[Bone mass in celiac patients]

Bone mineral content was measured in the whole body, the spine (L2-L4) and hip by Dual Photonic Absorpciometry (densitometer Norland 2600 Gd-153), in seventeen celiac patients, aged 6 to 12 years, with good adherence to the gluten free diet. The diagnosed was made before 30 months of age in 50% of cases. Average treatment duration was 69.8 +/- 36 months. The randomly selected control group was composed of 48 school age children, of the same age and sex of patients. Total bone mass (TBM) and bone mineral density (BMD) were expressed as Z scores on the basis of normal values established by the authors in Chilean children. Celiac patients had lower TBM and BMD of whole body, than controls (-1.11 +/- 0.94 vs 0.00 +/- 0.85 and -0.59 +/- 0.76 vs 0.06 +/- 0.84, respectively) and at the spine (-0.79 +/- 1.04 vs 0.003 +/- 0.92 and -1.49 +/- 0.99 vs 0.06 +/- 0.87 respectively). A lower TBM was founded at the hip (-0.62 +/- 1.28 vs -0.08 +/- 0.82) without differences in BMD. Celiac patients had a lower bone mass than controls despite early diagnosis and good compliance with the gluten-free diet. These differences could not be atributed entirely to the lower height of celiac patients. These results suggest that celiac patients constitute a risk group for development of osteoporosis later in life. This fact should be taken into consideration in the treatment of this condition.

Meningococcal disease epidemiology and control in New Zealand

Epidemiology, surveillance and research New Zealand has a high quality surveillance system for meningococcal disease that successfully integrates notification and laboratory data. Since 1991, New Zealand has had elevated incidence rates of meningococcal disease rising to 6.2 per 100,000 population in 1994. This represents a rate that is four times that recorded in 1989/90. Serogroup B infection predominates and international experience suggests that these elevated rates may continue for 5 to 15 years. Rates of meningococcal disease in Maori and Pacific Islands populations were three times higher than in Europeans at 10.0 and 12.3 per 100,000 respectively in 1994. The rates were particularly high for infants with the rate in Maori infants under 1 year reaching 120 per 100,000. The case fatality rate at 5.3% for 1994 would appear to be relatively low by international standards. Case control studies could be used to investigate potentially modifiable primary risk factors for disease. Intensive case review studies to investigate the role of such factors as preadmission antibiotics in reducing severe outcomes may be of benefit. The Ministry of Health or research funding organisations should consider the potential value of such studies in more detail.

Helicobacter pylori-associated gastroduodenal disease in symptomatic Chilean children: diagnostic value of serological assay

A newly developed enzyme-linked immunosorbent assay (ELISA) IgG serological assay for the diagnosis of Helicobacter pylori infection was used recently in two epidemiological surveys in Chile. To evaluate the diagnostic efficacy of this assay in a local symptomatic pediatric population, we studied 70 school-age patients referred for upper gastrointestinal endoscopy because of complaints suggestive of gastroduodenal disease. Evidence for antral H. pylori infection was sought by three biopsy-related methods: culture, histology, and urease activity. IgG anti-H. pylori serum antibodies were determined by ELISA. Altogether, chronic antral gastritis was found in 55 patients and duodenal ulcers in nine; 11 subjects had normal histology. Sixty (86%) patients had H. pylori in the antrum. This group had significantly higher mean IgG optical density values when compared with the H. pylori-negative group (1.860 versus 0.669; p < 0.001). The sensitivity and specificity of the assay in detecting antral H. pylori were both 90%; the positive predictive value was 98% and the negative, 60%. Accuracy of the assay was superior in predicting the presence or absence of gastroduodenal lesions with a sensitivity of 96%, a specificity of 92%, a positive predictive value of 98%, and a negative predictive value of 86%. We conclude that the diagnostic efficiency of this assay renders it appropriate both to screen for H. pylori-associated gastroduodenal disease in individual patients and to be used in seroepidemiological surveys.

