Squamous papilloma of the esophagus

BACKGROUND

Squamous papilloma of the esophagus (SPE) is a rare lesion, with a prevalence of 0.01% to 0.04%. This study was to assess the incidence, symptoms, signs and prognosis of squamous papilloma of the esophagus.

METHODS

From October 1981 to October 1994, 124,000 patients at our hospital were examined with panendoscopy; 9 (0.0073%) subjects were histologically proved to have squamous papilloma of the esophagus.

RESULTS

They included 4 males and 5 females, aged 60.8 +/- 9.7 years, ranging from 49 to 78 years old. These tumor locations were seven in the lower, one in the middle and one in the upper portion of the esophagus; sizes were not larger than 5 mm. Most of them were single (seven of nine) and sessile (eight of nine). Three of them were followed up with panendoscopy and six of them were followed up through clinical symptoms. The longest follow-up period were 11 years. The mean following time was 2.2 +/- 3.6 years.

CONCLUSIONS

All of the patients are alive, and none has malignancy in the SPE. It is suggested that squamous papilloma of the esophagus may have a benign clinical course. Symptoms and signs are thought to be associated with gastroesophageal reflux or peptic ulcer diseases, and not to be related to the squamous cell papilloma itself.

[Gastric emptying in non-insulin dependent diabetic patients]

Disordered gastrointestinal motility is an often overlooked clinical problem. Delayed gastric emptying of solid and/or liquid meal in patients with both type 1 and type 2 diabetes mellitus occurs in approximately 50% of these patients. Gastric emptying time (GET) was studied in seventy four non-insulin dependent (type 2) diabetic out-patients by using radionuclide gamma-photography with Tc-99m phytate solid experimental meal. Thirty nine of them received Tc-99m phytate liquid test meal on the next day. Forty six normal healthy volunteers acted as controls. The results showed that solid GET in patients with type 2 diabetes mellitus was significantly delayed (149.44 +/- 64.0 min) as compared with that in the control group (88.7 +/- 14.2 min) (p < 0.001). Fifty three among these 74 diabetic patients had delayed solid GET, accounting for 71.6%. Only 5 of 39 (12.8%) diabetic patients showed delayed liquid GET (average 38.7 +/- 35.3 min; control 46.2 +/- 11.1 min). There were no differences in sugar control, duration of the disease, and upper gastrointestinal symptoms between patients with delayed GET and those with normal GET. We concluded that delayed gastric emptying is very common in patients with non-insulin dependent diabetes mellitus and which has no direct correlation to blood sugar control, duration of the disease, and upper gastrointestinal symptoms. Radionuclide solid gastric emptying test is a both safe (low radioactivity) and convenient (non-invasive) diagnostic tool in non-insulin dependent diabetic gastroparesis.

Abnormal gastric emptying in patients with liver cirrhosis

Twenty-eight patients (aged: 44-76 years) with liver cirrhosis secondary to chronic hepatitis were included in this study. None of the patients had a history of gastric surgery, diabetes, hypothyroidism, or neurological or collagen vascular disease. The patients were divided into groups based on the presence or absence of the following conditions: (1) ascites, (2) splenomegaly, (3) esophageal varices. Radionuclide labelled solid meals were used to evaluate gastric emptying (GE). GE was represented by the gastric retention ratio of the solid meal at 90 min (RR90), and calculated by the following formula: RR90 = residual radioactivity within the region of interest (ROI) covered the whole stomach at 90 min divided by the initial radioactivity within the ROI at 0 min. The RR90 values of the patients were compared with the RR90 values of 25 normal control volunteers. If the RR90 was more than two standard deviations (SD) above the mean of the control group (> 0.687), GE was defined as abnormal. The results showed 71% (20/ 28) of the cirrhotic patients had abnormal GE. Patients with ascites, splenomegaly, or esophageal varices had higher RR90 values than patients without ascites, splenomegaly or esophageal varices. The differences in RR90 among patients with and without ascites, and patients with and without splenomegaly, were not significant (P values > 0.05). However, there were significant differences among the 2 patient groups separated according to the presence or absence of esophageal varices (P values < 0.05). In addition, poor correlations (R square values < 0.01) were found for RR90 and serum values of bilirubin and albumin.

Granulocyte-macrophage colony-stimulating factor overrides the immunosuppressive function of corticosteroids on rat pulmonary dendritic cells

Pulmonary dendritic cells (DC) are present in extremely small numbers, but they are the most potent antigen-presenting cells in the lungs. Pure populations of DC can be isolated from the lung following collagen digestion, Percoll gradient centrifugation, removal of phagocytic cells and flow cytometric sorting for cells which exhibit high levels of surface major histocompatibility complex (MHC) class II molecules. Exogenous GM-CSF enhances this immunostimulatory capacity of the pulmonary DC. Soluble factors produced by type II airway epithelial cells and interstitial macrophages also enhance the immunostimulating capacity of pulmonary DC while alveolar macrophages suppress it. Thus, the function of DC may be regulated by locally produced cytokines. Corticosteroids are widely used as immunosuppressive agents in pharmacotherapy. While these agents are known to inhibit T cell proliferation and macrophage activation, their effects on DC are not known. We found that dexamethasone (Dex) pretreatment resulted in about a 50% reduction in the immunostimulatory capacity of rat pulmonary DC. This was associated with downregulation of MHC class II (Ia) expression. Dex-induced suppression of DC function could be restored with GM-CSF. We conclude that corticosteroids downregulate antigen-presenting capacity by direct suppression of pulmonary DC. This immunosuppressive effect of corticosteroids on DC may, however, be abrogated by exogenous GM-CSF. Corticosteroids and GM-CSF are therapeutic agents with potent direct immunomodulating effects on DC.

Urokinase is required for the pulmonary inflammatory response to Cryptococcus neoformans. A murine transgenic model

Urokinase (uPA) is hypothesized to provide proteolytic activity enabling inflammatory cells to traverse tissues during recruitment, and it is implicated as a cytokine modulator. Definitive evaluation of these hypotheses in vivo has previously been impossible because uPA could not completely and irreversibly be eliminated. This limitation has been overcome through the development of uPA-deficient transgenic mice (uPA-/-). Using these mice, we evaluated the importance of uPA in the pulmonary inflammatory response to Cryptococcus neoformans (strain 52D). C. neoformans was inoculated into uPA-/- and control mice (uPA+/+), and cell recruitment to the lungs was quantitated. The number of CFU in lung, spleen and brain was determined to assess clearance, and survival curves were generated. By day 21 after inoculation, uPA-/- mice had markedly fewer pulmonary inflammatory (CD45+), CD4+, and CD11b/CD18+ cells compared with uPA+/+ controls (P<0.0007); pulmonary CFUs in the uPA-/- mice continued to increase, whereas CFUs diminished in uPA+/+ mice(P<0.005). In survival studies, only 3/19 uPA+/+ mice died, whereas 15/19 uPA-/- mice died (p<0.001). We have demonstrated that uPA is required for a pulmonary inflammatory response to C. neoformans. Lack of uPA results in inadequate cellular recruitment, uncontrolled infection, and death.

Relationship between C14 urea breath test values and solid-phase gastric emptying time in non-ulcer dyspepsia patients

BACKGROUND

Non-ulcer dyspepsia (NUD) is a poorly understood syndrome often found with endoscopic evidence of gastritis; Helicobacter pylori (Hp) is a common and important cause of gastritis. In the recent literature, gastric hypomotility is thought to be a cause of NUD. Thus, this investigation studied the relationship between Hp and delayed gastric emptying in NUD patients.

METHODS

Using a radionuclide-labelled solid meal to calculate gastric emptying time (GET) of 78 NUD patients. The carbon-14 urea breath test (C14 UBT) was used to quantitate Hp infection.

RESULTS

The prevalence of Hp infection in patients with NUD reached 59%. There was a strong association of Hp infection with advanced age (p = 0.0091). There was no significant difference between solid-phase GET and C14 UBT values among three different age groups (young, middle, old) of NUD patients. There was no difference among sex, age, body weight and solid-phase GET between Hp-positive and Hp-negative NUD patients. However the solid-phase GET was significantly prolonged in patients with NUD, compared with the controls.

