Response of bacteria and fungi to high-pressure stress as investigated by two-dimensional polyacrylamide gel electrophoresis

In an attempt to generalize previous observations (Jaenicke et al., Appl. Environ. Microbiol. 1988, 54, 2375-2380) and to find a convenient model system for studies of the pressure response, we tested the suitability of Escherichia coli and Thermotoga maritima (bacteria), and of five different eukaryotic species including the filamentous fungi Asteromyces cruciatus and Dendryphiella salina, and the marine yeasts Debaryomyces hansenii, Rhodosporidium sphaerocarpum, and Rhodotorula rubra. Using two-dimensional polyacrylamide gel electrophoresis, detailed investigations on the pressure response were carried out with E. coli and Rhodosporidium sphaerocarpum. In the former organism, major pressure response proteins could not be detected, although there are significant differences in expression of some proteins as well as some minor components that are found in all of the high pressure cell extracts but not in extracts from cultures grown at atmospheric pressure. In Rhodosporidium sphaerocarpum, no change in protein expression patterns was observed between 0.1 and 20 MPa. However, approaching the limit of viability of 50 MPa, additional protein spots became detectable at 45 MPa. This finding correlates with the observation of abnormal growth forms of the organism at this pressure (Lorenz, R. et al. manuscript in preparation).

[Carbohydrate substitutes: comparative study of intestinal absorption of fructose, sorbitol and xylitol]

BACKGROUND

The carbohydrate substitutes fructose, sorbitol and xylitol are gaining more and more importance in the production of dietary food. But they can provoke gastrointestinal side-effects. In a randomized double blind study the rate of malabsorption of these sugars was compared and the concomitant symptoms were recorded.

SUBJECTS AND METHODS

25 healthy controls received 25 g of each sugar within 3 consecutive days. The intestinal absorption was determined by H2-exhalation tests and the clinical symptoms were recorded.

RESULTS

The rate of malabsorption was 84% for sorbitol, 36% for fructose and 12% for xylitol (p < 0.01 for sorbitol versus fructose and xylitol). 57% of the participants with pathological H2-test after sorbitol and 56% after fructose reported symptoms, while all of the 3 malabsorbers of xylitol were symptomatic.

CONCLUSIONS

There is an advantage to administering xylitol and fructose with regard to the intestinal absorption and concomitant symptoms as compared with sorbitol. H2-exhalation tests appear to be a reliable diagnostic tool to detect carbohydrate malabsorption and should find broader application in patients suffering from non-specific abdominal complaints.

[Substitution of factor XIII concentrate in treatment refractory ulcerative colitis. A prospective pilot study]

BACKGROUND

Severe acute inflammation in ulcerative colitis is often associated with major intestinal blood loss. Studies on hemostasis present a deficiency of F XIII which is important for clot formation and wound healing.

PATIENTS AND METHODS

A total of ten patients had been treated with 5-aminosalicylic-acid and corticosteroids consequently for three weeks. Thereafter a clinical improvement did not occur, the colitis activity index (CAI) and the endoscopic score (ES) remained elevated (9.9 +/- 1.5 points and 8.9 +/- 2.3 points, respectively). Because of this therapy-resistant active stage of disease in an open and prospective pilot trial F XIII concentrate (1,250 IU, Fibrogammin HS, Behringwerke, Germany) was additionally administered intravenously for ten days.

RESULTS

The additional substitution therapy resulted in a significant improvement of complaints, the stool frequency decreased from 9 +/- 4.1 to 2.4 +/- 1.5 (p < 0.001). Both, the clinical activity index (2.8 +/- 1.6; p < 0.0001, vs day 0) and the endoscopic score (4.4 +/- 2.2; p < 0.005, vs day 0) declined significantly during the F XIII substitution. The F XIII activity was markedly reduced initially (46.1 +/- 17.4%) and showed a significant increase after the substitution (171 +/- 41.7%; p < 0.001).

CONCLUSION

The results may suggest that substitution therapy with F XIII concentrate can be beneficial in patients with therapy-resistant active stage of ulcerative colitis and proven F XIII deficiency. To verify this preliminary results, controlled clinical trials will have to be performed.

Dose and dose-rate dependence of the frequency of HPRT deficient T lymphocytes in the spleen of the 137Cs gamma-irradiated mouse

The frequency of hypoxanthine phosphoribosyl transferase (HPRT) deficient splenic T lymphocytes was measured in the 137Cs gamma-irradiated mouse by the T cell cloning method. Doses from 0.3 to 6 Gy were applied at the dose-rates 0.5 Gy/min, 1 Gy/day and 1 Gy/week. Mutants were determined 8-10 and 30-40 weeks after the end of exposure. Radiation-induced mutant frequency (MFi) was calculated by subtracting the age corrected spontaneous mutant frequency (MFsp) from total mutant frequency (MF) found in irradiated animals. Data were fitted to linear and linear-quadratic dose-response models. MFi depended markedly on dose, dose-rate and time after exposure. When mutants were determined 8-10 weeks after acute irradiation (0.5 Gy/min) the dose-effect curve fitted the linear-quadratic equation MFi = 6.9 x 10(-6) Gy + 1.2 x 10(-6) Gy2, whereas in low dose-rate experiments (1 Gy/day, 1 Gy/week) the dose-effect curves were linear. The slope of the linear regression was about 3 x 10(-6). When low dose-rate-irradiated animals were killed 30-40 weeks after irradiation, MFi was about one-third of that observed after 8 weeks. The dose dose-rate effectiveness factor (DDREF) for radiation mutagenicity was calculated in animals that had been exposed 8-10 weeks previously. For doses < 2 Gy the reduction in effectiveness was about 1.5 when the irradiation dose-rate was < or = 1 Gy/day. For higher doses DDREF was 3-5.

