Oxygen consumption and cardiac response of short-leg and long-leg prosthetic ambulation in a patient with bilateral above-knee amputation: comparisons with able-bodied men

This study measured oxygen uptake (VO2), minute ventilation (VE), and heart rate (HR) in a bilateral above-knee (AK) amputee and in three able-bodied controls during progressive treadmill exercise. Walking conditions for the amputee included using bilateral short-leg (SL) and long-leg (LL) prostheses. A progressive treadmill protocol to maximal capacity was used for the amputee and duplicated by the control subjects. An automated system was used to measure VO2, VE, and HR throughout exercise. Data analysis was restricted to the use of parameter averages and percentages to describe differences between experimental conditions. Maximal VO2 for the amputee averaged 23.3mL/kg-1/min-1 with the LL and 22.8mL/kg-1/min-1 with the SL prostheses, a negligible difference between conditions; however, exercise duration was 27% longer when using the SL prostheses. In addition, when averaged over the first four stages of exercise, VO2, VE, and HR were 24%, 32%, and 14% higher, respectively, when the LL prostheses were used. Treadmill walking by unimpaired controls averaged 47% and 79% more economical than walking with the SL or LL prostheses, respectively. These results demonstrate that the use of currently available AK prostheses requires significant energy expenditure, which limits their use to only the most physically fit individuals.

Epidemiological survey of coeliac disease and inflammatory bowel disease in first-degree relatives of coeliac patients

One hundred and sixty-two of 182 patients with coeliac disease provided satisfactory details of family size and the prevalence of coeliac disease and inflammatory bowel disease among their first-degree relatives. Patients ranged in age from 11 months to 79 years with a mean age of 41 (+/- 23) years. Twenty patients had at least one first-degree relative with coeliac disease: a total of 25 of 861 relatives were affected (prevalence = 2904/100,000) compared with an expected 0.9 cases (prevalence = 100/100,000; p less than 0.001). Six relatives had inflammatory bowel disease (prevalence = 697/100,000) compared with an expected 1.3 cases (prevalence = 150/100,000; p less than 0.001). Five of these had ulcerative colitis, and one had Crohn's disease. The relative risk of ulcerative colitis is, therefore, five times greater for first-degree relatives of people with coeliac disease than for the general population (95 per cent confidence interval, 4.7-7.2). There is a clear association between coeliac disease and ulcerative colitis, which may point to factors involved in the aetiology of colitis.

3-Deazaadenosine--an inhibitor of interleukin 1 production by human peripheral blood monocytes

3-Deazaadenosine (c3Ado) has been reported to have properties of an immunosuppressive and anti-inflammatory agent. This study was designed to investigate whether c3Ado might exert anti-inflammatory activities through inhibiting Interleukin 1 (IL-1). c3Ado was found to be a potent inhibitor of IL-1 production by LPS stimulated human peripheral blood monocytes and acted at the level of synthesis rather than secretion. c3Ado also had direct effects on IL-1 biological activity in two separate assays; thymocyte proliferation and induction of prostaglandin release. Further experiments indicated that c3Ado also inhibited growth factor dependent proliferation driven by both Interleukin-2 and Interleukin-3 as well as the proliferation of a number of non-growth factor dependent cells. However, short term exposure to c3Ado resulted in no inhibition of 3H-thymidine incorporation by cells but a significant inhibition of 3H-uridine uptake into TCA precipitable material. These results suggest that c3Ado is a selective inhibitor of RNA synthesis and inhibits IL-1 production and activity by blocking new messenger RNA production induced by LPS or IL-1. General inhibition of RNA synthesis would also account for its anti-proliferative activity.

Phagocytosis of Histoplasma capsulatum yeasts and microconidia by human cultured macrophages and alveolar macrophages. Cellular cytoskeleton requirement for attachment and ingestion

Phagocytosis of Histoplasma capsulatum (Hc) yeasts and microconidia by human macrophages (M phi) was quantified by a fluorescence quenching technique. Phagocytosis of unopsonized Hc yeasts by monocyte-derived M phi and human alveolar M phi (AM) was rapid. After 60 min, 79% of cultured M phi and 59% of AM had ingested an average of 9.8 and 11 yeasts/M phi, respectively. In contrast, only 26% of monocytes ingested 4.5 yeasts/cell after 60 min. Phagocytosis of unopsonized microconidia by cultured M phi and by AM was equivalent. Monoclonal antibodies specific for the alpha-chains and beta-chain of the CD18 family of adhesion receptors inhibited the binding of Hc yeasts and microconidia to cultured M phi and AM. Thus, the M phi CD18 complex mediates recognition of both phases of this dimorphic fungus. Disruption of actin microfilaments with cytochalasin D inhibited both attachment and ingestion of yeasts by M phi. In contrast, nocodazole, which prevents polymerization of microtubules, did not inhibit binding or ingestion. Both drugs inhibited ingestion, but neither drug inhibited binding of C3b- and C3bi-coated sheep erythrocytes to complement receptors type one (CR1) or type three (CR3), respectively. Therefore, different signal transducing mechanisms for phagocytosis appear to be triggered by the binding of Hc yeasts to CD18, and by the binding of EC3bi to CD11b/CD18, respectively.