Decreased uptake of cyclosporin A by P-glycoprotein (Pgp) expressing CEM leukemic cells and restoration of normal retention by Pgp blockers

The P-glycoprotein (Pgp) molecules which are expressed on multidrug resistant (MDR) tumor cells can efflux a variety of cytostatics. In both normal and tumoral epitheliums, Pgp molecules are selectively expressed on the apical surface of the epithelial cells. Such a distribution seems to be responsible for the transcellular transport of Pgp substrates, including cyclosporin A (CsA), from the basal to the apical side. Some normal lymphoid cells also express small amounts of Pgp molecules, for as yet unknown functions. Nevertheless, the sensitivity of their mitogen-induced proliferation to cytostatics, including doxorubicin and CsA, could be increased by the Pgp blockers. Using isotopically-labeled CsA and tumoral lymphoid cell lines, we now show a higher CsA retention in Pgp-lacking parental ('Par') cells than in Pgp-expressing MDR cells. The Pgp blockers can restore the CsA retention in the MDR cells to its level in the Par cells.

Giant colonic diverticulum: an unusual manifestation of a common disease

Giant colonic diverticula are an uncommon manifestation of colonic diverticular disease. This report documents another case of this rare entity. The clinical presentation is variable, but abdominal pain and the presence of an abdominal mass are common. Their etiology is uncertain, but they are thought to originate from pulsion diverticula. Abdominal plain films and barium enema are helpful in making the diagnosis. Computerized tomography is useful when the diagnosis is unclear. Surgical resection is recommended to alleviate symptoms and avoid complications.

Does hormonal therapy have any benefit for bleeding angiodysplasia?

Sixty-four patients took part in a cohort study measuring the efficacy of daily hormonal therapy in diminishing intestinal bleeding from small bowel angiodysplasia. Thirty patients received 5-10 mg norethynodrel either with mestranol, 0.075-0.15 mg (24 patients) or with conjugated estrogens, 0.625 mg (six patients). The cohort group consisted of 34 patients who either refused hormonal therapy (six patients) or were diagnosed early in our experience, before the resurgence of hormonal therapy (28 patients). Mean follow-up was 15.6 months (range 2-31 months) for the treated group and 13.4 months (range 1-23 months) for the untreated group. In addition, the change in monthly transfusion requirement with therapy was analyzed ("within group" analysis). Fifty percent (15 of 30) of the treated group required no further transfusion during therapy, while 44% (15 of 34) of the untreated group required no further therapy (not significant). During therapy, the mean monthly transfusion requirement of packed red blood cells in the treated group was not significantly different from that found before therapy (1.5 vs. 2.2 units, NS) or from that of the control group (1.5 vs. 1.6 units, NS). The findings do not support the use of hormonal therapy for bleeding from small intestinal angiodysplasia.

Evaluation of a chemiluminescent DNA probe assay for the rapid confirmation of Listeria monocytogenes

A Listeria monocytogenes-specific, acridinium-ester-labelled DNA probe was evaluated in a chemiluminescent homogeneous protection assay (HPA) for the rapid confirmation of suspect L. monocytogenes colonies from blood agar plates. The HPA uses an acridinium-ester-labelled chemiluminescent DNA probe in a free-solution hybridization format. After the DNA probe hybridized with the target ribosomal RNA, the acridinium label on the unhybridized probe was inactivated by a chemical differential hydrolysis step. Formation of a hybrid between probe and target was detected in a luminometer after the addition of a detection reagent. The assay can be completed in 30 to 45 min and allows for simultaneous processing of several (50-100) samples. The probe showed 100% sensitivity and 100% specificity for L. monocytogenes when evaluated in the HPA against L. monocytogenes, other Listeria species and other Gram-positive bacteria. The lower detection limit of the HPA was between 10(4) and 10(5) cells. In an evaluation with 296 bacterial colonies isolated from food, the HPA colony confirmation showed 100% agreement with conventional biochemical characterization. HPA will be useful for the rapid confirmation of L. monocytogenes isolated from food and clinical specimens.

[Solitary rectal ulcer syndrome]

The solitary rectal ulcer syndrome is an infrequent entity consisting of a rectal lesion, caused by straining during defecation; it is characterized by specific histological changes. The condition is most frequent in adults between 30 and 50 years of age, but a few pediatric cases have been reported. Five patients (4 boys) are presented. All suffered from moderate rectal bleeding, straining, tenesmus and mucous discharge. One of them had clinical and endoscopic evidence of rectal prolapse. On defecography all children showed failure of pelvic floor relaxation during straining. Endoscopic evaluation showed single or multiple ulcers in four patients and a nodular fibrotic lesion in one. The histopathology of the rectal mucosa revealed replacement of the stroma of the lamina propria by collagen, lack of orientation of smooth muscle fibers and considerable hyperthopy of the muscularis mucosae. Medical treatment was satisfactory in four patients, one case required transabdominal rectopexy for relief of his symptoms. The most appropriate form of treatment has not been determined, but surgery should be used when prolapse is a prominent clinical feature. Greater awareness of this condition will lead to more frequent diagnosis.

