Pleuropericarditis and disseminated intravascular coagulation in ulcerative colitis

We report a 30-year-old woman with pleuropericarditis, cardiac tamponade, and disseminated intravascular coagulation complicating active ulcerative colitis (UC). Other autoimmune diseases were not present. She responded to pulsed steroid therapy and anticoagulant with resolution of the complication and UC. We reviewed the literature and found 27 cases of pleuropericarditis associated with idiopathic inflammatory bowel disease (IBD). It has been reported that pleuropericarditis associated with IBD responds well to nonsteroidal antiinflammatory drugs, as well as steroids. The causes of cardiac involvement in IBD remain unclear, but the pleuropericarditis must be recognized as a potential extraintestinal manifestation of IBD.

Serum hyaluronate in patients with acute and fulminant hepatitis

We evaluated serum hyaluronate (HA) levels in 17 patients with acute hepatitis and 9 with fulminant hepatitis (FH). Upon admission, patients with FH showed increased levels of serum HA and these levels showed significant correlation with biochemical parameters such as human hepatocyte growth factor, hepaplastin test, and prothrombin activity. In patients with AH, the levels of serum HA decreased during convalescence. Higher serum HA levels were observed in patients with type A acute hepatitis than in patients with non-A type. In patients with FH, serum HA levels were decreased in the survivors, while they were elevated in the non-survivors. These findings suggest that serum HA levels may be a useful indicator for evaluating the prognosis of patients with acute and fulminant hepatitis. Further study is necessary to determine whether there is a causal relationship between elevated serum HA levels and the type of hepatitis virus.

Eosinophilia in primary biliary cirrhosis

OBJECTIVES

Recent studies have shown the occurrence of eosinophilia in patients with primary biliary cirrhosis (PBC). To examine whether eosinophilia is indeed a distinctive feature of PBC, we performed extensive leukocyte differential analysis using a highly sophisticated hematology instrument. We also investigated the relationship between eosinophil dynamics and clinical features of PBC including the effects of ursodeoxycholic acid (UDCA) treatment.

METHODS

A flow cytometry-based blood cell analyzer (Technicon H6000) was used to examine peripheral blood eosinophil counts in 38 patients with PBC and 131 patients with various liver deseases. We also performed eosinophil quantitation in 19 PBC patients before and after administration of UDCA for 4 wk.

RESULTS

Patients with PBC had significantly higher relative and absolute eosinophil counts when compared with other liver diseases (5.7 +/- 0.5% [p < 0.0001, mean +/- SEM] and 312 +/- 26 cells/microliter [p < 0.01], respectively). Twenty-one of 38 PBC patients (55%) exhibited relative eosinophilia. In patients with PBC, the eosinophil count was: 1) significantly higher in those with early histological stages (stage I-II, 6.5 +/- 0.5% vs stage III-IV, 4.4 +/- 0.7%,p < 0.05), 2) positively correlated with basophil count (p < 0.01), serum IgA levels (p < 0.05), and the degree of eosinophil infiltration in the portal tract (p < 0.01), and 3) markedly reduced by UDCA treatment (before: 5.9 +/- 0.7%, 307 +/- 37 cells/microliter; after: 2.8 +/- 0.03% [p < 0.001], 162 +/- 26 cells/microliter ¿p < 0.001]).

CONCLUSIONS

Eosinophilia is a common and distinctive feature of patients with PBC. UDCA ameliorates eosinophilia as well as liver function tests in PBC patients. Eosinophilia may be useful as one of the initial clues in the diagnosis of PBC, especially in its early stage.

A case of posttransfusion hepatitis A

A 63-year-old female case of cancer of the colon who developed posttransfusion hepatitis A was presented. She became ill 49 days after receiving a single unit of concentrated red cells from a donor who also developed hepatitis A 10 days after donation.

Activated macrophages are responsible for the tumor-inhibitory effect in mice receiving intravenous injection of OK-432

Mouse spleen cells, either pretreated in vitro with 100 U/ml of OK-432-induced IFN gamma for 18 h or obtained from mice 24 or 48 h after i.v. injection of OK-432(100 micrograms/mouse), were examined for their anti-tumor effect by Winn's neutralization assay against Meth-A tumor cells in BALB/c mice. Spleen cells treated in vitro or obtained in vivo 24 h after i.v. injection clearly neutralized the growth of admixed Meth-A cells. Two booster injections of 200 U of IFN gamma near the tumor site accelerated this neutralizating effect. In order to determine the effector subpopulation, inhibitory spleen cells were treated with either anti-Thy-1 monoclonal antibody plus complement, anti-asialo GM1 serum plus complement or with adherence on plastic plates followed by Sephadex G-10 column treatment. The effector cell activity in Winn assay was lost only after the removal of macrophages through plastic plate adherence and Sephadex G-10 column treatment, but not after anti-Thy-1 or anti-asialo GM1 treatment, with either in vitro- or in vivo-treated spleen-cell populations. The growth of Meth-A cells was inhibited not only by these activated macrophages in Winn's assay, but also by adoptive transfer of OK-432-induced cytotoxic macrophages intralesionally 4 days after the implantation of 1 X 10(6) Meth-A cells. Our evidence suggests that the systemic action of OK-432 can be explained by the effect of induced IFNgamma, through the activation of macrophages.

[Anticancer effects of OK-432 (2). Anticancer actions of M phi activated by OK-432]

Mouse spleen cells (DDI, BALB/c, 10 weeks old), either pretreated in vitro with 100 u/ml of OK-432-induced IFN gamma for 18 hr or obtained from mice 24 or 48 hr after iv injection of OK-432 (100 micrograms/mouse), were examined for their antitumor effect by Winn assay against Meth-A tumor cells in BALB/c mice. Both of these spleen cells preparations clearly inhibited the growth of admixed Meth-A cells. In order to determine the effector subpopulation, these spleen cells were treated with either anti-Thy-1 monoclonal antibody plus complement, anti-asialo GM1 serum plus complement or in combination of adherence on plastic plates followed by Sephadex G-10 column treatment. As a result, the effector activity in Winn assay was lost only after the removal of macrophages through plastic plate adherence and Sephadex G-10 column treatment, but not after anti-Thy-1 or anti-asialo GM1 treatment, with either spleen cell populations. Moreover, after anti-Thy-1 treatment, the effector activity of spleen cells increased, suggesting the presence of suppressor T cells in these spleen cell populations. The growth of Meth-A cells was not only inhibited by these activated macrophages in Winn assay but also by adoptive transfer of OK-432-induced cytotoxic spleen macrophages, intralegionally 4 days after the implantation of 1 X 10(6) Meth-A cells. In conclusion, the effector cells which appeared in mouse spleens after iv injection of OK-432 were found to be cytotoxic macrophages, which inhibited the growth of Meth-A cells, both in vitro and in vivo. IFN gamma induced by OK-432 in mouse spleen cell cultures produced the same cytotoxic macrophages when added to the spleen cell cultures, at a dose as low as 100 u/ml. All of our evidence suggests that the systemic action of OK-432 can be explained by the effect of IFN gamma induction.