Influence of colectomy on hydrogen excretion in breath.

INTRODUCTION: Hydrogen breath test is the most commonly used method to analyze carbohydrate absorption and diagnose carbohydrate malabsorption. The result of the H(2) breath test is influenced by different factors, which are mostly related to quantitative or qualitative aspects of colonic flora. A scarcely studied variable is the effect of colonic anatomical integrity on H(2) excretion in breath. PURPOSE: The present study aims to determine whether loss of colonic integrity reduces H(2) excretion capacity after an oral load of an unabsorbable carbohydrate. METHODS: An observational study was conducted in three patient groups: controls with preserved colon, patients with partial colectomy, and patients with complete colectomy and ileostomy. H(2) concentration in breath was measured by gas chromatography every 10 min for 3 h after oral lactulose administration. RESULTS: Twenty-two patients with partial colectomy, 18 controls with preserved colon, and seven patients with ileostomy were included. H(2) excretion after lactulose did not differ between patients with partial colectomy and controls (basal excretion = 8.5 vs 4 ppm; delta increase = 50.0 vs 47.5 ppm; area under the curve = 4,480.0 vs 4,710.5 ppm/min). In contrast, H(2) excretion was significantly lower in the ileostomy group. CONCLUSIONS: Partial colectomy does not influence the capacity for H(2) excretion after oral unabsorbable carbohydrate administration.

Periodic meningitis and familial Mediterranean fever.

A 33-year-old man had had, since he was 20 years old, recurrent attacks of fever, rash, and aseptic lymphocytic meningitis. A nephrotic syndrome developed that was found, on renal biopsy, to be due to amyloid deposit. After colchicine therapy, no further recurrence of fever and meningitis was observed. These findings suggest that aseptic periodic meningitis (Mollaret's syndrome) should be considered as an unusual manifestation of familial Mediterranean fever.

The evolution of alpha heavy chain disease.

Two patients with alpha heavy chain disease are described. In the first patient, treatment with cyclophosphamide, prednisone and doxycycline was associated with a 28 month-long remission and the disappearance of the paraprotein and lymphoplasmocytic infiltration of the intestine. Shortly afterwards, a retroperitoneal immunoblastic lymphoma was found associated with an immunoglobulin G-kappa-paraproteinemia, and gamma heavy and kappa-light chains in the urine; the intestinal biopsy specimen was normal. In the other patient, the alpha chain only appeared two years after the malabsorption syndrome. The fact that in the first, apparently cured patient, a tumor of different anatomic site and secretory capacity appeared, suggests the existence of a B-cell neoplasia of different clone from that which gave rise tothe original disease. In the second patient, it is probable that only the increase in the mass of neoplastic cells led to the detection of the protein abnormality, or alternatively the antigenic-oncogenic stimulus led to the abnormal secretion only after two years.

Stimulation of mucosal inflammatory activity by the normal fecal flora in a rat model of colitis.

SUMMARY: : Bacteria and their products stimulate inflammatory responses and may play a role in the pathogenesis of inflammatory bowel diseases. We investigated interactions between fecal flora and injured colonic mucosa using the trinitrobenzenesulfonic acid model of colitis in the rat. First, we tested the effects of broad-spectrum antibiotics administered at different times after induction of colitis. Second, in rats pretreated with antibiotics, we studied the effects of reintroduction of fecal flora on the release of inflammatory mediators and on the morphology of colonic lesions. Antibiotics reduced colonic lesion scores when started on day 1 after induction of colitis, but had no significant effect when started on day 7. In antibiotic-treated rats, intracolonic administration of a suspension of fecal contents 6 h after induction of colitis enhanced mucosal inflammatory activity and aggravated lesion scores. This effect was not observed when the suspension was administered 3 days after induction. Sonication of the suspension inhibited bacterial growth in aerobic and anaerobic cultures, and abolished its effect on colonic inflammation. In this model, bacteria of the common flora stimulate inflammatory activity and play a role in the induction of colonic mucosal lesions.

