Soluble interleukin-2 receptor levels and immune activation in patients with schistosomiasis and carcinoma of the urinary bladder

Soluble interleukin-2 receptor (sIL-2R) level in serum is a marker of immune regulation and lymphocyte activation. Highly elevated levels of sIL-2R in serum were observed in patients of schistosomiasis with carcinoma of the bladder (SCB) and carcinoma of the bladder without schistosomiasis (CB) compared with patients with carcinoma of the prostate with or without schistosomiasis and normal healthy controls. Patients with SCB, who had an elevated percentage of cells expressing CD38+ activation antigen and CD71+ transferrin receptors in circulation, also had elevated levels of sIL-2R in serum. There were few interleukin-2 receptor (CD25+) positive cells in circulation in some patients with SCB. Despite this, the sIL-2R levels were extremely elevated. Our data suggest that in SCB, CD38+ and CD71+ cells may be the source of secretion of sIL-2R in serum. This relationship was confirmed by phenotypic characterizations of mononuclear cells and sIL-2R levels in individual patients. Measurements of sIL-2R levels in serum may provide a sensitive method of immune activation in patients with SCB.

Impact of schistosomiasis on urinary bladder cancer in the southern province of Saudi Arabia: review of 60 cases

The histopathologic findings reported in 254 consecutive urinary bladder biopsies were reviewed. Evidence of urinary schistosomiasis was identified in 88 biopsies (35%) and malignant neoplasms were diagnosed in 60 cases (24%). Nine out of 60 (15%) cases of bladder cancer had urinary bladder schistosomiasis and the remaining 51 cases (85%) had no clinical evidence of schistosomiasis. Transitional cell carcinoma was the commonest type of urinary bladder cancer (70%) followed by squamous cell carcinoma (20%) adenocarcinoma (8%) and rhabdomyosarcoma (2%). The mean age of the patients included was 60 +/- 15 years and the male:female ratio was 9:1. Comparison of our findings to those reported from other provinces of Saudi Arabia and from other countries, including those with known high incidence of schistosomiasis, is included.

Differentiation between pathogenic and non-pathogenic Yersinia enterocolitica strains by colony hybridization with a PCR-mediated digoxigenin-dUTP-labelled probe

The Polymerase Chain Reaction (PCR) method was used to generate a vector-free digoxigenin-dUTP labelled probe that targets the Yersinia enterocolitica gene encoding the heat stable enterotoxin (yst). The probe was used in DNA-DNA colony hybridization to screen 113 strains of Y. enterocolitica and related species for the presence of the enterotoxin gene. In Y. enterocolitica, the probe clearly discriminated between pathogenic and non-pathogenic strains even those belonging to the same serotype. Of the other Yersinia species, only three strains of Y. kristensenii possessed DNA sequences homologous to the yst gene. The probe was further checked for its specificity in artificially inoculated fecal samples and could easily detect the target sequence of the yst gene. The digoxigenin-labelled probe proved to be a reliable epidemiological tool to discriminate between pathogenic and non-pathogenic strains in pure and mixed culture, thus offering the advantage of using a non-radioactive detection system in clinical laboratories with the possibility of reusing the same hybridization solution several times and obtaining results within a relatively short time.

Serum levels and receptor expression of tumor necrosis factor-alpha following human allogeneic and autologous bone marrow transplantation

We have investigated tumor necrosis factor-alpha levels in serum samples of patients before and after allogenic (16 patients) or autologous (8 patients) bone marrow transplantation. A sensitive immunoradiometric assay for monitoring levels of endogenous tumor necrosis factor-alpha was used. The serum levels of tumor necrosis factor-alpha were found to be relatively low (ranging from less than 15 to 77 pg/ml). Among 13 patients having graft-versus-host disease following allogeneic bone marrow transplantation 8 patients did not have detectable tumor necrosis factor-alpha (less than 15 pg/ml) while 4 out of 8 patients undergoing autologous bone marrow transplantation had detectable tumor necrosis factor-alpha levels (15 pg/ml), indicating a lack of correlation between tumor necrosis factor-alpha serum levels and the occurrence of graft-versus-host disease. Because the tumor necrosis factor-alpha levels detected in patient sera could be regulated by TNF-receptor expression, the presence of TNF-receptor on patients' peripheral blood mononuclear cells was also studied using fluorescent liposome-conjugated tumor necrosis factor-alpha and immunofluorescence analysis. Our data indicate that peripheral blood mononuclear cells of some patients receiving either autologous or allogeneic bone marrow transplantation expressed significant levels of TNF-receptors, suggesting a lack of correlation between TNF-receptor expression and graft-versus-host disease development.