Isolation and quantification of class 1 MHC gene mutants in mouse T cells by immunoselection with a magnetic cell sorter (MACS)

A method is described for determining the frequency of cells with a mutation in an autosomal gene coding for a membrane protein. Using a monoclonal antibody to H-2Kk surface antigen and magnetic cell separation (MACS) more than 10(4)-fold enrichment of the H-2Kk negative population was achieved, as tested with artificial mixtures containing a known number of antigen-negative cells. After a second magnetic sorting mutant frequencies as low as 10(-6) could be measured. The number of clonogenic mutants was evaluated by limiting dilution cloning and verification of the mutant phenotype by FACScan (flow cytometry) analysis in a representative number of clones. The spontaneous frequency of H-2Kk deficient mutants was 0.80 x 10(-6), and this increased after irradiation with 6 Gy X rays to 3.38 x 10(-6) within the next 8 weeks. About 50 mutant clones were screened for the presence of other class 1 antigens on the cell surface by FACScan analysis. All mutants continued to express other class 1 antigens.

Activation of the coagulation cascade in severe falciparum malaria through the intrinsic pathway

The mechanisms involved in the activation of the coagulation cascade in severe falciparum malaria were studied in 22 adult patients (19 male, three female) aged 18-45 (mean +/- SD 31 +/- 11) years. Of these, nine had multiple vital organ dysfunction, and bleeding occurred in four patients, two of whom died. During acute illness the reduction in plasma antithrombin III (AT III) concentrations and elevation in thrombin-AT III complexes were associated with significant reductions in factor XII and prekallikrein activities, and an increase in the C1 inhibitor antigen/activity ratio. Serial plasminogen activity remained within the normal range in all patients while protein C activity was significantly reduced. All patients had markedly elevated plasma polymorphonuclear leucocyte elastase (PMN-elastase) levels with mild depletion of alpha-2 macroglobulin but normal concentrations of alpha-1 antitrypsin. There was no correlation between PMN-elastase concentrations and any of the coagulation parameters or concentrations of proteinase inhibitors. These results suggest that the intrinsic pathway of the clotting cascade is activated in severe malaria. This may cause activation of the complement system and release of bradykinin and PMN-elastase and could contribute to the pathogenesis of severe malaria.

[Chemoimmunotherapy of malignancies of the gastrointestinal tract]

Stimulation of the immune response could be obtained in outpatients with inoperable locally advanced or metastasizing gastrointestinal tumors (n = 56), who were palliatively treated with cyclophosphamide (cy), 350 mg/m2 i.v., thymostimulin, echinacin i.m. and in part additionally with epirubicin, 15 mg/m2 i.v. At present, outpatients with pancreatic (n = 7) or colon carcinomas (n = 1) receive interleukin 2 (IL-2) intralesionally, 2 x 10(5) Cetus units (CU), days 3, 5 and 7 after cy, and by portable continuous infusion systems i.v., 3 x 10(5) CU/day, days 3-8 after cy. Subsets of lymphocytes slightly decreased in the patients' peripheral blood, recall antigen reactivity slightly increased. Patients' mean survival time was 5.7 +/- 1.7 months.

Infant mortality in Oklahoma, 1970-1990

Patterns of infant mortality in Oklahoma are unlike the rest of the United States. Oklahoma has a significantly higher post neonatal mortality rate than the United States, with SIDS and congenital disorders being the leading causes of death in that age group. Conversely, Oklahoma has a significantly lower neonatal mortality rate than the United States. Vital statistics information for the period 1970-1990 are examined to describe patterns of infant death in Oklahoma. Despite long-term decreasing trends in infant death, disconcerting trends were observed in 1990 suggesting that a stronger infant mortality reduction strategy is needed in Oklahoma. Potential areas for public health intervention are suggested based on Oklahoma-specific data.

[Globus pharyngis: indications for flexible endoscopy?]

Flexible endoscopy of the upper gastrointestinal tract usually does not form part of the primary diagnostic evaluation of the globus syndrome. In order to find out the value of this investigation in the differential diagnosis of globus sensation, 51 globus patients were examined by flexible endoscopy of the upper gastrointestinal tract. Pathological findings requiring therapy were diagnosed in 70.6% of cases. The most frequent findings were reflux esophagitis (n = 24; 47%) and hiatal hernia (n = 25; 49%). In 16 cases (31.4%) these were accompanied by other pathological lesions. A total of 32 patients (62.7%) suffered from esophageal diseases as sole etiological factors of the globus syndrome, which allowed us to postulate a causative relationship in these cases. Flexible endoscopy, therefore, can contribute significantly to the differential diagnosis of the globus syndrome. The investigator should consider the potentially high diagnostic "yield" of flexible endoscopy for this indication, also.

