Focal xanthogranulomatous pyelonephritis: partial nephrectomy as definitive treatment

OBJECTIVES

We report 11 cases of focal xanthogranulomatous pyelonephritis (FXGP), a disease that is very uncommon. The aim of the present work is to assess the effectivity of conservative treatment.

MATERIAL AND METHODS

Eleven of the 82 cases of XGP (12.5%) diagnosed between 1970 and 1995 presented the focal form (FXGF). Clinical features, laboratory findings, radiological imaging studies, surgical treatment and follow-up were evaluated.

RESULTS

FXGP occurred in middle-aged women (female/male ratio 4.5:1) who had a history of calculosis, urinary infections produced by Escherichia coli and Proteus mirabilis, or urinary tract abnormalities. FXGP was unilateral in all cases. The most frequent symptom was flank pain. Some hematological and biochemical parameters were altered. Intravenous urography and sonography revealed calculosis, hydronephrosis or renal mass, but these findings are nonspecific. Only abdominal CT scan can establish the correct diagnosis. Five of these patients (45.5%) underwent partial nephrectomy at our hospital. During the follow-up, patients showed no relapse in the ipsilateral or contralateral kidney. Serum parameters were in normal range.

CONCLUSION

When FXGP is diagnosed, local excision is recommended in all cases, since relapse in the affected kidney is unusual.

Acute pancreatitis and microcrystals. Importance of the bile collection and biochemical parameters

For a substantial number of patients with acute pancreatitis, no recognizable causes can be identified and such cases are called "idiopathic". With the introduction of duodenal bile collection for microscopic examination, it became possible to detect minor constituents of the bile, such as cholesterol and/or calcium bilirrubinate crystals. The mechanism by which crystals produce pancreatitis seems to be related to migration of aggregate crystals through the papilla, inducing papillary trauma or temporary impaction which can cause a biliopancreatic reflux. We now report a series of 45 patients with acute pancreatitis idiopathic, 120 with gallstones and 22 alcoholic. Of the patients with idiopathic pancreatitis whom we studied by biliary drainages, 22 were found to have abnormal drainages (MC+) (20 cholesterol crystals and 2 calcium bilirrubinate), 9 patients had more than 10 crystals per slide. The microcrystals positive (MC+) group had significantly higher values for AST (69.8 +/- 1.7) (mean +/- SEM), ALT (123.3 +/- 28.1), FA (252 +/- 28.1), G-GT (144.6 +/- 26.7) and BT (1.83 +/- 0.37) than the microcrystals negative group: AST (19.6 +/- 2.5), ALT (28.3 +/- 5.8), FA (170.5 +/- 15.1), G-GT (54.3 +/- 10.7) and BT (0.76 +/- 0.09). The more 10 crystals group had higher values (AST: 82.0 +/- 29.1, ALT: 143.1 +/- 43.5, FA: 294.8 +/- 57.2, G-GT: 171.8 +/- 38.4, BT: 2.61 +/- 0.82) than in the microcrystals negative group. We concluded that in the absence of other overt causes, the presence of crystals in bile of patients with pancreatitis justifies etiology. The number is not important.

Thermal Resistance of Bacillus stearothermophilus Heated at High Temperatures in Different Substrates

The effect of mushroom extract, with or without acidification with glucono-δ-lactone, and the overnight incubation of the spores in CaCl₂, on the heat resistance of B. stearothermophilus ATCC 12980 spores was studied. The temperature range considered was 121 to 140°C for mushroom extract and CaCl₂ and 121 to 145°C for double-distilled water as a reference substrate. The results indicated that mushroom extract without added acid significantly reduces the thermal resistance of the spores in comparison to the double-distilled water. Acidification of the mushroom extract reduces the heat resistance of spores of B. stearothermophilus at 121 °C. However, above 130°C lowering of the pH did not significantly reduce the thermal resistance of the spores, and so no generalizations should be made with regard to the effect of the pH when high temperature-short time (HTST) processes are being considered. Overnight incubation in CaCl₂ and subsequent heat treatment lead to increased heat resistance at 121 °C compared to that observed in double-distilled water. However, at 130°C and above CaCl₂ did not increase the apparent heat resistance of the spores.

