Human ehrlichiosis: a newly recognized tick-borne disease.

Human ehrlichiosis was first described in the United States in 1986. Since then, more than 215 cases have been reported, including some fatalities. Ehrlichia species belong to the same family as the organism that causes Rocky Mountain spotted fever. Human ehrlichiosis occurs most frequently in the southern mid-Atlantic and south-central states, during spring and summer months. The clinical presentation is similar to that seen in Rocky Mountain spotted fever although, with ehrlichiosis, leukopenia is more often found and skin rash is less often noted. Definitive diagnosis is based on acute and convalescent serum antibody titers. Ehrlichiosis cannot reliably be distinguished from other common febrile illnesses on the basis of clinical, epidemiologic or laboratory features. Therapy must be initiated empirically in suspected cases. Both ehrlichiosis and Rocky Mountain spotted fever respond well to tetracycline and chloramphenicol, but not to penicillins or cephalosporins.     

BK polyomavirus: a newly recognized threat to transplanted kidneys

Reactivation of latent infection with BK polyomavirus is now being recognized as a cause of failure of renal allografts. An increasing serum creatinine concentration in a kidney transplant recipient should prompt a referral for reevaluation by the transplant center.     

Enteropathogenicity of Providencia alcalifaciens,a newly recognized pathogen causing food-poisoning

Providencia alcalifaciens, a member of the family Enterobacteriaceae, has been thought to be a normal flora or an opportunistic pathogen. In 1996, a large outbreak (including 270 patients) of acute gastroenteritis occurred in Fukui. No known enteropathogens were detected in fecal samples of the patients, but P. alcalifaciens was detected from 7 of the 18 samples. The isolates were a clonal by pulsed-field gel electrophoresis. The specific antibody against the isolated strain was elevated in the patients' sera. The isolates showed invasiveness into Caco-2 cells and fluid-accumulation in rabbit ileal loops. These results indicate that P. alcalifaciens can be one of the causative agents of gastroenteritis or food-poisoning.     

Endoscopic observation of squamous metaplasia of the stomach: a report of two cases

Squamous metaplasia of the stomach is a rare clinical entity that occurs during healing of gastric ulcers or chronic inflammation. We have treated two patients with this condition, which has only occasionally been observed endoscopically. The first was a 60-year-old woman who initially presented with multiple gastric ulcers. Two months after treatment, a white patch about 4 cm in diameter was found in the lesser curvature of the cardiac region of stomach. The second patient was a 65-year-old woman, who also developed a white patch in the same region. Two months later, a small ulcer and inflamed mucosa were seen near the lesion. The white areas in both patients were stained with Lugol's iodine solution, and biopsy specimens confirmed squamous epithelium. The squamous metaplasia was observed as a white mucosal area in the stomach, and the metaplastic area stained positively with Lugol's iodine solution.     

Multiple mucosal bridge formations in the stomach, report of a case

An unusual gastric lesion comprising multiple bridges in a 62-year-old woman is presented. Radiographic and endoscopic examination revealed several mucosal bridges and mucosal tags. The resected stomach showed eight mucosal bridges and five mucosal tags along the course of the mucosal folds in the fundic gland area, the former measuring 3 cm in diameter. This paper concludes with short discussion of the etiology of these proliferative gastric lesions from a clinicopathological standpoint.     

Mechanisms underlying capsaicin-stimulated secretion in the stomach: comparison with mucosal acidification

