from unexplained headache, cryptococcosis was diagnosed in a progressive secondary stage. After treatment with the standard combination therapy of amphotericin B + flucytosine for 34 d, the patient was clinically symptom-free and discharged, upon his own request, from the hospital. He remained under ambulatory mycological control. After an interval of 65 d during which the urine had been free from Cryptococcus neoformans (Cr.n.), the fungus could not be isolated from urine but 3 X 10(5) CFUs/ml were found in the seminal fluid. Andrologically, teratospermia and hyposemia were present. There were no clinical signs in the genitourinary tract including the prostate. The significance of ecological niches for Cr.n. colonization of the genitourinary tract after antimycotic therapy is discussed. In such cases, in addition to cultural examination of urine for Cr.n. by the membrane filtration technique (MFT) and Staib agar, an additional cultural examination of seminal fluid is recommended. It is also proposed to pay more attention to Cr.n. in andrological examinations. Special regard should be given to a possible occurrence of Cr.n. in the seminal fluid of AIDS patients. In cytology of the seminal fluid, use of the Giemsa stain is unsuitable for the purpose of Cr.n. detection. For this reason, it should be supplemented by PAS staining.

Gastritis and bacterial colonization of the gastric mucosa in adolescents

Among 256 examined gastric biopsies from 200 adolescents, inflammatory changes were found strikingly often: 44.5% showed chronic superficial gastritis without atrophic processes. However, the percentage of biopsies of normal mucosa was substantially higher than that of a compared series of biopsies not selected according to age of the patients. According to our findings in adolescents, the interstitial stroma of normal gastric mucosa in the antrum, as well as in the corpus, was absolutely free of round cells. Bacterial colonization with Campylobacter-like organisms (CLO) occurred almost as frequently as in the series not selected according to age. Consequently, the biopsy material of adolescents substantially more often featured normal mucosa with bacterial colonization, mostly of the minimal focal variety, than did the compared series. Colonization with CLO apparently takes place at an early age, and may exacerbate into a massive colonization.

[Caudal anesthesia combined with general anesthesia in comparison with general anesthesia in ambulatory circumcision]

In 100 boys (5.9 +/- 3.2 years old) undergoing outpatient circumcision, analgesia was provided with 0.375% bupivacaine 1 ml/year of age by caudal injection (group I), administered after induction of general anesthesia. This group was compared with 100 boys (6.3 +/- 3.4 years old), who received only general anesthesia (group II). The puncture technique described was free of complications and the caudal blocks were 98% successful. There was a great difference with regard to the levels of general anesthesia: the average enflurane concentrations required to block autonomic reactions during surgical intervention was 1.3 vol% in group I and 2.7 vol% in group II. The amount of pethidine needed for perioperative pain relief was 8 mg (+/- 5.7) in 17/100 of group I and 17.3 mg (+/- 6.8) in 91/100 of group II. In addition, paracetamol was given in 10/100 of group I and 30/100 of group II. The boys in group I showed calm postoperative behavior. In both groups there were only slight differences in hemodynamic parameters. Of the parents who answered our questionnaire (50 answers to 60 questionnaires), 68% were amazed at the duration of analgesia. During the late postoperative period, in group I there was an almost total absence of vomiting (4%), with an associated rapid return to normal feeding. In 83% the effect of late postoperative analgesia worked so well that no subsequent analgesic was given. In 15% the pain relief lasted 6.3 +/- 2.5 h. The excellent postoperative pain relief produced by caudal anesthesia justifies its frequent use for children subjected to genital surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Long-term studies of colonization of the gastric mucosa by Campylobacter pyloridis]

Multiple biopsy specimens of gastric mucosa of 15 patients taken at different intervals with an observation period of 4 to 20 years were evaluated. Histological examination revealed superficial gastritis in most cases without radical and progressive destruction of the mucosa and in all but one case the presence of CLO was demonstrated with varying degree of intensity. No evidence was found for causal relationship between bacterial colonization and inflammation.

