Wegener's granulomatosis masquerading as pancreatic carcinoma

Summary A 62-year-old male presented with painless jaundice and solitary pulmonary and pancreatic masses. An extensive evaluation revealed Wegener's granulomatosis as the etiology. His pancreatic mass and jaundice responded to temporary stenting and therapy with cyclophosphamide and prednisone. While pancreatic vasculitis in Wegener's granulomatosis has been noted previously in autopsy studies, symptomatic involvement has been reported only once previously and never as a presenting feature of the disease. The antineutrophil cytoplasmic antibody (ANCA) assay proved useful in establishing the diagnosis. Necrotizing vasculidities can mimic pancreatic carcinoma and should be considered in the differential diagnosis of atypical cases.The opinions expressed are the private views of the authors and should not be construed to represent the view of the Navy or Department of Defense.     

Age-related deficiency of the synthesis of platelet activating factor by leukocytes from Zellweger patients

Ca2+-ionophore A23187-induced synthesis of the alkoxyether lipid platelet activating factor (PAF) by leukocytes from Zellweger patients was undetectable in two patients studied at 3 and 4 weeks of age, reduced in a third patient studied at 2 months of age, and in the low normal range in four patients studied between 4 months and 5 years of age. We have previously reported that plasmalogen-type phosphatidylethanolamine (PE) levels of erythrocytes are reduced in Zellweger patients up to 20 weeks of age, but normal in older patients. These levels were reduced in the three patients with abnormal PAF synthesis, and normal in the other four patients. The results suggest a close relationship between the age of the patients at sampling, and both the A23187-induced capacity of leukocytes to synthesize PAF and the plasmalogen PE levels in their erythrocytes.     

The clinical significance of nonspecific gastritis

Summary Chronic nonspecific gastritis can be looked upon as a single pathologic process. The various stages represent steps in the direction of atrophy, with variable evidences of repair, including eventually even outspoken epithelial hyperplasia.I believe that uncomplicated chronic nonspecific gastritis causes no illness. For many decades the concept of gastritis has been used as a diagnostic excuse to cover dyspeptic symptoms that have not been understood.The complications of gastritis are moderately common and may occasionally be very serious—gastric secretory deficiency, pernicious anemia, hyperplastic tumor formation, possibly malignant transformation, and hemorrhage.     

Squamous cell carcinoma of the rectum

Summary A case of squamous cell carcinoma of the rectum is reported. This case is of interest because of its unusual histologic type and because it was discovered at a stage in which its pathogenesis could be readily determined. The views expressed are those of the authors and do not necessarily reflect those of the Navy Department or the Naval Service as a whole.     

Retrovirus-mediated reconstitution of respiratory burst activity in X- linked chronic granulomatous disease cells

X-linked chronic granulomatous disease (X-CGD) results from mutations in the gene encoding gp91phox, the larger subunit of the respiratory burst oxidase cytochrome b. In this study, a recombinant retrovirus vector was constructed and evaluated for its expression of human gp91phox in a human X-CGD myeloid cell line in which the endogenous gp91phox gene had been disrupted by gene targeting. The retrovirus construct, Zip/PGKgp91, was first introduced into the GP+envAm12 amphotropic packaging line and yielded virus producer clones with estimated titers of up to 1 x 10(5) cfu/mL. Coculture infection of X- CGD myeloid cells with Zip/PGKgp91 resulted in restoration of respiratory burst activity to 15% of the cells. Isolated clonal infectants expressed relatively low levels of recombinant gp91phox (< or = 12% of wild-type), but exhibited considerable superoxide- generating activity (up to nearly 60% of wild-type). These results show the feasibility of phenotypic correction of CGD using gene replacement therapy and suggest that even modest levels of gp91phox expression may lead to considerable functional correction of X-CGD neutrophils.     

Relationship between living arrangements and the psychological well‐being of older people in Hong Kong

Objectives: This study explored the relationship between three types of living arrangements, namely living alone, living with family, and living in a hostel, and the psychological well‐being of older people in Hong Kong. The impact of various sociodemographic factors on the choice of living arrangements of older people was also studied. Methods: Ninety healthy Hong Kong Chinese were recruited from four multi‐service centres and one hostel. An individual interview was conducted with each participant and the General Health Questionnaire‐12 and the Center for Epidemiological Studies Depression Scale‐10 were administered. Results: The results suggested that the psychological well‐being of older people living in hostels was better than that of older people living alone, but that the psychological well‐being of older people living with their family was not different from that of older people living alone. Conclusion: That the psychological well‐being of older people in different living arrangements is different may be explained by the differences in time for leisure, access to social services, as well as changes in their attitude towards co‐residence with children.     

The adverse effect of chocolate on lower esophageal sphincter pressure

Decreased lower esophageal sphincter (LES) pressure after ingestion of chocolate has been previously noted. We have further evaluated the effect of chocolate on the known ability of gastric alkalinization or bethanechol to increase LES tone. 9 normal subjects were studied using an infused open-tip recording system. Pressure was monitored for a 15-min basal period, and for 60 min after ingestion of 120 ml of chocolate syrup either alone or with the concurrent administration of commercial antacid, oral bethanechol, or subcutaneous bethanechol. After chocolate ingestion, mean basal LES pressure of 14.6±1.1 (±SEM) mm Hg decreased significantly (P<0.01) to 7.9±1.3 mm Hg. An identical LES response occurred when antacid was given with the chocolate dose. Oral bethanechol (25 mg) and chocolate together resulted in lesser decreases in LES pressure. Subcutaneous bethanechol (5 mg) and chocolate produced significant increases (P<0.05) in sphincter pressure, although of lesser magnitude than reported with bethanechol alone. These results indicate that the adverse effect of chocolate on the LES is not reversed by gastric alkalinization and suggest that bethanechol in sufficient dose may overcome chocolate-induced decreases in LES pressure.This work was supported by the Department of the Navy Clinical Investigation Program Grant #5-05-530R.     

Tuberculous anal ulcer

Two patients with anorectal tuberculosis, without prior or concurrent knowledge of active pulmonary infection with mycobacteria, are described. Anal fissure in an unusual location which is slow to heal should have a biopsy performed, with appropriate stains and cultures carried out, to rule out tuberculous disease. Chemotherapy is then highly effective for ulcerative perianal tuberculosis