Ventral pancreatitis in a patient with pancreas divisum

Pancreas divisum results in drainage of most pancreatic secretions through the minor papilla via the dorsal duct, and the association of minor papilla stenosis has been implicated as a cause of pancreatitis. Most of the reported cases represent pancreatitis confined to the dorsal part. The authors treated a 10-year-old boy with recurrent pancreatitis that was substantially more severe in the ventral part. The patient was referred with a brief history of abdominal pain and had undergone a laparotomy when segmental ventral pancreatitis had been observed. Severe pancreatitis and acute renal failure developed, which required drainage of the lesser sac and hemodialysis, respectively. After 5 months, he had another episode that subsequently led to a pseudocyst in the ventral part. Endoscopic retrograde cholangiopancreatography via minor papilla showed a normal-caliber dorsal duct communicating with a part of the fine ventral ducts. A normal biliary tree was shown, but no ventral duct was visualized by cannulation to the major papilla of Vater. Dual sphincteroplasties and a cholecystectomy were performed. The minor papilla was stenotic and admitted only the finest lacrimal duct probe. The orifice of the ventral duct could not be observed. Thus it was clarified that the dorsal duct with its stenotic orifice had drained both the dorsal and ventral pancreas. The patient has remained asymptomatic over 36 months postoperatively. Despite their limited experience, the authors believe that (1) this anatomic variant led to ventral pancreatitis, and (2) the sphincteroplasty of the minor papilla was successful.

In vivo isomerization of retinoic acids. Rapid isomer exchange and gene expression

The in vivo isomerization of all-trans- and 9-cis-retinoic acids (RAs) was evaluated by high performance liquid chromatography after oral administration to rats. All-trans (2 ng/ml)- and 13-cis (1.8 ng/ml)-RAs, but not 9-cis-RA, were detected in the serum of normal rats. When an excess of either all-trans-RA or 9-cis-RA (100 micrograms/rat) was intragastrically administered to the retinoid-depleted rats, a rapid isomer exchange between 9-cis- and all-trans-RAs along with appearance of the administered RA occurred shortly after the dose (30 min). RA rapidly isomerized when an excess of either all-trans- or 9-cis-RA (1 mg/rat) was administered to normal rats. To examine whether the isomerized RAs elicit biological actions in vivo, the induction of target genes-[cellular retinol-binding protein type II (CRBP II) for 9-cis-RA and all-trans-retinoic acid receptor beta (RAR beta) for 9-cis- and all-trans-RAs] was determined. The degree of induction of the two genes did not differ 4 h after administration of either 9-cis-RA or all-trans-RA. However, unlike all-trans-RA, the RAR-specific synthetic retinoids did not induce the CRBP II gene. These results suggested that the apparent actions of 9-cis- and all-trans-RAs on gene expression in vivo may be mediated to some extent by the converted stereoisomer.

Sequential evaluation of clinical and immunological findings in hypersensitivity pneumonitis: serial subclass distribution of antibodies

The long-term outcome of hypersensitivity pneumonitis (HP) is variable depending upon the individual. To evaluate the mechanisms involved in the progression or regression of HP, the longitudinal changes in pulmonary function test results, bronchoalveolar lavage (BAL) cells and the subclass distribution of IgA and IgG antibodies were investigated in 14 patients with HP, including 5 cases with bird fancier's lung (BFL). The present study has shown that: (1) All patients with bird fancier's lung (BFL) demonstrated either a restrictive pattern or a reduced diffusing capacity for carbon monoxide (DLco), or both; one BFL patient showed deterioration in %VC and %DLco after avoidance of direct exposure. (2) All three patients with summer type HP who demonstrated reduced VC and DLco at the initial test improved, (3) T cells, especially CD8 cells, were predominant in the BAL fluids of the summer type HP patients, whereas either CD8 or CD4 cells were less common, but showed an increase in the BAL fluids of the BFL patients, depending upon individuals, (4) The number of CD8 cells in the summer type HP patients decreased gradually, but at slower rate than in the BFL patients; (5) Antibody activities of IgG1, G2, G3, G4, and A1 subclasses in the sera and BAL fluids were detected during the 5-year observation period; (6) IgA2 subclass was abundant in the BAL fluids of both BFL and summer type HP patients, in contrast to very minute amounts in sera; (7) The level of IgG2 antibody in the BAL fluids of the summer type HP patients was low (0.15 +/- 0.05) as compared to that in BFL (0.82 +/- 0.29); (8) The level of IgG3 antibody in the BAL fluids of summer type HP patients was lower (0.18 +/- 0.05) than in BFL (1.01 +/- 0.1); and (9) The antibody activities in most immunoglobulin subclasses fluctuated, but declined gradually in the BAL fluids, although they were well beyond the normal ranges. We were unable to predict the progression or the disappearance of hypersensitivity pneumonitis based merely upon the results of the present study.