Ribosomal DNA fingerprinting of Listeria monocytogenes using a digoxigenin-labeled DNA probe

A nonisotopic ribosomal DNA fingerprinting technique was developed for the characterization of Listeria monocytogenes. Plasmid pKK3535 (a pBR322-derived plasmid containing rrnB ribosomal RNA operon of Escherichia coli) was labeled with digoxigenin-11-dUTP by random priming and used to probe EcoRI fragments of L. monocytogenes chromosomal DNA on nylon filters. The method was successfully applied to the characterization of two sets of patient and food isolates of L. monocytogenes.

[Campylobacter pylori in children and adults subjected to endoscopy, correlation of endoscopic, bacteriologic and histopathologic findings]

Campylobacter pylori has been associated to peptic ulcer and gastritis. We investigated the presence of C pylori in 17 children and 50 adults who needed endoscopy to investigate upper gastrointestinal symptoms. Gram stain, Whartin-Starry stain and the urease test were used to identify the germ; best results were obtained with the Gram stain. C pylori was present in 5.8% of children and 88% of adults, including all patients with peptic ulcer and 36 out of 39 with histologic evidence of gastritis. However, the germ was also found in 79% of patients with a normal mucosa. Our results suggest that C pylori is frequently present in gastric mucosa of children and adults with upper gastrointestinal problems. Further studies are needed to elucidate its possible pathogenic role in gastritis or peptic ulcer.

The effect of fraction size on control of early glottic cancer

A retrospective analysis of 600 patients treated for head and neck malignancy at the Cooper Hospital/University Medical Center was undertaken. Patients who had surgical intervention (excluding biopsy) were withdrawn from this review. Fifty-eight patients with Stage I Glottic Laryngeal Carcinoma were identified and constitute the basis of this report. Various parameters were analyzed to assess their impact on local control. These include age, sex, serum hemoglobin, tumor bulk, differentiation, field size, total dose, total treatment time, and fraction size. Overall local control was 87% with a median follow-up of 63 months. The only factor that influenced local control was fraction size. Of 28 patients treated with 180 cGy fractions, seven (25%) had a local recurrence within 3 years. Twenty-eight patients treated with 200 cGy or greater fractions have had no failures to date. The difference in control rate when comparing the two treatment schema was significant (p less than 0.01). The median dose in the controlled 180 cGy group was 6660 cGy (range, 6300-7020 cGy). In the patients who failed in the 180 cGy group the median dose was 6660 cGy (range, 6480-6840 cGy). The patients receiving 200 cGy fractions or greater had a median dose of 6600 cGy (range, 6000-6950 cGy) and an average dose of 6507 cGy. The mean NSD in the 180 cGy group failing was 1787 RET (range, 1735-1843 RET). Patients who were controlled and received 180 cGy fractions had a median NSD of 1796 RET (range, 1743-1868). The mean NSD in the 200 cGy group was 1847 RET. The median TDF in the 180 cGy group of patients controlled was 102. Those failing also had a TDF of 102 (range, 101-105). Patients receiving 200 cGy fractions or greater had a median TDF of 109. It appears from this data that fraction size is a highly significant factor in our ability to control glottic laryngeal cancer.

Epidemiology of human T cell leukemia virus type I infection in East Sepik Province, Papua New Guinea

A serological survey of 317 healthy residents of rural Papua New Guinea (PNG) showed a 26% prevalence of antibodies to human T cell leukemia virus type I (HTLV-I). Antibody to HTLV-I was detected in 16% of children less than or equal to 10 years old (including an 18-month-old child) and increased to greater than or equal to 24% in subjects greater than 20 years old. Prospective examination for antibody in 104 residents of one village revealed a seroconversion rate of 13% over a one-year period. The mean titer of antibody in these subjects (1:183) was lower (P less than .0005) than that in persons who were persistently seropositive (1:718). Analysis for clustering of infected subjects suggested that personal contact within the home played a role in the horizontal spread of HTLV-I. These data indicate that HTLV-I infection has a higher prevalence in PNG than in other endemic parts of the world, exposure occurs at an early age, and infection and/or seroconversion is common in adults as well as in children.