Effect of nicotine and cotinine on the production of oxygen free radicals by neutrophils in smokers and non-smokers

1. Neutrophils play a role in the pathogenesis of ulcerative colitis. Most of the patients with ulcerative colitis are non-smokers. 2. Neutrophil function was examined in healthy males, five smokers and five non-smokers, measuring production of oxygen free radicals by chemiluminescence. 3. The chemiluminescence was examined in the presence of nicotine and its main metabolite cotinine in various concentrations. 4. 10 mM nicotine inhibited production of oxygen free radicals (90.2% +/- 11.6) compared with controls (P less than 0.001), as did the same concentration of cotinine (58.9% +/- 34.2), (P less than 0.05). 5. 1 mM solutions had no effect and 3 mM nicotine was required to achieve 50% inhibition. 6. Smokers and non-smokers did not differ. 7. Since plasma concentrations of nicotine after a cigarette are only between 5 and 15 mM, the observed effects of nicotine and cotinine in much higher pharmacological concentrations in this system are unlikely to be of clinical relevance in ulcerative colitis.

Evidence for an intercellular covalent reaction essential in antigen-specific T cell activation

The inductive interaction between class II+ APC and Th cell was investigated in a human system at the chemical level. The study set out to test the predictions of a model of Ag presentation in which epsilon-amino groups and carbonyl groups at the surface of APC and T cell react covalently to form reversible intercellular Schiff bases. In the experimental system of oxidative mitogenesis this process results in T cell activation. If oxidative mitogenesis is an experimental amplification of a physiologic process, and intercellular Schiff base formation is essential in Ag presentation, then it should be possible to inhibit Ag presentation by prior formation of Schiff bases on the surface of participating cells. In this situation Ag-induced T cell activation and T cell activation induced by periodate oxidation should invariably behave in the same way. It should also be possible to demonstrate Schiff base formation occurring between accessory cells and lymphocytes directly and definitively by means of specific reduction with sodium cyanoborohydride. Aldehyde treatment of accessory cells should prevent this intercellular Schiff base formation. In this study the following observations were made. 1) Both Ag-specific and periodate-induced T cell activation were inhibited by aldehyde treatment of class II+ accessory cells. 2) Noncross-linking donors of carbonyl groups other than aldehydes inhibited Ag-specific T cell activation. 3) Brief, low-dose treatment of T cells with aldehydes inhibited Ag-dependent T-cell activation. 4) Exogenous amino groups in the form of lysine and other amino acids inhibited both Ag-specific and periodate-induced T-cell activation. 5) The weak reducing agent sodium cyanoborohydride which is specific for Schiff bases at neutral pH inhibited both Ag-induced and periodate-induced T cell activation. Responses to PHA were markedly prolonged by this reagent. 6) Schiff base formation occurring between accessory cells and lymphocytes was detected directly and definitively by means of radiolabeling with NaCNB(3H)3 at neutral pH. These data are consistent with the view that the formation of reversible covalent Schiff bases between ligands on APC and T cell is an essential process in Ag-induced T cell activation.

Evidence for an intercellular covalent reaction essential in antigen-specific T cell activation

The inductive interaction between class II+ APC and Th cell was investigated in a human system at the chemical level. The study set out to test the predictions of a model of Ag presentation in which epsilon-amino groups and carbonyl groups at the surface of APC and T cell react covalently to form reversible intercellular Schiff bases. In the experimental system of oxidative mitogenesis this process results in T cell activation. If oxidative mitogenesis is an experimental amplification of a physiologic process, and intercellular Schiff base formation is essential in Ag presentation, then it should be possible to inhibit Ag presentation by prior formation of Schiff bases on the surface of participating cells. In this situation Ag-induced T cell activation and T cell activation induced by periodate oxidation should invariably behave in the same way. It should also be possible to demonstrate Schiff base formation occurring between accessory cells and lymphocytes directly and definitively by means of specific reduction with sodium cyanoborohydride. Aldehyde treatment of accessory cells should prevent this intercellular Schiff base formation. In this study the following observations were made. 1) Both Ag-specific and periodate-induced T cell activation were inhibited by aldehyde treatment of class II+ accessory cells. 2) Noncross-linking donors of carbonyl groups other than aldehydes inhibited Ag-specific T cell activation. 3) Brief, low-dose treatment of T cells with aldehydes inhibited Ag-dependent T-cell activation. 4) Exogenous amino groups in the form of lysine and other amino acids inhibited both Ag-specific and periodate-induced T-cell activation. 5) The weak reducing agent sodium cyanoborohydride which is specific for Schiff bases at neutral pH inhibited both Ag-induced and periodate-induced T cell activation. Responses to PHA were markedly prolonged by this reagent. 6) Schiff base formation occurring between accessory cells and lymphocytes was detected directly and definitively by means of radiolabeling with NaCNB(3H)3 at neutral pH. These data are consistent with the view that the formation of reversible covalent Schiff bases between ligands on APC and T cell is an essential process in Ag-induced T cell activation.