[Blood concentrations of thrombomodulin in patients with various diseases]

Concentrations of thrombomodulin in blood plasma were measured by a one-step sandwich enzyme immunoassay (EIA). The concentrations in normal healthy subjects were 9.9 +/- 2.9 ng/ml. The concentrations were found to be significantly higher in patients with SLE, RA and other collagen diseases in their active stages than at their non-active stages. The concentrations increased in patients with DIC, and significantly higher levels were observed when DIC was complicated by multiple organ failure. These findings indicate that plasma concentrations of thrombomodulin may be a useful parameter for vascular injuries caused by inflammatory processes or coagulation/fibrinolysis reactions.

Plasma thrombomodulin as an indicator of thromboembolic disease in systemic lupus erythematosus

We serially measured the plasma thrombomodulin (TM) levels in systemic lupus erythematosus (SLE) patients and assessed them clinically. The patients who responded to medical treatment experienced a decrease in plasma TM levels. Patients who developed exacerbations of SLE, thrombotic thrombocytopenic purpura or thrombosis, displayed increased plasma TM levels. There was no significant difference between the plasma TM levels of the lupus anticoagulant-positive (LAC-positive) patients and the LAC-negative patients or between the plasma TM levels of the anticardiolipin antibody-positive (aCL-positive) patients and the aCL-negative patients. While LAC and aCL titers did not always coincide with improvement in the patients' clinical course or with aggravation of the disease, the TM values correlated well with the patients' clinical condition. Plasma TM values may be used to evaluate disease activity and may predict the occurrence of thrombosis in SLE.

[Metastasis of an adenocarcinoma of unknown origin to mediastinal lymph nodes, and transient regression]

A 67-year-old woman was admitted to our hospital because of fever. Chest roentgenogram showed an enlargement of mediastinal lymph nodes. Despite thorough examination, no definite diagnosis could be made. The mediastinal lymph nodes got smaller over the next 3 weeks and a chest roentgenogram taken 4 months later showed no mediastinal lymphadenopathy. The mediastinal lymphadenopathy and fever recurred 5 months later. She underwent thoracotomy and the mediastinal lymph nodes were excised. Microscopic examination of pretracheal lymph node specimens showed invasion of poorly differentiated adenocarcinoma associated with abundant tumor-infiltrating lymphocytes. The other lymph nodes showed sarcoid reaction. Although she has been followed for one year and 11 months, no primary site of the cancer has been found. Metastasis of cancer of unknown origin to mediastinal lymph nodes is extremely rare. It is also interesting that the lymph node swelling diminished spontaneously. The tumor-infiltrating lymphocytes and sarcoid reactions may have been immunological responses to the cancer and may have caused the transient regression.

[Efficacy of combination therapy against MRSA in Ibaraki Prefecture]

Clinical efficacies of fosfomycin (FOM) or arbekacin (ABK) plus beta-lactam combination therapies against methicillin-resistant Staphylococcus aureus (MRSA) infections were examined in 15 major hospitals in Ibaraki Prefecture. The subjects were 54 inpatients from January 1991 to April 1993, and most of them showed moderate to severe infections with underlying diseases. MRSA alone was isolated from 23 patients and the other 31 patients had polymicobes including MRSA. Pseudomonas aeruginosa was the most frequent among the co-isolated strains. The number of patients treated with FOM and cefmetazole (CMZ) was 22 (Group C) and that with FOM and flomoxef (FMOX) was 25 (Group F). CMZ or FMOX was administrated 60 minutes after FOM administration. To 8 nonresponding patients in Groups C and F and 7 nonresponders to the other therapies, ABK and ceftazidime (CAZ) or ABK and piperacillin (PIPC) were treated simultaneously (Group A). The clinical efficacies of Groups C and F were 63.6% and 64%, respectively. The bacteriological efficacies (eradication rates) of both groups including microbial substitutions were 42.9% in the former and 56.5% in the latter. No statistical differences were observed in the clinical and the bacteriological efficacies between Groups C and F. The clinical and bacteriological efficacies in Group A were 66.7% and 46.2%, respectively. No side effects were observed in any cases. Mild disturbances of hepatic functions were observed in 2 cases of Groups C and F, and there were no abnormal laboratory test results in Group A.(ABSTRACT TRUNCATED AT 250 WORDS)