The gastroenterologist's approach to dysphagia

In the gastroenterological diagnostic armamentarium, dysphagia is considered as an important symptom for diseases of the esophagus. Concerning the history of illness, symptoms such as retrosternal pain and heartburn are often associated with gastroesophageal reflux disease. Morphological changes of the mucosa can be diagnosed by flexible endoscopy and radiographic examinations. Investigation with 24-h pH monitoring, manometry, and pharmacological tests is necessary for the diagnosis of functional disorders. Additionally, dysphagia can be associated with multiple internal diseases, including muscular diseases such as dermatomyositis, progressive systemic sclerosis, as well as lupus erythematosus. Difficulties in swallowing associated with hypo- and hyperthyroidism can also be interpreted as muscular lesions. Metabolic disorders such as alcoholism, and diabetes mellitus can be the cause of dysphagia. Increasing importance in the differential diagnosis of dysphagia is attached to infections of the upper GI tract. Especially in immunocompromised patients, infections of Candida albicans, mycobacterias, herpes, varicella zoster, and cytomegaloviruses can produce dysphagia and odynophagia. The differential diagnosis of the "angina-like chest pain" has to differentiate between cardiac disease and a noncardiac genesis. Therefore, besides the cardiac diagnostic investigation, endoscopy, radiography, and manometry are often indicated.

The globus syndrome: value of flexible endoscopy of the upper gastrointestinal tract

Flexible endoscopy of the upper gastrointestinal tract usually does not form part of the primary diagnostic evaluation of the globus syndrome. In a prospective trial, a flexible endoscopy was performed in 51 globus patients with normal results of the laryngologic and radiographic examination. Pathologic findings requiring therapy were diagnosed in 70.6 per cent of cases. The most frequent findings were reflux oesophagitis (n = 24; 47 per cent) and hiatal hernia (n = 25; 49 per cent). In 16 cases (31.4 per cent) these were accompanied by other pathologic lesions. A total of 32 patients (62.7 per cent) suffered from oesophageal diseases as sole aetiologic factors of the globus syndrome, which led us to postulate a causative relationship in these cases. Flexible endoscopy therefore can contribute significantly to the differential diagnosis of the globus syndrome. It must be kept in mind, however, that there is a 'blind zone' for endoscopic assessment in a region of the hypopharynx, thus some indications may require rigid endoscopy.

The value of endoscopy and endosonography in the diagnosis of the dysphagic patient

The value of endoscopy in dysphagia is limited in the diagnosis of motility disorders and small structures, webs, and hiatal hernias. Endoscopy is of special use for the clarification of an organic cause of dysphagia. Intraluminal tumors can be seen and in a high percentage of cases be definitely diagnosed by taking biopsies; a malignant degeneration in Barrett's esophagus is detectable by endoscopy in 89.1% of cases. Gastroesophageal reflux disease can be diagnosed on endoscopy as it leads to an endoscopically visible inflammatory reaction; however, normal findings on endoscopy cannot exclude reflux disease. Endoscopy is the method of choice in the diagnosis of nonreflux esophagitis, especially Candida and viral esophagitis. A further advantage of endoscopy is the fact that a microscopic diagnosis can be obtained and endoscopic treatment can be performed simultaneously. Submucosal or extramural lesions can be missed by endoscopy. Endosonography, the combination of endoscopy and ultrasonography (EUS) yields additional information in diagnosing submucosal and extramural lesions of the esophagus which is missed by other imaging procedures. One of the main advantages of EUS is the detection of small and submucosal lesions. The most important indication is the local staging of esophageal carcinomas; the accuracy of endosonography in determining the depth of infiltration ranges between 79% and 92%. The detection of paraesophageal lymph nodes is successful in 60%-82%, although EUS cannot differentiate benign from malignant lymph nodes. Submucosal tumors can be visualized by endosonography and their size, echopattern, and the layers of origin can be determined with high accuracy. Further indications for EUS are the exclusion of focal lesions in achalasia or peptic strictures.

Normal and reverse dose-rate effect for the induction of mutants in somatic cells by ionizing radiation

In radiobiology the reduction of the dose-rate in general diminishes the degree of the biological effect per unit dose. This phenomenon is characterized by the dose-rate effectiveness factor (DREF). DREF is the factor by which a risk per unit dose obtained from data at high dose and high dose-rate overestimates the risk at low doses and/or low dose-rates. In general, DREF is in the range of 2 to 10. In the first part of this review, a short survey of the modern microdosimetric approach for a better understanding of radiation load on the cellular level and the significance of dose-rate is given. Experiments on the influence of dose-rate on the mutagenicity of ionizing radiation in cultured cells are reviewed. In contrast to other biological effects, in most experiments the reduction of the dose-rate had no or even a reverse dose-rate effect (DREF < or = 1). In the second part results on the influence of dose-rates on the induction of HGPRT-deficient T-lymphocytes in mice irradiated in vivo are given. Mutagenicity decreases with dose-rate and DREF values between 3-10 were measured. Possible reasons for the discrepancy between in vitro and in vivo experiments are discussed.