Mathematical model for the combined effect of temperature and pH on the thermal resistance of Bacillus stearothermophilus and Clostridium sporogenes spores

Two mathematical models have been studied to establish the relationship between the pH, treatment temperature and thermal destruction constant (k) of Bacillus stearothermophilus and Clostridium sporogenes spores. The study was carried out by heating the spores in mushroom extract acidified with two different acidulants (citric acid and glucono-delta-lactone). Among the models studied, the one that best described the inactivation was a second order polynomial equation, the precision of which depended on the microorganism studied.

[Comparison of the indexes of serologic activity with endoscopy in intestinal inflammatory disease]

The correlation of the most commonly used clinical and serologic parameters in clinical practice were studied with an endoscopic model for inflammatory bowel disease (IBD). Eighty patients diagnosed with IBD with colic involvement (40 patients with ulcerous colitis [UC] and 40 with Crohn's disease [CD]) were prospectively studied. The CDAI was used as a clinical index of activity in the cases of CD and the True-love and Witts index was used in those with UC. The analytical parameters studied were erythrocyte sedimentation rate (ESR), hemoglobin (Hb), platelets (Th), iron (Fe), protein-C-reactive (PCR), albumin (Ab), orosomucoid (Oro), and alpha-1-antitrypsin (AAT). An excellent correlation was found in the UC in both the clinical index and serologic parameters. However, the correlation in CD was poor and only significant with iron and albumin.

Intraepithelial and lamina propria leucocyte subsets in inflammatory bowel disease: an immunohistochemical study of colon and rectal biopsy specimens

AIMS

To gain new insights into the pathogenesis and differential diagnosis of ulcerative colitis and colonic Crohn's disease.

METHODS

Immunohistochemistry for different leucocyte subsets was performed in biopsy specimens of the sigmoid colon and rectum from 55 patients with inflammatory bowel disease and 11 healthy controls.

RESULTS

Colonic biopsy specimens from patients with active ulcerative colitis had significantly higher numbers of CD45+ and CD3+ leucocytes compared with those from patients with inactive disease, and higher numbers of total leucocytes and macrophages than those from patients with Crohn's disease. Rectal biopsy specimens from patients with Crohn's disease had greater numbers of intraepithelial leucocytes (CD45, CD3 and CD8 cells) than specimens from patients with active or inactive ulcerative colitis, or from healthy controls.

CONCLUSIONS

Because of the phenotypic differences in the inflammatory infiltrate in the mucosa from the sigmoid colon and the rectum, the segment of the intestine to be biopsied should be specified. Assessment of the leucocytic component of the intraepithelial infiltrate in rectal biopsy specimens was more useful than examination of colonic biopsy specimens in the differential diagnosis of ulcerative colitis and Crohn's disease.

Growth and Heat Resistance of Clostridium Sporogenes PA 3679 Spores Heated and Recovered in Acidified Media

The effect of subculture medium composition (pH, type of acidulant, presence of EDTA) on the germination of spores of Clostridium sporogenes PA 3679, both with and without heat treatment in phosphate buffer (30 s at l25°C), was studied. Additionally, the effect of the heating medium substrate and pH and subculture medium pH and composition on the heat resistance of the spores was evaluated. The results indicate that the pH of the recovery medium and the type of acidulant have significant effects (P ≤ 0.05) on counts of PA 3679. Adding EDTA only increases inhibition of this microorganism when the pH is near neutral. For a given pH level, citric acid provided greater inhibiting power than glucono-δ-lactone, although the percentage of undissociated acid was less for citric acid. No growth was observed at pH 5.7, although in the case of glucono-δ-lactone sporadic colony development was seen in some plates. The pH of the heating medium acidified with glucono-δ-lactone did not affect the heat-resistance parameters (D and z) of spores heated to temperatures between 121 and 140°C in relation to the unacidified extract. Nor did we see any significant influence of the composition and pH of the recovery medium on these heat-resistance parameters when comparing the results with those obtained using the usual recovery medium.

D Values of Bacillus stearothermophilus Spores as a Function of pH and Recovery Medium Acidulant

The effect of the pH and the type of acidulant (citric acid or glucono-δ-lactone) of the recovery medium on the thermal resistance of Bacillus stearothermophilus ATCC 12980 was studied. The spores were heated in bidistilled water as a reference substrate and in acidified mushroom extract using citric acid or glucono-δ-lactone as acidulants (pH 6.2) and subcultured in reference (pH 7) and acidified (pH 6.2) media. A period of treatment-dependent pH sensitization was observed in heat-treated spores. In all cases, D values were lower in the acidified recovery medium than those obtained in the reference medium, but the type of acidulant used in the recovery medium had no influence on the D values. No influence on z values was observed as a consequence of the different recovery media, but they changed within a range of 7 to 10°C as a function of the different heating substrates. Glucono-δ-lactone proved to be as effective as citric acid in controlling the microbiological spoilage of foods. The pH has a great influence on decreasing the D values, mainly when acidification of the substrate and acidification of the recovery medium are combined. Consequently, it would be appropriate to take this effect into account in process calculations or validation.

