Jejunal bacterial overgrowth and intestinal permeability in children with immunodeficiency syndromes

Seventeen paediatric patients with immunodeficiency syndromes (10 with selective IgA deficiency, four with panhypogammaglobulinaemia, and three with selective T cell deficiency) were investigated for bacterial overgrowth of the small intestine and gut permeability to macromolecules. Five of 12 patients showed viable bacterial counts of more than 2 x 10(5)/ml in jejunal fluid. Bacterial overgrowth was also confirmed indirectly by breath hydrogen determination, which was higher than 10 ppm in four of the five patients with positive jejunal culture. Gut permeability to lactulose and L-rhamnose was abnormal in 16 of the 17 immunodeficient patients, who also had higher mean urinary excretion ratios than control subjects-mean (SD) values were 0.216 (0.160) and 0.029 (0.002), respectively. These studies indicate that bacterial overgrowth of the small intestine is a common feature in immunodeficient patients, regardless of the immunological abnormality. Moreover, these patients have an increased gut permeability to macromolecules.

Penetration of cefonicid into human lung tissue and lymph nodes

The present study was undertaken in order to investigate the penetration of cefonicid, a long-acting parenteral cephalosporin, with enhanced activity against most gram-positive and gram-negative pathogens, into human lung tissue and lymph nodes in patients undergoing open thoracotomy. Samples of lung tissue, lymph nodes and serum were obtained at various times after a single intramuscular dose of 1 g. The concentration of cefonicid was assayed by an agar diffusion method with Bacillus subtilis used as the test organism. The mean concentrations of cefonicid in serum at 2, 4, 8, 12 and 24 h after the injection were 91.5, 66.1, 35.7, 21.8 and 2.9 micrograms/ml, respectively. The mean levels of cefonicid into the hilar lymph nodes at the same times were 22.3, 18.7, 12.0, 6.9 and 1.5 micrograms/ml, respectively, while its concentrations in lung tissue were lower than those in lung lymph nodes up to the 12th hour (12.1, 14.6, 7.8, 5.4 and 1.9 micrograms/ml, respectively). Our results show that cefonicid was well distributed in interstitial fluid from which pulmonary lymph is formed and that its concentrations in lung tissue and lymph nodes were sufficient to inhibit most pathogens involved in respiratory tract infections. This finding was considered important, because it demonstrated that the high binding by plasma protein of cefonicid did not prevent it from entering lung tissue and fluids in useful quantities.

Effect of prednisone on DR-positive T cells in children with chronic active hepatitis B

The effect of short-term immunosuppressive treatment on the percentage of circulating DR-bearing T cells was investigated in 16 children with HBsAg-positive chronic active hepatitis. DR-positive T cells, thought to represent activated T cells, were significantly increased in all patients as compared to 10 age-matched controls [14.5 +/- 4.2% (mean +/- SD) vs. 0.4 +/- 0.1%, p less than 0.001]. Fifty-six percent of patients showed a decrease in the percentage of DR-positive T cells after 72 h of prednisone therapy. A response did not correlate with the presence of HBeAg, anti-HBeAg, or anti-delta antibodies. There was an inverse relationship (r = -0.56; p less than 0.05) between the decrease of the percent of DR-positive T cells during immunosuppression and pretreatment alanine aminotransferase levels. The persistence of high levels of circulating DR-bearing T cells during therapy may represent the immunological counterpart of more severe disease, and of nonresponsiveness to corticosteroids.

[Primary intestinal lymphomas. Review of the literature apropos of a clinical case]

A rare case of primary lymphoma of the bowel in a 26 year old woman is reported and the complex problems of diagnosis and treatment are examined. The importance of establishing the primary or secondary nature of this tumour of the small bowel is emphasised. This is because primary intestinal tumours require the most radical treatment possible even in advanced stages of the disease in order to avoid complications and to identify the areas involved in the proliferative process. Finally the importance of continuing surgery with drug and radiation treatment in order to improve prognosis is emphasised.

Action of anticytoskeletal compounds on in vitro cytopathic effect, phagocytosis, and adhesiveness of Trichomonas vaginalis

The cytopathic effects of Trichomonas vaginalis treated with inhibitory concentrations of anticytoskeletal compounds (mebendazole, griseofulvin, colchicine, taxol, and cytochalasin B) were studied in mouse CLID fibroblast cultures. The evaluation, at different times, of cell numbers and morphological alterations showed that cytopathic effect was considerably reduced when protozoa were pretreated with mebendazole and griseofulvin, whereas colchicine, taxol, and cytochalasin B had less effect. Furthermore, treatment with mebendazole, griseofulvin, and colchicine decreased adhesiveness of the protozoan, whereas treatment with cytochalasin B and colchicine completely inhibited its phagocytic activity. From these results it may be concluded that alterations induced in the trichomonal cytoskeleton may affect its adhesiveness and its in vitro cytopathic effect, but there is no direct correlation between protozoan phagocytosis and its in vitro pathogenic effect.