Phenotype, activation and lymphokine secretion by gamma/delta T lymphocytes from schistosomiasis and carcinoma of the urinary bladder

In humans the majority of the CD3+ T cells usually express an alpha/beta T cell receptor (TcR) and a minority express a gamma/delta TcR. The CD3+ TcR alpha/beta and CD3+ TcR gamma/delta cells from blood of the patients with schistosomiasis with carcinoma of the urinary bladder (SCB) were analyzed for phenotype, activation, secretion of interleukin 2 (IL 2). B cell growth factor (BCGF) and B cell differentiation factor (BCDF), as well as for autologous (AMLR) and allogeneic (MLR) mixed lymphocyte reaction. Patients with SCB had a highly increased percentage of CD3+ TcR gamma/delta and a decreased percentage of CD3+ TcR alpha/beta T cells in their circulation. These CD3+ TcR gamma/delta T cells expressed the CD25 (IL 2 receptor), CD38, CD71 (transferrin receptor) and HLA-DR activation antigens at a higher intensity after in vitro stimulation with recombinant IL 2, phytohemagglutinin and soluble egg antigen (from Schistosoma haematobium). The SCB patients' CD3+ TcR gamma/delta T cells were highly deficient in secretion of IL 2 but produced highly elevated levels of BCGF and BCDF. On the contrary, both BCGF and BCDF activities of the CD3+ TcR alpha/beta T cells were decreased. Moreover, CD3+ TcR gamma/delta T cells demonstrated highly deficient AMLR and MLR activity. These observations suggest a possible role of CD3+ TcR gamma/delta T cells in the immune response and the disease pathogenesis in human schistosomiasis infections.

T-cell abnormality and defective interleukin-2 production in patients with carcinoma of the urinary bladder with schistosomiasis

Patients with schistosomiasis of the urinary bladder (SB) and schistosomiasis with carcinoma of the urinary bladder (SCB) had significantly increased percentage of IL-2R-, HLA-DR-, and transferrin receptor (T9)-bearing T cells in circulation. The percentage of these activated T cells decreased by in vitro culture with PHA but increased by Schistosoma haematobium soluble egg antigen. These patients with SB and SCB had a PHA-specific defect in IL-2 production. A functional defect with induction of IL-2R-positive suppressor monocytes appears to correlate with the defective PHA-induced IL-2 production by CD4+ T cells and monocytes. Disordered regulation of PHA-induced IL-2 production by the CD4+ T cells and monocytes may be the key feature in the highly depressed cell-mediated immune response in schistosomiasis. However, immune activation and significantly elevated IL-2 production in response to disease-specific S. haematobium soluble egg antigen may be related with the pathogenesis of SB and SCB. Thus, S. haematobium-specific CD4+ T cells are present in schistosomiasis, and their function is determined by adequate release of IL-2-and/or IL-2R-bearing CD11+ suppressor monocytes.

