Crohn's Disease of the Colon

Using accepted diagnostic criteria we have selected, for study, 160 patients with Crohn's disease involving the colon. There is a remarkable discrepancy between the clinical diagnosis prior to or at the time of initial admission to this hospital and the diagnosis following definitive investigation and observation of the progression of disease.
The peak age incidence occurred in the second decode The colitis group showed a greater percentage of patients over 30 years of age. Although histopathology was not obtained in all patients, there appeared to be sparing of the ascending colon in a small percentage (9%) of patients with ileocolitis.
Comparison of the clinical features of granulomatous disease limited to the colon and granulomatous ileocolitis shows a significantly greater incidence of extraintestinal symptoms and overt bleeding in the former. Nausea, vomiting, subacute obstruction, abdominal mass and internal fistulas were substantially more common in ileocolitis but the difference was not statistically significant. In this series retroperitoneal abscess did not occur in patients with disease localized to the colon. In the 10 patients with ileocolitis who developed an abscess, however, the site of fistula was the colon in four patients. In one of these, the abscess was left-sided.     

Oral anticoagulation reduces activated protein C less than protein C and other vitamin K-dependent clotting factors

Oral anticoagulant therapy, which is used for prophylaxis and management of thrombotic disorders, causes similar reductions in plasma levels of vitamin K-dependent procoagulant and anticoagulant clotting factor zymogens. When we measured levels of circulating activated protein C, a physiologically important anticoagulant and anti-inflammatory agent, in patients on oral anticoagulant therapy, the results unexpectedly showed that such therapy decreases levels of activated protein C substantially less than levels of protein C, prothrombin, and factor X, especially at lower levels of prothrombin and factor X. Thus, we suggest that oral anticoagulant therapy results in a relatively increased expression of the protein C pathway compared with procoagulant pathways not only because there is less prothrombin to inhibit activated protein C anticoagulant activity, but also because there is a disproportionately higher level of circulating activated protein C.     

Effects of adrenalectomy and corticosterone administration on mouse lung tumor susceptibility and histogenesis

The effects of adrenalectomy (Ax) on urethan-induced lung tumors were determined in strains of mice that vary in their respective tumor susceptibilities: A/J (sensitive), BALB/cByJ (intermediate), and C57BL/6J (B6, resistant). Ax increased tumor number in both A/J (by 25%) and B6 mice (by 400%), but not in BALB/cByJ mice. The relative proportions of adenomas exhibiting the alveolar or papillary histological growth patterns were unchanged. Implantation of corticosterone-containing pellets into adrenalectomized B6 mice restored tumor multiplicity to that of sham-operated mice and into adrenalectomized A/J mice reduced multiplicity below that of sham-operated mice. Corticosterone, therefore, regulates neoplastic development of mouse lung epithelial cells.     

Evaluation of Lactobacillus Preparation on Enterotoxigenic E. Coli-induced Rabbit Ileal Loop Reactions

A commercially available lactobacillus-containing preparation has been used extensively in the treatment of diarrhea but few laboratory tests have been performed to determine the efficacy of this product. The rabbit ileal loop reaction was used here to determine the effect of the lactobacillus preparation and its ingredients on E. coli enterotoxin-induced loop fluid response. Enterotoxigenic E. coli cells grown overnight in shake cultures were washed and resuspended in saline to the original volume. They were then diluted in TSB suspensions of the lactobacillus preparation or its ingredients and injected into ileal loops. E. coli diluted in TSB served as positive controls. Fluid response was measured after 18 hours and the loop fluid ratio (LFR) (ml./cm.) of the lactobacillus preparations was compared to the positive controls. The positive controls always showed a high loop fluid ratio (> 1.1 ml./cm.) and negative saline controls showed no fluid response. The lactobacillus granules and tablets had low LFR's (0.08 and 0.05, respectively). Ingredients (whey, talc, sugar, evaporated milk, mineral oil) had variable LFR's (0.65, 0.78, 1.39, 1.46 and 1.54, respectively). Individual ingredients used to make this preparation show little antifluid response when used separately but the final product exhibits a significant antienterotoxin response.     