[The effect of environmental factors in inflammatory bowel disease]

In an attempt to elicit risk factors in inflammatory bowel disease in Spain, we have carried out a case-control study in which we conducted personal interviews asking marital status, place of residence, economic status, use of tobacco and contraceptives, and the method of lactation in infancy. IBD was more common in patients with a low economic level; UC was predominantly found in rural population. No differences were found in the remaining categories. Our results differ from those reported from North and Central Europe.

Thermal resistance characteristics of PA 3679 in the temperature range of 110-121 degrees C as affected by pH, type of acidulant and substrate

The influence of mushroom extract, acidification and type of acidulant (citric acid or glucono-delta-lactone) on the thermal resistance of PA 3679 spores has been studied. The pH values were 7 (phosphate buffer), 6.7 (non acidified mushroom extract), 6.22, 5.34 and 4.65 (acidified mushroom extract). Spores were less heat resistant in the non-acidified mushroom extract than in phosphate buffer. However, acidification of the extract had an effect on D values which was dependent on the specific pH. At pH 6.22, D values were higher than those in non-acidified extract, for both type of acidulants, but the difference between D values in both substrates was affected by temperature, the higher the temperature, the less the difference. Acidification at other pH levels did not significantly affect D values obtained, neither did the type of acidulant. The z value ranged from 9.79 to 12.09 degrees C for citric acid and from 8.18 to 10.18 degrees C for glucono-delta-lactone. When pH was decreased the z value increased for both acidulants.

Epidemiology of inflammatory bowel disease in the Province of Granada, Spain: a retrospective study from 1979 to 1988

An epidemiological study of inflammatory bowel disease in the Province of Granada, Spain, was conducted between 1979 and 1988. Altogether, 257 cases were identified: 167 ulcerative colitis, 79 Crohn's disease, and 11 indeterminate colitis. The mean incidence of ulcerative colitis in the 10 year period was 2/10(5) and 0.9/10(5) for Crohn's disease. This is the first epidemiological study in Spain of the incidence of ulcerative colitis and corroborates the results of an earlier population based study on the incidence of Crohn's disease in Spain.

APL program for evaluation of heat processes for spherical foods

The present program solves the heat transfer equations for spherical foods by a numerical procedure that uses the Crank-Nicolson method. The program is implemented for conditions with as few restrictions as possible to enhance versatility. The results agree with the analytical solutions for two particular cases of boundary conditions. The program also computes the thermal effect in the foodstuff from the temperature data obtained by the numerical program.

Ganglioside and phospholipid composition of forebrain, cerebellum, and brain stem from adult and newborn rats

The aim of this study was to elucidate whether sex or pregnancy state might affect the content and/or pattern of gangliosides from the forebrain, cerebellum and brain stem of rats. Adult male, mother (1-day after offspring) and nonpregnant rats of similar age were analyzed. Non-significant differences in ganglioside concentrations and patterns were found for the respective neural area of adult male and female rats except for a decrease in cerebellum and brain stem content from mothers and 12.0 months-old males, respectively. Thus, it seems that neither sex nor pregnancy hormones affect these parameters. By contrast, significant differences were found for pattern and ganglioside contents between adult (male and female) rats and newborns (1 day-old). Newborns showed a significant decrease in their forebrain (2.5-fold), cerebellum (2.0-fold) and brain stem (2.0-fold) ganglioside content when compared with adult (male and female) rats. Significant increases (p less than 0.001) were found in the phospholipid and cholesterol contents in the different brain areas in mothers versus their newborns. The phospholipid pattern also showed significant changes in all brain areas, with an increase (p less than 0.001) in phosphatidylethanolamine percentage in adult animals, among the main variations. An explanation for these facts is suggested.