[Bacterial colonization of the gastric mucosa]

In 380 histologically prepared biopsy specimens taken from the mucous membrane of the stomach, the employment of Giemsa staining and Warthin-Starry silver staining has revealed an often surprisingly abundant (i. e., to the extent of 66.1%) bacterial colonization of the surface of the gastric mucous membrane and of the gastric foveolae. The bacteria encountered here involve gram-negative and morphologically uniform flora of thin, S-shaped or slightly curved bacteria designated as campylobacter-like organisms (CLO). Evidence for Campylobacter pyloridis was also obtained in 55.1% of cultures from 49 native, microbiologically prepared gastric biopsy specimens. Bacterial colonization of the gastric mucous membrane by CLO is definitely correlated with inflammatory alterations in gastric membranes. Active forms of gastritis, however, are not more abundantly colonized by bacteria than are dormant forms. The positive correlation between inflammatory gastric alterations of various degrees and bacterial colonization of the gastric mucous membrane, furthermore, is not proof of an etiological relationship. These bacteria, obviously adapted to the mucus in the gastric foveolae and on the surface of stomach lining, are not evidence of an aggressive behavior or of penetration tendencies. Facultatively pathogenetic significance cannot, however, be excluded for bacteria occurring in such abundance in intimate epithelial contact. Pathogenetic influence of abundant colonization by CLO could well develop if additional noxae become effective.

[Experimental ocular cryptococcosis under the influence of time-limited kidney failure--a pathohistological study]

This animal experiment is characterized by a missing virulence of Cryptococcus neoformans strain A94 (isolated from bird manure) for the immunocompetent mouse after intraperitoneal injection and following hematogenous dissemination into all organs including the central nervous system (CNS) and by the induction of a renal failure of short duration by intramuscular injection of glycerine. In 50% of the group of 80 animals damaged in such a way ocular cryptococcosis was found in association with the selective involvement of the CNS. The involvement of the eyes was dependent on a time-limited interval between the date of infection and the date of induction of the renal failure. The partly extensive pathohistological findings in the eye, with a predominance of mycotic processes in the retina and with some cases of endophthalmitis, were found to be similar to those described in man. The animal experiment described is proposed as a model for experimental studies to resolve problems of the immunology and therapy of the ocular cryptococcosis which are of current interest.

[Peracute disseminated course of fatal Aspergillus fumigatus infection in liver failure and corticoid therapy. A case report on the epidemiology, pathogenesis and diagnosis of the systemic course of Aspergillus infections]

Cytostatic-treated persons and cases of severe hepatic failure under corticoid therapy are predisposed to disseminating Aspergillus infections. Constant exposure to Aspergillus spores may result in a fatal Aspergillus infection. The triad of hepatic failure, corticoid therapy and constant exposure to Aspergillus spores is described in a 70-year-old female patient. A painless icterus was clinically diagnosed as non-A non-B hepatitis, with a protracted cholestatic course. She had been treated with an oral corticoid preparation. After leaving the hospital at her own insistance when still in the icteric stage, severe pneumonia due to Aspergillus developed within 14 days; this was confirmed radiologically. The autopsy results showed unexpected infarction, similar to pneumonic foci, in all lobes and dissemination in the myocardium, stomach, kidneys and brain. The liver showed subacute dystrophy. Constant exposure to the conidia of A fumigatus came about as a result of the soil of potted ornamental plants in the patient's living room. The fungus could only be successfully cultured by putting infected tissue particles on Sabouraud dextrose agar; it was not possible by the common method of fractionated streaking.

[Diagnostic problems of virus-induced atypical squamous cell proliferations in the area of the anus and genitalia. A case report on Bowenoid papulosis]

Papillomatous proliferations of squamous epithelium of the genital and anal region termed Bowenoid Papulosis (BP) macroscopically resemble condylomata acuminata, whereas histologically they show in part severe dysplasias. Despite the similarity of these lesions to Bowen's disease they are - like condylomas - induced by papilloma viruses and may regress spontaneously. Condyloma-like but predominantly flat proliferations of squamous epithelium of the transitional zone between exocervix and endocervix, which are likewise caused by viruses and have a prognosis similar to that of BP, are even more problematic in differential diagnostic differentiation from cervical carcinoma in situ. Both these atypical proliferations of squamous epithelium of the exocervix referred to as "flat condylomas" and BP contain koilocytes as a sign of cell regression relatively typical of virus-induced cell change. In a reported case of a 38-year old woman with widespread BP of the ano-genital region intranuclear papilloma virus antigen could be demonstrated immunohistochemically in the papillomatous proliferations of squamous epithelium and furthermore in sections made from the filed paraffin blocks of a cone biopsy taken five years ago. In two of altogether seven cases of BP presented in tables papilloma virus antigen could be shown as well. In one woman of already 54 years of age widespread BP is described more comprehensively, because due to the feature of inverted papillomatosis carcinoma was suspected clinically. BP and flat condylomas have been defined as terms only in recent years and - as virus-induced lesions - been differentiated from carcinoma in situ on account of a more favourable prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolation of sporothrix schenckii from the floor of an indoor swimming pool