Incidence of Aeromonas and Listeria spp. in red meat and milk samples in Brisbane, Australia

A total of 150 samples, 50 each of beef, lamb and pork from 10 local retail stores in Brisbane metropolitan area as well as 150 raw bovine bulk milk tank samples obtained from Queensland United Foods (QUF), were examined for the presence of Aeromonas and Listeria spp. over a period of 1 year. Different sets of enrichment and plating media were used to recover the organisms with subsequent identification using conventional biochemical and serotyping techniques. A total of 509 isolates consisting of Aeromonas spp. (350) and Listeria spp. (159) were obtained from 60%, 58%, 74%, 26.6%, 34%, 40%, 30%, 2.6% of samples of beef, Lamb, pork and milk respectively. Motile aeromonads (A. hydrophila, A. sobria, A. caviae) and Listeria innocua were isolated from all kinds of samples whereas L. monocytogenes was only isolated from flesh food. A. hydrophila contributed the largest percentage of the motile aeromonads (60%). The majority of L. monocytogenes cultures were serotype 4.

Activated CD4-positive T-lymphocytes and impaired cell-mediated immunity in patients with carcinoma of the urinary bladder with schistosomiasis

Patients with schistosomiasis of the urinary bladder (SB) associated with carcinoma of the bladder (SCB) or carcinoma of the prostate (SCP) have a variety of immunologic abnormalities, including the presence of HLA-DR+ and interleukin-2 receptor-positive (IL-2R+) T-lymphocytes in circulating blood. This study demonstrated that, the HLA-DR+ and IL-2R+ antigens are selectively expressed on majority of the CD4+ T-lymphocytes of patients with SCB, whereas, these antigens are expressed almost equally on both CD4+ and CD8+ T-lymphocytes of patients with SB and SCP. Expressions of HLA-DR+ and IL-2R+ antigens in CD4+ T-lymphocytes, and a depressed response of this T-cell subset to phytohemagglutinin and Concanavalin A stimulations seems to be the characteristic feature of these patients with SCB. In addition, the autologous mixed lymphocyte reaction (AMLR) and allogenic mixed lymphocyte reaction (MLR) was depressed in patients with SCB. However, patients with SCP demonstrated a normal MLR, even though the AMLR was highly depressed. The immunoregulatory role of the HLA-DR+, IL-2R+, CD4+ helper/inducer T-lymphocytes, and the AMLR and MLR abnormalities we have identified in patients with SCB may be important and could play a role in the pathobiology of these diseases in humans.

A false positive I-131 MIBG due to dilated renal pelvis: a case report

A case of false positive I-131 MIBG imaging for detection of pheochromocytoma is presented. There was an area of increased tracer uptake in the left renal region that showed steadily reducing activity over a period of three days. This raised the suspicion of a dilated renal pelvis, which was later confirmed by Tc-99m DTPA imaging. It is advisable in cases of ambiguous I-131 MIBG imaging to use Tc-99m DTPA rather than Tc-99m DMSA for localizing the kidneys and renal pelvis.

Radical cystectomy and ileocaecal bladder reconstruction for carcinoma of the urinary bladder. A study of 130 patients

One hundred and thirty patients underwent radical cystectomy and ileocaecal bladder reconstruction for carcinoma of the urinary bladder. The actuarial 5-year survival rate was 45%. Local pelvic recurrence was noted in 26.3% of patients. Most of those in the series (81.9%) had perfect control of micturition. Intravenous urography performed up to 10 years post-operatively showed preservation of renal configuration in 92.2%. The normal flow curves recorded showed that it was possible to achieve a balanced vesicourethral unit. Ileocaecal bladder reconstruction is less disabling than urinary diversion after radical cystectomy.

Hemoglobin Mississippi (beta 44ser----cys). Studies of the thalassemic phenotype in a mixed heterozygote with beta +-thalassemia

Hemoglobin Mississippi (HbMS: beta 44ser----cys) has anomalous properties that include disulfide linkages with normal beta-, delta-, gamma-, and alpha-chains, and the formation of high molecular weight multimers. While heterozygotes for HbMS are clinically and hematologically normal and carriers of the beta +-thalassemia gene in our family had mild microcytic anemia, the proband with HbMS-beta +-thalassemia had a hemoglobin level of 7 g/dl, mean corpuscular volume (MCV) of 68 fl, reticulocytes of 2-6%, HbF of 18%, marked anisocytosis and poikilocytosis, and splenomegaly, all features of thalassemia intermedia. With oxidant stress, her erythrocytes developed multiple dispersed Heinz bodies, but HbMS was only mildly unstable. HbMS was susceptible to proteolytic degradation in the presence of ATP. The unexpectedly severe clinical findings in HbMS-beta +-thalassemia may result from the proteolytic digestion of HbMS, as well as the excessive alpha-chains characteristic of beta +-thalassemia, which combined provide the increment of cellular damage that results in the phenotype of thalassemia intermedia.

