Pulmonary blastoma with argyrophil cells and lacking sarcomatous features (pulmonary endodermal tumor resembling fetal lung).

A tumor of the lung in a 35-year-old woman contained numerous complex, branching tubules resembling the developing fetal lung in its canalicular state. Some of the epithelial cells within the tubules were argyrophilic, and electron microscopy demonstrated the dense-core neurosecretory-type cytoplasmic granules. These characteristics support an endodermal origin for this neoplasm. Morphologically the tubules are similar to the epithelial component seen in pulmonary blastoma, but the tumor lacks the sarcomatous areas integral to the concept of blastoma. The designation pulmonary endodermal tumor resembling fetal lung may better describe this unusual neoplasm.

Immunocytochemical localization of carcinoembryonic antigen in benign and malignant colorectal tissues. Assessment of diagnostic value.

Immunoperoxidase and immunofluorescence staining for carcinoembryonic antigen (CEA) was performed on paraffin and frozen sections, respectively, of colonic carcinomas (70), liver and lymph node metastases (20), mesenteric nodes (150), mucosa adjacent to carcinoma (40), colonic resection margins (20), normal colon (ten), and colorectal polyps (64) in order to assess its potential diagnostic value. On the basis of this study of the immunocytochemical localization of CEA in colorectal tissues, conclusions were as follows. (1) Localization of CEA to glycocalyx of surface epithelial cells is a normal finding in the colon and is similar in normal colon and mucosa distant and adjacent to infiltrating carcinoma. (2) Although strongly positive cell surface and intraluminal staining frequently correlates with the presence of carcinoma in neoplastic polyps, it is not by itself a reliable diagnostic criterion. (3) Failure to demonstrate CEA in a gland-forming carcinoma makes a diagnosis of colorectal carcinoma unlikely. (4) Poorly differentiated colorectal carcinoma usually contains much less demonstrable surface CEA, but may occasionally stain cytoplasm strongly. (5) Although lymph node micrometastases from colorectal carcinoma are readily demonstrated by immunoperoxidase staining for CEA, screening of hematoxylin and eosin-stained sections by a competent pathologist appears to be adequate for their detection.

Lack of effect of three putative vasoactive intestinal peptide receptor antagonists on vasoactive intestinal peptide-induced secretory responses in rat colon.

We have assessed the potential usefulness of three vasoactive intestinal peptide antagonists for investigating whether vasoactive intestinal peptide has a functional role as a secretomotor neurotransmitter at the neuroepithelial junction in rat colonic mucosa. Vasoactive intestinal peptide (VIP) increases short-circuit current in muscle-stripped preparations of rat colon. The response is unaffected by tetrodotoxin and can only be obtained when the peptide is applied to the basolateral side of the membrane. Three putative antagonists were tested for their ability to inhibit short-circuit current responses to vasoactive intestinal peptide. Vasoactive intestinal peptide-(10-28) (1 microM and 3 microM), human growth hormone releasing factor (human GRF) analogue [Ac-Tyr1]human GRF-(1-40)OH (0.1 microM and 1 microM) and [Lys1,Pro2,5,Arg3,4,Tyr6]VIP (0.5 microM) produced concentration-dependent increases in basal short-circuit current but were ineffective as antagonists to vasoactive intestinal peptide.

Thermal injury and gastrointestinal function. II. Evidence for the production of hepatic dysfunction in the rat following acute burn injury.

Following acute thermal injury to rats produced by scalding water, there was marked elevation of a number of plasma enzyme activities, including GOT, GPT, and 5'-nucleotidase, suggesting hepatic dysfunction. Changes in plasma enzyme activities were observed within minutes following application of acute burn trauma, and remained elevated for at least one month. The magnitude of the elevations of the plasma enzyme activities was dependent upon the length of time the acute burn trauma was applied to the skin and/or the percentage of skin surface area burned. These changes in plasma enzyme activity correlated with histologic examination of the hepatic tissue, indicating single cell necrosis. These data suggest that acute burn trauma to rats is associated with altered hepatic function.

Thermal injury and gastrointestinal function. I. Small intestinal nutrient absorption and DNA synthesis.

