Overlap syndrome of primary sclerosing cholangitis and autoimmune hepatitis

We report a 46-year-old patient with the typical biochemical, histological and cholangiographic findings of primary sclerosing cholangitis (PSC) whose clinical and laboratory findings would also qualify her for the diagnosis of definite autoimmune hepatitis (AIH), according to the aggregate score of the International Autoimmune Hepatitis Group. We suggest that this patient may represent an example of the overlapping syndrome of PSC and AIH.     

Reported influenza in pregnancy and childhood tumour

The present study was conducted to test the hypothesis that exposure to influenza in pregnancy increases the risk of tumour of certain type in childhood. Children ages 17 years or less diagnosed in Greece with brain tumours or neuroblastomas from 1982 to 1993 (n=94) were contrasted to 210 controls selected from the same hospitals. Mothers of these children were interviewed about a variety of possible etiologic factors. The prevalence of influenza in Greece for each year during the period 1984–1992 was also compared with the number of children born during the same year who subsequently developed brain tumour or neuroblastoma. The results indicate a significant association between influenza in pregnant women and occurrence of tumour in index child (OR: 3.15, 95% CI: 1.13–8.77). These results persisted when adjustment for potential confounding factors was made. The findings should be interpreted cautiously because of lack of serologic documentation of information about infection obtained in interviews. A positive correlation (r = 0.74) of the number of tumour births by year of birth with the prevalence of influenza during the same year was also noted. This exploratory study is one of the few case-control studies of the epidemiology of childhood tumours in children, and the results suggest directions for future epidemiologic studies in this relatively uncharted field.     

The role of polymorphonuclear cells in psoriasis

Neutrophil cell function in psoriasis was studied through polymorphonuclear cell adherence to nylon wool, chemotaxis under agarose, and phagocytosis of Candida albicans. Differences in PMN adherence were not found between psoriatics and controls. The chemotactic response to zymosan activated serum (ZAS) did not differ between psoriatic and normal PMNs. The psoriatic serum exhibited chemoattracting properties equal to ZAS. Psoriatic serum was shown to be chemoattracting to psoriatic and normal PMNs whereas normal serum was only to psoriatic cells. Differences in recognition mechanisms between psoriatic and normal cells are proposed. Phagocytosis of Candida by psoriatic PMNS was earlier and more prolonged and candidacidal activity was earlier and definetely increased at given times compared to normal PMNs. A protective role of psoriatic PMNs in Munro's microabcesses against bacterial invasion is postulated.     

Some further features for differential diagnosis between squamous cell carcinomas and basal cell epitheliomas

Two further methods for the characterization of epidermal skin tumors are described: the antinuclear antibody (ANA) immunofluorescent test, which consists of indirect immunofluorescence with known high titer sera containing homogenous ANAs on epidermal skin tumors, and the ammoniacal-silver cytochemical method, which specifically stains nuclear histones. Squamous cell carcinomas (SCCs), basal cell epitheliomas (BCEs) as well as control specimens from normal skin and benign epidermal hyperplasias were studied. The ANA immunofluorescent test was positive for most SCCs, mixed SCC and basal cell carcinomas and metatypical BCEs. The ammoniacal-silver method gave a characteristic staining pattern shared among SCCs, mixed carcinomas and metatypical BCEs. BCEs, besides metatypical ones, were always negative by the ANA immunofluorescent test and the same applied for the control specimens. The ammoniacal-silver method gave a characteristic staining pattern for BCEs and control sections quite different from the staining pattern of the more aggressive forms of epidermal tumors. The two methods usually yielded parallel results.     

