Aspirin-induced increases in soluble IL-1 receptor type II concentrations in vitro and in vivo.

This study examined the influence of low-dose aspirin on interleukin (IL)-1alpha , IL-1 receptor antagonist (IL-1ra), and soluble receptor type II (sIL-1RII) secretion in vivo and in vitro. Blood mononuclear cells were isolated from healthy young men who ingested 81 mg of aspirin on alternate days for 2 weeks and from unmedicated controls. Aspirin had minor effects on ex vivo secretion of IL-1beta and no influence on IL-1ra. In contrast, unstimulated ex vivo secretion of sIL-1RII was over twice as high by cells from aspirin-treated subjects (1115+/-123 vs. 460+/-77 pg/mL, P = 0.02). Lipopolysaccharide-stimulated sIL-1RII secretion was influenced similarly. Plasma sIL-1RII concentrations were 23% higher in aspirin-treated subjects (10.2+/-0.6 vs. 8.4+/-0.3 ng/mL, P = 0.03). In addition, cells from unmedicated subjects cultured in vitro with aspirin (10 microg/mL) secreted significantly greater amounts of sIL-1RII. Thus, low-dose aspirin therapy may prevent inflammation by increasing soluble receptor secretion, thereby preventing IL-1 from binding target cells.

Long-term complete remission of melanoma liver metastases after intermittent intra-arterial cisplatin chemotherapy and surgery.

This paper presents the case of a female patient with liver metastases of a malignant melanoma showing complete remission after 10 courses of regional, intra-arterial chemotherapy with cisplatin. The drug was administered as continuous infusion for 5 days. The daily dosage amounted to 30 mg/m2. The interval between courses was 6 weeks. Nausea and vomiting were seen after each course, while pathological serum creatinine levels only appeared after the eighth course. The only lesion in the liver still visible on CT scan after chemotherapy was removed by left hemihepatectomy. Meticulous histological examination revealed a big focus of necrotic tissue without any tumour cells. At the time of publication the patient is alive and disease-free over 9 years later.

Renal pathology and premortem clinical presentation of Caucasian patients with AIDS: an autopsy study from the era prior to antiretroviral therapy.

PRINCIPLES: Renal disease in patients with HIV infection is becoming increasingly frequent. A particular form of HIV-associated nephropathy (HIVAN) has been found in patients of predominantly African-American and Hispanic origin. However, only limited data are available on renal pathology and premortem clinical presentation of kidney disease in Caucasian patients with AIDS. METHODS: To determine the prevalence, clinical presentation and aetiology of renal disease in Caucasian patients with AIDS at the time of death we have performed a prospective autopsy study with 239 patients who died of AIDS between 1981 and 1989. None of these patients had received HIV-specific antiretroviral therapy. Autopsies and histological analyses were performed on the basis of a standardised protocol. Clinical and laboratory data were gathered according to a uniform questionnaire. RESULTS: 95% of patients were of Caucasian race. 75% of all patients had extended AIDS (stage IV). Clinical signs of nephropathy prior to death were found in 36% of patients, including proteinuria (18%), abnormal urinary sediment (19.5%), and renal insufficiency (11%). Histopathological lesions were present in 43% of the autopsies, with two or more distinct structural lesions in 12.5% of patients. Of the pathological findings 28% were glomerular or vascular, 33% were non-glomerular, and 29% were combined lesions. The remaining 10% were renal infiltrations of infectious agents or neoplastic tissue. The most common findings were ischaemic changes and vascular scars (18% of patients), as well as pyelo- and interstitial nephritides (12.2%). Importantly, FSGS was present in only 1.7% of patients, and only a single African patient had classical HIVAN. CONCLUSIONS: Renal involvement in HIV disease is very common at the time of death among patients of Caucasian origin. However, classical HIV-associated nephropathy is absent in this population. These findings suggest that kidney disease affects all races and supports the hypothesis that HIVAN is specifically related to non-Caucasian ethnicity. The results reflect renal disease unaffected by HIV-specific antiretroviral therapy.

[The imaging diagnosis of sclerosing peritonitis (SP) following continuous ambulatory peritoneal dialysis (CAPD)]. / Bildgebende Diagnostik der sklerosierenden Peritonitis (SP) nach kontinuierlicher ambulanter Peritonealdialyse (CAPD).

Sclerosing peritonitis is a serious complication of CAPD characterised by thickened peritoneal membranes which lead to decreased ultrafiltration and intestinal obstruction. The roentgenographic signs of SP were analysed in 11 patients who underwent plain x-ray of the abdomen, follow-through examinations of the small bowel, ultrasonography and computed tomography. Results were correlated with the histological degree of SP. Besides the non-specific findings of intestinal obstruction, patients with histologically marked SP had loculated fluid collections, thickening of the bowel wall and/or peritoneum, peritoneal calcifications and thickened peritoneal membranes. Due to the fact that postoperative complications often occur in patients with SP, detection of the radiological signs should lead to cautious surgical interventions and changeover to haemodialysis.