A soluble adenosine triphosphate-dependent proteolytic system in human peripheral red blood cells

A soluble adenosine triphosphate (ATP)-dependent proteolytic system has been detected in human peripheral blood erythroid cells. Hemolysates prepared from reticulocyte-rich blood of subjects with autoimmune hemolytic anemia, treated pernicious anemia, and iron deficiency anemia or from pools of red blood cells enriched for reticulocytes by density gradient centrifugation were tested against a radioactive casein standard. Up to 57% of the casein was rendered trichloroacetic acid (TCA) soluble after incubation with such hemolysates for 60 minutes in the presence of 1.0 mmol/L ATP. In the absence of ATP or in hemolysates prepared from reticulocyte-poor blood as little as 6% to 10% of the casein was hydrolyzed. The proteolytic activity was found in the 100,000-g supernatant of active hemolysates and was blocked by hemin, N-ethylmaleimide, and sodium vanadate and thus resembles a previously described activity in rabbit reticulocytes. In the presence of ATP, similar lysates prepared from rabbit reticulocytes preferentially hydrolyzed the abnormal human hemoglobins Leiden and Gun Hill compared with hemoglobin A. These results suggest that there is an active ATP-dependent proteolytic system in young human erythroid cells that can degrade certain abnormal globin chains; the enzymatic activity is lost in the transition from reticulocyte to erythrocyte.

Antiemetic efficacy of high-dose dexamethasone: randomized, double-blind, crossover study with high-dose metoclopramide in patients receiving cancer chemotherapy

A double-blind, randomized, crossover study was conducted to compare the efficacy and safety of high-dose dexamethasone and high-dose metoclopramide in the treatment of chemotherapy-induced nausea and vomiting. All entered patients had no prior chemotherapy and all received inpatient emetogenic chemotherapy mainly without cisplatin. Of the 40 evaluable patients, 23 (58%) had no vomiting with dexamethasone compared with only 11 (28%) receiving metoclopramide (P less than 0.025). Dexamethasone was found to have less adverse effect than metoclopramide on patient's appetite and activity (P less than 0.025 and P less than 0.01, respectively). Twenty-one patients (53%) developed mild to severe somnolence with metoclopramide compared to only seven (18%) who experienced this adverse effect with dexamethasone (P less than 0.01). Six patients (15%) developed extrapyramidal manifestations with metoclopramide, but none with dexamethasone. Furthermore, during dexamethasone therapy, patients developed less diaphoresis, insomnia, headache and dizziness. Upon questioning patients about their preference to future use of the antiemetic drug therapy, 28 patients (70%) preferred dexamethasone, two (5%) preferred metoclopramide and 10 (25%) found no difference. We conclude that high-dose dexamethasone has a greater antiemetic activity and is more safe than high-dose metoclopramide in patients receiving emetogenic chemotherapy mainly without cisplatin.

A particle-associated ATP-dependent proteolytic activity in erythroleukemia cells

An ATP-dependent proteolytic activity has been detected in both mouse erythroleukemia (Friend) cells and human (K562) erythroleukemia cells. Exposure of the Friend cells to dimethyl sulfoxide, which stimulates differentiation, increased ATP-dependent proteolysis approximately 2-fold although inducing differentiation in the K562 line had no significant effect on proteolysis. In contrast to the previously described soluble ATP-dependent proteolytic system of reticulocytes, the activity in the more primative erythroid cells is associated with a particulate fraction and is readily sedimentable by centrifugation at 100,000 X g for 1 h. Like the soluble reticulocyte system, the particulate activity requires divalent cation and is inhibited by hemin as well as vanadate. The activity was isolated on a sucrose cushion (30%) and did not appear to be associated with membranes, cytoskeleton, or polysomes. This enzymatic activity which degrades abnormal globin chains may initially reside in a particulate fraction and then become solubilized during erythroid maturation to the reticulocyte stage. Alternatively, the particulate activity may disappear with cell maturation being replaced by a distinct soluble activity. ATP-dependent proteolytic activity is eventually lost with reticulocyte maturation and further aging of erythrocytes.