Sucralfate and cimetidine as maintenance treatment in the prevention of duodenal ulcer recurrence

This multicenter trial investigated the ability of the cytoprotective agent sucralfate and the antisecretory agent cimetidine to prevent ulcer relapses. Seventy-one patients with recently healed duodenal ulcer were included, randomly assigned to one of the two treatment groups, and administered sucralfate 2 g per day or cimetidine 400 mg per day for six months; the treatment period was followed by another six months of follow-up without treatment. The response to therapy was evaluated by systematic single-blind endoscopy controls during the sixth and the 12th months. Quantitative (42 percent relapse rate with sucralfate and 52 percent with cimetidine) as well as qualitative (20 percent silent relapses with sucralfate and 47 percent with cimetidine) differences were observed, although these could not be demonstrated to be statistically significant.

Ganglioside composition of liver and kidney from rat after pentazocine treatment

1. Female non-pregnant rats were intramuscularly injected with pentazocine for 3 months. Liver showed a statistically significant (P less than 0.05) increase in its ganglioside content after the pentazocine treatment; in addition, no changes were found in the kidney ganglioside content. 2. We have also found changes in the ganglioside pattern of these rats after the pentazocine injection. The GM1 and GD1b liver content was decreased (P less than 0.05) in parallel with an increase (P less than 0.05) in GD3 and GT1b content; kidney showed a decrease (P less than 0.05) in GM1, GD1a and GD1b content and an increase (P less than 0.05) in GM4, GD2, GT1b and GQ content. 3. Female pregnant rats were also injected with pentazocine from the first to the nineteenth day of the gestation period. The total ganglioside content of liver and kidneys from mothers and their newborns did not show statistically significant differences after the treatment. 4. Mothers showed a decrease (P less than 0.05) in the GM1 content of liver and an increase (P less than 0.05) in the GT1b content of liver and GM1, GD3 and GD1a content of kidney. Only the GM3 content from kidney was increased (P less than 0.001). 5. Newborns showed minor changes in their ganglioside pattern. GT1b content from liver and GD2 and GQ content from kidneys were decreased (P less than 0.05).

Lymphangioma of the duodenum: an ultrastructural study

Two cases of duodenal lymphangioma were diagnosed by endoscopy, and light and electron microscopic findings are reported. Ultrastructural studies showed smooth muscle cells around lymphatic vessels, and amyelinic nerve fibers and smooth muscle cells in the interstitium. On the basis of the ultrastructural features, a hamartomatous rather than tumoral origin is suggested for the duodenal lymphangioma. Lymphangiectatic cysts of Letulle and lymphangiectasia are discussed in the differential diagnosis. Submucosal lymphangiomas of the small bowel might be considered lymphangiectatic cysts.

Isolation and characterization of gangliosides from pig lymphocytes

Two major gangliosides from pig spleen lymphocytes, accounting for 57% of the total lipid-bound sialic acids, were isolated and purified to homogeneity by column chromatography on DEAE-Sephadex and silica gel. They were identified as GM3 (II3Neu5GcLacCer), and GD3 (II3(Neu5Gc)2LacCer), by thin-layer chromatography in comparison with standards and by analysis of the constituent sugars. The major fatty acids of these gangliosides were stearic acid and myristic acid, respectively. In addition to these gangliosides, GD2 and bands comigrating on thin-layer chromatography with authentic GM2, GM1, GD1a and GD1b were found. These compounds also occur in pig peripheral blood lymphocytes, where, however, GD3 represents about 70% of the total lipid-bound sialic acid.

Studies on neuraminidase from influenza virus A(H3N2) obtained by two procedures

1. Neuraminidase was obtained by (A) bromelain solubilization or (B) by treatment with N-lauroylsarcosine. 2. 5-N-acetyl-2-O-(3-methoxyphenyl)-alpha-D-neuraminic acid, employed as substrate, avoids the interference produced by the thiobarbituric acid method, and is not interfered by the ampholytes. 3. Only about 20% of original enzyme activity was lost after electrofocusing. The sample from procedure A showed two peaks, corresponding to pIs 4.4 and 5.6. The sample from procedure B, having a higher activity, showed only one peak at pI 4.4. 4. Samples A and B showed different Km and hydrolysis rate with N-acetylneuraminyl-lactose and glycophorin A. It was not found significantly different with other substrates: alpha 1-acid glycoprotein, brain gangliosides, 5-N-acetyl-2-O-(3-methoxyphenyl)-alpha-D-neuraminic acid and 2'-(4-methyl umbelliferyl)-alpha-D-N-acetylneuraminic acid.