Gastric ulcers after endoscopic sclerosis of esophageal varices

Two patients with bleeding esophageal varices underwent endoscopic sclerosis. Each developed a gastric ulcer of the fundic mucosa approximately 6-7 cm below the gastro-esophageal junction. It seems probable that these lesions were related to the retrograde flow of sclerosing solution into the venous system which drains the gastric mucosa.

Behavioral effects of peripheral administration of arginine vasopressin: a review of our search for a mode of action and a hypothesis

In this review we present data summarizing our studies concerning the mechanism of action for the behavioral effects of peripheral arginine vasopressin (AVP) administration. We have demonstrated a clear performance improvement in a one trial appetitive task designed to measure the memory-learning process. This behavioral effect is blocked by peptide analogs which block the pressor response to AVP. From these data, and from other data obtained in aversively motivated tasks, we hypothesize that peripheral AVP injections induce effects of physiological-endocrinological origin and that these peripheral signals (e.g. vasopressor actions) alert and arouse the animal, thus helping to improve its association of environmental events. This hypothesis is similar to that proposed by others regarding peripheral hormones and memory and still leaves open the possibility that vasopressin in the brain acts independently of the above proposed action for peripherally derived vasopressin.

Multiple NMR T2 relaxation values in human liver tissue

Twenty-one human hepatic liver biopsy samples were evaluated by nuclear magnetic resonance spectroscopy. This spectroscopy was performed by obtaining multiple and not single T2 values (T2-long and T2-short). Neoplastic tissue had greater T2-long and T2-short values than diffuse liver disease. The T2-short correlated, r = 0.947 (p less than 0.01), with the percentage of cancer cellularity within the tissue specimens. There was no correlation between the multiple T2 values and the degree of fibrosis and inflammation. Minimal correlation was noted between the T2-long and percentage of fat within the diffuse disease (cirrhotic) specimens, r = 0.636 (p less than 0.05). The possible reasons for the above findings are discussed.

Pharmacological effects of Ro 22-1319: a new antipsychotic agent

Ro 22-1319, a novel pyrroloisoquinoline compound, was identified as a potential antipsychotic agent in a rat discrete avoidance procedure that is highly specific for such agents. Results in this test are highly correlated with the clinical potency of all types of antipsychotic agents. The avoidance-blocking potency of Ro 22-1319 (0.7 mg/kg) in this procedure approached that of haloperidol (0.4 mg/kg) and was 7- and 12-times greater than that of chlorpromazine and clozapine, respectively. Ro 22-1319 exhibited similar high potency in other rat and monkey avoidance procedures, rat motor activity, and antagonism of apomorphine emesis in dogs. High potency and antipsychotic-like activity have been demonstrated in monkey EEG and in an in vivo 3H-spiroperidol binding assay. Although studies of amphetamine antagonism in rats indicate antidopaminergic activity at nigrostriatal sites, Ro 22-1319 exhibited relatively weaker cataleptogenic and antistereotypic activity than haloperidol, and had minimal activity in a rat chronic stereotypy model of receptor supersensitivity. This profile suggests that Ro 22-1319 is an efficacious antipsychotic compound, almost as potent as haloperidol, with fewer or less intense extrapyramidal effects and low potential for tardive dyskinesia.

Display and analysis of cell size distributions with a Coulter Counter interfaced to an Apple II microcomputer

A model ZBI Coulter Counter was interfaced to an Apple II microcomputer via analog and digital interfaces. It was possible to obtain a graphic display of cell size versus channel number (1000 channels), integration of selected channels, plots, listings, and storage of the data on floppy disk, using a convenient menu selection enabling operators unfamiliar with computer technology to master the system quickly. Examples are presented of calibration of the Coulter Counter and its use for rapid and precise analysis of E rosettes.

Endoscopic estimate of gastric acid secretion

We measured the pH of the residual pool of gastric juice during routine endoscopy of the stomach and duodenum in 27 patients. After injecting 3 micrograms/kg pentagastrin intravenously additional samples were obtained 10--12 minutes later for determination of pH. No complications occurred in spite of the rapid administration of this dose. Analysis of the "basal" determinations revealed a large overlap between groups but the pH of the "poststimulated" specimens proved much more accurate in the division of patients into "low," "normal," or "high" secretor groups. When the pH of the stimulated specimens was converted to hydrogen ion concentration and then calculated to yield an estimate of peak acid output, the results were almost identical to the standard measurements of gastric secretory output after subcutaneous pentagastrin.

