Common bile duct calculi: updated experience with dissolution with methyl tertiary butyl ether

The authors describe their experience with methyl tertiary butyl ether (MTBE) in a larger series of patients than previously reported in order to acquaint physicians with both its effectiveness for dissolution of common bile duct calculi and the limitations of its use. Ten patients with 13 biliary calculi underwent percutaneous stone dissolution treatment with the experimental cholesterol solvent, MTBE. Three stones completely dissolved within 30 minutes, seven were reduced in size, and three were visibly unaffected. All stones not completely dissolved were easily extracted by means of a stone basket except for one in a patient taken to surgery. Although MTBE perfusion is an effective technique for management of biliary calculi, practitioners should be aware that its use is quite time consuming and its odor difficult to control.     

Severe Chlamydia trachomatis pneumonia in a patient with no immune deficiency

A 40-year-old patient with no immune deficiency was admitted because of severe bilateral pneumonia and pleural effusion. The diagnosis of Chlamydia trachomatis pneumonia was confirmed by isolation of the pathogen and the appearance of serum antibodies to Chlamydia species.     

The role of the macrophage in cutaneous leishmaniasis.

The investigation of the role of the macrophage in cutaneous leishmaniasis has been prompted by observations of the clinical behaviour of the infection. In contrast to the self-healing oriental sore, chronic leishmaniasis is characterized by persistent lesions and leishmania recidiva by lesions that flare up locally long after clinical healing. In both clinical types, the parasite is thought to be maintained inside the macrophages. It will be shown that the normal macrophages of mice and guinea-pigs are parasitized by L. tropica; the parasite is not killed by the macrophages but it multiplies within these cells. Incubation of the macrophages with rabbit or human anti-Leishmania sera on the other hand, leads to the attachment of specific immunoglobulins to the macrophage cell surface and consequently to the prevention of parasitization by L. tropica under the experimental conditions. The parasite appears to be immobilized at the macrophage cell surface. Normal rabbit or human sera did not interfere with parasitization. It is postulated that the parasite specifically immobilized at the cell surface might possibly be better exposed to and affected by the immune response than intracellular parasites. Furthermore, infected parasitized macrophages contribute to the immune response by processing soluble antigens from the intracellular parasites and presenting them on their surfaces, as seen by the greater affinity (higher dilution) of anti-Leishmania antibody for the cell membrane of infected macrophages than for normal macrophages.