[Can nuclear magnetic resonance tomography supplement and expand splenic diagnosis in malignant systemic diseases? Comparison of nuclear magnetic resonance tomography, ultrasound and computerized tomography findings]

Can magnetic resonance imaging supplement or expand the diagnostic evaluation of the spleen in malignant systemic disease? A comparison of magnetic resonance imaging, ultrasonography and computed tomography.

Pituitary adenomas: serum hormone levels and immunohistochemical staining for ACTH, GH and prolactin

In 37 pituitary adenomas obtained by surgery the immunohistochemical staining for ACTH, GH and prolactin and the tumor size were related to the basal serum hormone levels. 5 adenomas were associated with Cushing syndrome, 9 with acromegaly, 17 with hyperprolactinemia and 6 were preoperatively diagnosed as inactive. A rather close correlation between immunoreactivity of tumor tissue and basal serum hormone levels was found for GH and prolactin whereas these two parameters were not significantly correlated in the corticotrophic adenomas examined. Furthermore there was no obvious correlation between serum hormone levels and tumor size. Several non immunoreactive adenomas showed slight hyperprolactinemia; all of them were macroadenomas with extended sellar lesions. This fact may be explained by disturbances in the hypothalamic-hypophyseal regulation of serum prolactin.

Combined influence of salinity and temperature (Phoma-pattern) on growth of marine fungi

Investigating the combined influence of temperature and salinity on growth of some marine fungi, Ritchie (1957. Am. J. Bot. 44: 870 – 874) showed for some species (e.g., Pestalotia sp., Phoma sp.) an increased salinity optimum with increasing incubation temperature (Phoma-pattern). This was confirmed later for several marine fungi but using different methods and parameters. In this paper the investigations were repeated and enlarged using one method over a broader range of salinities (0–300% seawater) and temperatures (12–42 °C) for seven marine fungi from different taxonomic and ecological groups and biogeographical zones where the Phoma-pattem was reported. The Phoma-pattern was confirmed for all seven fungi for temperatures of 22 °C and higher. For Curvularia and Pestalotia, the Phoma-pattern was evident only at the highest temperatures tested. In addition, three strains of one species, Dendryphiella salina, from different geographical regions of the oceans were examined. All three isolates of Dendryphiella salina showed the Phoma-pattern. The Phoma-pattem does not seem to be correlated with certain taxonomic and ecological groups of marine fungi or biogeographical zones. Key words: Phoma-pattern, marine fungi, growth, salinity, temperature.

Use of natural and artificial seawater for investigation of growth, fruit body production, and enzyme activities in marine fungi

Investigation of marine fungi suffers from an often inadequate comparability of methods and results, e.g., the use of natural as opposed to artificial seawater. Consequently, several marine fungi of different systematic positions were tested for growth, enzyme activity, and fructification on solid media with natural and artificial seawater. Growth as colony diameter and production of enzymes by the basidiomycete Halocyphina villosa and the ascomycete Lulworthia sp. were compared on both media. In all cases the results showed either no difference or only minor quantitative differences. Investigation of further species (two ascomycetes, one basidiomycetous yeast, two deuteromycetes) and other enzymes also showed no differences between the two media with the exception of three cases. Fructification in Halocyphina villosa occurred on both types of seawater. Addition of boric acid in natural concentrations to the artificial seawater medium had no effect on the growth of nine marine fungi. Artificial seawater medium gives comparable results to natural seawater in experiments with marine fungi, results in better comparability and reproducibility of experiments, and is often cheaper and easier to obtain. Key words: natural seawater, artificial seawater, marine fungi, growth, enzymes, fruit bodies.

Local staging and assessment of resectability in carcinoma of the esophagus, stomach, and duodenum by endoscopic ultrasonography

Eighty-eight patients with carcinoma of the esophagus (N = 44), stomach (N = 41), and duodenum (N = 3) who underwent surgery were pre-operatively examined by endoscopic ultrasonography (EUS). The ability of EUS to accurately predict the T stage and the N stage was 82% and 70% for esophageal carcinoma, 71% and 75% for gastric cancer, and 100% and 66% for duodenal malignancy. In esophageal carcinoma, the accuracy of T staging was only slightly lower in cases with non-traversable tumor stenoses (77%) compared with traversable carcinomas (84%). This was probably due to the fact that all non-traversable tumors were either in stage T3 or T4. The accuracy of EUS in predicting the stages T1 to T3, which correspond to R0 resectability (no macroscopic or microscopic tumor remains), was 92% for adenocarcinoma of the distal esophagus and 85% for gastric cancer. However, in squamous cell carcinoma of the esophagus, R0 resection was possible in only 66% of all cases, whereas EUS predicted an 84% R0 resection rate. In adenocarcinoma of the distal esophagus and stomach, EUS prediction of stages T1 to T3 correlated well with the actual rate of R0 resection. These results show that EUS is a reliable diagnostic method for the local staging of upper gastrointestinal cancer. Its impact on treatment and hence on prognosis of patients with these malignancies has yet to be determined.

