[Diagnosis, etiology and treatment of cholangitis following bilio-digestive surgery]

Cholangitis occurring after biliary-enteric anastomosis is a well-recognized but insufficiently analyzed surgical complication. Guidelines for assessment have not been established and management remains controversial. We examined a two-year experience with recurrent cholangitis following bilio-enteric anastomosis; cholangitis in the absence of anastomotic obstruction was surprisingly frequently encountered. Although selected cases without anastomotic stenosis may be amenable to nonoperative treatment, a low threshold for surgical reintervention should be maintained because radiologic assessment of anastomotic patency is often equivocal and the clinical problem is often best managed surgically.

Multiple tumors of the biliary tract

Multiple synchronous tumors of the extrahepatic biliary tree are not frequently reported. Over a 2-year period, 54 operative procedures were performed for tumors of the extrahepatic biliary tract or periampullary region. In five of these cases, unsuspected tumors were observed. Of these, one patient had multiple benign papillomatosis of the extrahepatic biliary tree. All four of the other patients were found to have unsuspected small carcinomas of the gallbladder in association with mid- or low bile duct cancer. Multiple tumors of the extrahepatic biliary apparatus may occur more frequently than previously thought, and the incidence of unsuspected gallbladder cancer in association with bile duct cancer may be high. These tumors should be suspected and looked for in each instance by intraoperative endoscopy and careful histologic examination of the gallbladder.

Preautopsy magnetic resonance imaging: initial experience

To our knowledge, there are no prospective data in the literature investigating the role of magnetic resonance imaging (MRI) in detecting abnormalities in cadavers to determine the feasibility of this concept. We prospectively studied six cadavers (three stillborn infants, one infant, and two adults) with a 0.15 T resistive magnet. The images obtained allowed detection of abnormalities in multiple organs. Although autopsy was superior to MRI in detecting very small abnormalities, MRI was equal to autopsy in detecting gross cranial, pulmonary, abdominal, and vascular pathology in this small series. In addition, MRI was superior to autopsy in detecting air and fluid in potential body spaces. Preautopsy MRI may be an alternate method in restricted or denied autopsies and may provide an additional MRI research and educational tool.

Kerr-McGee and the NRC: from Indian country to Silkwood to Gore

By focusing upon the Nuclear Regulatory Commission's appraisal of the Kerr-McGee Corporation's safety record in the Four Corners area and at two facilities in Oklahoma, this article examines the political economy of nuclear regulation in American society. Particular attention is given to the agency's response to intervenor groups which protested various operations at Kerr-McGee facility in Gore, Oklahoma, both prior to and following the accidental rupture of a cylinder containing uranium hexafluoride. Despite a consistent record of violations and nuclear mishaps by Kerr-McGee, the Nuclear Regulatory Commission permitted the company to essentially monitor its own activities. Rather than protecting workers and the public from the hazards of the nuclear industry, state regulation attempts to legitimize and defuse public opposition to its endeavors.

Neutrophils and mast cells: characterization of cells responsive to neutrophil-derived histamine-releasing activity (HRA-N)

Supernatants from human neutrophils (polymorphonuclear leukocytes) contain a factor capable of causing temperature and calcium-dependent histamine release from rat basophil leukemia (RBL) cells, termed neutrophil-derived, histamine-releasing activity (HRA-N). HRA-N caused dose-related histamine release from human basophils (5% to 22% net) and from isolated human cutaneous mast cells (3% to 28% net). Equivalent amounts of histamine were released from human basophils, RBL cells, and cultured mouse P cells exposed to HRA-N (16.3 +/- 3.4%, 12.2 +/- 1.2%, and 15.5 +/- 2.5%, respectively; p was not significant). Intradermal injections of HRA-N also caused chlorpheniramine-inhibitable blueing in vivo in rat and guinea pig skin. In general, supernatants that were active on RBL cells also induced histamine release from human basophils, although the magnitude of response to individual HRA-N preparation varied among basophil donors. HRA-N is stable to boiling and filters at a molecular weight greater than 1000 daltons. Boiling enhances HRA-N, suggesting the presence of a heat-labile inhibitor of HRA-N. These data suggest that HRA-N is a heat-stable factor that causes histamine release from human basophils and human cutaneous mast cells, that HRA-N is active across species lines both in vivo and in vitro, and that HRA-N acts maximally to induce histamine release under physiologic conditions.

The role of specific IgE and beta-propiolactone in reactions resulting from booster doses of human diploid cell rabies vaccine

Reactions after booster injections of human diploid cell rabies vaccine (HDCV) were investigated to determine the possibility of IgE-type antibody involvement. Although normal manufacture of HDCV involves the inactivation of the virus with beta-propiolactone (BPL), the effect of BPL on nonviral vaccine components, such as host cell components or stabilizing proteins, may be typical of the haptenic action of small molecular weight chemicals. Specific IgE to commercial HDCV preparations, BPL-treated preparations of noninfected host MRC5 cell sonicate (BPL-MRC5), and a human albumin (HA) (BPL-HA) used as a stabilizing agent were detected in sera from five individuals who reported reactions after booster doses of HDCV. However, these patients had no detectable IgE to normal HA. Sera from nonvaccinated individuals, vaccinated individuals who reported no reaction after HDCV booster, and pollen-allergic individuals had no detectable IgE to HDCV, BPL-MRC5, or BPL-HA. Changes in the ratios of pre- to postbooster serum levels of specific IgE to HDCV and BPL-HA were significantly different in a group of 19 individuals who reported reactions to HDCV boosters; these changes in pre- to postbooster IgE levels in nonreactive vaccinees were not significant. Prebooster serum IgE RAST ratios to HDCV or BPL-HA were not predictive of potential reactions to HDCV. A number of experimental BPL-HA reaction mixtures were assayed to examine the effect of variable concentrations of BPL to HA. Increasing relative molar concentrations of BPL to HA resulted in increased electrophoretic mobility, whereas the highest relative specific IgE binding was detected in BPL-HA molar reaction mixtures of approximately 12.5:1.(ABSTRACT TRUNCATED AT 250 WORDS)