CONCLUSIONS

Solid-phase GET is not correlated with the C14 UBT values, and Hp gastric colonization does not account for dyspeptic syndrome in NUD patients.

Cytomegalovirus colitis in an immunocompetent old woman successfully treated with ganciclovir: a case report

Cytomegalovirus (CMV) diseases occur almost exclusively in the immunocompromised hosts. Persons most commonly affected are patients with acquired immunodeficiency syndrome (AIDS). On rare occasions, however, CMV diseases can be seen in apparently immunocompetent persons. A CMV colitis in a 68-year old immunocompetent woman presenting with watery diarrhea, malaise, and body weight loss of about 5 kg over a three week period is reported. Colonoscopy and mucosal biopsy revealed CMV colitis involving the sigmoid colon. Treatment for two weeks with ganciclovir (10 gm/kg/day I.V. in 2 divided doses) resulted in resolution of colitis and clinical symptoms without any noticeable side-effects. There was no relapse of infection by six months of follow-up. The possibility of CMV colitis should be considered in any elderly person with watery diarrhea, general debilitation, marked body weight loss and with negative stool cultures. CMV colitis may be more frequent than is usually believed. It has a favorable response to ganciclovir without further relapse after the successful treatment in patients with normal immune function.

Evaluation of lung ventilation and alveolar permeability in cirrhosis

This study sought to evaluate lung ventilation and alveolar permeability (AP) in patients with cirrhosis of the liver.

METHODS

Pulmonary function in 29 patients with cirrhosis was measured by 99mTc-DTPA aerosol inhalation lung scintigraphy, using commercial lung radio-aerosol delivery units. Equilibrium lung ventilation images were visually interpreted according to the presence or absence of inhomogeneous distribution, inverted base-to-apex gradient and segmental defects. Degree of AP damage to the upper, middle, lower and total right lung was expressed as the slopes of the time-activity curves from dynamic lung images. The patients were classified into three groups, according to cirrhotic severity, using the modified Child's classification (A = good; B = fair; C = poor). Twelve healthy nonsmokers (2 women, 10 men; 42-75 yr old) formed the control group, and all had normal chest radiographic and pulmonary function test results.

RESULTS

None of the 29 patients had significantly abnormal lung ventilation findings, but 13 had reduced lung ventilation in the basilar lung zone. The incidence of lung ventilation abnormalities was 20% (3 of 15), 50% (3 of 6) and 88% (7 of 8) in patients with nil, slight-to-moderate and moderate-to-severe ascites, respectively (p < 0.05 for nil versus moderate-to-severe ascites). The AP studies showed higher time-activity curve slopes for patients with cirrhosis than for normal control subjects. The slopes for the right total lung showed no significant differences among the three groups; however, those for right upper and right lower lung showed significant differences between some subgroups. In addition, albumin and bilirubin levels showed no significant correlation with slope values in cirrhotic patients.

CONCLUSION

Although lung ventilation is normal in most patients with cirrhosis of the liver (16 [55%] of 29 in the present study), the disease can predispose patients to AP damage; however, the degree of damage is not related to cirrhotic severity.

The effect of Helicobacter pylori infection on gastric emptying of digestible and indigestible solids in patients with nonulcer dyspepsia

OBJECTIVE

There is no general agreement with regard to the effect of Helicobacter pylori infection on gastric emptying in patients with nonulcer dyspepsia.

METHODS

We performed the 14C urea breath test as well as simultaneous recordings of scintigraphic gastic emptying and gastric clearance of radiopaque markers to determine the effect of Helicobacter pylori infection on gastric emptying of digestible and indigestible solids in nonulcer dyspepsia patients.

RESULTS

Sixty patients, 30 males and 30 females, were enrolled in the study. There were 22 patients (36.7%) without and 38 patients (63.3%) with H. pylori infection. Twenty-four of the 60 patients (40%) showed normal and 36 patients (60%) showed delayed gastric emptying of digestible solids. In addition, 21 patients (35%) showed normal and 39 patients (63%) showed delayed gastric emptying of indigestible solids. There was no correlation between delayed gastric emptying of digestible and indigestible solids (p > 0.05, difference not significant). Although not statistically significant, the incidence of delayed indigestible solid emptying was higher than that of delayed digestible solid emptying (65% vs. 60%). Among different patterns of gastric emptying, no difference was noted between the patients with and without H. pylori infection.

CONCLUSION

Delayed gastric emptying of indigestible solids is as common as delayed gastric emptying of digestible solids in nonulcer dyspepsia patients. The status of H. Pylori infection appeared not to influence the incidence of delayed gastric emptying of digestible and indigestible solids.

Gastric clearance of radiopaque markers in non-ulcer dyspepsia patients

BACKGROUND

The use of radiopaque markers has been proposed as an easy, non-invasive method for measuring gastric emptying. In this study we intended to evaluate the effectiveness of this test in determining the gastric motor function in patients with non-ulcer dyspepsia.

METHODS

Simultaneous recording of scintigraphic solid gastric emptying and gastric clearance of radiopaque markers were conducted in 65 non-ulcer dyspepsia patients.

RESULTS

Forty-two patients (64.4%) showed abnormal gastric clearance of radiopaque markers, and 38 patients (58.5%) showed delayed solid gastric emptying. There was no correlation between delayed solid gastric emptying and abnormal gastric clearance of radiopaque markers (p > 0.05). Although the frequency of abnormal gastric clearance of radiopaque markers was higher than that of delayed solid gastric emptying (64.6% versus 58.5%), it was not statistically significant.

CONCLUSIONS

On the basis of the results of our study, gastric clearance of radiopaque markers may be used as an easy, non-invasive screening test for the purpose of detecting gastric motor dysfunction. However, this test is not superior to scintigraphic gastric emptying studies.

Discrepant pattern of solid and liquid gastric emptying in Chinese patients with type II diabetes mellitus

While abnormal gastric emptying has been widely reported in patients with diabetes, its clinical relevance is still uncertain. We conducted scintigraphic gastric emptying studies in patients with Type II diabetes mellitus who had symptoms suggestive of delayed gastric emptying in an attempt to evaluate the incidence of abnormal gastric emptying and to assess the clinical parameters of the different patterns of gastric emptying. Seventy male diabetic patients were included in the study. The patients were divided into four groups according to the results of liquid and solid gastric emptying: group 1, normal liquid and solid emptying (n = 22); group 2, normal liquid but delayed solid emptying (n = 30); group 3, delayed liquid but normal solid emptying (n = 7); group 4, delayed liquid and solid gastric emptying (n = 11). To assess clinical significance, we compared duration of disease, status of blood sugar control, presence or absence of vascular complications and of peripheral neuropathy among the four groups. Of the 70 patients, 18 (25.7%) showed delayed liquid gastric emptying and 41 (58.6%) delayed solid gastric emptying. There were no significant differences in the clinical parameters of the four groups, except that patients with good sugar control were likely to have normal liquid gastric emptying. Based on the results of this study, delayed solid gastric emptying is more common than liquid gastric emptying in symptomatic Type II diabetes mellitus patients. Of the different patterns of gastric emptying, delayed liquid gastric emptying with normal solid gastric emptying is the most unusual. For Type II diabetic patients with symptoms suggestive of delayed gastric emptying, both liquid and solid gastric emptying studies should be performed.

Delayed gastric emptying does not predispose to Helicobacter pylori infection in non-ulcer dyspepsia patients

Non-ulcer dyspepsia is a common disorder in clinical practice. The pathogenesis and predisposing factors that lead to the development of Helicobacter pylori infection are still unclear. The aim of the present study was to evaluate the prevalence of H. pylori infection in non-ulcer dyspepsia patients with delayed gastric emptying and those with normal gastric emptying, and to determine if delayed gastric emptying predisposes to H. pylori infection. A total of 70 patients (29 males, 41 females) aged 18-59 years (mean +/- S.D. 40.5 +/- 11.2 years) took part in the study. A solid-phase scintigraphic gastric emptying study and 14C urea breath test were performed on each patient. There was no statistically significant difference in age between those patients with and without delayed gastric emptying (40.8 +/- 11.9 vs 40.4 +/- 10.5 years), or between those with and without H. pylori infection (40.5 +/- 12.6 vs 40.5 +/- 9.8 years). Of the 70 patients, 45 (64.3%) had delayed gastric emptying and 25 (35.7%) had normal gastric emptying. The overall incidence of H. pylori infection was 58.6%. The incidence of H. pylori infection among patients with delayed gastric emptying was 60% (27/45 patients) and among patients with normal gastric emptying 56% (14/25) patients). The incidence of H. pylori infection in the two groups was not significantly different. The incidence of H. pylori infection in the non-ulcer dyspepsia patients in this study was similar to that of age-matched asymptomatic volunteers in Taiwan. In conclusion, based on the results of this study, delayed gastric emptying does not lead to a predisposition to H. pylori infection in non-ulcer dyspepsia patients.