Evaluation of Pseudomonas aeruginosa influence on the cytoskeleton of Hep-2 cells

The cell cytoskeleton (microtubules, microfilaments and intermediate filaments) plays an important role in many cell functions, such as maintenance of cell locomotion, movement and compartimentalization of intracellular organelles and cell-to-cell interaction. Therefore, cytoskeleton alterations may result in sever impairment of cell functions. The aim of this paper was to study the in vitro effects of Pseudomonas aeruginosa on the cytoskeleton of cultivated Hep-2 cells. Cytoskeleton modifications were evidenced by immunofluorescence using monoclonal and polyclonal antibodies against tubulin and vimentin, and rhodamine conjugated phalloidin, that specifically binds to actin microfilaments. We report here that P. aeruginosa has a strong cytopathic effect on monolayers within a few hours of contact with the cells, and influences the organization of microfilaments, but has no discernable effect on microtubules or intermediate filaments.

Immunoregulatory functional abnormalities in children affected by HBsAg-positive chronic active hepatitis: role of prostaglandins in T-mediated suppression

Suppressor cell function was evaluated in children affected by HBsAg-positive chronic active hepatitis. Circulating concanavalin A- (ConA) precultured lymphocytes failed to suppress the proliferative response of autologous responder cells to a mitogen. In four of eight patients with a failure of ConA-induced suppressor activity, indomethacin added during the induction phase of T suppressor cells abolished the defect, indicating that prostaglandin-producing adherent cells may influence ConA-induced suppressor activity. An inverse relationship between suppressor cell activity and the number of suppressor/cytotoxic subsets defined by the OK T8 monoclonal antibody was found. Our findings strongly support the hypothesis that an abnormality in the immunoregulatory system plays a role in the pathogenesis of HBsAg-related chronic active hepatitis. It is also suggested that non-T regulatory cells are implicated in the immunological abnormality in chronic active hepatitis.

Inhibition of Trichomonas vaginalis replication by the microtubule stabilizer taxol

Taxol, a plant alkaloid stabilizer of microtubules, inhibits in vitro the replication of the human pathogenic flagellate Trichomonas vaginalis in a dose-dependent fashion. Micromolar concentrations of the drug induce massive assembly of microtubules, resistant to antimicrotubule agents, and block the mitosis of the protozoa at an early stage preceding the formation of the spindle fibers and the depolymerization of the axostylar microtubules. Some hypotheses involving the inactivation of the microtubule-organizing centers and the stabilization of axostylar microtubules are formulated to explain the mechanism of action of taxol.

Impaired suppressor activity in children affected by coeliac disease

Immunoregulatory cells were enumerated in 19 coeliac disease children on a gluten free diet by means of monoclonal antibodies that define total T lymphocytes (T3), helper/inducer T cells (T4), suppressor/cytotoxic T cells (T8) and monocytes (M1), as well as by means of surface receptors for Fc fragments of IgM and IgG (T mu and T gamma, respectively). In addition, suppressor cell function was assessed in 17 coeliac disease patients by examining the ability of concanavalin-A (Con-A)-activated suppressor cells to inhibit autologous cell response to mitogenic stimulus as compared with age-matched controls. No statistically significant differences were found in the percentages of subsets defined by monoclonal antibodies between coeliac disease patients and age-matched controls, whereas coeliac disease patients had a significant decrease of the subpopulation bearing membrane receptor for Fc fragment of IgG. Mean value was 8.5% in coeliac patients versus 13.4% in age-matched controls. In the functional assay, mononuclear cells from 10 out of 17 coeliac disease patients either totally or partially failed to suppress responder cells after Con-A-activation. This defect is not related to HLA-DR status, because no difference was found between patients-HLA-matched and unmatched normal individuals. In this assay, mononuclear cells of three coeliac disease patients with low suppressor activity were able to inhibit responder cells to the same extent as controls, when indomethacin was used to block prostaglandin production in the induction phase of Con-A-activated suppressor cells. Our results suggest that an abnormality in immunoregulation may play a role in the pathogenesis of coeliac disease.

Microsurgical approach to pancreatic duct occlusion in the pig by means of a prolamine solution

Prolamine is an alcoholic solution of zein, with the property of polymerizing within 15 minutes in a humid medium. Such a substance has been injected in the pancreatic duct of 10 pigs with a microsurgical technique, causing complete occlusion. The prolamine gel produces a progressive fibrosclerosis of the exocrine pancreatic parenchyma, sparing the endocrine portion. The resulting pancreatic atrophy avoids the occurrence of inflammatory complications that often hamper surgery on such gland. The 10 pigs under study showed post-operative normal values of blood glucose and insulin, and a decrease in serum alpha-amylase levels. Complications occurred in only one case, and the microscopic pattern was similar in all cases. Microsurgical approach and use of prolamine are considered effective both in pancreatic transplantation and in chronic pancreatitis.