[Low dose dibutylic cyclic AMP administration during coronary artery bypass graft surgery]

To evaluate the effectiveness of low dose dibutylic cyclic AMP (DBcAMP) during coronary artery bypass graft surgery, we compared circulatory and endocrine-metabolic parameters among the three different doses: (1) DBcAMP 10 microg.kg-1.min-1 (A-10 group), (2) DBcAMP 20 microg.kg-1.min-1 (A-20 group), and (3) control (A-0 group). In the A-10 group, perfusion pressure was significantly higher than in the A-0 group at the point of maximum cooling and at the start of warming during cardiopulmonary bypass (CPB), while peripheral vascular resistance was significantly lower than in the A-0 group at the closing of CPB. On the contrary, in the A-20 group, perfusion pressure was significantly lower than in the A-0 group at the point of maximum cooling and the start of warming during CPB, while peripheral vascular resistance was significantly lower than in the A-0 group at the start of warming and the closing of CPB. Among these groups, the hourly urine volume during CPB was significantly largest in A-10 group. Endocrine-metabolic parameters showed no statistic difference among these groups. These results suggest that the administration of DBcAMP 10 microg.kg-1.min-1 during CPB might improve the cardiac performance and maintain the tissue perfusion without the endocrine-metabolic deterioration.

[A case of crescentic glomerulonephritis associated with anti-myeloperoxidase antibody presenting as alveolar hemorrhage]

A 77-year-old man was admitted because of hemoptysis. Chest roentgenograms initially showed progressive infiltrative shadows, which improved spontaneously in 3 months. Transbronchial lung biopsy specimens obtained during the first admission revealed alveolar hemorrhage with neither granuloma nor vasculitis. Alveolar hemorrhage associated with renal dysfunction recurred 9 months later. Serum creatinine level was elevated to 3.5 mg/dl. No other organ than lungs or kidneys was involved. Renal biopsy was performed to confirm the pathological diagnosis of crescentic glomerulonephritis. Anti-basement-membrane antibody was negative, whereas anti-neutrophil-cytoplasmic antibody was positive for perinuclear pattern (P-ANCA) by indirect immunofluorescent (IF) method. He was diagnosed as having idiopathic crescentic glomerulonephritis complicated with alveolar hemorrhage, and the presence of anti-myeloperoxidase (MPO) antibody in serum was anticipated. Anti-MPO antibody level in his serum evaluated by ELISA was markedly elevated. Although myeloperoxidase has been considered as a common antigen to P-ANCA and anti-MPO antibody, the determination of P-ANCA has been clinically unreliable because of equivocal results. In contrast, the presence of anti-MPO antibody is highly specific for idiopathic crescentic glomerulonephritis complicated with alveolar hemorrhage or its incomplete variant case. Also, it is a better index of disease activity. Therefore, there is a possibility that those patients diagnosed as having idiopathic pulmonary hemosiderosis or pulmonary-renal syndrome may be categorized into the one disease, anti-MPO antibody-associated disease, and the measurement of anti-MPO antibody may lead to prompt treatment prior to the histological diagnosis.