Computed tomography in reversible ischaemic attacks: clinical and prognostic correlations in a prospective study.

Two hundred and nineteen patients admitted with reversible atherothrombotic ischaemic attacks were prospectively evaluated by computed tomography. Of these patients, 122 were diagnosed as suffering from transient ischaemic attacks, 58 from reversible ischaemic neurological deficits and 39 from reversible ischaemic neurological deficits with incomplete resolution. In 133 cases the ischaemic event affected the carotid system, in 63 the vertebrobasilar system and in 23 cases the system could not be determined. Brain infarctions were observed in 64 patients (29.2%), cerebral atrophy in 96 (44.4%) and dilatation of a ventricle in 17 (7.8%). The frequency of brain infarction was related to the duration of the neurological deficit, being 20.5% in those with transient ischaemic attacks, 37.9% in those with reversible ischaemic neurological deficits and 43.6% in patients with reversible ischaemic neurological deficits with incomplete resolution (P = 0.005). Ischaemic lesions were closely correlated with abnormalities on supra-aortic trunk angiography or Doppler ultrasonography. During an average follow-up period of 21 months, a higher percentage of recurrence was found in those patients with CT infarctions, but the difference was not significant.

Eosinophilic gastroenteritis presenting as ascites and splenomegaly.

A 25-year-old man with a 1 year history of episodic abdominal pain presented with splenomegaly, eosinophilic ascites and peripheral eosinophilia. Full-thickness biopsies from his gastrointestinal tract revealed intense eosinophilic infiltration involving both muscular and serosal layers and extending from his stomach to his ileum. When given oral steroids, the patient's condition improved and he was discharged without symptoms. Eighteen months later, he remains asymptomatic and without recurrence of ascites or splenomegaly. This report adds to the scarce data on extraintestinal involvement in eosinophilic gastroenteritis. Special attention is drawn to the differential diagnosis of eosinophilic ascites and to the optimal approach to its management.

Pancreatitis and haemobilia due to arterioportal fistula after percutaneous liver biopsy resolved by selective arterial embolization.

Haemobilia and arterioportal fistula are uncommon complications secondary to percutaneous liver biopsy. We report the case of a patient who developed haemobilia and subsequently acute pancreatitis as a result of a liver biopsy. Selective hepatic angiogram showed an arterioportal fistula. Transcatheter arterial embolization successfully occluded the fistula. The patient remained asymptomatic 4 months later. We review the published literature concerning acute pancreatitis associated with haemobilia and draw conclusions for management of similar cases in the future.

Influence of inflammatory bowel disease on different dimensions of quality of life.

OBJECTIVE: To establish the impairment of different dimensions of quality of life in inflammatory bowel disease (IBD). DESIGN: Prospective observational study. PARTICIPANTS: 289 patients [160 with ulcerative colitis (UC) and 129 with Crohn's disease (CD)]. MEASURES: Health-related quality of life was assessed by means of the Inflammatory Bowel Disease Questionnaire (IBDQ) and the Psychological General Well Being Index (PGWBI). RESULTS: In active IBD, all dimensions of the quality of life scored significantly lower than in inactive IBD, indicating a poor quality of life. Social impairment was the least impaired dimension of the IBDQ in active UC and CD, compared with digestive and systemic symptoms. In inactive IBD, the systemic symptoms domain received the lowest score (P < 0.01). In a subgroup of 22 patients studied before and after remission, emotional function was the most impaired dimension after achieving remission. The Psychological General Well Being Index was significantly impaired in active UC [78.5 (range 64-89)] and CD [76.5 (range 69-97)] relative inactive IBD [104 (range 93-111)] vs 106 (95-113), respectively; P < 0.05]. CONCLUSIONS: Quality of life is impaired in IBD. During relapse, clinicians should pay attention to digestive symptoms and psychological distress. In remission, they should be sensitive to systemic symptoms.

Role of microecology in chronic inflammatory bowel diseases.