The cytoskeleton of hydatid cyst cultured cells and its sensitivity to inhibitors

Cell cultures obtained from the germinal layer of hydatid cysts of the parasitic tapeworm Echinococcus granulosus were characterized with respect to their microtubule and microfilament systems. These were stained using monospecific antibodies against tubulin from sea urchin spermatozoa or sheep brain and against Dictyostelium discoideum actin as well as rhodamine conjugated phalloidin. The results show that the distribution of microtubules nad actin containing fibres of these cells is remarkably similar to that of mammalian cells both during interphase and mitosis. Hydatid cells, however, could not be stained with a specific antivimentin antibody. Indirect immunofluorescence with antitubulin antibodies of inhibitor treated cells shows that hydatid cell microtubules are sensitive to several antimicrotubular drugs including benzimidazole derivatives, colchicine, vinblastine, and griseofulvin.

Immunoregulatory T subsets in chronic active viral hepatitis: characterization by monoclonal antibodies

Immunoregulatory T subsets, defined by monoclonal antibodies, were enumerated in children affected by HBsAg-positive chronic active hepatitis. The helper to suppressor/cytotoxic cells ratio was lower in patients than in age-matched controls. The lower ratio was mainly due to an increase of lymphocytes of the suppressor/cytotoxic phenotype. Helper cells were even fewer in severe chronic hepatitis patients, thereby lowering still further the helper/suppressor ratio. Therapy seemed to influence the ratio in patients affected by moderate active chronic hepatitis, for four of eight children treated with azathioprine and prednisone had a ratio within -1 SD of normal values. The increase of the suppressor/cytotoxic cells in patients affected by chronic hepatitis might be a means for limiting virus-induced cell hyperactivity.

Observations on the molecular components stabilizing the microtubular system of the marginal band in the newt erythrocyte

Microtubules have been classified as either stable or labile, according to their resistance towards depolymerizing agents. The highest stability belongs to those organized in composite structures, in which many other proteins are associated with the tubulin. Among these microtubular systems, the marginal band of amphibian erythrocytes is unusually stable. This system can be readily isolated from Triturus red blood cells, and therefore lends itself very readily to ultrastructural and biochemical analyses. Immunofluorescence and electrophoretic analyses of the isolated bands reveal 14 components, among which tubulin, actin, myosin and a 90K glycoprotein were identified. Tannic acid-glutaraldehyde fixation reveals a conspicuous opaque material surrounding the microtubules. Cationized ferritin binding suggests the presence of anionic sites. Moreover, neuraminidase causes the disorganization of the microtubule-associated opaque material. The 90K glycoprotein is presumed to be related to the unusual stability of the microtubular system forming the marginal band.

Nerve growth factor potentiates actomyosin adenosinetriphosphatase

The nerve growth factor protein (NGF) favors polymerization of brain actin and induces its organization to form paracrystalline structures that activate myosin ATPase (ATP phosphohydrolase, EC 3.6.1.3) to an extent greater than actin alone. Binding studies show that the initial 1:1 stoichiometry of NGF-G-actin complexes decreases to 1:7-10 when polymerization is ended and paracrystalline structures are formed. The ratio becomes even lower when heavy meromyosin is added in the absence of ATP, suggesting that heavy meromyosin displaces NGF bound to actin microfilaments. This conclusion is supported by the finding that when heavy meromyosin is added to NGF-microfilament complexes, under conditions for "decorating" microfilaments, the usual paracrystalline structure of the complexes disappears. The NGF-mediated organization of actin and activation of myosin ATPase is visualized as a self-regulatory and self-propagating mechanism, because progressive displacement of the growth factor induced by heavy meromyosin binding to F actin as ATP consumption proceeds renders an increasingly higher amount of NGF free for new interactions. These findings are discussed in the light of the mechanism of action of NGF in the target cells.

Effect of NGF on in vitro preformed microtubules. Evidence for a protective action against vinblastine

The nerve growth factor protein (NGF) induces organization of in vitro preformed microtubules (MTs) to form multiple arrays. These complexes, in cross-section, appear to be formed by clusters of single tubules in parallel in close contact with center distance similar to the diameter of a microtubule. In the absence of NGF, on the contrary, microtubules are far apart from each other. Addition of vinblastine to NGF-MT complexes does not result in the usual reorganization of microtubules into paracrystalline arrays, noticeable when the growth factor is not present. The vinblastine treated NGF-MT complexes have several round-shaped elements along the tubules and at their endings which, at higher magnification, appear to be formed by closely packed, ring-like structures. These 'boutons' are postulated to represent the point of resistance to the depolymerizing action of the vinca alkaloid. These findings are discussed in relation to a similar antagonistic effect observed in vivo between NGF and vinblastine and to the possible involvement of microtubules in the mechanism of action of the growth factor.

[Complete polygraphic examination using the Diamont and Killip calculations in the functional evaluation of the heart patient]

Recently discharged infarct patients were examined to assess their ability to rehabilitate. This led to the elaboration of a classification based on polygraphic parameters, rather than the history and clinical record, coupled with comparison with the ideal values given for such subjects by the formula of Diamont and Killip.

[Prevention of arrhythmias during heart catheterization]

The utility of using beta blocking drugs, specifically Pindolol, as a prophylaxis for arrhythmia during cardiac microcatheterism according to Grandjean's technique has been observed. The drug is even more useful when it is considered that it does not affect dp/dt value.