Effect of mast cell degranulation on gastric mucosal damage produced by sodium taurocholate in the rat

The source of the histamine released during damage to the gastric mucosa has been investigated in rats using perfused total gastric pouches. Two groups of rats were treated with either intraperitoneal normal saline or compound 48/80, and agent that produces mast cell degranulation, over a 5-day period. On the 5th day, total gastric pouches were prepared and connected to a perfusion circuit that enabled a 20-ml volume to be circulated through the pouches. The experiments consisted of three 30-min periods during which transmucosal potential difference was monitored and ionic (hydrogen and sodium) flux measured; standard acid solution was used in the first two periods and a taurocholate solution in the third. Sodium taurocholate produced a significant increase in ionic flux and fall in the potential difference, the magnitude of the changes being similar in the 48/80- and saline-treated groups. Histamine was released from the mucosa in significantly greater amounts during the taurocholate period, and the increase was similar in both groups of rats. Histological examination of the stomachs confirmed mast cell degranulation in the 48/80-treated groups. We conclude that the histamine released during mucosal damage is probably derived from the "nonmast cell pool" and that this histamine may play a role in mediating the mucosal damage.

Carbenoxolone and incorporation of (3H) glucosamine into gastric mucosa

The effect of carbenoxolone on incorporation of the labelled sugar, (3H) glucosamine, into rat gastric mucosa was examined. Rats were treated with either 25 mg/kg, or 50 mg/kg or 75 mg/kg carbenoxolone for 10 days. The rats were then killed and the uptake of (3H) glucosamine by gastric mucosal scrapings measured. There was no statistically significant difference in uptake between treated and untreated scrapings. The results do not confirm earlier findings of other investigators which suggested that carbenoxolone promoted gastric ulcer healing by stimulating specific glycosyl transferases to produce a modified mucus.

Nuclear glucocorticoid binding in chronic lymphatic leukemia lymphocytes

A reliable procedure is described for isolating 3H-triamcinolone acetonide (3H-TA) receptor complexes from purified chronic lymphatic leukemia (CLL) lymphocyte nuclei, based on the use of carbobenzoxy-L-phenylalanine (CBZ-L-phe) to prevent breakdown of hormone-receptor complexes during extraction of nuclei with 0.6M KCl. Using this method, specific nuclear glucocorticoid binding was demonstrated in 14/14 patients with untreated CLL. No correlation was found between levels of nuclear-associated 3H-TA and peripheral white blood cell count or rosetting ability of circulating lymphocytes.

Allescheria boydii infections in the immunosuppressed host

Allescheria boydii, a true fungus frequently isolated from soil, is best known as a causative agent of maduromycosis of the foot. In our report we describe two patients under treatment for acute leukemia who died from rapidly progressive A. boydii infections. One patient had signs of central nervous system infection and was found at autopsy to have had a large brain abscess. The second patient had a cavitary necrotizing pneumonia with thoracic inlet obstruction (Pancoast's syndrome) and failed to show improvement despite treatment with amphotericin B. The clinical spectrum of allescheriasis is reviewed with particular emphasis on its role as a pathogen in the compromised host. Since A. boydii may resemble other fungi morphologically in tissue sections and may produce infections clinically similar to other mycoses, culture of the organism is required for definitive diagnosis. Based on recently reported in vitro susceptibility studies, miconazole may have a future role in the therapy of A. boydii infections which are resistant to presently available antifungal agents.

Effect of histamine receptor antagonists on bile damage to the gastric mucosa of canine Heidenhain pouches

The net ionic fluxes of H+ and Na+ were examined in Heidenhain pouches during damage with sodium taurocholate solution. The increase in ionic flux which occurred with taurocholate could be prevented in animals given H1 and H2 histamine antagonists in combination. The results suggest that histamine mediates changes in the transmucosal ionic flux produced by bile acid.

Disseminated Trichosporon capitatum infection in an immunosuppressed host

Trichosporon is a frequent cause of superficial mycotic infections but has rarely been associated with invasive disease. A patient undergoing bone marrow transplantation who died from disseminated Trichosporon capitatum infection with endocarditis is reported, and the clinical spectrum of human infection caused by fungi of this genus is reviewed. To our knowledge, this is the first reported case of clearly invasive disease caused by this specific organism and emphasizes the expanding spectrum of unusual infections in the severely immunosuppressed patient.

Metronidazole in the treatment of chronic proctitis: a controlled trial

Twenty-two patients with chronic proctitis were treated with metronidazole for 28 days in a double-blind controlled trial, but they did not appear to benefit from the drug.

Paracoccidioidomycosis (South American Blastomycosis) in the United States

The findings in a patient with paracoccidiodomycosis (South American blastomycosis) diagnosed by open-lung biopsy and treated successfully with a combination of trimethoprim and sulfamethoxazole are reported, and the clinical spectrum of the disease is reviewed. Although paracoccidioidomycosis is rarely encountered in the United States and is clinicially similar to other deep mycoses, it should be considered in patients who are suspected of having a fungal infection and have had previous exposure in an area endemic for paracoccidiodomycosis.

