Deoxyribonucleic acid amplification and hybridisation in Crohn''s disease using a chlamydial plasmid probe.

The possibility that Crohn's disease is caused by infection with Chlamydia trachomatis was examined by probing for chlamydial plasmid deoxyribonucleic acid (DNA) in DNA extracts from Crohn's disease tissue and by means of a serological study. Gut DNA extracts were obtained from 10 patients with Crohn's disease and four control subjects and were probed with a chlamydial plasmid probe after Southern blotting. The polymerase chain reaction was also used to amplify any chlamydial plasmid DNA present in tissue DNA extracts, before Southern blotting and probing. Chlamydial proctitis control specimens were not available: gut DNA extracts mixed with traces of chlamydia plasmid served as positive controls. Using these techniques, no chlamydial plasmid DNA sequences were found in Crohn's disease tissue. An enzyme linked immunosorbent assay for C trachomatis LI was performed on 48 patients with Crohn's disease and 48 control subjects. Seropositivity was present in 14.6% of patients and 29% of control subjects and was not statistically significant (p greater than 0.05). The failure to show chlamydial DNA and the lack of serological response to chlamydia make C trachomatis infection a very unlikely factor in the pathogenesis of Crohn's disease.     

A dual-balloon technique for nonoperative removal of retained biliary stones

Retained intrahepatic biliary stones were dislodged with and crushed between two occlusion balloon catheters. Standard angiographic catheters and guide wires with exchange for occlusion balloon catheters can be used in situations where a stone basket cannot, and have certain advantages over Fogarty biliary balloon catheters.     

Pyoderma gangrenosum in Crohn's disease: Report of a case

Summary A case of pyoderma gangrenosum of the abdominal wall occurring in a patient with histologically proven Crohn's disease of the colon is described. An aggressive surgical approach (wide excision with delayed skin grafting) resulted in rapid healing of the abdominal wall. Subsequent colectomy through the previously involved abdominal site was accomplished without complication. Joseph B. Whitehead Department of Surgery. Emory University Affiliated Hospital Residency Training Program.     

The surgical management of primary hyperparathyroidism: a personal series.

Primary hyperparathyroidism includes a spectrum of abnormalities relative to the size and histologic characteristics of the diseased glands. The lack of uniform agreement upon pathological interpretation and discrepancies between gross and histologic findings perpetuate the controversy regarding the mass of parathyroid tissue necessary to be resected. From 1960 to 1978, 193 primary hyperparathyroid patients (aged 20-80 years; mean: 55 years) were operated on by the senior author with a mean follow-up of 41.5 months. An approach evolved that included gross identification of all parathyroid tissue with frozen section confirmation and assessment of cellularity-the latter modifying the extent of parathyroid resection in 11 patients (11%) of 100 patients who had biopsies of at least four parathyroids. Overall persistence and recurrence rates of hypercalcemia were 6.2% (12 patients) and 1% (two patients), respectively, despite routine biopsy in 100 patients. No permanent hypocalcemia developed, but five patients (2.6%) were hypocalcemia one to 16 weeks postoperatively. No operative deaths occurred. Submission of additional parathyroid tissue by routine biopsy disclosed a higher prevalence of nodular hyperplasia than usually found, and the clinical significance of this finding is discussed. With findings based on gross and microscopic intraoperative study, the authors believe, the surgeon is better able to categorize pathologic variants of hyperparathyroidism and better equipped to deal with recurrent disease.     

Psychological and social correlates of HIV stigma among people living with HIV

Abstract

HIV/AIDS remains a highly stigmatized condition jeopardizing both prevention and treatment efforts. Prior research on the psychological and social correlates of HIV stigma has produced mixed results. This study examined whether demographic factors, mental health status, perceived health, mode of HIV transmission, social support, and risky sexual behavior were associated with perceived HIV stigma. Cross-sectional data collected from the intake questionnaires of clients receiving HIV-related social services at an urban clinic in the Southeastern U.S. were analyzed using multiple linear regression analysis. Results showed that younger age, heterosexuality, psychological distress, contracting HIV from sources other than injection drug use or homosexual contact between men, and not knowing your last sexual partner’s HIV status were positively associated with perceived HIV stigma. Implications of study findings for the design of HIV stigma reduction interventions are discussed.     

Alpha 1 antitrypsin phenotypes and alcoholic pancreatitis.

Altered frequencies of alpha 1 antitrypsin phenotypes have been reported in patients with chronic pancreatitis, suggesting a possible genetic basis for individual susceptibility to this disease. Alpha 1 antitrypsin phenotypes, with particular regard to alcoholic pancreatitis, were studied. Patients with alcoholic pancreatitis were compared with alcoholic control subjects with no history of pancreatic disease. Serum alpha 1 antitrypsin concentrations were raised in pancreatitis patients sampled within one month of an acute attack of pancreatitis, but otherwise values were similar to those of control subjects. There were no significant differences in alpha 1 antitrypsin phenotypes between alcoholics with pancreatitis and alcoholic control subjects. This study of alpha 1 antitrypsin phenotypes provides no evidence of an inherited susceptibility to alcoholic pancreatitis.     

Ileal pouch-anal anastomosis. The Emory University experience.

The ileal pouch-anal anastomosis has become a practical alternative to proctocolectomy for the treatment of ulcerative colitis and polyposis coli. To evaluate its success, the Emory University Affiliated Hospital experience from February 1984 to March 1989 was retrospectively reviewed. There were a total of 50 patients identified; 84 per cent had ulcerative colitis, and 16 per cent had polyposis coli (familial polyposis and Gardner's syndrome). The majority of these patients underwent a two-stage operation, but one-third required a three-stage procedure due to difficulty in mucosal proctectomy or toxic megacolon. J-pouch construction was performed in 72 per cent of patients, S-pouch construction in 14 per cent, straight ileo-anal anastomosis in 8 per cent, and lateral isoperistaltic ileo-anal anastomosis in 6 per cent. Of the 50 patients, 36 (72%) have had closure of the temporary ileostomy. Fourteen patients have not had ileostomy closure due to change in diagnosis to Crohn's disease, operative complications, or ileostomy closure pending. The combined operative morbidity per patient for the ileal pouch-anal anastomosis and the closure of the ileostomy was 32 per cent. This included bowel obstruction, 16 per cent; pelvic abscess, 6 per cent; and ileo-anal separation, 4 per cent. Follow-up on patients with ileostomy closure ranged from 6 months to 4 years (mean, 1.3 years). Stool frequency was 5.9 stools per 24 hours at 6 months and improved with time. During the follow-up period, all patients were eventually completely continent of stool during the day, and most became completely continent of stool at night.(ABSTRACT TRUNCATED AT 250 WORDS)