In a routine mycological examination of an indoor swimming pool during the winter season (January 1981) in Berlin (West), Sporothrix schenckii was isolated from the floor near a shower. The strain was characterized by cultural, morphological and biochemical properties typical of strains which are causative agents of sporotrichosis. It is suggested that in routine mycological examinations of swimming pools attention should not be limited to dermatophytes and yeast-like fungi.

Pulmonary and extrapulmonary manifestations of L. pneumophila

In three of five fatal cases of Legionnaires' Disease (LD) bacteria have been detected by DFA in extrapulmonary organs including spleen, liver, kidney, heart and brain. Typical fluorescent pleomorphic rods were seen mostly intravascularly and occasionally in phagocytes of the mononuclear phagocytic system. Legionellae were found extravascularly in the myocard and in the brain tissue together with single cell necrosis of either muscle fibres or ganglion cells in the respective organ. It was of special interest in this context that the clinical data and functional abnormalities reported for the respective cases might well be explained by the histopathological findings.

[Functional evaluation of islet cells following pancreatic duct occlusion--a long-term study]

The transduodenal occlusion of the pancreatic duct with Prolamin (Ethibloc) was carried out in an experiment with 38 Göttinger minipigs. Occlusion of the pancreatic duct leads to selective atrophy of the excretory pancreatic parenchyma. Up until now it has not been clear whether the endocrine functional capacity of the gland stays intact in a long-term experiment or whether the islands of Langerhans are also altered by the pancreatic duct occlusion. The following tests were carried out by us to determine the endocrine status: 1. Intravenous glucose tolerance test (i.v. GTT); 2. Glucose assimilation analysis after CONARD (K-value); 3. Insulin analysis during i.v. GTT; 4. Intravenous Tolbutamid test. Twelve months after the occlusion, reduced glucose tolerance and a reduction in insulin secretion were detected in the intravenous glucose tolerance test. Glucose assimilation (K-value) was not changed significantly. Fasting blood sugar and basic insulin level remained unchanged. Only a small blood-sugar decrease was measured after selective B-cell stimulation with Tolbutamid. The fibrosclerosis produced by the occlusion of the pancreatic duct with Prolamin also seemed to attack the cells of the islands and lead to their partial destruction.

Successful treatment of pulmonary and cerebral aspergillosis in an immunosuppressed child

A favourable outcome was observed in a 12 year-old boy who developed invasive pulmonary and cerebral aspergillosis during antineoplastic treatment for central nervous system relapse of acute lymphoblastic leukemia. Combination therapy with amphotericin B and 5-Fluorocytosine led to complete regression of pulmonary infiltrates. Despite enlargement of the cerebral lesion monitored by computerized tomography, no viable fungi were found in the completely resected abscess after a 4 weeks' course of antifungal treatment preceding neurosurgery. Histological examination confirmed the diagnosis of an aspergillotic abscess. The initially severe neurological symptoms disappeared after successful surgery. Aspergillus fumigatus was detected in the soil of a potted ornamental plant in the mother's living room, suggesting that this might have been the source of the infectious agent.

[Chronic pulmonary cryptococcosis. A case contribution for diagnosis of cryptococcosis in man from a pathologic-anatomic viewpoint]

Routine use of differential nutrients for isolating cryptococcus neoformans (Staib-Agar) during post-mortem examination revealed previously unsuspected chronic pulmonary cryptococcosis in a 64-year-old woman. Cause of recurrent pleural effusions over three years were probably sub-pleural cryptococcomas. In on-target and specific search for the cryptococcosis pathogen, the lung deserves special attention as a probable gateway.