The motility of lung lymphocytes in hypersensitivity pneumonitis and sarcoidosis

Lymphocytes obtained by bronchoalveolar lavage (BAL) in hypersensitivity pneumonitis (HP) and pulmonary sarcoidosis (PS) are believed to be derived from interstitial inflammatory lesions of the lung in which lymphocytes have migrated from the blood. Because cellular motility is one of the important factors in lymphocyte migration, we investigated the motility of BAL lymphocytes from 12 patients with HP and 12 with PS, as well as their responsiveness to chemoattractants in vitro by modified Boyden chamber method. Motility was evaluated by the number of migrated cells and the migration distance. The numbers of migrated BAL lymphocytes from patients with HP and PS in albumin-containing medium were 318.3 +/- 93.0 (mean +/- SD) and 207.6 +/- 35.5, respectively, and were greater than those of BAL lymphocytes from normal control subjects (133.3 +/- 40.9) and blood lymphocytes, and comparable with those of mitogen-activated blood lymphocytes. The motility of BAL lymphocytes in these diseases compared with blood lymphocytes was also increased in protein-free medium. In addition, the culture supernatants of alveolar macrophages (AM) enhanced the motility of BAL, mitogen-activated, and blood lymphocytes. These results suggest that BAL lymphocytes in these diseases are functionally motile, and their enhanced motility, as well as mediators from AM, may facilitate the accumulation of lymphocytes at the epithelial surface.

Positive and negative regulation of retinoid X receptor gene expression by thyroid hormone in the rat. Transcriptional and post-transcriptional controls by thyroid hormone

The 9-cis-retinoic acid receptors (RXRs), belonging to the members of the steroid/thyroid hormone receptor superfamily, act as auxiliary proteins, heterodimerizing with other nuclear receptors such as retinoic acid receptors (RARs), vitamin D receptor, thyroid hormone receptors, and peroxisome-proliferator activated receptor, thereby transactivating target genes in a ligand-dependent manner. We have previously reported that in the rat, thyroid hormone (TH) positively and negatively regulates the hepatic mRNA levels of RXR beta and RXR gamma, respectively. In the present study, we have tried to elucidate the level at which TH regulates the gene expression of RXR beta and RXR gamma in the rat. A RNA synthesis inhibitor (actinomycin D), but not a protein synthesis inhibitor (cycloheximide), blocked the induction of RXR beta mRNA by TH. On the other hand, none of these drugs inhibited the decrease of RXR gamma mRNA levels caused by TH. Nuclear run-on assays showed that the transcription rate of the RXR beta gene was positively regulated by TH, whereas the transcription of RXR gamma gene was not controlled by TH. Taken together, these results indicate that the gene expression of RXR beta is positively regulated by TH at transcriptional level, while the negative regulation of the RXR gamma gene expression by TH may occur at a post-transcriptional level in intact rat. Thus, the RXR-mediated signal transductions may be modulated in part through TH control of the levels of RXR beta and RXR gamma.

[A case of yellow nail syndrome presenting as recurrent pneumonia]

We report a case of yellow nail syndrome (YNS) associated with recurrent episodes of pneumonia. The patient, a 31-year-old female, presented with yellow nails, chronic bronchitis and pleural effusion. The etiology of YNS remains unknown although it has been postulated to be associated with lymphatic abnormalities. YNS is a rare disease with only 22 cases reported in Japan. However, YNS is often associated with respiratory infections, and should thus be borne in mind.

Gene expression of cellular retinol-binding protein I (CRBP I) is affected by dietary proteins in the rat liver

The effect of dietary proteins and vitamin A status on the gene expression of cellular retinol-binding protein I (CRBP I) was studied in the rat liver. The gene expression was estimated as amounts of transcript (mRNA) by Northern blot analysis using rat CRBP I cDNA. Though vitamin A status is known to positively regulate the gene expression of CRBP I in the extrahepatic tissues, in the present study we observed that the amount of the CRBP I transcript in liver was neither reduced by vitamin A-deficiency, nor affected by replenishment with an excess dose of all-trans retinoic acid. These results indicate that in the liver, different from the extrahepatic tissues, the gene expression of CRBP I may not be controlled by vitamin A. However, when the rats were fed on the diets that differed in dietary proteins, the gene expression of CRBP I in liver was enhanced by higher quality and quantity of dietary proteins, though no effect of dietary proteins was observed upon the hepatic contents of retinol. The concentrations of serum retinol were almost proportional to the mRNA levels of CRBP I. In contrast, the hepatic gene expression of another retinol-binding protein, RBP, and one subtype of retinoic acid receptor, RAR alpha was not influenced in the nutritional condition tested here. Our findings suggest that the gene expression of CRBP I in liver may be under control of the intake of dietary proteins. Thus, it is likely that in the light of the function of CRBP I on cellular transport and metabolism of retinol, dietary proteins may affect the actions of vitamin A in the extrahepatic tissues through changing the amounts of CRBP I in liver.

