Gamma-interferon in aplastic anemia: inability to detect significant levels in sera or demonstrate hematopoietic suppressing activity

A radioimmunoassay (RIA) was used to quantitate biologically active gamma interferon (INF-gamma) in sera and in supernatants of cultured mononuclear cells obtained from 50 patients with aplastic anemia. Only five of the 50 serum samples had INF-gamma levels above background (greater than 0 less than 0.5 units per mL). Detectable levels of spontaneous INF-gamma (0.3 to 868 U/mL) were found in 18 of the 50 mononuclear cell supernatants tested. The addition of patient sera or INF-gamma positive supernatants to cultures of normal hematopoietic colonies did not result in reduced colony growth. Flow cytofluorimetric analysis of mononuclear cells failed to establish a correlation between the presence of INF-gamma in supernatants and the number of activated T cells or natural killer (NK) cells in the mononuclear cell population. However, a significant correlation did exist between the presence of monocytes and the production of INF-gamma. Contrary to previous reports, our data suggest that patients with aplastic anemia do not have high circulating levels of INF-gamma. Unstimulated mononuclear cells from some patients will produce significant levels of INF-gamma, but this does not result in decreased in vitro hematopoiesis.     

Acquired malposition of the colon and gallbladder in patients with cirrhosis: CT findings and clinical implications

Topographic relationships among the gallbladder, liver, hepatic flexure of the colon, right hemidiaphragm, and anterolateral peritoneal reflection were evaluated with computed tomography in 75 patients with biopsy-proved cirrhosis and in 200 control subjects to determine the effect of cirrhotic liver morphology on the anatomy of the right upper quadrant of the abdomen. Interposition of the colon between the liver and anterolateral abdominal wall and/or diaphragm was seen in 18 of the 75 (24%) cirrhotic patients and in six of the 200 (3%) control subjects. There was a strong correlation among gallbladder malposition, colonic interposition, and a ratio of transverse caudate lobe width to right lobe width (C/RL) exceeding 0.60. Patients with cirrhosis, colonic interposition, and gallbladder malposition had a mean C/RL of 0.62, compared with a mean of 0.50 for cirrhotic patients without interposition (P less than .0001). The mean C/RL for control subjects without interposition was 0.43, as compared with 0.69 for control subjects with interposition (P less than .01). These acquired malpositions of the colon and gallbladder may pose a diagnostic dilemma and increase the risk of inadvertent injury during percutaneous liver biopsy, interventional biliary tract procedures, and laparotomy.     

Percutaneous transluminal renal angioplasty: initial and long-term results

Renal artery stenosis in 201 patients with hypertension was treated with percutaneous transluminal renal angioplasty (PTRA). A total of 213 procedures were performed as treatment of 262 separate stenosis. The stenosis was caused by atherosclerosis in 134 cases and by fibromuscular dysplasia (FMD) in 52 cases; the cause was indeterminate in 27 cases. Of the 213 procedures, 172 were successful or resulted in improvement, for a technical success rate of 80.8%. The initial clinical results could be evaluated in 210 cases; cure or improvement was achieved in 80%. There were 23 cases in which neither technical nor clinical success was achieved. Data on the remaining 187 cases were the basis of this long-term follow-up study. The cumulative patency rate at 5 years was 80% in the atherosclerosis group, 89% in the FMD group, and 74% in the indeterminate group. The mortality was less than 1%. Because spasm occurred in 33 cases, causing an infarction in ten instances, antispasmodic medication seems warranted. These long-term results indicate that PTRA is the treatment of choice in patients with renovascular hypertension.