Inflammatory bowel diseases (IBD) are chronic conditions of unknown etiology. Current therapy mitigates the severity of acute bouts of mucosal inflammation but an eradication therapy is lacking. Growing incidence of IBD is associated with social development. Epidemiology suggests a relationship between the establishment of the individual gut flora and the risk of developing IBD. Patients show an impaired tolerance towards commensal bacteria of the resident flora. Unrestrained activation of the intestinal immune system against some commensal bacteria appears to be responsible for the characteristic relapsing course of these diseases. Wide-spectrum antibiotic therapy reduces bacterial load and mitigates intestinal inflammation in human IBD and in animal models. Current research aims at the identification of probiotics for bacterial antagonism therapies. Probiotics are living microorganisms which upon ingestion in certain numbers exert health benefits beyond inherent basic nutrition. Colonization with a Lactobacillus reuteri strain can prevent the development of colitis in genetically susceptible mice. Other studies have used a bacterium genetically engineered to secrete the antiinflammatory cytokine IL-10 and demonstrated a therapeutic effect in animal models of colitis. Moreover, some probiotics may naturally exhibit antiinflammatory properties when interacting with the human gut mucosa. Prebiotics such as inulin have also been shown to prevent colonic inflammation in animal models. Preliminary clinical trials with probiotics in IBD are encouraging. Probiotics offer a valuable tool for the prevention and control of inflammatory bowel diseases.

Hepatitis in exanthematous mediterranean fever.

In 38 patients suffering from rickettsiosis caused by Rickettsia conorii (Mediterranean Exanthematous Fever), hepatic involvement was studied via laboratory tests and in 26 cases by means of liver biopsy. SGOT, SGPT and alkaline phosphatase were found to be elevated in more than half of the patients (SGOT 74.4 +/- 93 U.K., SGPT 82.2 +/- 93 U.K., a.p. 58 +/- 21 mU/ml). In 14 patients, liver biopsy showed the existence of inclusion corpuscles in Kupffer's cells. Electron microscopic study demonstrated the existence of phagosomes inside the epithelioid cells, which, however, were difficult to categorize. The frequent existence of granulomatous hepatitis in this rickettsiosis was confirmed, while the presence of the infecting agent in the liver could not be established.

Monoclonal antibodies raised to the dengue-2 virus (Cuban: A15 strain) which recognize viral structural proteins.

Mouse monoclonal antibodies (MAbs) were raised to dengue-2 virus (D-2V) Cuban (A15) strain and the cell culture supernatants were screened by ELISA using the homologous virus. Three MAb-secreting lines were further characterized using immunoblot, haemaglutination, complement-fixation, and neutralization assays. One of these, MAb 8H8, weakly reacted with the viral nonstructural-1 protein (NS1) but more specifically identified the capsid protein (C), MAb 3E1 recognized in serological assays D-2V A15 but it had a weak reaction to C protein by immunodetection whereas another, MAb 4G3, weakly neutralized the homologous virus isolate and blocked the binding of specific anti-envelope (E) Mab, and its reaction with this protein could not be confirmed using immunoblot assays. These reagents are now being used to compare virulent plus avirulent Caribbean viruses antibody dependent enhancement (ADE) assays.

Quantitative ELISA for mouse monoclonal antibody determination in culture supernatants and in human serum.

An ELISA has been set up for quantifying mouse monoclonal antibodies in culture supernatant. The assay includes rabbit anti-mouse IgG antibodies chromatographycally purified. This preparation was used as coating and as conjugated antibodies in the ELISA. The assay can detect IgG1 with sensitivity of 0.2 ng/mL, IgG2a (0.85 ng/mL), IgG2b (0.13 ng/mL), and IgG3 (3.19 ng/mL) in culture supernatants. The effective working range was from subnanogram per mL quantities to 30 ng/mL by using a computer statistical program. Variation coefficient of ELISA was below 7%. Correlation estimates with a similar ELISA using commercial reagents were performed for each mouse antibody subclass. The assay was able to detect the four mouse monoclonal antibody subclasses in pure human serum as compared with the same ELISA using commercial antibodies. A 24-h pharmacokinetic profile of 1 patient treated with an IgG2a monoclonal antibody is presented.