The effect of acute burn trauma, produced by scalding hot water, on rat small intestinal nutrient absorption and DNA synthesis has been examined. Burned rats showed decreased small-intestine mucosal weight and altered small-intestine transport of nutrients (calcium, glucose, or amino acid) in vitro. In addition, there was decreased 3H-thymidine incorporation into intestinal DNA in vivo and decreased intestinal thymidine kinase activity in vitro 18 hours after acute burn. These data suggest that after the severe stress produced by acute burn trauma, there is altered small-intestine nutrient absorption and DNA synthesis. These alterations may affect delivery of nutrients by the gut to the burn patient.

Inhibition of in vivo DNA synthesis in regenerating rat liver following thermal injury.

Hepatic repair and regeneration which is extremely important after thermal injuries can be inhibited by the acute inflammatory reaction. Since thermal injury initiates this acute inflammatory reaction, DNA synthesis was studied in the regenerating liver following this injury. In vivo incorporation of [3H]-thymidine into hepatic DNA, autoradiographic determination of a labeling index, and thymidine kinase activity were determined. Incorporation of [3H]-thymidine into hepatic DNA and labeling indices were markedly diminished at 24 hours if partial hepatectomy and thermal injury were carried out concurrently. After partial hepatectomy, the expected elevations in thymidine kinase activity were inhibited by the thermal injury (p less than 0.01) and elevation of serum fibrinogen, a marker of the acute phase reaction that normally follows thermal injury, was blunted by the partial hepatectomy (p less than 0.05). The combination of thermal injury and partial hepatectomy resulted in a greatly diminished DNA replicative response as compared to partial hepatectomy alone and suggests that multiplicative injury is more likely to result in multi-system failure.

The effect of short-term starvation on mucosal barrier function in the newborn rabbit.

The compromised human newborn frequently presents with overwhelming feeding problems which lead to inadequate intake. These problems may affect the development of the small intestine, especially mucosal barrier function, leading to increased infections and susceptibility to allergens. To study this, an animal model was established using neonatal rabbits deprived of nutrients from birth until 72 h. Mucosal barrier function was compared in deprived and control (naturally fed 72-h-old animals) rabbits by measuring immunoreactive bovine serum albumin in serum 4 h after intragastric infusion of crystalline bovine serum albumin (200 mg/100 g body weight). Trypsin activity was measured in rinse fluid obtained from the small intestine. Representative sections of jejunum from control and experimental animals were formalin fixed and stained with hematoxylin and eosin for morphologic comparison. Following the bovine serum albumin feeding, a significantly increased serum immunoreactive bovine serum albumin and significantly decreased trypsin-like activity of the small intestinal rinse fluid was noted in starved animals compared to controls. In addition, the enterocytes of malnourished animals were more cuboidal and contained fewer and smaller supranuclear granules on microscopic examination than the enterocytes of controls. This study suggests that short-term starvation in newborns affects mucosal barrier function. Acute starvation may place newborns at increased risk for infections and allergic disease.

5-Aminosalicylic acid enemas in refractory distal ulcerative colitis: a randomized, controlled trial.

5-Aminosalicylic acid (5-ASA), the presumed active moiety of sulfasalazine, has shown clinical efficacy when administered per rectum as initial therapy to patients with distal ulcerative colitis. We report the results of a randomized double-blind trial comparing nightly retention of a 4-g 5-ASA enema with continued administration of hydrocortisone enemas in 18 patients with persistent active distal ulcerative colitis after at least a 3-wk course of treatment with 100-mg hydrocortisone enemas with or without oral sulfasalazine. Continuation of hydrocortisone enemas rather than placebo was used in the control group to reflect the realistic alternative therapy likely to be employed in current practice. Response to therapy was assessed after 3 wk by comparing pretreatment and posttreatment point scores of clinical, sigmoidoscopic, and histological severity. Improvement in clinical score was achieved in seven of nine 5-ASA enema-treated patients versus one of nine hydrocortisone enema-treated patients (p less than 0.05). Sigmoidoscopic and histological improvement generally paralleled clinical improvement. We conclude that in patients with distal ulcerative colitis unresponsive to standard therapy, treatment with 5-ASA enemas results in significant short-term clinical and sigmoidoscopic improvement in a majority of cases. Moreover, a significantly greater number of refractory patients improve when switched to 5-ASA enemas than when continued on standard therapy.

Immune complex-induced enteropathy in the rat. I. Clinical and histological features.