The histology of anal skin tags in Crohn's disease: an aid to confirmation of the diagnosis

We have investigated excision biopsy of anal skin tags as an adjunct to rectal biopsy in the diagnosis of Crohn's disease. Twenty-six patients with proven Crohn's disease of the large and/or small bowel were studied. All had perianal skin tags removed under local anaesthesia as outpatients, when rectal biopsies were also obtained. Three sections from each skin tag and three from each rectal biopsy were examined for granulomas. The rectal biopsies were also examined for changes 'suggestive' of Crohn's disease. Anal skin tags from 26 patients without Crohn's disease acted as controls. Of the patients with Crohn's disease, granulomas were found in both anal skin tags and rectal biopsies in five patients, in anal skin tags only in four, and in rectal biopsies only in three. When present, granulomas were more plentiful in anal skin tags than in rectal biopsies, being seen in all 3 sections in 7 of 9 'positive' tags (i.e.: in 31% of 78 sections), compared to only 1 of 8 'positive' rectal biopsies (i.e.: in 13% of 78 sections). No granulomas were seen in control anal skin tags. The procedure provides a simple technique which is complementary to rectal biopsy, by which histological confirmation of Crohn's disease may be obtained.

A study of the menopause, smoking, and contraception in women with Crohn's disease

One hundred and ninety-six women with Crohn's disease from south-east Wales were asked to provide details of their menstrual cycles, age at menopause, history of surgery, smoking habits and use of oral contraceptives. One hundred and forty-six provided the information (response rate 77 per cent). Eighty-four were still menstruating, three were pregnant, 10 had undergone hysterectomy, one had a pharmacologically-induced menopause and 48 had had a physiological menopause. Of these 48 women, 33 were diagnosed as having Crohn's disease before the menopause. Twenty-five of these were smokers. The mean age at menopause was similar in smokers and non-smokers and in those diagnosed before and after the menopause. The mean age at menopause was between 46 and 47. A logistic analysis using the 'status quo' method showed that 50 per cent of women with Crohn's disease had the menopause at 47.6 years compared with 49.6 years in a group of healthy women from the same area. The two groups had similar smoking habits and it would seem that a premature menopause is associated with Crohn's disease.

Immunoregulatory properties of novel specific inhibitors of 5-lipoxygenase

The immunoregulatory properties of novel specific inhibitors of 5-lipoxygenase (5-LO) were investigated in vitro. These novel acetohydroxamic acids were found to inhibit the proliferation of lymphocytes in response to Interleukin-1 (IL-1) and Interleukin-2 (IL-2). Mitogen- and antigen-induced lymphoproliferation were likewise inhibited and so too was the spontaneous proliferation of transformed cells of myeloid and lymphoid origin. In this respect the compounds were one-tenth as potent as azathioprine on a molar basis. The production of IL-1 and IL-2 remained unaffected. Inhibition of lymphocyte proliferation was not related to inhibition of 5-LO. The latter occurred at 40-fold lower concentrations of 5-LO inhibitor. Moreover, inhibition of lymphoproliferation was not reversible in the presence of excess arachidonic acid. IL-1-induced collagenase production by chondrocytes was unaffected by 5-LO inhibitors. Contrary to a number of published reports, products of 5-LO do not appear to be obligatory mediators in IL-1 and IL-2 signal transduction. The immunosuppressive action of the 5-LO inhibitors described here seems to be a novel secondary property of the compounds.

Effect of ranitidine on gastroduodenal mucosal damage in patients on long-term non-steroidal anti-inflammatory drugs

Twenty-four patients taking long-term non-steroidal anti-inflammatory drugs (NSAIDs) were followed in a double-blind placebo-controlled trial to assess the effect of ranitidine 300 and 600 mg daily on upper gastrointestinal mucosal damage and to assess methods of monitoring mucosal damage. Sixteen were given ranitidine and 8 had placebo throughout the study. Comparisons suggested that ranitidine reduced symptoms and endoscopic evidence of mucosal damage. Histological evidence of gastritis was present in only half of those on ranitidine but in all receiving placebo. Erosions and blood loss occurred intermittently during the study but faecal blood losses using 51Cr-labelled red cells failed to identify any difference between groups. Endoscopic observation of erosions and serial biopsies may provide simple, reliable measurements for future studies to assess the effect of therapy in reducing mucosal damage from long-term NSAIDs.