The role of histamine receptors in the pathophysiology of gastric mucosal damage

In four canine Heidenhain pouches the net fluxes of H+ and Na+ have been examined before, during, and after instillation of sodium taurocholate into the pouch. These experiments were conducted in animals given H1 (mepyramine maleate) and H2 (metiamide) histamine antagonists, alone and in combination. Control experiments without antagonists were also conducted. In control experiments, as well as in those using the histamine antagonists separately, the usual sequence of events followed exposure to taurocholate-that is, a gain in the volume of the solution in the pouch and an increase in the fluxes of Na+ and H+ across the mucosa. In experiments in which H1 and H2 histamine antagonists were used in combination, taurocholate had very little effect on the ionic fluxes of H+ and Na+, suggesting that changes in the ionic permeability of the gastric mucosal barrier are mediated by histamine through both H1 and H2 receptor sites.

Effect of dietary bran on serum lipids in patients with previous myocardial infarction, with gallstones, and in normal subjects

Sixteen subjects received between 50 g to 121 g of wheat bran in their diet for between 6 to 26 weeks. Five were normal subjects, 5 had gallstones, and 6 young men had suffered a previous myocardial infarction. The serum cholesterol did not show any consistent change in the normal subjects, but there was a fall in cholesterol at 20 weeks in patients with gallstones; patients with previous myocardial infarction had a rise in cholesterol which returned to normal at 20 weeks. There was no significant change in the serum triglyceride.

Fungal endophthalmitis following intraocular lens implantation

Endophthalmitis developed in a 61-year-pld man after an intraocular lens implantation. A whitish opacity developed, visual acuity decreased to light perception, and we enucleated the eye. Paecilomyces lilacinus (Thom) Samson, a saphrophyte that has contaminated laboratory solutions, was cultured.

The prevalence of gallbladder disease in patients with ileostomy

The prevalence of gallstones has been examined in an unselected group of ileostomy patients who had undergone surgery for ulcerative colitis. In this group 11 of 55 patients were found to have gallbladder disease which is an overall incidence of 20%. This is considerably higher than that found in a control population in the same area.

Some minimal effects of bile acid on canine gastric mucosa in Heidenhain pouches

The gastric mucosa in four canine Heidenhain pouches was damaged with sodium taurocholate in a concentration which was just sufficient in each dog to produce consistent changes. Solutions were placed in the pouches and changes in the volume, concentrations, and fluxes of both hydrogen ion and sodium ion were measured before and during exposure to taurocholate. Changes which occurred with taurocholate were compared with control periods; taurocholate caused a relative increase in volume of 1 ml and approximately a fourfold increase in the hydrogen ion and sodium ion concentrations and the sodium ion flux. Changes in the hydrogen ion flux were smaller and, in some experiments, insignificant. Change in the hydrogen ion flux is less sensitive than the other parameters as an indicator of minimal mucosal damage.

The effect of an aldosterone antagonist on the protective action of carbenoxolone on the gastric mucosal barrier

The effect of an aldosterone antagonist on the protective action of carbenoxolone sodium on the gastric mucosal barrier has been studied in three dogs with Heidenhain pouches. The net fluxes of hydrogen ion and sodium ion were measured before, during, and after contact with a 10 mM bile acid solution at pH 2, in pouches which had not been treated with drugs, in pouches treated with carbenoxolone sodium and in pouches treated with both carbenoxolone sodium and the aldosterone antagonist, spironolactone. Hydrogen ion back diffusion from, and sodium ion gain by the untreated pouch was increased by 10 mM bile acid solution. Addition to the pouches of either carbenoxolone sodium alone or carbenoxolone sodium and spironolactone reduced the hydrogen ion back diffusion after exposure to the bile acid solution. The spironolactone did not change the protective effect of carbenoxolone on the gastric mucosal barrier. Carbenoxolone did not change the increased sodium ion diffusion caused by bile.

Immunoglobulin E in rectal mucosa of patients with proctitis

Rectal-biopsy specimens were obtained from a group of patients with proctitis in different stages of activity. Large numbers of brightly fluorescent IgE-producing cells were demonstrated in rectal-biopsy specimens taken from these patients during disease activity and clinical remission. An immediate hypersensitivity reaction is suggested as one of the mechanisms involved in the pathogenesis of proctitis.

Disodium cromoglycate in the treatment of chronic proctitis

The effect of topical disodium cromoglycate (DSCG) has been examined in 30 patients with chronic active proctitis using a double-blind crossover trial. Each treatment period was four weeks and patients were given DSCG 200 mg by enema twice daily and 100 mg orally three times each day. Twenty-six patients completed the trial successfully, 14 responded to DSCG treatment, two improved with placebo, and 10 responded to neither. Patients who responded to DSCG had significantly more eosinophils in their rectal biopsies than those who failed to respond and in some instances the counts were very high. The findings support the hypothesis than an allergic reaction is important in the pathogenesis of proctitis.