The effect of coffee on gastric emptying

The effect of coffee on gastric emptying was addressed in a scintigraphic liquid-phase gastric emptying study in patients with non-ulcer dyspepsia. Ninety-three subjects (56 males, 37 females; mean age 40 years, range 17-77 years) diagnosed as having non-ulcer dyspepsia were enrolled in the study. The baseline study was to drink 500 ml of 5% glucose water and the coffee study was to drink 500 ml of 5% glucose water containing 4 g of regular instant coffee. The two studies were performed on separate days. Fifteen of the 93 subjects were chosen at random to undergo repeated coffee studies for evaluation of reproducibility. Overall the 93 subjects showed accelerated gastric emptying, as measured by half emptying time (T1/2) with coffee compared with baseline (35.7 +/- 10.5 vs 45.0 +/- 23.1 min, P < 0.001). However, 68 (73.2%) subjects showed accelerated emptying (-14.8 +/- 19.5 min), while 25 (26.8%) subjects showed delayed emptying (5.9 +/- 4.5 min) after ingestion of coffee. There was no significant difference in the change in gastric emptying with coffee in duplicate measurements from the 15 subjects who had two coffee studies (P = 0.082). We conclude that coffee accelerates liquid-phase gastric emptying in the majority of patients with non-ulcer dyspepsia.

[Ulcerative colitis in Taichung Veterans General Hospital: a clinical study]

This report concerns 34 patients of ulcerative colitis admitted to Taichung Veterans General Hospital, from 1983 to 1994. Among them 26 were male and 8 were female. The age at onset were mostly from 50 to 60. The average duration between onset of symptoms and the date of definite diagnosis was 10 months. The most common presenting symptom was bloody diarrhea (64.7%). Most of our patients were in the moderately severe group of disease (67.6%), according to the severity defined by Truelove and Witts. The most frequent endoscopic findings of mucosa was classified as Grade III (38.2). Descending colon (91.2), rectum (85.3%), and sigmoid colon (88.2%) were the most frequently involved areas. The major clinical course were chronic intermittent and chronic continuous type (55.9%). Extraintestinal manifestations were found in 2 cases: one was found in the skin, and the other in the joint, respectively. Treatment of ulcerative colitis in our series was mainly medical (91.2%). However, 3 patients received emergent surgical intervention, and 10 patients finally underwent operation because of major complications or failure to respond to medical treatment.

Increased accuracy of the carbon-14 D-xylose breath test in detecting small-intestinal bacterial overgrowth by correction with the gastric emptying rate

To date, there is no general agreement as to which test is to be preferred for the diagnosis of small-intestinal bacterial overgrowth. The 1-g carbon-14 D-xylose breath test has been proposed as a very sensitive and specific test for the diagnosis of bacterial overgrowth. However, in patients with severe gastrointestinal motor dysfunction, the lack of consistent delivery of 14C-D-xylose to the region of bacterial contamination may result in a "negative" result. The aim of this study was to determine whether the accuracy of 14C-D-xylose breath test for detecting bacterial overgrowth can be increased by correction with the gastric emptying rate of 14C-D-xylose. Ten culture-positive patients and ten culture-negative controls were included in the study. Small-intestinal aspirates for bacteriological culture were obtained endoscopically. A liquid-phase gastric emptying study was performed simultaneously to assess the amount of 14C-D-xylose that entered the small intestine. The results of the percentage of expired 14CO2 at 30 min were corrected with the amount of 14C-D-xylose that entered the small intestine. There were six patients in the culture-positive group with a 14CO2 concentration above the normal limit. Three out of four patients with initially negative results using the uncorrected method proved to be positive after correction. All these three patients had prolonged gastric emptying of 14C-D-xylose. When compared with cultures of small-intestine aspirates, the sensitivity and specificity of the uncorrected 14C-D-xylose breath test were 60% and 90%, respectively. In contrast, the sensitivity and specificity of the corrected 14C-D-xylose breath test improved to 90% and 100%, respectively. In conclusion, using the gastric emptying rate of 14C-D-xylose as a correcting factor, we found a higher sensitivity and specificity for the 14C-D-xylose breath test in the detection of small-intestinal bacterial overgrowth than were achieved with the conventional method.

Regulation of rat pulmonary dendritic cell immunostimulatory activity by alveolar epithelial cell-derived granulocyte macrophage colony-stimulating factor

The presentation and recognition of foreign antigen is the critical initial event in the development of local immunity. In the lung, antigen-presenting cell activity is largely attributable to pulmonary dendritic cells (DC) that are distributed along the airways and throughout the pulmonary interstitium in close proximity to overlying alveolar epithelial cells. To test the hypothesis that DC immunostimulatory activity might be locally regulated by overlying alveolar epithelial cells, we evaluated the ability of rat type II alveolar epithelial cells to influence the capacity of purified rat pulmonary DC to stimulate T-cell proliferation in an allogeneic, mixed leukocyte reaction. We found that alveolar epithelial cells greatly enhanced the ability of dendritic cells to induce T-cell proliferation. This effect on DC immunostimulatory activity was mediated by a soluble factor preferentially secreted from the basolateral epithelial cell surface. Alveolar epithelial cultures were found to express mRNA for granulocyte macrophage colony-stimulating factor (GM-CSF), and blocking antibodies against GM-CSF partially neutralized the effect of epithelial cell-conditioned media on DC stimulatory activity, indicating that the effect was due at least in part to alveolar epithelial cell-derived GM-CSF. Through the polar secretion of GM-CSF, alveolar epithelial cells may play an important role in creating distinct immunologic environments within the lung.

Down-regulation of the afferent phase of T cell-mediated pulmonary inflammation and immunity by a high melanin-producing strain of Cryptococcus neoformans

The interaction(s) between cryptococcal virulence factors and leukocytes involved in generating protective cell-mediated immunity is not well defined. Intratracheal inoculation of Cryptococcus neoformans strain 52 induced a vigorous T cell-mediated pulmonary inflammatory response that controlled the growth of the organism. In contrast, strain 145 induced a pulmonary inflammatory response that was delayed in onset, slower to develop, and ineffective in controlling the infection. In addition, the expansion of cryptococcus-specific lymphocytes in the pulmonary lymph nodes and titer of specific Abs in the serum of strain 145-infected mice were both diminished markedly. Of the known cryptococcal virulence factors, these two strains differed only in melanin production (52-low and 145-high). Heat-killed strain 145 cryptococci (HKC-145) that had been rendered melanin-negative induced TNF-alpha production by alveolar macrophages in vitro and stimulated vigorous cryptococcus-specific lymphoproliferation. In contrast, high melanin-containing HKC-145 inhibited TNF-alpha production and lymphoproliferation. In vivo, mice infected with melanin low strain 52, but not melanin high strain 145, had elevated levels of TNF-alpha in the bronchoalveolar lavage fluid. Mice co-infected with strains 145 and 52 generated a pulmonary inflammatory response resulting in increased long-term survival. Taken together, these studies demonstrate that melanin does not protect cryptococci from being eliminated in vivo by recruited, activated effector cells; but melanin can inhibit the recognition of the organism by host defenses, thereby down-regulating the afferent phase of T cell-mediated immunity, e.g., TNF-alpha production and lymphoproliferation.