Platelet number and size in relation to serum orosomucoid concentration in Crohn's disease

The relationship between platelet size and platelet count was investigated in 41 patients with Crohn's disease. A high platelet count was associated with a decrease in platelet size, but an overall increase in the platelet crit. There was also a significant correlation between the patient's platelet count and serum orosomucoids, which have traditionally been used to assess disease activity.

Adherence of Pneumocystis carinii in lung cells during in vitro cultivation

This study describes an approach to cultivation of Pneumocystis carinii (Pc) on 2 cell lines derived from lung (A549, human and L2, rat) with emphasis on the organisms which adhered to the cells. Immunofluorescent staining was used for growth assays.

Does smoking improve colitis?

In 14 of 30 patients with ulcerative colitis who resumed smoking there was an improvement in their symptoms over the subsequent median period of 6 weeks. This group smoked a median number of 20 cigarettes, compared with 10 by those who did not improve.

Increased rate of spinal trabecular bone loss in patients with inflammatory bowel disease

The rate of spinal trabecular bone loss during one year was measured in 54 patients with inflammatory bowel disease. The mean change in spinal bone mineral content was -5.1 mg/ml K2HPO4, representing 3% of the initial bone mineral content. The rate of bone loss showed a significant negative correlation with body mass index (r = -0.276, p less than 0.05) but no other significant correlations were found with other clinical or biochemical indices, including the total amount of prednisolone taken during the course of the study. Eleven patients had bone loss greater than 15 mg/ml/year; these included four non-steroid treated patients, two of whom had disease confined to the large bowel. The results indicate rapid rates of bone loss in some patients with inflammatory bowel disease over the course of one year. Although steroid therapy and malnutrition are likely to be contributory factors in some patients, other, as yet unidentified, risk factors also operate. The rapid bone loss observed in some patients emphasises the need for effective prophylactic regimes.

Endocrine pancreas in the rat model of exocrine pancreatic insufficiency

A new technique to obstruct the pancreatic ducts was developed by injecting zein solution into the common bile duct of the rat. Four weeks after the injection, the fate of the endocrine pancreas was investigated by studying (a) pancreatic content of four pancreatic hormones, (b) histology and immunohistochemistry of the pancreas, (c) i.v. glucose tolerance and i.v. insulin tolerance tests for monitoring plasma glucose, insulin, and pancreatic polypeptide (PP) levels in vivo, and (d) in vitro perifusion of pancreatic tissue slices to assess insulin and PP secretion. In zein-injected rats, the total pancreatic content of insulin, glucagon, PP, and somatostatin was reduced to 80, 70, 40, and 20%, respectively, of the corresponding controls. In response to insulin-induced hypoglycemia, the plasma PP levels rose to about one-half that of the controls. By contrast, perifused zein-injected rat pancreases released several times more PP than the controls in response to carbachol stimulation. In zein-injected rats, total pancreatic protein was reduced to 20% of the controls and pancreatic amylase was almost absent, reflecting practically complete loss of acinar tissue. Thus, this experimental model appears to be suitable for producing chronic pancreatic insufficiency in the rat and provides a useful model for studying both endocrine and exocrine functions in the small rodent.

Late presentation of ulcerative colitis in ex-smokers

Details of the smoking history were obtained from 288 patients with ulcerative colitis who were more than 15 years of age when colitis developed. Men who had previously smoked presented with colitis at a later age than lifelong non-smokers (mean age difference 15.2 years). The proportion of ex-smokers in this group of patients with colitis was more than twice that expected in the general population. The interval between cessation of smoking and subsequent onset of colitis in ex-smokers was found to be relatively short and in two-thirds of patients occurred within seven years. A tentative model to explain the association between smoking and subsequent colitis is proposed. We suggest that whilst current smokers may have a lower incidence of colitis, ex-smokers appear to be at increased risk of developing the disease. An alternative explanation is that smoking may act in a manner analogous to sulphasalazine.