[The endosonographic staging of pancreatic carcinoma]

Endoscopic ultrasound (EUS), conventional ultrasound (US), computed tomography (CT) and angiography were compared in their assessment of local resectability in 35 consecutive patients (19 men, 16 women; mean age 49.8 [42-821] years) with non-metastatic carcinoma of the pancreas. The findings were made prospectively and independently of each other. EUS proved to be superior to transabdominal US and to CT in the diagnosis of tumour infiltration of the portal and splenic veins. For the portal vein the sensitivity was 93% by EUS, 14% by US and 36% by CT. Corresponding figures for the splenic vein were 92%, 39% and 69%. EUS was markedly superior to angiography in the diagnosis of portal vein involvement (sensitivity of 93% and 36%, respectively), but the two methods had similar sensitivity regarding splenic vein infiltration (92 and 100%). Tumour involvement of the coeliac trunk was diagnosed with higher sensitivity angiographically (86%) than by EUS (57%), CT (71%) or US (29%). Regarding T and N staging, EUS was superior to both US and CT. These data indicate that EUS is the most accurate method for local tumour staging of potentially resectable pancreatic carcinoma. It can replace angiography in the diagnosis of portal vein infiltration.

Idiopathic portal hypertension in a renal transplant patient after long-term azathioprine therapy

We report the case of a patient with renal insufficiency who was admitted for the evaluation of splenomegaly. He had received a kidney allograft 6 1/2 years ago. Treatment with azathioprine and prednisolone for immunosuppression had been discontinued 1 year before admission. The underlying cause of the splenomegaly appeared to be an idiopathic portal hypertension. Until now, this disease has been described in only 13 kidney transplant patients receiving long-term immunosuppressive therapy with azathioprine. For the first time we demonstrate that azathioprine can cause this chronic liver disease even if the drug has been withdrawn some time before. Therefore, the indication for azathioprine must be considered very carefully.

Russell's viper venom: effects on coagulating whole blood in vitro

Russell's viper venom (RVV) leads to a strong activation of the coagulation system with consumptive coagulopathy and thrombopenia. For better comprehension of the pathophysiologic process, the effect of RVV was examined in an in vitro model of hemostasis. The stimulation of the coagulation system and of platelet activity can be discriminated by sequential measuring of fibrinopeptide A (FPA) generation and platelet factor 4 (PF 4) release, respectively. In coagulating whole blood both parameters show a parallel response curve in the control series (n = 6) with an initial slow phase followed by a rapid phase after 4.7 +/- 0.8 min (FPA) and 6.0 +/- 0.9 min (PF 4) of the incubation period. Varying concentrations of RVV (15, 50, 100 and 1,000 ng/ml; n = 6 each) cause a dose-dependent stimulation of FPA generation as well as of PF 4 secretion. Clot formation time shows a decrease from 9 min (controls) to 6.3 +/- 2.0 min (100 ng/ml RVV) and 2.7 +/- 0.5 min (1,000 ng/ml), respectively. The concomitant addition of antithrombin III (AT III, 20 U/ml) and RVV (100 ng/ml) leads to a nearly complete normalization of hemostasis in vitro. The beginning of the rapid activation phase is comparable to that of the control group, clot formation does not occur during the 10-min incubation period. Heparin (1 IU/ml) acts as an antagonist not only of the venom-induced FPA generation, but also of the PF 4 release. Prostaglandin E1 (PGE1) (150 ng/ml) does not inhibit the RVV-stimulated FPA generation, but causes a moderate inhibition of PF 4 secretion, especially during the rapid phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute operation on arteriovenous malformation with hematomas--report on six cases

Six cases with arteriovenous malformations (AVM) and intracerebral hematomas causing coma and tentorial herniation are presented. All patients were operated on acutely: The hematoma and malformation were removed. All patients survived. The acute operation on AVM with hematomas even in comatose patients with tentorial herniation is useful and possibly contributes to reduction of the total mortality.

Endosonographic diagnosis of submucosal upper gastrointestinal tract tumors

Endoscopic ultrasound (EUS) was performed in 37 patients with upper gastrointestinal tract submucosal tumors (SMT). Fourteen of these were located in the esophagus, 20 in the stomach, and 3 in the duodenum. In 26 patients histologic confirmation was achieved by operation (n = 15) or biopsy/puncture (n = 11). EUS was able to visualize all tumors and, with one exception, determined their originating wall layer correctly. It became evident that myogenic tumors arise from the echo-poor layers (second layer and fourth--that is, muscularis propria) and that other lesions, such as cysts or fibromas, originate from the third, echo-rich layer (submucosa). Tumor size was correctly (+/- less than 5 mm) predicted in 87% of cases. Computed tomography, performed in 22 patients, was successful in visualizing the SMT in only two-thirds of cases. No single endosonographic criterion could be obtained which enabled accurate differentiation between benign and malignant SMT. However, from a clinical point of view, it seems reasonably safe to regard smaller (less than 3 cm), smoothly demarcated SMT as benign and follow them up by repeated EUS, especially in patients at risk for surgery. Larger masses (greater than 5 cm) and those with irregular borders should be suspected of being malignant. In the future, application of new, small ultrasound probes that can be used during conventional endoscopy (two SMT were visualized successfully) may greatly simplify the procedure.