Plasmodium falciparum in vitro: diminished growth in hemoglobin H disease erythrocytes

Studies of the ability of Plasmodium falciparum to grow in vitro in the red blood cells of subjects with certain beta-thalassemia syndromes are often difficult to interpret because of the known inhibitory effect of an elevated cellular content of human fetal hemoglobin (HbF). P falciparum therefore was cultured in vitro in the erythrocytes of subjects with hemoglobin H (HbH) disease and various other alpha-thalassemia genotypes that are unaccompanied by increased levels of HbF. Growth of the malaria parasite was markedly retarded in HbH red blood cells, when compared with growth in blood from normal control subjects. No consistent impairment of growth was seen in the erythrocytes of subjects having deletion of only one or two alpha-globin genes. These results indicate that erythrocytes with a severe thalassemia phenotype provide a less hospitable growth environment for P falciparum than normally hemoglobinized red blood cells, even in the absence of increased levels of HbF.

Recovery of radiologically functionless obstructed kidneys

Eleven patients had radiologically non-functioning and unilaterally obstructed kidneys with normal kidneys on the other side. The kidneys were divided into three groups according to the urinary pH of the obstructed kidney at operation: Group 1 (pH 6.0 or less); Group 2 (pH 6.1-7.1); Group 3 (pH greater than 7.1). The obstruction was corrected in all patients despite the pre-operative radiological findings or the morphological appearance at operation. Radiological recovery was assessed 2 months post-operatively and was found to be good in all patients in Group 1. In Group 2, recovery was good in one patient, moderate in two and absent in one. In Group 3 there was no evidence of radiological recovery in either patient.

Changes in urinary pH and glomerular filtration rate in partially obstructed canine kidney

The creatinine clearance and urinary pH changes were studied in 12 male dogs in whom the ureters were unilaterally obstructed for periods ranging from 2 days to 27 weeks. The obstruction was then released and the recovery was studied. Using the contralateral kidney as control, significant drop in the creatinine clearance was observed to be consistently associated with failure to produce acidic urine. The obstructed kidneys with urinary pH above 7.00 had significant reduction in creatinine clearance when compared with obstructed kidneys with urinary pH 7.00 or less (p less than 0.005). The marked drop in the creatinine clearance and rise in urinary pH was observed to occur in kidneys obstructed for more than 3 weeks. With obstruction for shorter periods, the ability to produce acidic urine is preserved and the recovery potential is good.

Traumatic diaphragmatic rupture involving the pericardium

We have described a case of severe blunt injury to the thorax and abdomen causing an 8 cm laceration of the central tendon of the diaphragm, with extension into the pericardium. Herniation of the apex of the heart through this defect produced hypotension that was unresponsive to fluid resuscitation. Replacement of the heart into the mediastinum promptly restored the blood pressure to satisfactory levels.

Scrotal swellings in Sudanese patients: a surgical pathology study

Scrotal swellings are frequently encountered in surgical practice in the Sudan and other tropical countries and, because of the diversity of possible etiological agents, often pose problems in differential diagnosis. In this communication, 443 histologically verified scrotal swellings in Sudanese patients are surveyed as regards their causes and salient clinico-pathological features. Common lesions such as hydroceles have been considered as well as rarer but important conditions, including tuberculosis and Schistosomiasis. Clinicians practicing in tropical environments should consider these possibilities and the limitations of clinical diagnosis indicate biopsy confirmation. Since some conditions might respond to medical therapy, some orchidectomies could be avoided.