Functional abolition of monocyte HLA-DR by aldehyde treatment. A novel approach to studies of class II restriction elements in antigen presentation

The effect of low concentration aldehyde treatment (0.0012 to 0.005%) on the expression of HLA-DR Ag by human monocytes was investigated. This treatment was shown to selectively abolish the expression of HLA-DR determinants defined by a monomorphic mAb (YE2.36) in a rosette assay. The expression of class I MHC Ag and Fc gamma R remained unaffected. As a result, the presentation of the recall Ag tetanus toxoid and streptokinase-streptodornase (SK-SD) to freshly isolated autologous T cells and T cell clones was completely inhibited. Increasing the concentration of aldehyde to 0.05% consistently produced partial restoration of Ag-presenting capacity. Low dose aldehyde treatment did not affect monocyte viability or membrane turnover. Thus, aldehyde-treated monocytes produced a second generation of HLA-DR and expression was almost completely restored to normal after 24 h of culture. The presentation of monocyte class II Ag as alloantigens was also inhibited by low dose aldehyde treatment but inhibition was much less marked when monocytes were aldehyde treated at 2 h rather than at 24 h of culture. This is consistent with the reexpression of HLA-DR which occurred readily in the first 24 h of culture and much less readily thereafter. Low dose aldehyde treatment did not affect Ag uptake and processing. However, monocytes which had been pulsed with Ag, aldehyde-treated to abolish HLA-DR, and then cultured to allow regeneration of HLA-DR could present Ag only when given a second Ag pulse, suggesting that once the association between microbial Ag and HLA-DR had formed the Ag was not then free to reassociate with novel HLA-DR. Low dose aldehyde treatment did not affect monocyte IL-1 production, neither did it inhibit the detection of HLA-DR by soluble mAb in FACS analysis. These results are consistent with the view that low dose aldehyde treatment disrupts the tertiary structure of human Ia molecules such that allostimulatory determinants and restriction elements for exogenous Ag are rendered inaccessible to T lymphocyte receptors and to cell-bound anti-DR mAb in the rosette assay, although DR determinants may remain accessible to soluble mAb.

Functional abolition of monocyte HLA-DR by aldehyde treatment. A novel approach to studies of class II restriction elements in antigen presentation

The effect of low concentration aldehyde treatment (0.0012 to 0.005%) on the expression of HLA-DR Ag by human monocytes was investigated. This treatment was shown to selectively abolish the expression of HLA-DR determinants defined by a monomorphic mAb (YE2.36) in a rosette assay. The expression of class I MHC Ag and Fc gamma R remained unaffected. As a result, the presentation of the recall Ag tetanus toxoid and streptokinase-streptodornase (SK-SD) to freshly isolated autologous T cells and T cell clones was completely inhibited. Increasing the concentration of aldehyde to 0.05% consistently produced partial restoration of Ag-presenting capacity. Low dose aldehyde treatment did not affect monocyte viability or membrane turnover. Thus, aldehyde-treated monocytes produced a second generation of HLA-DR and expression was almost completely restored to normal after 24 h of culture. The presentation of monocyte class II Ag as alloantigens was also inhibited by low dose aldehyde treatment but inhibition was much less marked when monocytes were aldehyde treated at 2 h rather than at 24 h of culture. This is consistent with the reexpression of HLA-DR which occurred readily in the first 24 h of culture and much less readily thereafter. Low dose aldehyde treatment did not affect Ag uptake and processing. However, monocytes which had been pulsed with Ag, aldehyde-treated to abolish HLA-DR, and then cultured to allow regeneration of HLA-DR could present Ag only when given a second Ag pulse, suggesting that once the association between microbial Ag and HLA-DR had formed the Ag was not then free to reassociate with novel HLA-DR. Low dose aldehyde treatment did not affect monocyte IL-1 production, neither did it inhibit the detection of HLA-DR by soluble mAb in FACS analysis. These results are consistent with the view that low dose aldehyde treatment disrupts the tertiary structure of human Ia molecules such that allostimulatory determinants and restriction elements for exogenous Ag are rendered inaccessible to T lymphocyte receptors and to cell-bound anti-DR mAb in the rosette assay, although DR determinants may remain accessible to soluble mAb.

Cardiff Crohn's disease jubilee: the incidence over 50 years

The incidence of Crohn's disease in Cardiff between 1931 and 1985 has been examined using hospital diagnostic indices supplemented in recent years by records from clinicians, and the departments of pathology and radiology. Four hundred and seven new patients were confirmed after all notes had been reviewed. There has been a large increase from 0.18 cases/10(5) of the population per year in the 1930s to current values of 8.3/10(5)/year. The incidence continues to rise and shows an increasing proportion of patients with colorectal disease. Peak age specific incidences occur in the third and eighth decades of life.

Osteoporosis in patients with inflammatory bowel disease

Bone mineral content in spinal trabecular and peripheral cortical bone was measured in 75 unselected patients with small and/or large intestinal inflammatory bowel disease. Osteoporosis, defined as a bone mineral content greater than 2 SD below the age and sex matched normal mean value was present in 23 patients (30.6%). Three amenorrhoeic females aged 34, 38, and 42 years had severe clinical osteoporosis and a further three patients had one or more vertebral crush fractures. Eighteen of the 23 patients with osteoporosis had small intestinal disease with one or more resections and the mean lifetime steroid dose in those with osteoporosis was significantly higher than in those with normal bone mineral content. Bone mineral content in spinal trabecular bone showed significant negative correlations with lifetime steroid dose and serum alkaline phosphatase and a significant positive correlation with serum albumin. Peripheral cortical bone mineral content was positively correlated with body weight, height and body mass index. We conclude that the prevalence of osteoporosis is increased in patients with inflammatory bowel disease, severe clinical osteoporosis developing in some relatively young patients. The pathogenesis of this bone loss is probably multifactorial; steroid therapy is likely to be an important contributory factor.