Factor V deficiency in Philadelphia-positive chronic myelogenous leukemia

Factor V deficiency has been identified in 8 of 8 patients 7--20 yr of age, with Philadelphia-positive (Ph1+) chronic myelogenous leukemia (CML). In these 8 patients, factor V deficiency was not due to hepatic dysfunction, factor V inhibitors, or disseminated intravascular coagulation. In 3 patients, factor V activity rose 10%--12% (0.10--0.12 U/ml) after the infusion of 28--31 ml/kg body weight of fresh frozen plasma (FFP). The rise persisted less than 14 hr. The mean measured postinfusion rise in factor V was 18% of the expected rise calculated from the volume of FFP infused in the patients' plasma volume. In 4 patients, a small transient rise in factor V activity occurred after splenectomy or plateletpheresis. Factor V deficiency was completely corrected after a marked reduction in bone marrow cellularity in 2 patients with Ph1+ CML treated with extensive chemotherapy, total body irradiation, and bone marrow transplantation. Factor V deficiency was retrospectively observed in 6 of 20 patients, ages 20--80 yr, with Ph1+ CML and 3 of 6 patients with other myeloproliferative disorders. The factor V deficiency appears to be associated with the large myeloid- megakaryocytic cell mass characteristic of CML and other myeloproliferative disorders.     

Advanced fusarium keratitis progressing to endophthalmitis

PURPOSE: To review the clinical course, treatment, and visual outcomes of keratitis with endophthalmitis caused by the filamentary fungus Fusarium. METHOD: One hundred fifty-nine cases of Fusarium keratitis at Bascom Palmer Eye Institute between January 1, 1987 and August 21, 2000 were reviewed. Ten patients with culture-proven Fusarium keratitis progressed to endophthalmitis. All 10 underwent standard diagnostic microbiologic evaluation, and topical and oral antifungal therapy was instituted. Surgical therapy was applied when necessary. Main outcome measures included the incidence of intraocular invasion of fungal keratitis and response to treatment. RESULTS: Ten cases of 159 Fusarium keratitis patients had intraocular involvement that was culture proven. The isolated species were Fusarium oxysporum in seven cases and Fusarium solani in two cases, and in one case, the species could not be identified. Cultures of aqueous and intraocular tissues grew Fusarium in eight cases, whereas vitreous cultures were positive in two. Nine cases had preexisting risk factors. All patients received oral ketoconazole or fluconazole and topical natamycin 5%. In two cases, intravitreal amphotericin B injections were also given. Four patients required a penetrating keratoplasty, enucleation was performed in two patients, two patients required a combination of a penetrating keratoplasty and pars plana vitrectomy, and one patient developed phthisis. CONCLUSION: The combination therapy with oral imidazoles (fluconazole or ketoconazole) and topical natamycin is inadequate in severe Fusarium keratitis with intraocular spread. Early diagnosis and suspicion of endophthalmitis in patients with keratomycosis not responding to aggressive topical antifungal are important.     

Multivariate analyses of prognostic factors associated with hematopoietic recovery in autograft patients with different sources of progenitor cells: A GATMO experience

OBJECTIVE:: To evaluate in a multivariate analysis the prognostic factorsassociated with hematopoietic recovery and the supportive carerequirements after autotransplant of progenitor cells (PC) fromvarious sources: bone marrow (BMPC), BMPC & peripheral blood(PBPC), and PBPC alone. PATIENTS AND METHODS:: A total of 570 patients with hematological malignancies andsolid tumors underwent high-dose therapy followed by autotransplant.PBPC were obtained after mobilization with chemotherapy and/orcytokines. One-hundred five patients received BMPC, 217 receivedBMPC & PBPC and 248 PBPC alone; all of the patients receivedG-CSF or GM-CSF after infusion. RESULTS:: In a multivariate analysis the recovery of neutrophils was adverselyassociated with low numbers of nucleated cells infused (P<0.13),bone marrow progenitor cell source, and diagnosis of multiplemyeloma and acute leukemia (P<0.001). The factors that adverselyaffected platelet recovery were low number of nucleated cellsand diagnosis of multiple myeloma and acute leukemia (P<.001). CONCLUSION:: We conclude that BMPC adversely affect neutrophil recovery whilelow numbers of nucleated cells and diagnosis of multiple myelomaand acute leukemia adversely affect both neutrophil and plateletrecovery. autograft, bone marrow, hematological recovery, peripheral blood, progenitor cells, prognostic factors     