Aspirin-induced decline in prostacyclin production in patients with coronary artery disease is due to decreased endoperoxide shift. Analysis of the effects of a combination of aspirin and n-3 fatty acids on the eicosanoid profile

BACKGROUND

It was the purpose of this study to determine the effects of the combination of aspirin (ASA) and fish oil, which is rich in n-3 polyunsaturated fatty acids, on the eicosanoid profile of patients with coronary artery disease. Specifically, we wanted to determine whether the ASA-induced reduction in prostacyclin production is due to inhibition of endothelial cell cyclooxygenase or to reduced endoperoxide shift from platelets and whether ASA negates the potentially beneficial effects of fish oil on the eicosanoid profile.

METHODS AND RESULTS

Fourteen patients with clinically stable but advanced coronary artery disease received 12 g (n = 8) or 16 g (n = 6) of fish oil concentrate containing 6 or 8 g of n-3 fatty acids for 6 weeks. In addition to the fish oil, patients received increasing daily doses of ASA (50 mg, 100 mg, 325 mg, and 1,300 mg; the latter in four divided doses). Each dose was taken for 2 weeks. With fish oil supplementation, red blood cell phospholipid fatty acid content of arachidonic acid (AA) decreased and of eicosapentaenoic acid (EPA) increased so that EPA as a percent of AA increased from 2% to 26%. Serum thromboxane B2, which represents the production of TXA2 by maximally stimulated platelets, was suppressed by 38% on fish oil alone and by 97% or greater on all doses of ASA. Excretion of PGI2-M, the main urinary metabolite of PGI2 (derived from AA), fell from 50 +/- 4 ng/g of creatinine to 42 +/- 2 ng/g on fish oil alone (p = 0.02). On 50 mg of ASA per day, PGI2-M excretion was 26 +/- 2 ng/g of creatinine (p less than 0.001 versus fish oil alone). On 100 mg and 325 mg of ASA per day, PGI2-M was 24 +/- 3 ng/g and 27 +/- 3 ng/g, respectively (p V NS versus value on 50 mg per day). PGI3-M, the main urinary metabolite of PGI3 (derived from EPA), increased from 0.2 +/- 0.1 ng/g of creatinine to 4.9 +/- 0.7 ng/g on fish oil alone (p less than 0.001). In contrast with the marked ASA-induced decline in PGI2-M, PGI3-M excretion was not affected by the addition of ASA, even at the higher doses (4.6 +/- 0.7 ng/g and 4.9 +/- 0.5 ng/g on 325 mg per day and 325 mg four times daily, respectively).

CONCLUSIONS

Moderate-dose (325 mg per day or less) ASA taken once daily has no effect on PGI3 production despite significantly reducing PGI2 production. This suggests that endothelial cell cyclooxygenase is minimally inhibited by such doses of ASA and that a large percent of the PGI2 produced in patients with advanced coronary artery disease derives from the transfer of prostaglandin endoperoxides from activated platelets to endothelial cells. The loss of these substrates accounts for the decrease in PGI2 with moderate-dose ASA. Thus, the ASA-induced decrease in PGI2 may in large part be an unavoidable consequence of ASA-induced platelet cyclooxygenase inhibition. ASA does not negate the potentially beneficial effects of n-3 fatty acids on the eicosanoid profile.

[Endoscopic ultrasound in gastroenterologic tumors]

By means of endoscopic ultrasound (EUS) the visualization of the gastrointestinal wall Layers as well as a high-resolution imaging of the pancreas with neighbouring large vessels has become possible. EUS is especially sensitive in the local tumor staging in esophageal, gastric, pancreatic and ampullary carcinoma (accuracy rates 80-90%). Lymph node metastases are correctly identified in 70-80%. This also applies to the rectal cancer employing rigid instruments. Experience with colonic endosonography is still too limited to permit any definitive conclusions. For the primary diagnosis of submucosal tumors of the upper GI tract, and for the detection of small pancreatic lesions (e.g. endocrine tumors), endosonography is of high diagnostic accuracy.

An unusual case of active tuberculosis of the oesophagus in an adult

A case is reported of a 56-year-old woman of Libyan origin presenting with dysphagia, retrosternal pain and weight loss. Oesophago-gastroduodenoscopy revealed an ulcerated tumor in the upper oesophagus strongly suggesting a malignancy. A positive Mendel-Mantoux test along with histological evidence of epitheloid cell granulomas and clinical findings consistent with pulmonary and lymph node tuberculosis led to the presumptive diagnosis of oesophageal tuberculosis. The diagnosis was later confirmed by positive bacteriological cultures of oesophageal biopsies and gastric washings. It is very unusual for dysphagia to be the presenting symptom of active adult tuberculosis. Oesophageal tuberculosis is extremely rare and must be distinguished predominantly from oesophageal carcinoma.