Metabolism and urinary excretion of 5-amino salicylic acid in healthy volunteers when given intravenously or released for absorption at different sites in the gastrointestinal tract

In six healthy subjects serum concentrations of 5 amino salicylic acid (5ASA) and acetyl 5ASA were measured for up to 24 hours, and urinary excretion over 48 hours. After an intravenous injection of 3.26 mmol 5ASA serum concentrations fell rapidly with a distribution half-life of 17 +/- 2 min and an elimination half-life of 42 +/- 5 min. After 45 minutes acetyl 5ASA became the dominant compound and after seven hours serum concentrations of both components were almost unrecordable. Orally ingested 5ASA in three preparations to ensure its release in the stomach, small intestine and ileocaecal region respectively gave lower serum concentrations and urinary excretion than those obtained after an intravenous infusion. Bioavailabilities which ranged from 19% for ileocaecal release to 75% for release in the upper gastrointestinal tract, were calculated from areas under the serum concentration curves. Urinary excretion of 5ASA and its acetyl metabolite over 48 hours was 78%, 52%, 55%, and 21% respectively of the dose given intravenously and orally for gastric, small intestinal and ileocaecal release.

Time relationships between cessation of smoking and onset of ulcerative colitis

From 5 centres 154 patients with ulcerative colitis and a history of smoking completed a questionnaire about the temporal relationship between diagnosis of colitis and cessation of smoking. One hundred and thirty-eight of these were ex-smokers and 107 (69.5%) had stopped smoking before the diagnosis of colitis was made. Fifty-six patients (52%) developed colitis within 3 years of stopping smoking. The findings suggest that smoking exerts protective effect against the development of ulcerative colitis.

Trial of nifedipine for prevention of oesophageal spasm

We have used a placebo controlled trial to investigate the effect of long-term administration of nifedipine in the prevention of symptomatic episodes of oesophageal spasm. Diary card scoring was used to assess symptoms in 8 patients with oesophageal spasm who were each given nifedipine and placebo for at least 6 weeks. No significant differences in symptoms between the nifedipine and placebo treatment periods were seen.

Differences in character roles between adolescents from alcoholic and nonalcoholic homes

The present study was an initial investigation to determine whether differences existed in role-prescribed behaviors between adolescents from alcoholic and nonalcoholic homes. Specifically, the study investigated Black's contention that children of alcoholics adopt one or more of the roles of responsible child, placater, adjuster, and acting-out child. The Children of Alcoholics Screening Test (CAST) was used to identify responses to parental drinking behavior and the Children of Alcoholics Family Role Instrument (CAFRI) was developed to obtain a measure of subjects' perceptions of role behavior. The independent variable was group membership in either an alcoholic or nonalcoholic family and the dependent variables were the role scores on the CAFRI. Statistical comparisons of differences in individual roles between groups indicated that adolescents from alcoholic families rated themselves higher on the acting-out role with a prominent although nonsignificant tendency to exhibit behaviors characteristic of the placater and adjuster. A post-hoc analysis demonstrated no significant differences between roles on birth order or age. A significant effect for gender was evidenced on the placater role only, with females rating higher than males. Results are discussed in terms of the influence of a differential self-reported enactment of specific character roles between adolescents from alcoholic and nonalcoholic families.

Antibody response to anaerobic coccoid rods in Crohn's disease

The IgG and IgM specific antibodies against a panel of 23 anaerobic gut bacteria were examined in Crohn's disease, ulcerative colitis, and healthy controls. Four of the organisms, Bifidobacterium bifidum, Coprococcus comes (ME46), Coprococcus comes (Sp4), and Eubacterium limosum gave abnormal antibody titres in Crohn's disease compared with those of controls. In Crohn's disease specific IgG antibodies to three of the organisms were low and the IgM antibodies were higher than those of controls. IgM antibodies were also raised in ulcerative colitis. Antigenic cross reactivity could be shown between some of these organisms. The possible clinical importance of these abnormal antibody responses to specific organisms is unexplained.