Down-regulation of the afferent phase of T cell-mediated pulmonary inflammation and immunity by a high melanin-producing strain of Cryptococcus neoformans

The interaction(s) between cryptococcal virulence factors and leukocytes involved in generating protective cell-mediated immunity is not well defined. Intratracheal inoculation of Cryptococcus neoformans strain 52 induced a vigorous T cell-mediated pulmonary inflammatory response that controlled the growth of the organism. In contrast, strain 145 induced a pulmonary inflammatory response that was delayed in onset, slower to develop, and ineffective in controlling the infection. In addition, the expansion of cryptococcus-specific lymphocytes in the pulmonary lymph nodes and titer of specific Abs in the serum of strain 145-infected mice were both diminished markedly. Of the known cryptococcal virulence factors, these two strains differed only in melanin production (52-low and 145-high). Heat-killed strain 145 cryptococci (HKC-145) that had been rendered melanin-negative induced TNF-alpha production by alveolar macrophages in vitro and stimulated vigorous cryptococcus-specific lymphoproliferation. In contrast, high melanin-containing HKC-145 inhibited TNF-alpha production and lymphoproliferation. In vivo, mice infected with melanin low strain 52, but not melanin high strain 145, had elevated levels of TNF-alpha in the bronchoalveolar lavage fluid. Mice co-infected with strains 145 and 52 generated a pulmonary inflammatory response resulting in increased long-term survival. Taken together, these studies demonstrate that melanin does not protect cryptococci from being eliminated in vivo by recruited, activated effector cells; but melanin can inhibit the recognition of the organism by host defenses, thereby down-regulating the afferent phase of T cell-mediated immunity, e.g., TNF-alpha production and lymphoproliferation.

Effect of coffee on solid-phase gastric emptying in patients with non-ulcer dyspepsia

The purpose of this study was to evaluate the effect of coffee on solid phase gastric emptying in patients with non-ulcer dyspepsia (NUD). Twenty-one NUD patients with an endoscopic negative finding or superficial gastritis were included in this study. Radionuclide labeled solid meals were used to assess the gastric emptying times (GET) of the stomach. A control meal was composed of radionuclide solid meal and 500ml 5% of glucose water. The study meal was made from addition of 4g of instant coffee into the control meal. Of the 21 total cases, 1 demonstrated prolonged GET, 6 had shortened GET, and the other 14 showed no significant difference in GET. There were no statistically significant differences (p > 0.05) between the control and the study meal after coffee intake. Our data suggests that there may be some ingredient in coffee that promotes gastric motility, but this effect is counteracted by intestinal feedback, and the net effect is not significant.

Effect of oral erythromycin on patients with diabetic gastroparesis

BACKGROUND

Abnormal gastrointestinal motility is a well recognized complication of diabetes mellitus, and disordered gastric emptying may hamper glycemic control. The objects of this study were to investigate the effect of oral erythromycin on gastric emptying and to evaluate the effect of corrected gastric emptying on glycemic control in patients with diabetic gastroparesis.

METHODS

Twenty patients of Type II (non-insulin-dependent) diabetes mellitus with typical symptoms of gastroparesis and delayed solid phase gastric emptying were studied. There were 18 males and 2 females, aged 49 to 72 years. Erythromycin (erythromycin estolate) was given orally at a dose of 250 mg, 3 times daily, 30 minutes before each meal. Radionuclide-labelled solid phase gastric emptying and fasting blood sugar (FBS) were studied after one day of erythromycin therapy, and again after 2 weeks of the therapy. The half time of gastric emptying (GETt1/2) represented the time needed for 50 percent of the initial radioactivity to leave the stomach, and was used to express the gastric emptying status.

RESULTS

The GETt1/2 decreased from 198.0 +/- 58.9 minutes at baseline to 139.1 +/- 67.6 minutes following one day of erythromycin therapy (p < 0.01), and to 137.1 +/- 71.2 minutes after two weeks of treatment (vs. baseline p < 0.01). The FBS decreased from 159.0 +/- 40.2 mg/dl at baseline to 149.0 +/- 38.5 mg/dl following one day of therapy (p = 0.12, NS), and to 139.2 +/- 39.8 mg/dl after two weeks of treatment (vs. baseline p < 0.02).

CONCLUSIONS

It was concluded that erythromycin is an effective prokinetic agent for diabetic gastroparesis, and that corrected gastric emptying may improve glycemic control.

Effects of intravenous erythromycin on antroduodenal motility in humans: non-invasive observations with real-time ultrasound

Erythromycin has been shown to act on motilin receptors on gastrointestinal smooth muscle in vitro and to accelerate gastric emptying in normal subjects as well as in patients with diabetic mellitus. To evaluate the motor pattern that accounts for this accelerated emptying, the effects of 12.5 mg/min erythromycin vs. placebo on postprandial motility of the antroduodenum was examined with real-time ultrasound in 15 normal subjects. During 10 minutes of observation, erythromycin significantly increased forward transpyloric flow episode (1.04 +/- 0.19 vs. 0.37 +/- 0.41; p < 0.05), forward transpyloric flow duration (5.79 < 4.49 vs. 3.19 < 1.72 seconds; p < 0.05) and improved antro-pyloro-duodenal coordination (0.43 +/- 0.23 vs. 0.21 +/- 0.17; p < 0.05). However, no significant differences were found for gastric peristaltic cycle (22.62 +/- 3.06 vs. 23.40 +/- 2.14 seconds; p > 0.05), retrograde transpyloric flow episode (0.13 +/- 0.16 vs. 0.18 +/- 0.29; p > 0.05), and retrograde transpyloric flow duration (1.24 +/- 0.30 vs. 1.38 +/- 0.58 seconds; p > 0.05). We conclude that erythromycin increases episode and duration of forward transpyloric flow, and improves antro-pyloro-duodenal coordination, which may play a role in accelerating gastric emptying.

The relationship between Helicobacter pylori infection and gastric emptying in patients with non-insulin-dependent diabetes mellitus

Forty-four patients with non-insulin-dependent diabetes mellitus (NIDDM) were included in this study. Radionuclide-labelled solid meals were used to calculate gastric emptying times (GETs). The carbon-14 urea breath test (14C-UBT) was used to diagnose Helicobacter pylori (HP) infection. The patients were separated into groups according to the following two criteria: (1) HP infection was diagnosed on the basis of a 14C-UBT value of > or = 1.5; (2) the GET was defined as abnormal when it was > or = 117.1 min. The results showed that 61% (27/44) of the NIDDM patients had an HP infection, and 59% (26/44) had an abnormal GET. The incidence of abnormal GET in positive 14C-UBT patients (62%) was higher than that in negative 14C-UBT patients (56%). Similarly, the incidence of positive 14C-UBT in abnormal GET cases (62%) was higher than that in normal GET cases (56%). However, according to chi-square tests the differences were not significant. In conclusion, no significant relationship between HP infection and GET was found in patients with NIDDM.

Use of real-time ultrasound for detection of gastric motility

BACKGROUND

To evaluate the clinical applications and reproducibility of real-time ultrasound in detecting gastric motility, result of study of gastric motility in normal volunteers is reported.

METHODS

From January to May 1994, 21 normal volunteers, with a mean age of 31.7 years, 10 females and 11 males, entered this study. They fasted overnight. After consuming a liquid test meal (500 cc, 80.627 Kcal, containing sieved bran particles), they received real-time ultrasound examinations immediately to detect gastric peristalsis and transpyloric fluid flow. To evaluate the reproducibility of real-time ultrasound methods in gastric motility, four of the volunteers repeated this examination at an interval of one week.

RESULTS

The results showed that the mean gastric peristaltic cycle in humans is 24.29 seconds (s); mean forward transpyloric flow duration is 4.00 s; mean retrograde transpyloric flow duration is 1.45 s and mean time needed for initiating gastric peristaltic contractions after the test meal is 138.06 s. Age, body weight and body surface have a positive correlation to the mean gastric peristaltic cycle. Females, with a less body weight and body surface than males, exhibit a faster gastric peristaltic cycle. Real-time ultrasound is a reproducible method for studying gastric motility.

CONCLUSIONS

Real-time ultrasound is an inexpensive, reproducible and practical method for studying gastric motility. In addition, age, body weight and body surface have a positive correlation to gastric peristaltic cycle, with females, whose body weight and body surface are less than males, showing a shorter gastric peristaltic cycle.