Low levels of alpha-L-fucosidase activity in colorectal cancer are due to decreased amounts of the enzymatic protein and are related with Dukes' stage

Colorectal cancer remains a major medical problem and survival of the patients is directly correlated to the possibility of metastases occurrence. We searched for biochemical differences between colorectal adenocarcinomas and their precursor normal cells with the aim of complementing histological methods for the classification and prognosis of human colorectal tumours. Increased fucosylation is one of the most common phenomena associated with malignant transformation, invasion and metastases. It might be expected that the enzyme alpha-L-fucosidase (alpha-L-fucosidase fucohydrolase E.C.3.2.1.51), involved in the breakdown of fucose-containing glycoproteins and glycolipids, would play an important role in the maintenance of the fucose content of aberrant fucosylated glycoconjugates. Statistical evaluation of 110 patients with colorectal adenocarcinoma has shown that there is a significant decrease of alpha-L-fucosidase activity in the malignant tissue compared with the healthy colonic mucosa of the same patient. Characterisation studies have shown that there are remarkable similarities in the physicochemical and kinetic properties of the enzyme in both tissues. Using an immunodetection assay we conclude that the observed decrease of alpha-L-fucosidase activity is due to a significant decrease of alpha-L-fucosidase protein in colorectal tumours. Our results further demonstrate that the alpha-L-fucosidase content (either as enzymatic activity or as enzymatic protein) is lower in primary tumours at advanced stages (Dukes' B and C) than in primaries at early stages (Dukes' A).     

Validation of a differential PCR and an ELISA procedure in studying HER-2/neu status in breast cancer

HER-2/neu oncogene status and total cellular p185^HER-2 content were simultaneously analyzed in 415 invasive breast-cancer specimens by differential PCR and ELISA respectively. Mathematical analysis of the data led us to establish a cut-off value of 1.7 for the ratio between the intensity of the HER-2/neu gene band and the reference gene band, to consider the HER-2/neu gene amplified, and of 260 fmol/mg protein, to consider p185^HER-2 over-expressed. Of the 415 tumors studied, 15% showed a diverse degree of HER-2/neu gene amplification. Of these tumors, 87% showed over-expression of the p185^HER-2. Of the remaining 352 specimens that did not display HER-2/neu gene amplification, 97% showed no p185^HER-2 over-expression (p < 0.0001). In 40 selected samples with a p185^HER-2 level lower than 260 fmol/mg protein, the degree of p185^HER-2 phosphorylation was very low or undetectable. Conversely, 38 of 46 selected tumors with a p185^HER-2 level higher than 260 fmol/mg protein exhibited a considerable degree of p185^HER-2 phosphorylation (p < 0.0001). Our data suggest that: (i) differential PCR and ELISA, which are relatively simple procedures, give similar information on HER-2/neu status in breast cancer; and (ii) given the large series analyzed, the cutoff values established can be considered as safe values for determining whether, in a given tumor, the HER-2/neu oncogene is amplified or p185^HER-2 is over-expressed. © 1996 Wiley-Liss, Inc.     

Obstructive sleep apnea: diagnosis with ultrafast CT

Patients with sleep-disordered breathing often have physiologic and anatomic abnormalities of the upper airway that are demonstrable while awake. An ultrafast computed tomographic (CT) scanner was used to measure the oropharyngeal and nasopharyngeal cross-sectional areas of 11 patients with obstructive sleep apnea. Twenty-four healthy volunteers served as control subjects. The percentage of change in cross-sectional area during quiet tidal breathing was used as a measure of airway compliance. Compared with weight-matched control subjects, patients with obstructive sleep apnea had smaller oropharyngeal airways (40.4 vs 177.8 mm2) (P less than .001) and smaller nasopharyngeal airways (31.3 vs 134.2 mm2) (P less than .001). In addition, their oropharyngeal airways were significantly more compliant (75% vs 27%) (P less than .001). Patients with obstructive sleep apnea are characterized by a small, collapsible oropharyngeal airway and by nasopharyngeal airway narrowing. These abnormalities can cause sleep-disordered breathing. Ultrafast CT scanning allows rapid, noninvasive assessment of airway variables.