The effects of capsaicin and mucosal acidification on gastric HCO3(-) secretion were compared in wild-type and prostacyclin (PGI2) IP receptor or prostaglandin E receptor EP1 or EP3 knockout C57BL/6 mice as well as rats. Under urethane anesthesia, the stomach was mounted on an ex vivo chamber, perfused with saline, and the secretion of HCO3(-) was measured at pH 7.0 using the pH-stat method. Capsaicin or 200 mM HCl was applied to the chamber for 10 min. Capsaicin increased the secretion of HCO3(-) in rats and wild-type mice, the response at 0.3 mg/ml being equivalent to that induced by acidification. This effect of capsaicin in rats was abolished by ablation of capsaicin-sensitive afferent neurons and attenuated by indomethacin, N(G)-nitro-L-arginine methylester (L-NAME), and capsazepine [transient receptor potential vanilloid type 1 (TRPV1) antagonist] but not FR172357 [3-bromo-8-[2,6-dichloro-3-[N[(E)-4-(N,N-dimethylcarbamoyl) cinnamidoacetyl]-N-methylamino]benzyloxy]-2-metylimidazo[1,2-a]pyridine; bradykinin B2 antagonist] or the EP1 antagonist. The acid-induced HCO3(-) secretion was attenuated by indomethacin, L-NAME, the EP1 antagonist, and sensory deafferentation, but not affected by capsazepine or FR172357. Prostaglandin E2 (PGE2), NOR-3 [(+/-)-(E)-ethyl-2-[(E)-hydroxyimino]-5-nitro-3-hexeneamine] (NO donor), and bradykinin stimulated the secretion of HCO3(-), and the effect of bradykinin was blocked by indomethacin and L-NAME as well as FR172357. The stimulatory effect of capsaicin disappeared in IP (-/-) mice, whereas that of acidification disappeared in EP1 (-/-) mice. Intragastric application of capsaicin increased mucosal PGI2 but not PGE2 levels in the rat stomach. These results suggested that both capsaicin and acid increase gastric HCO3(-) secretion via a common pathway, involving PG and NO as well as capsaicin-sensitive afferent neurons, yet their responses differ concerning TRPV1 or prostanoid receptor dependence.     

Extension of a pulmonary blastoma into the left atrium

Pulmonary tumors of embryonic origin are rare, and pulmonary blastomas are probably the most uncommon. A thorough literature search disclosed no previous reports of extension of this type of tumor into the heart. We describe a patient whose initial clinical presentation suggested an obstructive left atrial mass; however, clinical and histologic findings indicated the mass was a tumor that originated from a pulmonary blastoma that extended into the left atrium through a pulmonary vein. The unique aspect of this case is that the patient's symptoms were related to the obstructive effects of the atrial mass, not to the primary pulmonary tumor.     

Syphilis and squamous cell carcinoma of the stomach: A case report

Gastric syphilis and squamous cell carcinoma of the stomach are both rare conditions. Their simultaneous occurrence in this patient, however, may represent more than chance. This case documents that squamous cell carcinoma may arise in areas of squamous metaplasia. It also provides an opportunity to briefly review the clinical and radiologic findings in gastric syphilis and to stress the nonspecific nature of these findings.     

Guanidinoacetate methyltransferase (GAMT) deficiency: non-invasive enzymatic diagnosis of a newly recognized inborn error of metabolism

Guanidinoacetate methyltransferase deficiency is a newly recognized inborn error of creatine biosynthesis. Manifestation of neurologic symptoms occurs in infancy and is partly reversible upon oral substitution of creatine. In the first two index patients, enzymatic diagnosis was established in a liver biopsy, and the underlying molecular defect in the GAMT gene has been identified. In order to provide non-invasive biochemical diagnosis, we have developed an enzyme assay based on the formation of radiolabeled creatine from ¹⁴C guanidinoacetate and S-adenosylmethionine in concentrated and dialyzed extracts from cultivated skin fibroblasts, Epstein–Barr virus transformed lymphoblasts, and cultivated amniotic cells. Cells were investigated from controls, from 1 index patient with proven GAMT deficiency and from 3 additional patients with clinical and biochemical signs of GAMT deficiency. Separation of ¹⁴C guanidinoacetate from ¹⁴C creatine in the reaction mixture was accomplished by HPLC on Hypersil ODS column and radioactivity was determined in fractions according to respective UV signals. GAMT activities in control fibroblasts (n=7), lymphoblasts (n=8) and in amniotic cells (n=2) were 0.38–0.56, 0.61–0.84 and 0.38–0.56 nmol/h/mg protein. Apparent Km values were 9.5–14.8 μM for guanidinoacetate and 68–78 μM for S-adenosylmethionine. In the index patient and in the three additional patients at risk, GAMT activity was <0.1 nmol/h/mg protein. The assay described here allows non-invasive diagnosis of GAMT deficiency in patients at risk.     