Regulation of the immunostimulatory activity of rat pulmonary interstitial dendritic cells by cell-cell interactions and cytokines

Pulmonary dendritic cells (DC) are potent antigen-presenting cells that are thought to play a critical role in the initiation of immune responses within the lung. Because the lung is both a site of entry into the body for microbial pathogens and the organ of gas exchange, pulmonary immune responses must be meticulously regulated to achieve a balance between host defense and respiration. The initial interaction of DC with T cells in the lung is an excellent point at which to control local immune responses. Studies of the regulation of DC accessory cell function have been greatly hampered by difficulties in obtaining pure populations of pulmonary DC that have not been subjected to prolonged incubations during which the DC may undergo functional alteration. We now describe a method for isolating pulmonary DC from the rat that yields 1 x 10(5) cells/rat with > 90% purity. These cells are potent accessory cells, inducing T cell proliferation in a mixed leukocyte reaction (MLR) at a stimulator-to-responder ratio of 1:1,000. This method, which involves flow cytometric separation of nonphagocytic cells that stain brightly for class II MHC (OX6) from a population of low-density pulmonary interstitial cells, avoids extended incubations at 37 degrees C and thus allows study of a relatively pure population of cells that have functional capacities resembling those of naive cells from the normal lung. With these cells, we demonstrate that the functional capacity of pulmonary DC as stimulator cells in an MLR is significantly increased by exposure to the cytokines interleukin-1 or granulocyte/macrophage colony-stimulating factor (GM-CSF) and by culture with interstitial, but not alveolar, macrophages. Furthermore, DC are heterogeneous with respect to the cell surface expression of receptor for GM-CSF, and this expression is subject to modulation in cell culture. From these studies, we conclude that the immunostimulatory capacity of pulmonary DC is a function of local interactions with cytokines and other parenchymal cells. This suggests that DC function may be an important regulatory point for the local control of pulmonary immune responses.

Sclerotherapy on liver cirrhosis with esophageal variceal bleeding: eight years of experience

BACKGROUND

Patients with liver cirrhosis usually die of hepatic failure and variceal bleeding. Successful treatment of the latter can reduce mortality. Sclerotherapy is one method often used. This study compared (a) the successful rate of acute bleeding control; (b) short- and long-term survival rate between those with and without treatment with sclerotherapy to evaluate the clinical benefit of sclerotherapy for liver cirrhosis patients with esophageal variceal bleeding.

METHODS

Between August 1983 and December 1991, 183 cirrhotic patients with esophageal variceal bleeding receiving endoscopic injection sclerotherapy (EIS) was compared with 123 patients without sclerotherapy treatment retrospectively. The severity of underlying liver disease was classified using a modified Child's classification. Sclerotherapy was done within 48 hours after active bleeding in the sclerotherapy-treated group, while the medical treatment group received Sengstaken-Blakemore (SB) tube or pitressin infusion only.

RESULTS

Successful rate of acute bleeding control was 81.63% (120/147) in the EIS group and 59.35% (73/123) in the medical treatment group. The worse the hepatic function of the patients, the lower the success of acute bleeding control in both groups. Fifty subjects (74.63%) had varices eradicated in 67 sclerotherapy treatment patients with regular follow-up. Patients receiving EIS had a better long-term survival than those without treatment. Benefit of EIS on long-term survival was more significant in Child B patients and less in Child C and Child A patients. Death from variceal bleeding was lower in the EIS group than in the medical treatment group (32% vs 62.6%). Complications of EIS were rare. Eight patients died of aspiration pneumonia, spontaneous bacterial peritonitis or acute renal failure after sclerotherapy, and most were Child B and C patients. Sixteen patients had esophageal stricture. Four needed dilatation treatment.

CONCLUSIONS

The sclerotherapy-treated group had a higher control rate of acute bleeding and lower mortality rate from esophageal variceal bleeding compared with the medical-treated group. The procedure prolonged long-term survival in Child B patients but did so less frequently in Child A and Child C patients. The incidence of complications was low. As a whole, EIS is a safe and efficient method for control of esophageal variceal bleeding.

Evaluation of gallbladder function by quantitative radionuclide cholescintigraphy in patients with gallbladder sludge or stones

Thirteen patients with gallbladder sludge, 14 patients with gallstones and 24 control cases with normal gallbladders were included in the study. Gallbladder function was represented as the filling fraction (FF) and the ejection fraction (EF) calculated using quantitative 99Tcm-DISIDA cholescintigraphy and compared in the groups. The results showed that (1) the patients with normal gallbladders had the highest FF and EF, (2) those with gallstones had the lowest FF, (3) the patients with gallbladder sludge had the lowest EF, and (4) the coefficient of variation (CV) of FF and EF of the normal controls were less than those for the patients with gallstones or sludge. There was only a statistically significant difference between the normal controls and the patients with gallstones for FF. However, no significant differences existed among the three groups for EF. In our preliminary results, we found that gallbladder sludge or stones may impair gallbladder function, especially FF, as evidenced by noninvasive and quantitative 99Tcm-DISIDA cholescintigraphy, and the higher CV value suggests that gallbladder function in patients with gallstones or sludge is more variable.

Sclerotherapy for esophageal variceal bleeding in advanced hepatocellular carcinoma: an 8-year experience in Taiwan

Between August 1983 and December 1991 at the Taichung Veterans General Hospital, Taiwan, 65 advanced hepatocellular carcinoma (HCC) patients with esophageal variceal bleeding received endoscopic injection sclerotherapy (EIS) and 60 such patients received conservative medical treatment without EIS. The rate of successful control of acute bleeding was 72.5% (27/40 patients) in the EIS group and 56.7% (34/60 patients) in the non-EIS group. The rebleeding rate was lower in the EIS group than in the non-EIS group (26.9% vs 73.5%). Thirty-one of the EIS and 44 of the non-EIS treatment patients, mainly Child's B and C patients, died within 2 months after the first bleeding. In the short term, EIS decreased the mortality due to esophageal variceal bleeding, but the survivors still had to face hepatic failure and tumor growth. Thus, benefits of EIS were noted on short- but not on long-term survival. The mean survival times were 2.38 months for the EIS group and 1.79 months for the non-EIS group. Since EIS had no beneficial effects on long-term survival it is doubtful whether sclerotherapy applied to esophageal variceal bleeding in patients with advanced HCC would be worthwhile, as the endoscopic procedure would only add to their suffering.

Experimental murine pulmonary cryptococcosis. Differences in pulmonary inflammation and lymphocyte recruitment induced by two encapsulated strains of Cryptococcus neoformans

BACKGROUND

Cryptococcus neoformans, the most common cause of lethal mycosis in AIDS, usually causes only subclinical pneumonitis in normal hosts. However, cryptococcosis can induce various pulmonary inflammatory reactions, and pulmonary cellular immunity is postulated to prevent dissemination. We hypothesized that cryptococcal strains possess different capacities to induce recruitment to the lungs of inflammatory cells, especially lymphocytes, which are necessary for cryptococcal clearance.

EXPERIMENTAL DESIGN

We examined the pulmonary response of CBA/J mice to intratracheal inoculation with C. neoformans of either of two strains: 52D (ATCC 24067), which rarely kills immunocompetent mice; and 145A (ATCC 62070), which is uniformly fatal. From 2-42 days after inoculation, lungs were either examined grossly and microscopically or were enzymatically digested and inflammatory cells counted and analyzed by flow cytometry. At 42 days, organism burden in lung and brain was quantified by colony-forming unit assay.

RESULTS

Pulmonary inflammation differed greatly between the two strains. Strain 52D induced dense perivascular and alveolar inflammation; infection progressed to day 21 and then waned. In contrast, strain 145A induced delayed, meager lymphocytic infiltration and slight alveolitis; organisms grew progressively. Recovery of inflammatory cells increased by day 13 with strain 52D, but not until day 31 with strain 145A. Although all lymphocyte subsets were greater in 52D infection, the disparity was greatest for CD4+ T cells. Nevertheless, lymphocytes from paratracheal nodes of infected mice proliferated in vitro to heat-killed cryptococci, indicating immune recognition of both strains. At day 42, strain 52D lightly infected lungs but not brain, whereas strain 145A heavily infected lungs and brain. CONCLUSIONS; Cryptococcal strains differ in their capacity to induce pulmonary cellular inflammation, especially CD4+ T cell recruitment. Our results suggest that strain-specific difference in the organism's ability to induce (or evade) pulmonary inflammation contributes to the outcome of infection.

