Impact of periampullary duodenal diverticula at endoscopic retrograde cholangiopancreatography: a proposed classification of periampullary duodenal diverticula

BACKGROUND/AIMS: To propose a classification schema to describe periampullary duodenal diverticula (PDD) found at endoscopic retrograde cholangiopancreatography (ERCP), and to study the characteristics of these diverticula. MATERIALS AND METHODS: Among 400 consecutive patients in whom an ERCP was performed, PDD were present in 131 (32.8%), being these patients significantly older than the remaining, served as controls. RESULTS: PDD were classified in 3 different types according to the position of the major duodenal papilla: type I (16.3%), inside the diverticulum; type II (10.2%), in the margin of the diverticulum; and type III (6.5%), near the diverticulum. PDD were not associated with a more difficult cannulation of the biliary tract. CONCLUSIONS: PDD are common, especially in older patients, and do not significantly increase the difficulty of deep cannulation.     

Annexin‐A1 identified as the oral epithelial cell anti‐Candida effector moiety

Innate and adaptive immunity are considered critical to protection against mucosal candidal infections. Among innate anti‐Candida mechanisms, oral and vaginal epithelial cells have antifungal activity. The mechanism is fungistatic, acid‐labile and includes a requirement for cell contact by intact, but not necessarily live, epithelial cells. The purpose of this study was to use the acid‐labile property to further characterize the effector moiety. Surface material extracted from phosphate‐buffered saline (PBS) ‐treated, but not acid‐treated, epithelial cells significantly inhibited the growth of Candida blastoconidia in a dose‐dependent manner which was abrogated by prior heat and protease treatment. Proteins extracted from PBS‐treated cells bound blastoconidia and hyphae more intensely than those from acid‐treated cells. Proteins from PBS‐treated cells eluted from Candida revealed two unique bands of approximately 33 and 45 kDa compared with acid‐treated cells. Mass spectrometry identified these proteins as Annexin‐A1 and actin, respectively. Oral epithelial cells stained positive for Annexin‐A1, but not actin. Western blots showed reduced Annexin‐A1 in proteins from acid‐treated epithelial cells compared with those from PBS‐treated epithelial cells. Lastly, it was demonstrated that immunoprecipitation of Annexin‐A1 from proteins extracted from PBS‐treated oral epithelial cells resulted in abrogation of inhibitory activity. Taken together, these results indicate that Annexin‐A1 is a strong candidate for the epithelial cell anti‐Candida effector protein.     

Glandular Inclusions in Inguinal Hernia Sacs: A Clinicopathological Study of Six Cases

Glandular inclusions in inguinal hernia sacs are not frequent. We present six cases of inguinal hernia with this finding, which represents an incidence of 2.6% in males and shows a predominance in the prepubertal stage. Five patients showed cryptorchidism and two cases were related to congenital malformations of the single umbilical artery type and 47,XY chromosome disorder with chromosomal marker. The most important differential diagnosis must be made with normal histological structures such as the vas deferens or epididymis. The mean diameter of the inclusions was 0.1988 mm and there was a significant difference in size between the inclusions and the vas deferens, but not the epididymis. Differentiation from the latter is based on the absence of a well-developed muscular coat in the wall of the inclusions. It is important to recognize that these inclusions can occur in hernia sacs because of the clinical and medicolegal implications that arise if they are confused with true epididymis or vas deferens. They may arise from paratesticular embryonal remnants.     

Kinetics of hypodermically injected technetium-99m and correlation with cutaneous structures: an experimental study in dogs

We investigated the involvement of cutaneous structures in specific linear migration pathways of technetium-99m pertechnetate hypodermically injected at points of low electrical resistance in the metacarpus of male beagles. Skin-deep incisions were made in the front or back legs on either the same side as the ^99mTc injection or on the opposite side. Incisions in the back legs did not affect the migration pattern. Incisions in the front legs before the injection of ^99mTc prevented tracer migration. After the injection of ^99mTc, incisions in the front contralateral leg caused sudden cessation of the migration, while incisions in the ipsilateral leg caused immediate disappearance of the pathway previously observed. Radioactivity was not detected in flaps obtained from the skin overlying the migration pathway or from the corresponding area of the contralateral leg. In conclusion, the specific linear migration pathways of ^99mTc hypodermically injected at points of low electrical resistance cannot be explained by any known biological function. Although the migration of ^99mTc does not seem to be strongly linked to any cutaneous structure, the skin overlying the radioactive pathway and the corresponding area of the contralateral leg must be intact if tracer migration is to take place.     