Mononuclear cell versus monocyte chemotaxis in psoriasis

Chemotaxis under agarose of psoriatic mixed mononuclear cells (MNs) and pure monocytes against Zymosan treated sera (ZAS), fresh psoriatic serum, and fresh normal serum was studied and compared with that of normal cells. Purification of monocytes was achieved on microexudate coated BHK flasks. Psoriatic MNs were found to be more chemotactic against psoriatic serum (P.S.) than normal MNs against normal serum (N.S.). Psoriatic cells were chemotactically more active than normal ones against psoriatic and normal serum but not against ZAS. Mixed mononuclear cells showed definitely increased chemotaxis over that of pure monocytes. When culture supernatants with lymphocyte derived factor (LDCF) activity were mixed with normal pure monocytes, the chemotactic activity of the monocytes recovered. It is, therefore, proposed that the LDCF from in vivo stimulated psoriatic lymphocytes by antigenic or mitogenic substances of psoriatic plaque might be an essential factor for the increased chemotaxis of mixed psoriatic MNs compared to pure monocytes. This hypothesis also explains the increased chemoattracting capacity of psoriatic serum for psoriatic and normal MNs as due to the in vivo release of lymphokine.     

Giant cell arteritis presenting as pulseless disease of the upper extremities

Summary The most frequently recognized clinical features of giant cell arteritis (GCA) derive from the involvement of the cranial arteries. In 10% of patients, however, the aorta and its major branches, are also affected. We report a case of a 53-year- old woman presenting with a fainting episode and diminished pulses in the upper extremities. Histologic examination of the temporal artery revealed features of giant cell arteritis.     

Intermittent therapy with high-dose 5-aminosalicylic acid enemas maintains remission in ulcerative proctitis and proctosigmoiditis

PURPOSE: The aim of this study was to compare the efficacy of intermittent therapy with mesalazine enemas and continuous oral mesalazine to maintain remission of distal ulcerative colitis or proctitis. METHODS: Thirt-yeight patients with distal ulcerative colitis (n=17) or ulcerative proctitis (n=21) in clinical, endoscopic, and histologic remission were randomly assigned to receive either oral mesalazine (0.5 g three times/day, Eudragit L coating, n=19) or intermittent therapy with mesalazine enemas (4 g of 5-aminosalicylic acid enema every third night, n=19). Both groups were comparable in regard to sex, age, age at disease onset, extent and duration of disease, number and mode of treatment of previous attacks, and time in remission. Patients were reviewed at the beginning of the study and, subsequently, at two-month intervals for 24 months or until a relapse occurred. At each visit, diaries were reviewed and clinical and laboratory assessments were performed. Sigmoidoscopy was carried out and biopsies were obtained by a blinded observer. Histology was assessed without knowledge of the patient's clinical state or treatment category. RESULTS: At the end of the study, 6 of 19 patients on oral mesalazine (32 percent) and 14 of 19 patients on mesalazine enemas (74 percent) were still in full remission (log rank test: 15.280,P <0.001). Differences in relapse rates between groups were significant even when data were stratified by extent of disease (P <0.01). In the oral group, six and seven patients relapsed at 12 and 24 months, respectively. In the enema group, three and two relapses occurred in the first and second year of the study, respectively. All patients complied with the treatment satisfactorily and there were no dropouts. CONCLUSION: These results suggest that intermittent therapy with mesalazine enemas is more effective than continuous oral mesalazine in maintaining remission in patients with distal ulcerative colitis and proctitis.Read at the meeting of the First United European Gastroenterology Week, Athens, Greece, September 25 to 30, 1992.     

Intravenous Tobramycin and Metronidazole as an Adjunct to Corticosteroids in Acute, Severe Ulcerative Colitis

Objectives : The aim of this study was to evaluate the role of metronidazole and tobramycin as an adjunct to corticosteroids in acute, severe ulcerative colitis. Methods : Thirty-nine consecutive patients with severe ulcerative colitis were randomized on admission to the hospital to receive intravenously either metronidazole (O.5g tid ) and tobramycin (4 mg/kg tid ) (n = 19), or placebo (n = 20). In addition, they were given parenteral nutrition, intravenous hydrocortisone (100 mg qid ) and hy-drocortisone enemas (100 mg bid). All patients were assessed after 10 days of continuous treatment, or at any time a severe complication occurred. Results : Twelve of 19 patients (63.15%) treated with antibiotics and 13/20 patients (65%) with placebo showed substantial improvement. Seven patients in each group did not improve (n = 9), or developed complications (n = 5) and underwent emergency colectomy without perioper-ative deaths or late deaths. Conclusions : These results do not support the routine use of intravenous tobramycin and metronidazole in the treatment of severe ulcerative colitis.