Endoscopic ultrasound in pancreatic tumor diagnosis

In a prospective study from 1988 to 1990, 132 patients with suspected pancreatic tumor were examined with endoscopic ultrasound (EUS), transabdominal ultrasound (US), computed tomography (CT), and ERCP. The final diagnosis of 102 pancreatic tumors of different origin (76 malignant and 26 inflammatory tumors) and the exclusion of a pancreatic tumor in 30 patients was made by operation (N = 47), puncture (N = 36), autopsy (N = 3), or follow-up of a mean of 51 weeks (N = 46). Sensitivity and specificity in pancreatic tumor diagnosis were significantly higher for EUS (99% and 100%) than for US (67%/40%) and CT (77%/53%) and equal to ERCP (sensitivity 90%). This was even more obvious in small pancreatic tumors of 3 cm and less. However, as with the other imaging procedures, EUS was not able to differentiate reliably malignant from inflammatory pancreatic masses (accuracy 76% for malignancy and 46% for focal inflammation). From analysis of the endosonographic pattern of pancreatic tumors, no consistent morphologic features were identified which could have been specifically attributed to malignant or inflammatory masses. Our results show that EUS is superior to US and CT and equal to ERCP in pancreatic tumor diagnosis. In contrast to the indirect evidence obtained by ERCP, EUS provides direct visualization of tumor size and shape in almost all patients examined. Thus, EUS should be considered early in the evaluation of patients with suspected pancreatic tumors.

The effects of cyclosporin A on eicosanoid excretion in patients with rheumatoid arthritis

Alterations in renal eicosanoid levels have been postulated as a factor in cyclosporin A (CSA) nephrotoxicity. The effects of CSA on renal eicosanoid excretion in rheumatoid arthritis were studied over a 24-week period, during which treatment with nonsteroidal antiinflammatory drugs was discontinued. The initial dosage of CSA was 4 mg/kg/day; at week 24, the mean dosage of CSA was 3.9 mg/kg/day. At week 24, the mean (+/- SD) serum creatinine level (1.04 +/- 0.24 mg/dl) was 32% above the baseline value; renal blood flow had decreased by 21% (P less than 0.03) and the glomerular filtration rate had decreased by 16%. There was a significant increase (P less than 0.03) in the 2,3-dinor thromboxane B2 level at week 2, but there was no significant change in the levels of the other eicosanoids. This study demonstrates that after CSA treatment, there is a selective increase in a thromboxane metabolite that parallels an increase in renal vascular resistance, even in the absence of nonsteroidal antiinflammatory drugs, and with unimpaired formation of other vasodilator eicosanoids.

Gastric fundus impression caused by splenic vessels: detection by endoscopic ultrasound

When a submucosal impression of the stomach fundus is seen during upper GI endoscopy, a true submucosal tumor can reliably be differentiated from an extragastric impression by endoscopic ultrasound (EUS). We report on 15 patients in whom EUS identified splenic vessels near the splenic hilum causing an impression of the posterior wall of the gastric fundus. Neither by EUS nor conventional ultrasound, computed tomography or clinical follow-up, was a tumor in the stomach or upper abdomen that could have been the cause of the gastric wall impression, identified. Two of the 15 patients had portal hypertension with multiple intra-/paramural venous collateral vessels. Twenty patients examined for other reasons and 10 patients with portal hypertension but without fundic impressions, served as controls: In these cases the splenic vessels were shown by EUS to follow a course more distant to the gastric wall. Thus, normal vascular structures should be included in the differential diagnosis of gastric fundus impression detected by endoscopy.

[Endosonography in the differential diagnosis of dysphagia]

Endosonography makes it possible to judge the normal and the pathologically altered wall of the upper digestive tract. At the tip of a duodenoscope with lateral view there is a mechanical sector scanner with a visual angle of 360 degrees. Owing to its high power of resolution five layers of different echogenicity can be differentiated. The inner echo-rich and echo-poor layer corresponds to the mucosa and the muscularis mucosae, the intermediate echo-rich layer to the submucosa. The outer echo-poor layer can be attributed to the tunica muscularis, the outer echo-rich layer represents either the border echo or adventitial tissue. Thickening of the wall, inhomogeneous structure of the echo and infiltration of the outer wall contour are considered pathological. Indications for endosonography are essentially the judgement of tumours in the framework of tumour staging and the detection of paraesophageal lymph nodes. Furthermore the detection of submucosal and extramural lesions such as lymphomata, leiomyomata and intra- and extramural varices is possible. In the diagnostics of dysphagia endosonography should be applied in all cases where other established procedures of morphological and functional diagnostics do not clarify the situation or where they result in the suspicion of small intra- or extramural lesions of the esophagus. Within the framework of tumor staging, endosonography is indispensable.

[Endoscopic ultrasound in small pancreatic tumors]

32 of 89 pancreatic tumors examined by endoscopic ultrasonography (EUS) from January 1986 to February 1990 had a diameter of 3 cm or less. The final diagnosis of a malignant (n = 28) or benign (n = 4) pancreatic neoplasma was achieved by operation, puncture or autopsy. The accuracy of EUS (100%) was higher than for ultrasound (61%), computed tomography (64%) or endoscopic-retrograde cholangiopancreatography (84%). The echopattern of the small pancreatic carcinomas showed, compared to larger neoplasms, less often regressive changes (21 vs. 77%) and a well demarcated or smooth tumor margin (25 vs. 2%). However, it is not possible to differentiate reliably a small malignant from a benign pancreatic tumor by the echofeatures alone. Since most pancreatic tumors are large at the time of clinical presentation, they can be visualized by conventional imaging methods in most cases. EUS adds clinically important information to the diagnosis of pancreatic carcinoma especially in small tumors.