Oral and vaginal epithelial cell anti-Candida activity is acid labile and does not require live epithelial cells

BACKGROUND: Candida albicans is the causative agent of oral and vaginal candidiasis. Innate host defenses against C. albicans are important against each infection. Among these are oral and vaginal epithelial cells that have anti-Candida activity. The mechanism of action includes a requirement for cell contact with no role for soluble factors, and a putative role for carbohydrates based on the sensitivity of the activity to periodic acid. METHODS: Periodic acid treatment of epithelial cells as well as the property of partial resistance of antifungal activity to fixation was used to further dissect the mechanism of action. RESULTS: The results herein effectively now challenge a role for carbohydrates alone. Firstly, the putative carbohydrate(s) released into supernatants of periodic acid-treated epithelial cells could not compete with fresh epithelial cells for activity, and equivalent abrogation of activity was observed by periodic acid-treated cells irrespective of the amount of carbohydrate released. Instead, the similar abrogation of activity following treatment with other acids or when cocultured under acidic conditions suggests that the activity is acid-labile. Finally, while activity requires intact epithelial cells, it does not require live cells; activity was minimally affected by fixing epithelial cells prior to coculture where the majority of cells remained impermeable to Trypan blue but were defined as non-viable by positive nuclear staining with propidium iodide. CONCLUSION: These results suggest that antifungal activity is dependent on contact by intact, but not necessarily live, epithelial cells through an acid-labile mechanism.     

Strain differences of dopamine receptor levels and dopamine related behaviors in rats

Here we have investigated whether differences in levels of dopamine D1-like, D2-like receptors, dopamine D3 receptors, and dopamine transporter could be related to behaviors such as immobility response and locomotion between Wistar rats and Sprague-Dawley rats. The levels of the dopamine receptors and transporter were measured by autoradiographic study at the level of basal ganglia and the limbic subregion. The behavioral study was done by open-field and immobility response tests. The Wistar rats exhibited a higher level of D1 receptor binding in the basal ganglia subregions than Sprague-Dawley rats. The Wistar rats have higher levels of dopamine D2 receptor binding and dopamine transporter binding in the dorsolateral part of the caudate-putamen. In addition, the dopamine transporter binding were also higher in the Wistar rats than in Sprague-Dawley rats in the ventral part of the caudate-putamen and nucleus accumbens core. However, there were no differences in the level of D3 receptor binding in the limbic or basal ganglia subregions between these two strains. In Wistar rats, the duration of the immobility responses was longer and with less locomotor activity after these immobility responses compared with Sprague-Dawley rats. These data suggest that the differences in dopamine receptors in these two rat strains may in part relate to the behavioral differences reported in these two strains.     

Subependymal giant cell astrocytoma in children with tuberous sclerosis

METHODS: Out of 105 patients with tuberous sclerosis (TS) admitted to the Hospital Nacional de Pediatría "Juan P. Garrahan" (Buenos Aires, Argentina), we surgically treated 17 children between January 1988 and December 2000. Two patients were operated on because of epilepsy and 15 patients because of an intraventricular tumor (subependymal giant cell astrocytoma [SGCA]). In this report we focus on tumors. Twelve of the 15 patients presented with hydrocephalus but none of them had a preoperative shunt. All tumors were surgically resected using frontal transventricular or transcallosal routes. Total removal was achieved in 12 out of 15 and subtotal removal in 3 out of 15 patients (resection of 70-95%). RESULTS: Exeresis of the tumor was not accompanied by significant morbidity and there was no perioperative mortality. Seizures and mental retardation did not improve after tumor resection. It was necessary to insert a postoperative shunt a long time after surgery in only one patient. There were no recurrences of SGCA that were totally removed after a mean follow-up of 51.7 months. CONCLUSIONS: We encourage surgery as soon as a lesion is diagnosed as a tumor. The "transformation" of subependymal nodules (SEN) into tumors (SGCA) may be considered controversial.     

Differential susceptibility of two species of macaques to experimental vaginal candidiasis.

Vulvovaginal candidiasis (VVC) caused by Candida albicans is a significant problem in women of childbearing age. Unfortunately, protective host defense mechanisms against VVC are poorly understood. Although rodent models of experimental vaginal candidiasis have been useful, several differences from humans limit the correlation of experimental data. The purpose of the present study was to examine two species of macaques as an alternative model of experimental vaginitis. Screening of pig-tailed and rhesus macaques demonstrated that each had mucosal Candida colonization and prior immune sensitization to C. albicans. Vaginal-associated immunity (cytokines, antibodies, and innate resistance) was also detected in cervicovaginal lavage fluid from both species. Nevertheless, intravaginal inoculation of C. albicans into both species, either untreated or under estrogen-treated conditions, resulted in vaginal infection in rhesus, but not pig-tailed, macaques. Several estrogen-dependent changes in the rhesus immune status coincided with susceptibility to infection. Taken together, these results suggest that pig-tailed and rhesus macaques may be useful in studying pathogenesis and immunity associated with C. albicans vaginitis.