Monitoring postprandial size of the proximal stomach by ultrasonography.

The purpose of this study was to develop a sonographic method to monitor postprandial size of the proximal stomach. Twenty-three healthy persons were scanned in a sitting position with a 3.25 MHz transducer after ingestion of 500 ml meat soup. The area in a sagittal section and the maximal diameter in an oblique frontal section were chosen as standard measurements. The soup emptied from the proximal stomach in a linear manner (r = 0.99) and at a rate of 2.0 +/- 1.3%/min. Intraobserver error of the scans (mean +/- SD) was 5.6% +/- 2.3% and 9.5% +/- 4.5% for sagittal area and frontal diameter, respectively, and the corresponding interobserver error was 5.3% +/- 4.0% and 8.3% +/- 5.3%, respectively. This sonographic method demonstrated a moderate day-to-day variation, had low intra- and interobserver error, and allowed estimation of initial emptying fractions of the proximal stomach.     

Relation between reflux of bile acids into the stomach and gastric mucosal atrophy, intestinal metaplasia in biopsy specimens

During endoscopic examinations we collected fluid in the stomach that included reflux fluid from the duodenum, and assessed the effect of quantitatively determined bile acids on glandular atrophy and intestinal metaplasia using biopsy specimens. A total of 294 outpatients were enrolled in this study. Total bile acid concentration was measured by an enzyme immunoassay. Glandular atrophy and intestinal metaplasia scores were graded according to the Updated Sydney System. An effect of refluxed bile acids on atrophy and intestinal metaplasia was shown in the high-concentration reflux group in comparison with the control group. However, when the odds ratios (ORs) were calculated according to whether Helicobacter pylori (H. pylori) infection was present, no significant associations were shown between reflux bile acids and atrophy in either the H. pylori-positive cases or -negative cases. The same was true for intestinal metaplasia in the H. pylori-positive cases, whereas intestinal metaplasia was more pronounced in the high-concentration reflux group in the H. pylori-negative cases (OR 2.4, 95%CI 1.1-5.6). We could not clarify the effect of the reflux of bile acids into the stomach in the progression of atrophy. High-concentration bile acids had an effect on the progression of intestinal metaplasia in the H. pylori-negative cases.     

A study of the morphological parameters of cervical squamous epithelium

Electrical impedance spectroscopy is a technique that has been investigated as a potential method for the diagnosis of epithelial carcinomas. Finite element modelling can provide an insight into the patterns of current flow in normal and pathological epithelium and hence aid in the process of probe design optimization. In order to develop a finite element model of the structure of normal and precancerous cervical squamous epithelium, it was first necessary to obtain the mean values and ranges of a number of morphological tissue parameters. The most important parameters in discriminating normal from neoplastic tissue were identified as being cell size and shape distribution, nuclear-to-cytoplasmic volume ratio and volume of extracellular space. A survey of the literature revealed an absence of reliable quantitative data for these parameters. We therefore present the results of our own basic image analysis on normal and pathological tissue sections, which we hope will be of use to other workers wishing to model cervical squamous epithelium, or other similar tissue structures.     

Extension of a secondary adrenal neoplasm into the inferior vena cava

Adrenal cortical carcinoma is well known to extend into the renal veins and inferior vena cava. It is less known that neoplasms metastatic to the adrenal might also extend into the renal vein and cava. Only a few reports in the literature document this extension. We report a case of metastatic neoplasm to the adrenal extending into the inferior vena cava.