Substitution of factor XIII: a therapeutic approach to ulcerative colitis

Three patients with ulcerative colitis in the active stage demonstrated reduced levels of F XIII activity and F XIII subunit A (61 and 80.3%, respectively). Because of the lack of clinical improvement during conservative therapy, the patients were treated additionally with F XIII concentrate (Fibrogammin HS, Behring, FRG) for 10 days. The substitution resulted in an increase in F XIII activity (144.3%) and F XIII subunit A (238%) as well as in a marked improvement in symptoms.

[Juxta-articular osteoid osteoma--Image morphology and diagnosis]

Juxta-articular osteoid osteomas as a cause of persistent pain of the shoulder, elbow and knee are presented basing on three own observations and a review of the literature. The sequence of the imaging examinations is equivalent to the osteoid osteomas in other localisations. CT permits a clear presentation of the nidus in the complex juxta-articular anatomy. Juxta-articular osteoid osteomas often show an absent or small perifocal osteosclerosis, whereas a laminar periosteal reaction was seen in all own cases.

[Sonographic percutaneous drainage of liver abscesses]

13 patients with pyogenic liver abscess and five patients with amoebic abscess underwent percutaneous drainage of the abscesses using the Seldinger (n = 8) or trocar technique (n = 11). The results showed that the trocar method was easier and faster to perform and well tolerated by the patients. No complications were observed despite of one case of transient peritonitis caused by a dislocated catheter. One patient with pyogenic liver abscess died of septic shock. All other patients were successfully treated, using local drainage and systemic antibiotic therapy.

[Diagnosis and differential diagnosis of a peritoneal carcinosis. Conventional techniques, sonography, computed tomography, magnetic resonance tomography]

Based upon the results obtained in 346 patients, the diagnostic value of conventional techniques, ultrasonography, computed tomography and magnetic resonance imaging in the detection of peritoneal tumor spread is analyzed. Since such signs as ascites, mesenteric and omental infiltration and peritoneal masses are non-specific, various conditions have to be considered in the differential diagnosis. None of the imaging modalities can exclude intraperitoneal tumor spread.

[Computed tomography and magnetic resonance tomography of rectal and sigmoid tumors]

CT and MR imaging are of minor importance for the preoperative diagnosis of rectosigmoid carcinoma. A synchronous colon tumor can be excluded with a barium enema, while an accurate diagnosis of liver metastases is possible using real-time ultrasonography. However, post-operative management requires the use of tomographic methods: MR imaging has proved to be more accurate than CT for differentiation between local recurrence and post-operative scars. Therefore MRI should be the method of choice after surgery for rectosigmoid carcinoma in all patients without postoperative baseline examinations.

[Endosonographic diagnosis of pancreatic tumors]

140 patients (72 men, 68 women; mean age 57 [26-83] years) with suspected pancreatic tumours were investigated by endoscopic ultrasound (EUS) and also by conventional ultrasound, computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP). The EUS scans were performed with an echo-endoscope in the descending part of the duodenum (for the head of the pancreas) or in the stomach (for the body and tail). The definitive diagnosis or exclusion of a pancreatic tumour (malignant n = 85, benign n = 4, inflammatory n = 23, no tumour n = 28) was made at operation (n = 63), by needle biopsy (n = 35), at necropsy (n = 4) or by clinical follow up (n = 38, mean 10.5 months). The sensitivity and specificity of endoscopic ultrasound (99% and 100%) were superior to the results given by conventional ultrasound scans (71% and 39%), CT (82% and 46%) and ERCP (89% and 64%). This was also true of small tumours of 3 cm or less (EUS 100%, conventional ultrasound 57%, CT 68% and ERCP 89%). However, the differential diagnosis between malignant and inflammatory masses in the pancreas was not feasible by endoscopic ultrasound, either prospectively (detection rate 69%) or by comparative analyses of echo structure. Endoscopic ultrasound appears to be a valuable aid to the diagnosis or exclusion of pancreatic tumours. When conventional ultrasound and CT give negative or doubtful results it can be used in conjunction with or instead of ERCP to confirm the diagnosis.

Retinal origin of VECP delays as revealed by simultaneously recorded ERG to patterned stimuli

Electroretinal and electrocortical potentials evoked by reversing checkerboards (PERG, PVECP) were simultaneously recorded in diseases of the central retina (10 patients) and in tumor-related optic nerve disorders (11 patients) exhibiting comparable P-100 delays in the PVECP. Retinal diseases showed a peak-time delay both in the PERG and in the PVECP, while optic nerve disorders revealed no delay in the PERG. Thus, simultaneous recording of PERG and PVECP may differentiate retinal from postretinal disorders of the visual system. The method also may provide information about the site of an underlying disorder in cases of visual disturbance without obvious changes of the ocular fundus.