Morphological and cytogenetic aspects of renal-cell carcinoma.

The medical history of 'hypernephroma' is characterized by errors which arose from the notion of 'disseminated adrenocortical foci.' Its origin from tubule epithelia of the kidney is on the other hand to be substantiated both in morphological and in immunological terms. Many attempts to arrive at a clinically serviceable establishment of the prognosis on the basis of the morphology have proved to be inadequate for the large group of the classical forms. Only the sarcomatous tumors and the oncocytes could be classified prognostically with sufficient certainty. An attempt is made in the present study to propagate the idea that besides the histogenetic, morphologically more or less tangible characteristics, molecular biological features are also important for the biological behavior of a tumor and should be used to appraise the prognosis.

[Effect of an enema on the macroscopic and microscopic appearance of the rectal mucosa]. / Der Einfluss eines Klysmas auf das makroskopische und mikroskopische Erscheinungsbild der Rektummukosa.

In flexible fiberoptic sigmoidoscopy the application of an enema is mandatory. By contrast, rigid sigmoidoscopy can be performed without preparation. In 16 patients we tested the influence of a hypertonic enema on the macroscopic and microscopic appearance of the rectal mucosa. As a first step in the unprepared patient the mucosa was assessed and a rectal biopsy obtained. After enema this procedure was repeated. Development of mucosal edema was observed, although the histopathologist was not always able to decide whether or not the biopsy was taken before or after the enema. Histological assessment of edema requires histometric measurements which cannot be obtained from biopsy specimens. A knowledge of these changes is particularly important in assessment of inflammatory bowel disease, where edema of the unprepared mucosa means slight proctitis, and we recommend that the histopathologist be informed if enemas are used for bowel preparation.

[Phenprocoumon-induced cholestatic hepatitis]. / Phenprocoumon-induzierte cholestatische Hepatitis.

HISTORY AND CLINICAL FINDINGS: A 78-year-old woman had 4 years age received phenprocoumon as prophylaxis against thromboembolism after implantation of a left total knee prosthesis. Ten weeks later she developed hepatitis with negative hepatitis serology. 6 weeks before her latest hospitalisation a right total knee implantation had been performed and she again received phenprocoumon. She was admitted now because of cholestatic jaundice with rapid deterioration of her general state. There were no significant abnormal findings other than jaundiced skin and sclerae. INVESTIGATION: Bilirubin concentration was clearly elevated to 11.5 mg/dl, and the transaminase activities were increased, together with raised gamma-GT and alkaline phosphatase levels. The Quick value was below 8%. Hepatitis serology was positive for hepatitis A antibodies, but negative for B and C antibodies. No antigens were demonstrated. The eosinophil count was elevated in the differential blood count. Sonography showed a normal-sized liver with slightly dense echo pattern, but no evidence of abscess or dilatation of the bile duct system. Liver biopsy revealed severe acute hepatitis of viral type and discrete eosinophilic infiltration. TREATMENT AND COURSE: After all medication had been discontinued, transaminase activities decreased while bilirubin concentration rose. Thus, prednisone treatment was started (initially 50 mg/d), the dose then gradually reduced. The cholestasis parameters became normal and the patient's general state was much improved so that she could be discharged. CONCLUSION: Cholestatic hepatitis is a rare side effect of phenprocoumon. The associated eosinophilia suggests the cause to be an allergic genesis in the sense of a hypersensitivity reaction.

[Conspicuous accumulation of membranous glomerulonephritis following gold therapy in chronic polyarthritis--a side effect of a new preparation?]. / Auffällige Häufung membranöser Glomerulonephritiden nach Goldtherapie bei chronischer Polyarthritis--eine Nebenwirkung eines neuen Präparates?

The development of severe proteinuria or nephrotic syndrome as an adverse reaction to gold therapy in rheumatoid arthritis is well known. Morphologic examination reveals membranous glomerulonephritis in almost all cases. Since the beginning of 1978 there has been a striking increase in the number of such cases seen at this institute. 5 patients aged from 17 to 65 years who had been treated with sodium aurothiomalate for rheumatoid arthritis developed severe proteinuria. In all cases only minimal glomerular changes were observable by light microscopy. Electron microscopy demonstrated multiple electrondense, subepithelial deposits which were confirmed by fluorescence microscopy. In all cases characteristic lysosomes ("aurosomes") were demonstrated in the cytoplasm, mainly of the epithelial glomerular cells. This unusual accumulation of almost identical cases coincides with the introduction of a new gold preparation, Na-aurothiomalate (Tauredon), containing 46% metallic gold.