Adult male Sprague-Dawley rats injected with preformed rat anti-bovine serum albumin antibody-bovine serum albumin complexes prepared in fivefold antigen excess, developed intestinal lesions consisting of annular bands of serosal hyperemia alternating with nonhyperemic bands, causing a striped appearance. Histologically, vascular congestion and mucosal edema were observed; more severe lesions were accompanied by hemorrhage, epithelial necrosis and sloughing, and modest polymorphonuclear leukocyte infiltration. The lesions developed rapidly and were accompanied by hemoconcentration. A correlation between the dose of immune complexes injected and the intensity and extent of intestinal lesions was noted. The pathogenetic mechanism of the lesions was not determined. The similarity of the lesions to those observed in systemic anaphylaxis in the rat and experimental and clinical shock was cited. The implications of immune complex-induced enteropathy for studies of immune complex clearance by the mononuclear phagocyte system were considered.

Jejunal diverticulosis with perforation as a complication of Fabry's disease.

This study presents the case of a patient who had jejunal diverticulosis with perforation and abscess formation as a complication of Fabry's disease. Light microscopy disclosed glycolipid deposition in the neurons and nerve fibers of the intestinal nerve plexuses and smooth muscle. Silver stains of the myenteric plexus in the involved segment of the bowel showed enlarged, granular argyrophobic neurons and a marked decrease in the number of argyrophilic neurons, with those remaining being enlarged and distorted by the cytoplasmic glycolipid accumulation. These abnormalities of the myenteric plexus suggest that jejunal diverticulosis may be the result of a variety of disorders of the smooth muscle or myenteric plexus, or both. We propose that jejunal diverticulosis in our patient was a consequence of uncoordinated smooth muscle activity resulting from Fabry's involvement of myenteric plexus neurons, with mucosal protrusion through the smooth muscle.

Articular mastocytosis in rheumatoid arthritis.

The number and distribution of mast cells were assessed in 116 synovial membranes from patients with rheumatoid arthritis and in 30 control specimens. Rheumatoid synovial membranes contained a mean of 48.5 mast cells per 20 high-power fields (HPF) (range 0-252), and control synovial membranes had a mean of 3.9 mast cells per 20 HPF (range 0-13) (P less than 0.001). In a comparison of high and low mast cell subgroups in rheumatoid arthritis, counts were directly related to the intensity of clinical synovitis in the affected joint, but not to hemoglobin concentration or erythrocyte sedimentation rate. Joints excised from 5 patients with rheumatoid arthritis were characterized by active bone remodeling with increased osteoid, active resorption by osteoclasts, and trabecular osteoporosis. Mast cells were prominent in both extraosseous pannus and intraosseous invasive tissue. The possible roles of mast cells in the pathogenesis of rheumatoid arthritis are discussed.

CEA, ZGM and EMA localization in cells of pleural and peritoneal effusion: a preliminary study.

Carcinoembryonic antigen (CEA), the zinc glycinate marker (ZGM) and epithelial membrane antigen (EMA) have been described as epithelial or tumour markers of varying specificity. These antigens were studied by immunoperoxidase localization in selected cell blocks of 62 pleural or peritoneal effusions and compared to cytological findings and review of the clinical records. By cytological criteria, 25 of the cell blocks were positive for malignancy, 30 negative, and 7 inconclusive. CEA, ZGM, and EMA by immunoperoxidase staining were localized on the cell surface and often in the cytoplasm of malignant cells, in 11/25 (44 per cent), 17/25 (68 per cent) and 22/25 (88 per cent) of the positive cell blocks respectively. Ten (40 per cent) of these cases were positive for all three antigens, 7 (28 per cent) for two, and 6 (24 per cent) for one. Of the 7 cases which were inconclusive on routine cytological reporting, 5 were positive for at least one marker. In 3 of the 5 a diagnosis of malignancy was confirmed, and in the other two was strongly suspected as malignant on clinical grounds. Macrophages were sometimes positive for one or more markers (but showed cytoplasmic staining only) and mesothelial cells in some cases stained positively for EMA but were always negative for CEA and ZGM. Localization of the 3 antigens in cells of malignant effusions was compared with their localization in the primary tumours in 9 cases. Localization corresponded for CEA in 7 of 9 cases, for EMA in 8 of 8 an for ZGM in only 2 of 9. Effusion fluid levels for CEA were compared with the cytological and immunocytochemical findings in 30 cases. Mucin stains performed on the cell blocks were also compared with the immunoperoxidase findings.