Antisperm antibodies and human infertility

In a trial to evaluate the role of antisperm antibodies in human infertility, 120 couples (30 normal controls and 90 suffering from various types of infertility) were examined for the presence of agglutinating antibodies (by the Kibrick and Franklin-Dukes methods) and immobilizing antibodies in the serum, cervical mucus, and seminal plasma. In the male partners the highest and most significant incidence was found in the serum and seminal plasma of the group with poor sperm motility. In the female partners the highest and most significant incidence was found in the serum and cervical mucus of the group with unexplained infertility. It was concluded that it is greatly advisable to test for antisperm antibodies in selected groups of infertile couples.

Urinary lithogenesis in Sudanese patients: a study of stone formers

This prospective study confirms the previously reported high incidence of uric acid lithiasis in the Sudan. Despite this fact urinary pH in patients in whom stones formed was not significantly different from controls (p greater than 0.05). However, a significantly high serum uric acid level (p less than 0.01) was associated with recurrent and/or bilateral stones. In patients with single episodes of stones significant hyponatremia (p less than 0.001) may indicate excessive sweating. The resulting low urine output supersaturated with crystals may explain lithogenesis in this group of patients.

Sodium-losing nephropathy

We studied prospectively 18 patients with sodium-losing nephropathy. In 12 patients (66.7 per cent) the sodium-losing nephropathy was owing to obstructions, challenging the hitherto existing concept that the most common cause of the condition is pyelonephritis. The diagnosis of sodium-losing nephropathy is important in urological practice since sodium repletion in these cases shortens significantly the hospitalization and preoperative waiting time.

The relationship between urinary bilharziasis and urolithiasis in the Sudan

Nine hundred and ninety-seven Sudanese patients presenting to a urological unit in Khartoum were divided into a group consisting of 144 patients with a history or evidence of urinary bilharziasis and a second group of 853 patients with no history or evidence of this disease. Thirty-one per cent of the patients with bilharziasis and 32% of those without were found to have urinary calculi. In the bilharzial group there were recurrent stones in 7% compared with 12.4% in the non-bilharzial group. In the bilharzial group the stones were renal in 63.6%, ureteric in 27.3% and vesical in 9.1%, while in the non-bilharzial group 57% were renal, 30% ureteric and 13% vesical. Comparison of the incidence, rate of recurrence and site of stones in both groups suggests that urinary bilharziasis does not contribute to the high incidence of urolithiasis in the Sudan.

The first record of Angiostrongylus cantonensis from Egypt

In this paper the first record of the medically important nematode parasite, Angiostrongylus cantonensis, is made from Egypt. A survey of eight species of freshwater gastropods collected from natural water courses and of three species of wild rats caught from the same areas revealed respectively, that the ampullarid snail Lanistes carinatus acts as the intermediate host transmitting this parasite, and that the rat Rattus norvegicus is its definitive host. The life cycle of the parasite was successfully completed through experimental infection of laboratory bred albino rats with third-stage larvae, obtained from the above mentioned snail intermediate host. A morphological description of the adult worms and of all larval stages of the parasite is given.

Acute uraemic encephalopathy in tropical countries

This is a prospective study on 24 patients with chronic renal failure. Thirteen of them had evidence of acute uraemic encephalopathy. Of those 9 patients were found to have dilutional hyponatraemia, two patients severe salt and water depletion and one patient septicaemia. Hyponatraemia was associated with pulmonary oedema in 3 patients. Correction of salt and water disturbances and treatment of heart failure improved cerebral functions in 10 (77%) patients. It is therefore concluded that dilutional hyponatraemia probably leading to cerebral oedema is a reversibe major factor in the development of acute uraemic encephalopathy. This, if left uncorrected, may prove fatal especially in tropical countries.