[Recurrent episodes of acidosis with encephalopathy in a hemodialysis program patient with short bowel syndrome]. / Episodios recurrentes de acidosis con encefalopatía en un paciente en programa de hemodiálisis con síndrome del intestino corto.

We present a case of a patient with short bowel syndrome in a hemodialysis program, with recurrent episodes of serious acidosis. The presence of a D-lactic acidosis peak secondary to bacterial overgrowth in the intestine was discovered during an acute episode of acidosis, with neurological affection. The detection of acidosis in predialysis measurements and the acute episodes of acidosis, made it necessary to administer bicarbonate to the patient and give him additional hemodialysis sessions.

[Clinical and bacteriological aspects of purulent pericarditis (author's transl)]. / Aspectos clínicos, bacteriológicos y evolutivos de la pericarditis purulenta.

The clinical and bacteriological characteristics of eight cases with purulent pericarditis observed over the last five years are studied. The route of the infection and dissemination in the majority of the cases (75 percent) was through pleuropulmonary lesions in the form of pneumonia and/or empyema, attributing the remaining cases to a subhepatic abscess and a pericardial infection after a thoracic surgical operation. In seven patients the diagnosis of the disease was established while they were alive. The more orientative clinical data were the pericardial pain (50 percent), pericardial friction murmur (25 percent), and signs of cardiac tamponade (62.5 percent). The observation of the above mentioned clinical signs together with the presence of cardiomegaly and electrocardiographic alterations suggestive of pericarditis, obliged the practice of a pericardial puncture, which confirmed the diagnosis of a purulent pericarditis by the macro and microscopic characteristics of the fluid. Staphylococcus and pneumoncoccus were isolated in two cases, respectively; other Gram-negative bacillus (E. coli and Pseudomonas aeruginosa) were isolated in the remaining cases. All patients were treated with the appropriate antibiotic according to the isolated germ; surgical drainage was carried out in six cases, and a pericardiectomy in one. Two patients died, one as a consequence of a septic myocardiopathy and the other in which the diagnosis of purulent pericarditis was not clinically suspected. During the follow-up period one case presented a constrictive pericarditis, which was corrected by a pericardiectomy.

[Value of the serum measurement of alpha-L-fucosidase in the diagnosis of hepatocarcinoma]. / Valor de la determinación sérica de alfa-L-fucosidasa en el diagnóstico del hepatocarcinoma.

The serum catalytic concentration of alpha-L-fucosidase (AFU) was measured to evaluate its usefulness for the diagnosis of hepatocarcinoma (HPC). Fifty-one patients with hepatocarcinoma, 30 with hepatic metastases, 40 with hepatic cirrhosis, 22 with other hepatic diseases and 48 healthy individuals were evaluated. The values of serum AFU were significantly higher in all groups (p less than 0.001), than in the reference group; there were also significant differences between those with HPC and hepatic cirrhosis (p less than 0.01), and between HPC and other hepatic diseases (p less than 0.05). The highest effectiveness of the test was achieved with a catalytic concentration of serum AFU of 210 nKat/l, with a 37% sensitivity and a 91% specificity. When the AFU measurement was used concomitantly with that of alpha-fetoprotein (AFP) for the diagnosis of HPC, sensitivity increased to 72% when AFI or AFP were elevated, and specificity reached 99% when both were increased. We think that the measurement of serum AFU may be helpful for the diagnosis of hepatocarcinoma.

[Chronic ulcerative colitis and autoimmune hemolytic anemia (author's transl)]. / Colitis ulcerosa y anemia hemolítica autoinmune.

