Pouchitis Disease Course after Orthotopic Liver Transplantation in Patients with Primary Sclerosing Cholangitis and an Heal Pouch-Anal Anastomosis

Objective: Primary sclerosing cholangitis is associated with the development of pouchitis after ileal pouch-anal anastomosis for ulcerative colitis. This study determined the effect of liver transplantation for primary sclerosing cholangitis on the disease course of pouchitis.
Methods: Seven patients with an ileal pouch-anal anastomosis for ulcerative colitis underwent liver transplantation for primary sclerosing cholangitis. The medical record was reviewed to determine the pouchitis activity and pattern (no pouchitis, single acute, recurrent acute, chronic) before and after transplantation.
Results: Five of seven patients had pouchitis before transplant [recurrent acute (n = 3), chronic (n = 2)], and four of those five continued to have pouchitis after transplant (all chronic). Pretransplant sera were positive for antineutrophil cytoplasmic antibody in 6/6 patients, compared to 5/6 patients posttransplant. One patient with pouchitis pre-transplant became negative for antineutrophil cytoplasmic antibody posttransplant but continued to have pouchitis.
Conclusion: Pouchitis occurs frequently in patients with primary sclerosing cholangitis and an ileal pouch-anal anstomosis for ulcerative colitis. Liver transplantation does not alter the disease course of pouchitis for most of these patients.     

Phosphoinositide 3-kinase gamma-deficient hearts are protected from the PAF-dependent depression of cardiac contractility

OBJECTIVES: Following an ischemic insult, cardiac contractile recovery might be perturbed by the release of autacoids, like platelet-activating factor (PAF), that depress heart function by acting through G protein-coupled receptors (GPCRs). The signaling events downstream the PAF receptor that lead to the negative inotropic effect are still obscure. We thus investigated whether the GPCR-activated phosphoisositide 3-kinase gamma (PI3Kgamma) could play a role in the cardiac response to PAF. METHODS: The negative inotropic effect of PAF was studied ex vivo, in isolated electrically driven atria and in Langendorff-perfused whole hearts derived from wild-type and PI3Kgamma-null mice. Postischemic recovery of contractility was analyzed in normal and mutant whole hearts subjected to 30 min of ischemia and 40 min of reperfusion in the presence or absence of a PAF receptor antagonist. RESULTS: While wild-type hearts stimulated with PAF showed increased nitric oxide (NO) production and a consequent decreased cardiac contractility, PI3Kgamma-null hearts displayed reduced phosphorylation of nitric oxide synthase 3 (NOS3), blunted nitric oxide production and a complete protection from the PAF-induced negative inotropism. In addition, Langendorff-perfused PI3Kgamma-null hearts showed a better contractile recovery after ischemia/reperfusion, a condition where PAF is known to be an important player in depressing contractility. In agreement with a role of PI3Kgamma in this PAF-mediated signaling, postischemic contractile recovery in PI3Kgamma-null mice appeared overlapping with that of normal hearts treated with the PAF receptor antagonist WEB 2170. CONCLUSION: These data indicate a novel PAF-dependent signaling pathway that, involving PI3Kgamma and NOS3, contributes to postischemic contractile depression.     

The control of T cell responses by dendritic cell subsets

Dendritic cells are known as the most efficient antigen-presenting cell type to activate na?ve T cells; however, they are able to do more than just efficiently present antigen to T cells. They are key modulators of the immune response that can influence Th cell differentiation by preferentially inducing Th type 1 or 2 cell responses, and the differential polarisation of CD4(+) T cells appears to be mediated by discrete dendritic cell subsets.     

Removal of Epulis Fissuratum Associated to Vestibuloplasty with Carbon Dioxide Laser

. There have been numerous surgical techniques developed for removing the epulis fissuratum lesions in order to improve alveolar ridge contour and improving adaptation of full prostheses. Most of these techniques can cause postoperative complications, such as oedema, pain, difficulty in swallowing and jaw movements, haemorrhage, infections and slow placement of final prostheses. The use of carbon dioxide (CO₂) laser for the surgical removal of epulis lesions has resulted in many significant improvements including convenient mucosa removal, no bleeding or need for sutures, and minimal postoperative pain and oedema. This study is of 15 cases of removal of extensive epulis with vestibuloplasty in the maxilla and mandible that was carried out with CO₂ laser, with no postoperative complications, rapid healing, and excellent aesthetic and functional outcome, all of which allowed for more rapid placement of final prosthesis. Received for publication 15 June 1998; accepted following revision 18 December 1998.     

Blastomycosis of the colon resembling clinically ulcerative colitis.

An 8 year old Brazilian girl had an infection, apparently confined to the large intestine, with Paracoccidioides brasiliensis. The symptoms were diarrhoea with fresh blood and mucus, severe malnutrition, and a spastic and ulcerated colon. She is making good progress on co-trimoxazole.     

The influence of patient characteristics on the appropriateness of surgical treatment for breast cancer patients

BACKGROUND: Within the framework of a multi-annual educational interventionsponsored by the Ministry of Health and regional health authorities,patterns of the care delivered to breast cancer patients inItalian general hospitals were monitored in order to identifyareas of practice whose quality was in need of improvement DESIGN: Information on the diagnostic and therapeutic procedures in63 general hospitals in eight Italian regions performed in 1724consecutive breast cancer patients were retrospectively gatheredfrom medical records. Quality of care was assessed by a diagnosticand therapeutic score based on the observed degree of compliancewith previously established courses of action. RESULTS: The median value of the overall diagnostic and staging scorewas 60%. About one-third of surgical operations (38%) were inappropriate:one-fourth (24%) of patients with stage I-II disease had unnecessarilyradical surgery (i.e., Halsted mastectomy), and limited surgeryin patients with small tumors (i.e., < 2 cm) was under utilized.Chronological age influenced physicians' behaviour: elderlypatients were more likely to have a less intensive diagnosticwork-up and less appropriate surgical treatment (with more frequentperformance of an unnecessary radical operation and a less frequentutilization of limited surgery), independently of their overallhealth status. The presence of one or more co-existent diseaseswas associated with a failure to undergo axillary clearanceand with a lower utilization of conservative surgery independentlyof age. CONCLUSION: In accord with others, this study confirms the existence ofa clinically important effect of patient age on diagnostic andtherapeutic behaviour and the use of unnecessarily radical surgicalprocedures. The paper discusses the implications of these findingsfor the next stage of the educational project, in which practiceguidelines will be developed and implemented to improve thequality of care for breast cancer patients. breast neoplasm, human, quality of health care     

A ‘vigilance unit’ for households subject to triatomine control

An inexpensive ‘vigilance unit’ consisting of a cardboard box and attached plastic bag is described. This is utilized to provide two ways of detecting residual triatomine bugs present after an insecticide control programme in Brazil. How well it works will depend on the householders' enthusiasm to participate in the vigilance measures suggested by the control personnel.