Prediction of renal recovery in hydronephrotic kidneys

Urine produced by obstructed kidneys was analysed in 35 cases. In the absence of infection by urea splitting organisms, estimation of urinary pH of hydroephrotic kidneys was found to be a reliable method for determination of recovery potential. After removal of obstruction, radiological recovery was almost complete when the pH was lower than 6. Obstructed kidneys producing urine with a pH between 6-7.1 showed only partial radiological recovery after surgical correction. All kidneys that showed no function on IV urography and those found at operation to possess only a very thin shell of cortex to justify nephrectomy were found to have urinary pH near 7.3 or more, implying inability of those kidneys to acidify urine. Urinary specific gravity and sodium concentration of obstructed kidneys were not reliable in prediction of renal recovery.

Salivary amino acids and proteins in normal and malnourished Egyptian infants and young children

Amino acids and proteins in whole saliva of normal and malnourished Egyptian infants and young children were investigated. 16 amino acids, 7 of them are essential, could be detected in saliva of normal infants. Electrophoretic analysis revealed the existence of 10 protein components in saliva of either normal or malnourished infants. In oedematous cases, salivary aminoacids, particularly the essential ones, were increased as well as most of the protein components. In non-oedematous cases, the pattern was more or less normal, but in 3rd grade marasmus, amino acid and protein components of saliva were somewhat increased. The conclusion was drawn that such increase is mainly due to tissue degeneration which is more marked in oedematous than non-oedematous form of the disease.

Uric acid lithiasis in the Sudan

Fifty-seven per cent of Urinary Calculi in the Sudan contain Uric Acid, 20 per cent in the pure form and 37 per cent mixed with other constituents mainly calcium oxalate. The peak age presentation of urolithiasis is 30-40 years with more prediliction to males than females. An earlier study documented a high incidence of hyperuricaemia in Sudanese people. It is probable that "voluntary dehydration" and hyperuricaemia acting together may help in the formation of uric acid stones on the surface of which other crystals mainly calcium oxalate may be deposited to form the bigger calculi which are commonly encountered in this country.

Complications of repeated operations to control esophageal reflux (esophagogastrocutaneous and esophagogastropericardial fistulas)

Iatrogenic injury to the distal esophagus and gastric cardia with subsequent fistula formation may occur at times following repeated direct operative attempts to control reflux esophagitis. At re-operation when this problem occurs, the indirect operative procedure of Roux-en-Y diversion is a safe, effective and preferable method to control persistent reflux esophagitis.

Clinical, biochemical and histochemical studies on infants with Acrodermatitis enteropathica chronica

7 infants diseased with Acrodermatitis enteropathica and 10 normal controls were included in this study. The values of anthranilic acid glucuronide, 6- aminohippuric, anthranilic acid, N-acetyl Kneurine, Kneurine and 30 H Kneurenine, were estimated in mg/24 hours urine, both basal and after tryptophane load. In addition, histopathological and histochemical studies for lactase, succinic dehydrogenase, alkaline phosphatase, acid phosphatase, and alpha-non-specific esterases activities were done for the intestinal mucosal biopsies. All the previous investigations were then repeated after two months treatment with 500 mg/day diiodohydroxyquinoline. The tryptophan metabolites were significantly low in the diseased infants, both basal and after tryptophan load. Moreover, the intestinal enzymes activities were altered. After 2 months treatment with diiodohydroxyquinoline the diseased infants became clinically improved, tryphtophan metabolites became normal, but the activities of the intestinal enzymes were not altered. The biochemical and histochemical findings were discussed, giving the possibility of competitive inhibition of the diiodohydroxyquinolines and the by-product 8 OH Quinololic acid resulting in more degradation of Kneurine and 3 OH Kneurenine to nicotinamide adenine dinucleotide.

Absence of the alpha-thalassaemia syndromes in Egyptian Arabs

An investigation was undertaken to find the incidence of α-thalassaemia in Egypt. Blood was collected from the umbilical cords of 550 newborns and from 630 adults from central hospitals in Cairo that drain patients from all over Egypt.

Starch gel electrophoreses at both pH 8·6 and 7·0, and brilliant cresyl blue incubation revealed the absence of haemoglobins Barts and H in the blood specimens examined.