Inhibition of tumor necrosis factor production by lymphocytes from anti-TNF antibody-treated, cardiac-allografted rats

Tumor necrosis factor-alpha (TNF) is a multifunctional cytokine involved in the immunopathologic consequences of allograft rejection. We have previously demonstrated that anti-TNF antibody treatment prolongs cardiac allograft survival in rats. To elucidate the mechanism of anti-TNF antibody in modulating the immune response, we investigated TNF production by spleen and lymph node cells from anti-TNF antibody-treated Lewis rats who received MHC-mismatched Brown Norway rat cardiac allografts. In 10 untreated rats, cardiac allografts were rejected at 6.8 +/- 0.6 days after transplantation (mean +/- SD). Anti-TNF antibody treatment enhanced graft survival to 12.7 +/- 1.4 days (P < 0.001 vs controls). In other anti-TNF antibody-treated recipients spleen and lymph node cells were isolated on Day 5 after transplant. TNF production was measured and showed significantly less TNF than those from untreated (no anti-TNF antibody), transplanted recipient rats (28.7 u/10(6) spleen cells vs 76.4 u/10(6) spleen cells at 2 hr and 4.6 u/10(6) lymph node cells vs 9.2 u/10(6) lymph node cells at 24 hr). Furthermore, following lipopolysaccharide stimulation, spleen cells from anti-TNF-treated rats again produced significantly less TNF than those from untreated transplanted rats (68.9 u/10(6) cells vs 189.4 u/10(6) cells at 2 hr). Finally, with allogeneic cell stimulation, anti-TNF treated rats again produced significantly less TNF than untreated transplanted rats (spleen cells, 2.2 u/10(6) cells vs 40.4 u/10(6) cells at 24 hr; lymph node cells, 1.2 u/10(6) cells vs 22.2 u/10(6) cells at 72 hr). These findings suggest that anti-TNF antibody treatment may not only neutralize TNF activity, but also suppress TNF production itself, providing a new insight into the regulation of TNF by anti-TNF antibody.

Influence of age on gastric emptying in healthy Chinese

Radionuclide gastric emptying studies, including solid and liquid phases, were used to evaluate the gastric motility of healthy Chinese. Forty-eight patients (18-76 years old) and 38 volunteers (27-79 years old) accepted solid or liquid food gastric emptying studies, respectively. The solid meal was two fried eggs mixed with 500 microCi Tc-99m phytate and two pieces of toast to form a sandwich. The liquid meal was 500 ml of water with 5% glucose and 500 microCi Tc-99m phytate. Studies were performed with the subjects in the supine position and a gamma camera in a left anterior oblique (LAO) position while data were collected for 90 minutes and 30 minutes after finishing the solid and liquid meal, respectively. The gastric emptying time was presented as a half-time (t1/2) of the food emptying from the stomach. The study results showed that the t1/2 is 89.0 +/- 17.8 in older patients (> 60 years old) and 88.0 +/- 18.2 in younger patients (< or = 60 years old) for the solid phase studies (P > 0.05), and that the t1/2 is 46.2 +/- 11.1 in older patients (> 60 years old) and 31.9 +/- 11.3 in younger patients (< or = 60 years old) for the liquid phase studies (P < 0.05). We concluded that the age effects of gastric emptying in healthy Chinese occurred only in the liquid phase.

CD8 cells play a critical role in delayed type hypersensitivity to intact Cryptococcus neoformans

Although cell-mediated immunity is critical for optimal host defense to C. neoformans, the role of T lymphocyte subsets is complex and poorly understood. CD8 cells are important both for optimal host defense against C. neoformans, and for expression of delayed type hypersensitivity (DTH). Because host defense correlates with the ability to mount a DTH response to C. neoformans, the current studies were performed to determine the mechanism by which CD8 cells participate in DTH. Mice were immunized by the intratracheal route with live C. neoformans, or by the subcutaneous route with heat-killed C. neoformans. Mice were depleted of CD8 cells in vivo by administration of mAb. After challenge with soluble cryptococcal Ag, the DTH response was quantified as footpad swelling. We found that mice depleted of CD8 cells before immunization were unable to express DTH. Mice depleted of CD8 cells after immunization but before challenge also were unable to express DTH. Splenocytes of mice depleted of CD8 cells in vivo, before immunization, failed to transfer DTH to naive, undepleted mice. Immune splenocytes depleted of CD8 cells in vitro also failed to transfer DTH to naive, undepleted mice. These data indicate that CD8 cells were necessary during the challenge and immunizing phases of DTH, and were necessary for expression of DTH. However, CD8 cell depletion did not abrogate DTH in mice immunized with either soluble cryptococcal Ag in complete Freund's adjuvant, or sheep red blood cells, which are mediated by CD4 cells. These data suggest that CD8 cells play a critical role in the cell-mediated immune response to C. neoformans. Based on this information, it may be possible to protect hosts with deficiencies of CD4 cells, such as in AIDS, by designing immunizing strategies for stimulating CD8 cells.

CD8 cells play a critical role in delayed type hypersensitivity to intact Cryptococcus neoformans

Although cell-mediated immunity is critical for optimal host defense to C. neoformans, the role of T lymphocyte subsets is complex and poorly understood. CD8 cells are important both for optimal host defense against C. neoformans, and for expression of delayed type hypersensitivity (DTH). Because host defense correlates with the ability to mount a DTH response to C. neoformans, the current studies were performed to determine the mechanism by which CD8 cells participate in DTH. Mice were immunized by the intratracheal route with live C. neoformans, or by the subcutaneous route with heat-killed C. neoformans. Mice were depleted of CD8 cells in vivo by administration of mAb. After challenge with soluble cryptococcal Ag, the DTH response was quantified as footpad swelling. We found that mice depleted of CD8 cells before immunization were unable to express DTH. Mice depleted of CD8 cells after immunization but before challenge also were unable to express DTH. Splenocytes of mice depleted of CD8 cells in vivo, before immunization, failed to transfer DTH to naive, undepleted mice. Immune splenocytes depleted of CD8 cells in vitro also failed to transfer DTH to naive, undepleted mice. These data indicate that CD8 cells were necessary during the challenge and immunizing phases of DTH, and were necessary for expression of DTH. However, CD8 cell depletion did not abrogate DTH in mice immunized with either soluble cryptococcal Ag in complete Freund's adjuvant, or sheep red blood cells, which are mediated by CD4 cells. These data suggest that CD8 cells play a critical role in the cell-mediated immune response to C. neoformans. Based on this information, it may be possible to protect hosts with deficiencies of CD4 cells, such as in AIDS, by designing immunizing strategies for stimulating CD8 cells.

The relationship between Helicobacter pylori-associated gastritis or ulcer disease and gastric emptying

Forty-five patients with Helicobacter pylori (HP)-associated gastritis or ulcer disease were included in this study. Radionuclide-labelled solid meals were used to calculate gastric emptying times (GETs) and carbon-14 urea breath tests (14C UBTs) were used to measure the HP colonies quantitatively. The patients were assessed according to the following two criteria: (a) the HP colony number (i.e. high or low) and (b) the recorded duration of the GET (i.e. long or short). There was no statistically significant difference in the incidence of abnormal GET between high and low 14C UBT patients or in the incidence of abnormal 14C UBT between long and short GET cases. In conclusion, no significant relationship between HP-associated gastritis or ulcer disease and GET was found in this study.

[Autopsy study of 4074 pediatric cases]

4074 pediatric autopsies were performed in the Pathology Department of Guangzhou Children's Hospital from 1958 to 1992. The autopsy rate was 23.9%. However, the autopsy rate from 1958 to 1965 was higher (38.90%) than that for 1966 to 1976 (13.20%). Since 1977, the autopsy rate increased to 24.80% but still lower than the period between 1959 to 1965. Based upon the pathologic diagnosis, incorrect antemortem diagnosis was found in 22% of cases. It is of interest to note that the percentage of incorrect diagnosis was lower during the 1958-1969 period than the 1970-1992 period (15.30% and 25% and 25.8% respectively). This suggests that adoption of advanced diagnostic technique have not diminished the role of postmortem examination to confirm or correct clinical diagnosis.