Activation of murine macrophages by polysaccharide fractions from marine algae (Porphyra yezoensis)

Two discrete immunomodulating fractions were obtained from marine algae (Porphyra yezoensis): one was the Porphyra water-soluble fraction (PWSF) which was extracted with hot water from the whole body of algae, and the other was the Porphyra acid-soluble fraction (PASF) which was extracted with acid from the residue. The major constituent in both PWSF and PASF was a polysaccharide, the total sugar concentration in PWSF (56.4%) being lower than that in PASF (82.2%). The high contents of 3,6-anhydrogalactose and sulfate indicated the porphyran structure in PWSF and PASF. The results of an in vitro culture assay with proteose peptone-induced macrophages from mice revealed the PWSF and PASF both enhanced glucose consumption, as well as the production of nitrite and tumor necrosis factor (TNF), but that these were increased more by PWSF than by PASF. PWSF augmented IL-I secretion from these macrophages, while PASF did not. On the other hand, the carbon clearance activity of phagocytes from mice injected intraperitoneally with PASF was higher than that from PWSF-injected mice. The injection of PASF into mice also enhanced the carbon clearance activity in a dose-dependent manner. These results suggest that the two individual fractions possessed the ability to activate macrophages in vitro and in vivo in different ways.

[Pathogenesis of development of lung cancer in idiopathic interstitial pneumonia--growth factors in bronchoalveolar lavage fluid]

It has been generally accepted that lung fibrosis as in idiopathic interstitial pneumonia (IIP) is frequently associated with the development of lung cancer. This observation implies that the mechanism involved in carcinogenesis and/or enhanced proliferation of cancer cells is common to the fibrosing process. However, there are few studies reported on the pathogenesis of associated lung cancer except for several studies assessed from the point of view of surgical pathology. This study was undertaken to learn whether BAL fluid, which reflects the local milieu of the fibrosing process, enhances the proliferation of human lung cancer cell line Lu-99, Lu-65 and rat lung fibroblasts as assessed by 3H-thymidine incorporation. BAL fluid was obtained from patients with IIP (n = 8) and normal volunteers (n = 8). BAL fluids from patients with IIP enhanced the mean incorporation of 3H-thymidine of Lu-99 up to 3.6 times (p < 0.01) compared to that of normal volunteers. Furthermore, the mean incorporation of Lu-65 was increased up to 1.8 times (p < 0.05) by BAL fluids from patients with IIP. In contrast, BAL fluids from patients caused no significant increase of the mean incorporation of rat lung fibroblasts as compared to normal BAL fluids. The enhancing activities on the growth of cancer cell line Lu-99, Lu-65 were eluted in several fractions by high performance liquid chromatography using Superose 12. These observations indicate that the BAL fluid of IIP patients contains factors enhancing the growth of cancer cells.

Lung fibrosis in hypersensitivity pneumonitis. Association with CD4+ but not CD8+ cell dominant alveolitis and insidious onset

Seventeen cases of hypersensitivity pneumonitis (HP) at a symptomatic phase were categorized into two groups based on computed tomographic (CT) findings and histologic features of transbronchial lung biopsy specimens, HP accompanied by lung fibrosis (fibrosis group), and HP unaccompanied by lung fibrosis (nonfibrosis group). The fibrosis group comprised bird fancier's lung and HP of unknown etiology, whereas the nonfibrosis group mainly comprised summer-type HP. Comparison of results of pulmonary function tests between these two groups confirmed a restrictive impairment in the fibrosis group. Analyses of cellular components of bronchoalveolar lavage (BAL) fluids revealed lymphocytes, especially CD8+ T lymphocytes, were significantly increased in the nonfibrosis group in comparison with the fibrosis group, whereas CD4+ T cells were increased to the same level in the both groups. Analyses of the onset of disease showed that acute onset was observed mainly in nonfibrosis group and strongly correlated with increased CD8+ T lymphocytes in BAL fluids, while insidious onset was related to lung fibrosis and relatively increased CD4+ T lymphocytes in BAL fluids. These findings raise the possibility that highly elevated CD8+ T cells might have a protective effect on pulmonary fibrosis or that relatively increased CD4+ T cells might play an important role in the pathogenesis of pulmonary fibrosis of HP at the chronic phase.