Macrophage heterogeneity in receptor activity: the activation of macrophage Fc receptor function in vivo and in vitro

The Fc receptor activity of single macrophages and of distinct macrophage populations was examined in terms of cellular avidity for IgG antibody by using a rosette assay which permits characterization of receptor activity at the cellular level and quantitation of any changes in such receptor activity. Marked heterogeneity was shown to exist within normal populations of macrophages. Both normal peritoneal and alveolar macrophage populations exhibit a normal or logistic distribution of cellular avidities for IgG antibody. The mean avidity of the peritoneal population, however, was found to be approximately 3 times greater than that of the alveolar population. Moreover, alveolar macrophages possess a range of cellular avidities 3 times greater than that of peritoneal macrophages. Comparison of normal unstimulated peritoneal macrophages and induced inflammatory exudate macrophages revealed a 6-fold increase in the proportion of high avidity cells in the latter population. Normal peritoneal and normal alveolar macrophages were shown to undergo a striking increase in Fc receptor activity in vitro. Under certain conditions of culture these cells acquire the antibody-binding capacity characteristic of high avidity cells in the inflammatory exudate population. Fresh guinea pig serum was shown to prevent this activation of Fc receptor function in vitro. Aged guinea pig serum was somewhat less effective. The serum factor(s) responsible appears to be consumed or exhausted in some way by macrophages. It is heat stable and has a molecular weight of less than 100,000 daltons. Serum IgF was found not to be involved in the effects of fresh serum on receptor activation in vitro. The activation of Fc receptor function described here may facilitate both the presentation of antigen to specific T lymphocytes and the antibody dependent killing of tumor cells by macrophages. Changes in receptor activity of the kind described may thus play an important regulatory role in the induction of an immune response and in the effector mechanisms of immunologic surveillance.

Complications of carbenoxolone therapy

Side effects from carbenoxolone are common and are due to electrolyte disturbance, such as sodium retention and hypokalaemia. They occur particularly in the elderly, who may already be being treated for other illnesses. Eight patients are described with serious side effects from carbenoxolone therapy, some of which were unrecognized for some time because of inadequate follow-up or because clinicians were unfamiliar with them.

Natural history of patients with x-ray-negative dyspepsia in general practice

When 102 patients with dyspepsia who had normal findings on barium-meal examination in 1964 were interviewed in 1970, 85 of them (76%) were symptomatically improved, and only three were later shown to have a peptic ulcer. This suggests that "x-ray-negative dyspepsia" has a good prognosis in a general practice setting.

Controlled trial of azathioprine in Crohn's disease

The effect of azathioprine in patients with active Crohn's disease has been evaluated in a double-blind cross-over trial. Fifteen patients were treated with both azathioprine and placebo: only two improved while on azathioprine, six got worse, and in seven there was no change. The drug seemed to be the cause of deterioration in two of the patients. Although the drug may be of some value in a few patients, it should be used with caution and only when other measures have failed.

The effect of healing on bile reflux in gastric ulcer

Bile reflux has been studied by serial estimations of bile acid concentrations in the stomach before and after a liquid meal. Thirteen normal subjects and 38 patients with gastric ulcer were examined. Thirty-one in the ulcer group had the test repeated once or twice within two months of the initial test to observe any change in reflux associated with healing. Patients with gastric ulcer had significantly higher concentrations of bile acids than normal subjects, both before and after the meal, although there was an overlap between the groups. In patients with an ulcer which healed or showed some healing over two months, no consistent change in reflux was found.

A controlled trial of glycopyrronium and l-hyoscyamine in the long-term treatment of duodenal ulcer

A controlled single-blind trial has been carried out to determine the value of long-term anticholinergic therapy in duodenal ulcer. Of 106 male patients with symptomatic and radiologically proven duodenal ulcer admitted to the trial, 91 completed the study. Patients were divided randomly into three groups. They received either glycopyrronium, or 1-hyoscyamine in a sustained-release form, or inert tablets for one year. Progress was judged on the basis of frequency and severity of symptoms, monthly assessments by patients, antacid consumption, and radiology. By all criteria, glycopyrronium and 1-hyoscyamine were not significantly superior to placebo. Symptomatic improvement, both subjective and objective, occurred in approximately 80% of all patients during the year of observation; there was no significant difference between the groups.

Gastric acid secretion in patients with duodenal ulcer treated for one year with anticholinergic drugs

Ninety patients with duodenal ulcer, divided randomly into three groups, were treated continuously for one year with either glycopyrronium, 1-hyoscyamine (as a sustained-release preparation) or inert tablets. Dosage with active tablets was so adjusted that the patient experienced definite but tolerable side-effects. Basal and maximal gastric acid secretion were measured immediately before and one week after cessation of treatment. There was no significant change in the means of these measurements in patients who received placebo or 1-hyoscyamine. In those given glycopyrronium, mean basal output was significantly increased. Mean maximal acid output in this group fell, but not significantly.Individual measurements of maximal acid output showed quite marked fluctuations in all groups. It is concluded that spontaneous changes in parietal cell mass may occur in patients with duodenal ulcer, and that prolonged anticholinergic therapy does not reduce parietal cell mass.