Effect of granulocyte-macrophage colony-stimulating factor on rat alveolar macrophage anticryptococcal activity in vitro

Cryptococcus neoformans, a pathogenic fungus usually acquired by inhalation, causes the most common lethal mycosis in AIDS. The resident lung phagocytes, alveolar macrophages (AM phi), inhibit growth of C. neoformans poorly unless activated by cytokines such as IFN-gamma. In this study, we examined the effect of rat AM phi of the potent hematopoietic and M phi-activating cytokine, granulocyte-macrophage CSF (GM-CSF), alone and in combination with other cytokines. Rat AM phi monolayers were preincubated with 0.1 to 1000 U/ml GM-CSF without or with other recombinant cytokines, and then were incubated with viable C. neoformans (strain H99/C3D). Growth inhibition was assessed by counting cryptococcal CFU at 24 and 48 h of coculture; AM phi proliferation was assessed by measuring both uptake of [3H]TdR and AM phi numbers. AM phi preincubated with GM-CSF for 5 days (but not for shorter periods) inhibited growth of C. neoformans. Anticryptococcal activity required direct contact of AM phi with C. neoformans, but once induced by preincubation, did not require continued exposure to GM-CSF. Induction of anticryptococcal activity by GM-CSF was dose dependent (maximal induction at 250 U/ml), and was due to both increased ingestion and killing. GM-CSF induced AM phi proliferation, but anticryptococcal activity was not due totally to increases in AM phi numbers, indicating AM phi activation by GM-CSF. GM-CSF-induced AM phi proliferation was increased by IL-6, unchanged by IL-8, and abolished by LPS or IFN-gamma. However, IL-6 did not increase GM-CSF-induced anticryptococal activity. The combination of GM-CSF and IFN-gamma showed rapid and sustained anticryptococcal activity, unlike either cytokine alone. Our in vitro data suggest that the combination of GM-CSF and IFN-gamma may have beneficial effects on host defense against C. neoformans in vivo.

Effect of granulocyte-macrophage colony-stimulating factor on rat alveolar macrophage anticryptococcal activity in vitro

Cryptococcus neoformans, a pathogenic fungus usually acquired by inhalation, causes the most common lethal mycosis in AIDS. The resident lung phagocytes, alveolar macrophages (AM phi), inhibit growth of C. neoformans poorly unless activated by cytokines such as IFN-gamma. In this study, we examined the effect of rat AM phi of the potent hematopoietic and M phi-activating cytokine, granulocyte-macrophage CSF (GM-CSF), alone and in combination with other cytokines. Rat AM phi monolayers were preincubated with 0.1 to 1000 U/ml GM-CSF without or with other recombinant cytokines, and then were incubated with viable C. neoformans (strain H99/C3D). Growth inhibition was assessed by counting cryptococcal CFU at 24 and 48 h of coculture; AM phi proliferation was assessed by measuring both uptake of [3H]TdR and AM phi numbers. AM phi preincubated with GM-CSF for 5 days (but not for shorter periods) inhibited growth of C. neoformans. Anticryptococcal activity required direct contact of AM phi with C. neoformans, but once induced by preincubation, did not require continued exposure to GM-CSF. Induction of anticryptococcal activity by GM-CSF was dose dependent (maximal induction at 250 U/ml), and was due to both increased ingestion and killing. GM-CSF induced AM phi proliferation, but anticryptococcal activity was not due totally to increases in AM phi numbers, indicating AM phi activation by GM-CSF. GM-CSF-induced AM phi proliferation was increased by IL-6, unchanged by IL-8, and abolished by LPS or IFN-gamma. However, IL-6 did not increase GM-CSF-induced anticryptococal activity. The combination of GM-CSF and IFN-gamma showed rapid and sustained anticryptococcal activity, unlike either cytokine alone. Our in vitro data suggest that the combination of GM-CSF and IFN-gamma may have beneficial effects on host defense against C. neoformans in vivo.

In vivo depletion of murine CD8 positive T cells impairs survival during infection with a highly virulent strain of Cryptococcus neoformans

Cell-mediated immunity plays an important but incompletely understood role in host defense against Cryptococcus neoformans. Because of their multiple capacities as cytokine-secreting cells, cytotoxic cells, and antigen-specific suppressor cells, CD8 positive T lymphocytes could potentially either enhance or impair host defense against C. neoformans. To determine whether CD8 T cells enhance or inhibit host defence during an infection with a highly virulent strain of C. neoformans, we examined the effect of in vivo CD8 cell depletion on survival and on the number of organisms in mice infected by either the intratracheal or intravenous routes. Adequacy of depletion was confirmed both phenotypically and functionally. Regardless of the route of infection, we found that survival of mice depleted of CD8 T cells was significantly reduced compared to undepleted mice. Surprisingly, however, CD8 depletion did not alter organism burden measured by quantitative CFU assay in mice infected by either route. These data demonstrate that CD8 positive T cells participate in the immune response to a highly virulent strain of C. neoformans. By contrast to minimally virulent isolates that do not cause a life threatening infection, the immune response to a highly virulent isolate does not alter the burden of organisms, but does enhance host defense as it is necessary for the optimal survival of infected mice.

Accuracy of a rapid 10-minute carbon-14 urea breath test for the diagnosis of Helicobacter pylori-associated peptic ulcer disease

Urease in the human gastric mucosa is a marker for infection with Helicobacter pylori (HP), an organism which is associated with peptic ulcer disease. To detect gastric urease, we examined 184 patients (144 males, 40 females; mean age: 49.8 +/- 15.6 years) with suspected peptic ulcer disease. Fasting patients were given orally 5 microCi of carbon-14 labelled urea. From each patient only one breath sample was collected in hyamine at 10 min. The amount of 14C collected at 10 min was expressed as follows: [(DPM/mmol CO2 collected)/(DPM administered)] x 100 x body weight (kg). The presence of HP colonization was determined by examination of multiple endoscopic prepyloric antral biopsy specimens subjected to culture or a rapid urease test. For the purpose of this study, HP-positive patients were defined as those with characteristic bacteria as indicated by a positive result of either the culture or the rapid urease test; HP-negative patients were defined as those with negative findings on both the culture and the rapid urease test. Of the 184 cases, 99 (53.8%) were positive for HP infection, and 85 (46.2%), negative. The sensitivity and specificity of the rapid 10 min 14C-urea breath test for the diagnosis of HP-associated peptic ulcer disease were evaluated by a receiver operating characteristic (ROC) curve with a variable cut-off value from 1.5 to 4.5. When a cut-off value of 1.5 was selected, the sensitivity was 100% and the specificity, 83.5%; when a cut-off value of 4.5 was selected, the sensitivity was 54.5% and the specificity, 97.6%.

Colloidal bismuth subcitrate, ranitidine, and ranitidine plus metronidazole in the treatment of duodenal ulcer and Helicobacter pylori infection: a controlled and prospective study

A controlled, prospective clinical trial of colloidal bismuth subcitrate (CBS), ranitidine and ranitidine plus metronidazole for the treatment of duodenal ulcer (DU) is reported here, with evaluation of the possible pathogenic role of Helicobacter pylori (HP) on DU in a six-month follow-up. A total of 42 patients with active DU on endoscopy were randomly selected to receive oral CBS (300 mg 1 hour before each meal, and at bedtime, n = 16), ranitidine (150 mg bid; n = 12) or ranitidine (150mg b.i.d.) plus metronidazole (250 mg t.i.d; n = 14) treatment for one month. Ulcer healing was endoscopically evaluated. Healed patients received another two-week treatment; unhealed subjects received another one-month treatment with the same agents. Healed patients were followed endoscopically at 1, 3, and 6 months after the cessation of medication without maintenance therapy. Unhealed or relapsed subjects were excluded. To assess HP status, during each endoscopy two prepyloric mucosal biopsies were taken for urease testing and culture of HP. The prevalence of HP in patients with DU was 95.2%. Data showed that those treated with CBS had a lower DU healing rate than those treated with ranitidine or ranitidine plus metronidazole after the one-month treatment, but there was no statistical significance in the DU healing rates after the two-month treatment, and at follow-up six months after the cessation of medication. After one month of treatment those treated by CBS showed the highest rates of HP clearance on gastric antral mucosa among the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Depletion of murine CD8+ T cells in vivo decreases pulmonary clearance of a moderately virulent strain of Cryptococcus neoformans