A 27-year-old male developed an autoimmune hemolytic anemia during the initial episode of chronic ulcerative colitis. Laboratory studies revealed a positive direct Coomb's test (IgG + C), and the presence of specific anti-Hr antibody. Salicylazosulfapyridine was tested by means of immunohematologic techniques, but results discarded this drug as the responsible agent for autoimmune hemolytic anemia. Association of ulcerative colitis and autoimmune hemolytic anemia is an uncommon finding; around 36 cases have been published in the literature. Hemolytic anemia may develop as a consequence of treatment with salicylazosulfapyridine, the antimicrobial of choice in the management of inflammatory diseases of the bowel.

[Determination of serum activity of glucose phosphate isomerase and glutathione reductase in intra and extra hepatic cholestasis.(author's transl)]. / Determinación de la activdad érica de glucosa fosato isomerasa y glutatión glutatión reductasa e n las colestasis intra y extrahepáticas.

Serum activity of glutathione reductase (GR), glucose phosphate isomerase (GPI), aspartate aminotransferase (AST), alanine aminotransferase (ALT) phosphate alkaline (PAL), and gamma-glutamyl transferase (GGT) was studied in 142 patients, in all serum bilirubin was more than 2 mg/dl. Distribution was as follows; 68 cirrhosis of the liver; 27 acute hepatitis; 31 benign extra-hepatic biliary obstruction; and 16 neoplastic obstruction of the biliary tract without liver metastasis. Fifty-three healthy volunteer blood donors were used as the control group. Mean values for GR activity in our patients were significantly higher than those for the control group, although less so in benign obstruction (p less than 0.01) than in those with acute hepatitis (p less than 0.001), cirrhosis (p less than 0.01) and neoplasic biliary obstruction (p less than 0.001). The GPI values were higher than the control groups in patients with acute hepatitis (p less than 0.001) and obstructive neoplastic jaundice (p less than 0.02). In cases with cirrhosis, 87% presented slightly higher values of GR, while GPI was within normal levels in 93 % of all cases. In patients with acute hepatitis, 92% showed a definite increase in GPI and GR values. In 71% of those with benign biliary obstruction levels for both enzymes were normal, as they were in only 6% of those with obstructive neoplastic jaundice. These findings are statistically significant in all cases and of diagnostic value in establishing a differential enzymatic diagnosis in patients presenting with clinical and biological patterns of cholestasis.

[Transitory IgM monoclonal gammopathy associated with brucellosis and tuberculosis (author's transl)]. / Gammapatía monoclonal transitoria de tipo IgM asociada a brucelosis y tuberculosis.

Two cases of transitory IgM monoclonal gammopathy associated with infectious disease are presented. One patient was a 29 year-old woman with acute brucellosis; electrophoresis showed a homogeneous spike of slow gamma mobility constituted of IgM lambda. The second case was a 52 year-old male with milliary tuberculosis, in whom a homogenous spike of rapid gamma mobility constituted of IgM kappa was found. The monoclonal component disappeared in both cases after treatment of the infections; at 2 and 21/2 months respectively. The fact that the association of transitory IgM paraprotein and infection is not common, especially with brucellosis, is commented upon and a direct relationship between the infection and the monoclonal component is suggested.

[Primary liver carcinoma and markers of virus of type B hepatitis (author's transl)]. / Carcinoma primitivo de hígado y marcadores del virus de la hepatitis B.

Association of primary liver carcinoma with virus of type B hepatitis has been demonstrated around the world, especially in African and Asian countries where high titles for surface antigen of B hepatitis (HBsAg) have been found. Presence of viral markers of B hepatitis has been studied in a group of 34 patients with primary liver carcinoma, in 139 cirrhotic patients, and in 100 normal individuals. Positive titles of HBsAg or of antibodies against "core" antigen (anti-HBc) without evidence of antibodies against HBsAg (anti-HBs) were considered as positive markers for virus B infection. Percentages of positive markers in the series studied were as follows: 52% in the cases of primary liver carcinoma, 38% in the cirrhotic cases, and 5% in the control subjects. There is a significant difference in relation to the incidence of viral markers between patients with liver carcinoma and normal controls. A possible role of the virus of B hepatitis in the pathogenesis of primary liver carcinoma could be suggested on the basis of these results.