Unilateral outward-turning leg in infancy

An unreported condition of the legs in infants was found in more than 130 children referred to one hospital from 1973-1979. One hundred of these children were studied. One leg, usually the right, lay in external rotation. Although there was no loss or restriction of movement at the hip joints, in most cases there was a difference in the arc of rotation. Eleven children also had mild hooking of the forefoot on the unaffected side. Hip radiographs were normal in all cases. Obstetric records were reviewed in 70 cases, but no relation was found between presenting position at birth and side of the affected limb. The condition resolved spontaneously in most of the children who were follow up. This condition may cause anxiety to parents and doctors but it seems to be a variant of normal with an excellent prognosis.

Cimetidine, antacid, and hospitalization in the treatment of benign gastric ulcer: a multicenter double blind study

Two hundred forty patients with benign gastric ulcer were treated in a controlled clinical trial to assess the effect on healing of cimetidine, antacids, and hospitalization. Inpatients and and outpatients were randomly assigned to one of three treatments: cimetidine plus antacid, cimetidine plus dummy antacid, or placebo tablet plus antacid. In 206 patients who met criteria for analysis, ulcer healing as shown by endoscopy occurred by 12 days in 11 to 26 percent and by 42 days in 58 to 76 percent. There were no significant differences in healing between hospitalized and nonhospitalized patients or between treatment subgroups. Symptomatic response was equivalent in all groups. The median antacid consumption was 328 mEq of in vitro buffering capacity per day. Patients taking antacids experienced significant diarrhea compared with those taking no antacid. This investigation suggests that the effect of cimetidine is equivalent to that of large amounts of antacid, but because a true placebo group was not studied it is not possible to conclude from this study alone whether either agent influenced healing. In contrast to widespread belief, initiation of treatment in the hospital did not enhance healing, but because patients were not randomly assigned to inpatient and outpatient status no final conclusion about the effect of hospitalization on healing can be drawn.

Loperamide: a new antidiarrheal agent in the treatment of chronic diarrhea

Twenty-seven patients with chronic diarrhea due to Crohn's disease, ulcerative colitis, short bowel syndrome, and idiopathic (functional) causes participated in a multiphase study (open, double blind, and long term open) of loperamide HCl, a new single entity, oral antidiarrheal agent. In the open phase of the study, loperamide effectively relieved symptoms of diarrhea in 21 of 27 patients. The average number of stools dropped from eight in the initial relapse period to two stools after 1 month of treatment (P = 0.0001). Efficacy was confirmed in the double blind and long term open phases of the study. Four patients who were not relieved while on therapy had discontinued the drug because of abdominal cramping. No other side effects attributable to the drug were observed. Loperamide has been found to be a safe and effective agent for the treatment of chronic diarrhea.

Serum calcium responses to exogenous secretin

Increasing attention is being focused on the relationship between gastrointestinal hormones and calcium metabolism. While it is apparent that some relationship does exist, the exact nature and significance is as yet undefined. Information regarding the effect of secretin on serum calcium has been both sparse and contradictory. Boot's secretin, 3 units/kg, was given to a group of 44 patients consisting of normal controls and patients with duodenal, gastric, and marginal ulcers; primary hyperparathyroidism; and pernicious anemia. Six serial serum specimens were obtained from each patient at ten-minute intervals for calcium determination by atomic absorption spectrophotometry. Using two-way analysis of variance, no significant changes in postsecretin serum calcium values were observed. It is unlikely that physiologic levels of secretin exert any effect on serum calcium.

Bile reflux gastritis. Analysis of fasting and postprandial gastric aspirates

Gastric aspirates from 11 patients with bile reflux gastritis were studied for pH, bacterial cultures, proteolytic acitivity and bile salt pattern. Hypochlorhydria, significant bacterial overgrowth and unconjugated bile salts were found in all gastric specimens tested. The presence of unconjugated bile salts may account for the severity of the gastritis seen in these patients.

Liver disease, phlegmonous colitis, and gram-negative sepsis

Phlegmonous colitis, regarded as a terminal event in serious liver disease and hepatic coma, can also occur in reversible liver disease and can be the source of gram-negative sepsis. This paper presented such a case. Improved management of serious liver disease and hepatic coma should include consideration of colonic inflammation as another site of infection that must be treated to avoid complications of sepsis or peritonitis. Abdominal pain and loose or diarrheal stools should arouse a suspicion of the presence of phlegmonous colitis, and should be an indication for treating it and preventing sepsis.