Host defense mechanisms to the important fungal pathogen Cryptococcus neoformans are complex and incompletely understood. From in vitro studies, we could expect CD8+ T cells to have the potential for both protective and suppressive effects on defense against cryptococci. The current study used the technique of in vivo subset depletion to determine the net effect of CD8+ T cells during actual infection. Mice depleted of CD8+ T cells by monoclonal antibody (YTS 169.4) injections were infected with the moderately virulent cryptococcal strain 613D by the intratracheal route, which mimics natural pulmonary infection. To ensure adequacy of depletion, T cell subsets were enumerated by flow cytometry in blood, spleen, lymph node, and lung. Specific elements of host defense were measured by clearance of cryptococci in vivo and by the response to cryptococcal antigens, both in vivo by delayed-type hypersensitivity (DTH) and in vitro by lymphocyte proliferation. We found that depletion of CD8+ T cells decreased pulmonary clearance of C. neoformans. CD8 depletion abrogated DTH without affecting antigen recognition or lymphocyte proliferation in vitro. These data demonstrate that the net effect of CD8+ T cells to a moderately virulent strain of C. neoformans is to enhance rather than suppresses host defenses. Abrogation of DTH suggests that CD8+ T cells contribute to the protective immunologic response to C. neoformans. It is possible that in hosts deficient in CD4 cells, such as patients with AIDS, the protective effects of CD8+ T cells could be stimulated by selected immunizing epitopes.

Enhancement of lymphocyte proliferation assays by use of serum-free medium

Fetal bovine serum (FBS)-supplemented cell culture medium has been the standard medium used in assays of murine lymphocyte proliferation. While FBS allows cell growth and viability, it requires screening and contains uncharacterized elements which may yield inconsistent results from batch to batch. It also may include growth factors and immunologically reactive proteins that obscure assays for specific responses because of high background proliferation. Recently, chemically defined serum-free media have become available for human lymphocyte culture. We compared several of these media against FBS-supplemented medium and found that one of them, AIM V (Gibco), produced a marked increase in the ratio of positive to background counts in [3H]thymidine incorporation assays of antigen-specific proliferation. Similar results were obtained when responses to mitogenic lectins were examined. AIM V supported proliferation of lymphocytes in a variety of haplotypes, it supported MHC-specific proliferation in response to soluble antigens in a manner consistent with previous reports, and it supported proliferation in response to alloantigen as displayed in the mixed lymphocyte culture. A high ratio of positive to background counts was consistently observed. The results indicate that this serum-free medium enhances the analytic power of proliferation assays.

Hepatitis delta virus superinfection in Guangzhou area

Biopsy and autopsy specimens of liver tissues of two series of patients, one of adults and the other children suffering from hepatitis B virus (HBV) infection were used to evaluate hepatitis delta virus antigen (HDAg) by direct immunoperoxidase staining method. The results showed that four HDAg positive cases were found among 30 cases of HBV infected adult patients (13.3%), and 6 were found in 44 cases in the children series (13.6%). Therefore, we are convinced that hepatitis delta virus (HDV) superinfection does exist in Guangzhou area. The superinfection rates in adults and children are almost identical.

Disseminated histoplasmosis capsulatum. A report of two autopsy cases

The autopsy findings of two cases of disseminated histoplasmosis capsulatum are reported here. The pathologic changes involved multiple organs, such as lungs, liver, spleen, kidneys, thymus, and deep and superficial lymph nodes. The main pathologic features were caseous necrosis and macrophage infiltration, which engulfed numerous histoplasma in yeast form. In the first case, the colon and skin were also attacked by histoplasma capsuli, as was the head of pancreas in the second case. Acute regression of the thymus was found in both cases.

[Dynamic observation of the fibronectin content in plasma and subeschar tissue following burn]

Plasma and subeschar Fn levels were measured by one-dimension rocket immunoelectrophoresis and hemagglutination assay. In 16 healthy individuals, the mean value of plasma Fn was 318.7 +/- 82 micrograms/ml. In 16 burn patients with burn extent over 50% there was a significant lower plasma Fn value in all cases on the 1 day postburn (197.2 +/- 69.5) and 1 week postburn (189.4 +/- 84). It returned to within normal range on the 2 or 3 weeks postburn. Plasma Fn decreased progressively before death in 7 non-survivors. In another 19 patients with minor burns (less than 50%) plasma Fn values were all within normal range. Fn level of subeschar tissue shown by the study, Fn sequestration at sites of tissue injury may serve as a physiologic role in wound healing, this may also contribute to a deficiency of Fn in the plasma that may decrease host defense function. The causes of reduction of plasma Fn in major burned patients with sepsis were briefly discussed.

Monoclonal antibodies define the characteristics and cellular distribution of an Ia-associated protein

In a recent report we described the identification of physical associations between Major Histocompatibility Complex (MHC) Class II (Ia) antigens and other structures of Mr 67,000, which were significantly enhanced following brief T-B cell co-culture (1). To further investigate this 67K Ia-associated product, monoclonal antibodies (MAb) were produced against isolated 67K material and their reactivity examined. Cell surface binding by these MAb was detected only after perturbation of the membrane by cellular adherence or following aldehyde fixation, which indicates that the determinant recognized by these mAb is retained in the plasma membrane in a covert fashion. All lymphoid cells tested showed reactivity with the MAb as determined by immunofluorescence and by ELISA, but no binding was detected on bone marrow or peritoneal macrophages. Expression of the antigen reactive with these antibodies followed a similar pattern with established murine cell lines, with T and B cell lines and a pre-B cell line showing reactivity, while no antigen was detected on macrophage-like and fibroblast cell lines. The intensity of antigen expression by normal lymphoid cells was ordered: thymocytes greater than splenic T cells greater than or equal to bone marrow lymphocytes greater than splenic B cells. No correlation was observed between expression of Ia antigens by non-lymphoid cells and expression of the 67K molecule. These observations suggest that this antigen is primarily a marker of lymphoid cells, with the highest expression on cells of the T lymphocyte lineage. Finally, inhibition of antigen-specific, MHC-restricted T-cell activation by the MAb directed against the 67K structure suggests an important functional role for this interesting molecule originally identified by its physical association with Ia following T-B cell interactions.

[The treatment of maxillofacial hemangioma with transcatheter embolization]

Preliminary experience obtained from 7 cases with maxillofacial hemangioma treated with the external carotid arterial transcatheter embolization is presented. Of the 7 cases 2 were diagnosed as racemose hemangioma, 1 case as cavernous hemangioma and 4 cases as central mandibular and zygomatic arch cavernous hemangioma. External carotid arterial transcatheter embolization was adopted as radical treatment of hemangioma in 3 cases. Of them, excellent result was achieved in 1 case, and good in 2. Embolization was used as preoperative preparation for the treatment of hemangioma in 2 cases. Two operations were successfully performed and the results of hemostasis were excellent during the operation. The arterial transcatheter was all performed with Seldinger technique and through transfemoral approach. The embolization agents used included gel form, absolute ethanol, medical TH glue, sodium morrhuate, etc. The advantages of this method, and the relationships between the properties of the embolization agents and the effect of embolization, the physiological function of the target organ and the complication are discussed and evaluated.

Transcatheter arterial chemoembolization for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) was treated with transcatheter arterial chemoembolization (TACE) in a sample of 129 patients. The cumulative survival rate was 49% at 1 year and 22% at 2 years. The median survival time was 11.9 months. The survival rates at 1 year of 84 patients in Child's group A and 27 in Child's group B were 56% and 40%; out of 52 HCC patients with portal vein patent and 77 with portal vein invasion 75% and 40% survived, and the 1-year survival rates for 33 HCC patients with capsule intact, 14 with capsule broken and 82 with no capsule were 85%, 65% and 40% respectively. From the above results there were statistically significant differences in survival time in those with good clinical performance status by Child's classification, those showing patency of the portal vein and those where the capsule was present. Therefore, we would like to recommend, TACE of HCC in well-selected patients presenting with good clinical status, patency of the portal vein and without broken capsule, in order to achieve better clinical results.