Antigen presentation by human monocytes: effects of modifying major histocompatibility complex class II antigen expression and interleukin 1 production by using recombinant interferons and corticosteroids

Lymphocyte proliferation in response to monocytes pulsed with an antigenic extract of Candida albicans was measured in vitro and the effects of modifying major histocompatibility complex (MHC) class II antigen expression at the surface of the antigen-presenting cells was investigated. The study shows that no simple correlation exists between changes in MHC class II antigen expression and changes in the effectiveness of antigen presentation. Recombinant interferon-alpha 1 (rIFN-alpha 1), rIFN-gamma and hydrocortisone were found to increase the expression of monocyte class II MHC antigens. In contrast, rIFN-alpha 2 did not increase class II antigen expression although it did increase MHC class I expression. Treatment of monocytes with rIFN-alpha 1, rIFN-alpha 2 or corticosteroids during antigen pulsing resulted in a reduction in the subsequent proliferative lymphocyte response. In all cases this inhibitory effect was restricted to antigen-specific proliferative responses since the polyclonal lymphocyte response to pokeweed mitogen-pulsed monocytes remained unaffected. Only rIFN-gamma treatment of antigen-pulsed monocytes resulted in enhancement of the subsequent specific lymphocyte proliferative response. The suppressive effects of hydrocortisone could not be attributed to its well documented inhibitory effects on arachidonic acid metabolism. The effect of C. albicans antigen, IFN and corticosteroids on interleukin 1 (IL 1) production by monocytes was also investigated. C. albicans antigen alone induced IL 1 production. So too did IFN-alpha 1 and IFN-gamma. IFN-alpha 2 did not induce IL 1 production. Addition of interferons together with C. albicans, however, resulted in the same level of IL 1 productions as with C. albicans antigen alone. Neither antigen nor IFN had any effect on IL 1 action in the thymocyte assay. Corticosteroids did not affect IL 1 production by monocytes but were potent antagonists of IL 1 in the thymocyte proliferation assay. Mitogen-induced thymocyte proliferation was also inhibited by corticosteroids. Pretreatment of monocytes with hydrocortisone followed by washing did not markedly affect their subsequent ability to produce IL 1 neither was it possible to reverse the inhibitory effects of hydrocortisone on antigen presentation by addition of exogenous IL 1. Thus, signals which alter class II MHC antigen expression influence the antigen-presenting capacity of monocytes by a mechanism independent of IL 1. No simple correlation exists between class II expression and antigen-presenting capacity.

Male fertility in Crohn's disease

The fertility of 70 men with Crohn's disease and a group of age matched controls were compared. Crohn's disease was associated with a significant reduction in family size independent of steroid or sulphasalazine treatment.

Effect of prostaglandin PGE2 on alcohol-induced ulceration in the rat colon

The effect of pretreatment with topical prostaglandin E2, prednisolone and sulphasalazine in experimental colitis has been examined in the rat colon. Only prostaglandin E2 treatment significantly reduced mucosal ulceration. Long-term exposure of the rat colon to topical ethanol produced some of the histological changes seen in human colitis.

Crohn's disease in Jewish people--an epidemiological study in south-east Wales

The prevalence of Crohn's disease in the Jewish population of south-east Wales was established by a postal survey, review of case notes and a survey of Jewish congregations in the three synagogues of the area. The prevalence of Crohn's disease had been established in various earlier studies at 52/10(5). Seven Jewish patients were identified amongst a population of between 1,750 and 2,500. The prevalence ranged from 280 to 400/10(5) (95% confidence interval 120-862/10(5]. There was no significant difference in prevalence between orthodox and reformed Jews. Jewish people are at a relative risk of developing Crohn's disease of 5.4-7.7 (95% confidence interval 2.3-17.2, p less than 0.001), but the role of diet is yet to be established.

Angina-like esophageal pain: differentiation from cardiac pain by history

Consecutive patients coming as an emergency with chest pain due to myocardial ischemia or esophageal disease were interviewed on admission to the hospital, before they had been fully investigated. Classical features of angina pectoris were equally common in both groups and "crescendo angina" was often found in patients with esophageal disease. Features that helped to distinguish esophageal from cardiac pain were: an atypical response to exercise, pain that continued as a background ache, retrosternal pain without lateral radiation, pain that disturbed sleep, and the presence of certain esophageal symptoms. A positive diagnosis will be made more often in cases of suspected but unsubstantiated coronary disease by clinicians who are aware that esophageal pain and angina may be indistinguishable.

Vitamin D status in Crohn's disease: association with nutrition and disease activity

Forty patients with Crohn's disease were divided into undernourished (18) and well nourished (22) groups depending on whether their midarm circumference was below or above 90% of the ideal standard. Plasma 25-(OH)D3 and the dihydroxylated metabolites, 24,25-(OH)2D3 and 1,25-(OH)2D3 were measured in the summer. Results were related to clinical and biochemical parameters and also compared with results from patients with ulcerative colitis and healthy subjects who served as controls. Plasma 25-(OH)D3 was reduced in the undernourished Crohn's group compared with the well nourished Crohn's group, who did not differ from the controls. Over 50% of the undernourished Crohn's group had evidence of secondary hyperparathyroidism and raised alkaline phosphatase concentrations, although concentrations of 1,25-(OH)2D3 were normal. The low 25-(OH)D3 concentrations related to disease activity. It is suggested that undernourished Crohn's patients who have high levels of disease activity are at risk of vitamin D deficiency, and attempts should be made to improve their vitamin D nutrition.