Carcinosarcoma of the skin: immunohistochemical and electron microscopic observations

A rapidly growing, hemorrhagic, exophytic tumor on the upper back of a 44-year-old male patient was investigated. Histological, immunohistochemical, and electron microscopic studies revealed both basal cell carcinoma-like and spindle cell sarcoma-like structures intermingled in the same tumor. Clinical consequences to this patient were mainly dependent on the sarcomatous element.

[Subclass distribution of IgG and IgA antibodies in summer-type hypersensitivity pneumonitis]

The present study was undertaken to determine the most specific of the 3 serotypes of Trichosporon cutaneum responsible for summer type hypersensitivity pneumonitis and to elucidate the subclass distribution of the antibody response, which is partly dependent on the nature of the causative antigen. Western blot analysis revealed that serotype II (TIMM 1318) is the most specific antigen for summer type hypersensitivity pneumonitis. The subclass distributions of anti-Trichosporon cutaneum IgG antibodies and IgA antibodies in sera and bronchoalveolar lavage fluids (BALF) from 13 patients with summer type hypersensitivity pneumonitis and 10 normal volunteers were measured by biotin-avidin-linked immunosorbent assay. The results were as follows, (1) high levels of IgA2 antibodies were found in BALF, but minute amounts in sera, (2) IgG1 antibodies were the predominant subclass in sera and BALF, (3) three out of 13 cases showed high levels of IgG3 antibodies in sera and BALF associated with low levels of IgG1 antibodies, (4) IgA1 antibodies were found in both sera and BALF. (5) the levels of all antibody subclasses were higher in BALF than in sera. The subclass distributions suggest that the protein components of Trichosporon cutaneum are predominantly immunogen, although polysaccharides may participate as an antigen in the respiratory tract.

Thyroid hormone affects the gene expression of retinoid X receptors in the adult rat

Gene expression of three nuclear retinoid X receptors (RXR alpha, beta and gamma) was examined by Northern blot analysis in various rat tissues. The RXR alpha mRNA (5.5 kb) was detected in most tissues and particularly expressed at a high level in the liver. The RXR beta transcripts (2.4 and 3.0 kb) were expressed ubiquitously, and particularly at high levels in the brain and testis. In the liver, heart, kidney and lung, the RXR gamma mRNA (2.0 kb) was specifically detected. Furthermore, we examined the effect of retinoid, vitamin D and thyroid hormone status on the gene expression of RXR alpha, beta and gamma. Though retinoid and vitamin D did not affect the mRNA levels of three RXRs, the mRNA levels of two genes were controlled by thyroid hormone. Namely, positive (RXR beta) and negative (RXR gamma) regulations by thyroid hormone were observed with no effect on the gene expression of RXR alpha. These results suggest that thyroid hormone might affect the signal transduction of retinoid, vitamin D and thyroid hormone by changing RXR levels.

Pulmonary alveolar proteinosis. Xe-133 scintigraphic findings before and after bronchopulmonary lavage

A 44-year-old woman with pulmonary alveolar proteinosis was treated by repeated unilateral bronchopulmonary lavages over 6.5 years. The effectiveness of the treatment was assessed by Xe-133 scintigraphy as well as lung function tests and chest roentgenograms. Xe-133 scintigraphy clearly demonstrated improvement of regional ventilation and perfusion, and equalization of the ventilation and perfusion ratio. Therefore, Xe-133 scintigraphy was found to be useful in the analysis of changes in regional aeration, ventilation, and perfusion before and after bronchopulmonary lavage in pulmonary alveolar proteinosis.

The role of complement-derived chemotactic factors in lung injury induced by preformed immune complexes

Our previous studies have suggested a role for complement fragments presumably activated by immune complexes in patients with hypersensitivity pneumonitis. The present study has shown that circulating complement depletion by cobra venom factor resulted in the reduction in severity of immune-complex-mediated pulmonary inflammation. The activity of chemotactic factors for neutrophils generated in bronchoalveolar lavage fluids in complement-depleted animals was significantly diminished to 61.2% compared to the undepleted animals. In addition, reduced activity of chemotactic factors resulted in a marked reduction of accumulation of neutrophils in bronchoalveolar lavage fluids indicating that chemotactic factors play an important role in the sequestration of neutrophils on the alveolar side of the lung. In conclusion, chemotactic factors in bronchoalveolar lavage fluids which preceded the accumulation of polymorphonuclear cells are partially derived from complement.