Bile exclusion from the duodenum. Its effect on gastric and pancreatic function in the dog

The effect of diverting bile from the duodenum in four dogs with cholecystojejunostomy was studied using a double-marker perfusion technique. After the diversion procedure, a liquid meal increased acid secretion from 0.8 mmol H+/min to 1.48 mmol H+/min (P less than 0.05, paired t test); there was an associated rise in serum levels of gastrin 120 min after feeding (P less than 0.001, paired t test). Pancreatic secretion of trypsin decreased from 3.91 IU/min to 2.66 IU/min after bile diversion (P less than 0.01, paired t test), and the level of CCK was significantly lower 60 min after feeding (P less than 0.05, paired t test). There was no significant change in the rate of gastric emptying after bile diversion, but the pH of duodenal contents was lower in the later stages of digestion. These changes may explain the reported increase of peptic ulcer after diverting bile from the duodenum, and the procedure should not be considered unless the consequences of acid hypersecretion and pancreatic inhibition have been anticipated.

Absorption of delayed-release prednisolone in ulcerative colitis and Crohn's disease

The absorption and urinary excretion of [3H]prednisolone after oral ingestion was examined using hard gelatin capsules with and without a coating of Eudragit-S which delayed release of the contents. In 6 patients with ulcerative colitis absorption was delayed until the preparation reached the colon but the total absorption was unchanged. In 6 patients with Crohn's disease and ileal strictures the preparation broke proximal to the stricture and absorption was delayed until this occurred (within 4-12 h). In 5 patients with Crohn's disease and intestinal resections the capsules broke unreliably.

A small phospholipase inhibitory factor released by cultured cell lines

Cells of the mouse macrophage-like cell line RAW264 release a dialysable inhibitor of phospholipase activity into their culture medium. This inhibitor can be detected in saline solution, Hanks solution and a variety of tissue culture media in the presence or absence of serum. The inhibitor is stable at 4 degrees C, unaffected by trypsin, nucleases, or boiling, and partially extractable with chloroform/methanol. The release of both arachidonic acid and prostaglandins from mouse macrophages or human monocytes is inhibited by this material. A variety of other cell types release the inhibitor, which is effective against stimulation of arachidonic acid release from cultured macrophages by zymosan, serum, immune complexes and the calcium ionophore A23187.

Female gender is a major determinant of changing subsite distribution of colorectal cancer with age

Distribution by subsite and sector of 948 colorectal cancers diagnosed in Kansas in 1982 was analyzed in respect to sex and age in a population-based study. Regression analysis of percentage versus age showed decreasing left, increasing right, and unchanged transverse colon occurrence of cancer for both sexes. However, this was statistically significant only for women; left, -0.7066% per year (P = 0.0088) and right +0.6023% per year (P = 0.0012). Regression for seven subsites showed significant changes only for women; with rectosigmoid and sigmoid decreasing and cecum and ascending colon increasing. Similar results were obtained in analysis of the 5822 cases available in the Kansas cancer registry for the years 1978 to 1982. These findings have important implications for screening and diagnosis of colorectal cancer in the elderly, particularly women, and also provide a useful clue in the investigation of colorectal carcinogenesis.

Undernutrition in Crohn's disease: An anthropometric assessment

Anthropometric measurements of weight, arm-muscle area and arm-fat area were assessed in 106 unselected patients with Crohn's disease, and related to centiles derived from the United States Health and Nutrition Examination Survey of 1971-1974. Results were compared with those obtained in 106 patients with ulcerative colitis and 106 healthy subjects, age and sex-matched with the Crohn's patients. Measurements in healthy subjects and in patients with ulcerative colitis showed a normal centile distribution with the expected proportion falling below the 5th centile. In contrast, a significantly higher proportion of patients with Crohn's disease had measurements below the 5th centile, indicating depleted muscle and fat stores.

Precision of anthropometric measurements: The value of mid-arm circumference

A study was carried out to examine how reproducible anthropometric measurements were within and between two observers on a group of 24 normal subjects and 20 obese individuals. A further study was performed on 28 malnourished patients with Crohn's disease undergoing a controlled trial of nutritional therapy to assess how weight change correlated with other anthropometric parameters. The measurement that was most reproducible and correlated most with weight change was mid-arm circumference. As it is the simplest measurement to perform, we would recommend that it is used more often in nutritional studies.