Basophils Trigger Fibroblast Activation in Cardiac Allograft Fibrosis Development.

Fibrosis is a major component of chronic cardiac allograft rejection. Although several cell types are able to produce collagen, resident (donor-derived) fibroblasts are mainly responsible for excessive production of extracellular matrix proteins. It is currently unclear which cells regulate production of connective tissue elements in allograft fibrosis and how basophils, as potential producers of profibrotic cytokines, are involved this process. We studied this question in a fully MHC-mismatched model of heart transplantation with transient depletion of CD4(+) T cells to largely prevent acute rejection. The model is characterized by myocardial infiltration of leukocytes and development of interstitial fibrosis and allograft vasculopathy. Using depletion of basophils, IL-4-deficient recipients and IL-4 receptor-deficient grafts, we showed that basophils and IL-4 play crucial roles in activation of fibroblasts and development of fibrotic organ remodeling. In the absence of CD4(+) T cells, basophils are the predominant source of IL-4 in the graft and contribute to expansion of myofibroblasts, interstitial deposition of collagen and development of allograft vasculopathy. Our results indicated that basophils trigger the production of various connective tissue elements by myofibroblasts. Basophil-derived IL-4 may be an attractive target for treatment of chronic allograft rejection.

Basophils control T-cell responses and limit disease activity in experimental murine colitis.

Basophils have been recognized as important inducers of T helper type 2 (Th2) responses. Using the colitis model of adoptive transfer of CD4(+) CD62L(+) T cells into lymphopenic hosts, we have analyzed how basophils regulate T-cell responses and modulate disease activity. Transferred T cells rapidly proliferate, produce large amounts of interleukin (IL)-3, and expand the number of basophils in an IL-3-dependent manner. Depletion of basophils with two different antibodies substantially upregulated Th1 cytokines in transferred T cells at day 8. Increased Th1 cytokine expression persisted until the end of the experiment when basophil-depleted mice showed exacerbation of colitis with more severe loss of weight, histological damage, colonic leukocyte infiltration, and expression of pro-inflammatory cytokines. In vitro, we show that basophil-derived IL-4 and IL-6 downregulates expression of interferon-γ, IL-2, and tumor necrosis factor in T cells. These data show a beneficial role of basophils in a T-cell driven model of autoimmunity.

Therapeutic embolization of a systemic arterialization of lung without sequestration.

We report the case of a 51-year-old man with massive haemoptysis due to a systemic arterialization of lung without sequestration. Unlike bronchopulmonary sequestration there was a normal bronchial distribution and the involved lung parenchyma was normal. Therefore a therapeutic transarterial embolization of the aberrant systemic vessel from the distal thoracic aorta was performed. The embolization was successful and the patient did not suffer from further haemoptysis during the subsequent follow-up of ten months. A postembolization aortogram 6 months later demonstrated a complete occlusion of the embolized aberrant artery; in the lung perfusion scan there was only a small perfusion defect, but normal ventilation in the embolized basal part of the left lower lobe. Our case represents an alternative treatment to surgery for this rare anomaly.

[Rectus sheath hematoma--detection of hemorrhage of ruptured aneurysm of the epigastric artery in CT]. / Das Rektusscheidenhämatom--Nachweis einer Blutung eines rupturierten Aneurysmas der A. epigastrica im CT.

A case of rectus sheath hematoma is described. Computed tomography demonstrated a still active bleeding from an aneurysm which was situated at the junction of the inferior and superior epigastric artery. The recognition of a continuous hemorrhage contributed to the decision of an immediate surgical intervention.

Evidence for posttranscriptional stimulation of monoclonal antibody secretion by L-glutamine during slow hybridoma growth.

The addition of 5-40 mM L-glutamine to batch cultures of a murine hybridoma following the cessation of rapid growth significantly stimulated monoclonal antibody (mAb) synthesis and secretion per cell. Stimulation of mAb secretion following the cessation of rapid growth was also observed in response to addition of mitochondrial intermediates of glutamate oxidation and was not found to be the result of release of transiently stored mAb. Less than 1% of the secreted mAb was detected by ELISA in isolated hybridoma lysosomes. This stimulation was posttranscriptional and not the result of enhancement of levels of mAb mRNAs or stabilization of heavy (H) or light (L) chain encoding message. Sub-inhibitory levels of lysosomotrophic weak bases stimulated release of lysosomal contents but did not result in release of intact or partially degraded mAb. Inhibition of aspartic proteinase activity secreted by the hybridoma did not enhance mAb secretion even though a high level of mAb degrading proteinase activity was continuously secreted during both rapid and slow growth. These responses indicate that during slow growth, the addition of L-glutamine increases the availability of cellular ATP generated by mitochondrial respiration which stimulates some posttranscriptional step in the pathway of mAb secretion such as the rate of H or L chain translation, chain assembly, interorganelle transport or vesicular transport from the Golgi to the cell membrane.

Accuracy of magnetic resonance imaging compared to computerized tomography and renal selective angiography in preoperatively staging renal cell carcinoma.

During 1986 and 1987, 47 patients with renal cell carcinoma were evaluated preoperatively with CT, angiography and MRI. The preoperative tumor stage (T), lymph node metastases and venous involvement determined with the three methods were compared to the operative and histopathological findings. For T stage, angiography proved less accurate (54%) than CT (64%) or MRI (63%). MRI was found to be superior to CT in assessing lymph nodes, with an overall accuracy of 89% and sensitivity of 100% compared to 77 and 60%, respectively, of CT. For venous involvement CT was overall more accurate (74%) than angiography (65%) or MRI (63%). All three methods expressed a low sensitivity (between 31 and 41%) and a high specificity (between 95 and 100%) for detecting venous involvement. The minimal advantages of MRI compared to its high cost do not justify its routine use. CT remains the method of choice in staging preoperatively renal cell carcinoma.

[CT diagnosis in idiopathic thrombosis of the superior mesenteric vein]. / CT-Diagnostik bei idiopathischer Thrombose der Vena mesenterica superior.

We describe three cases of idiopathic thrombosis of the superior mesenteric and portal veins, in one case with additional thrombosis of the splenic vein. All patients suffered from unspecific, slowly increasing pain. The cause of the same could be detected only via CT. After anticoagulation the patients became symptom-free. A follow-up CT showed recanalisation of the affected veins.

Methods for determination of growth-rate-dependent changes in hybridoma volume, shape and surface structure during continuous recycle.

Hybridoma volume and surface membrane structure were found to vary as a function of specific growth rate using a method of cell recycle with continuous medium perfusion to vary growth rate. Mean hybridoma volume determined at constant osmolality by both electronic particle counting and scanning electron microscopic (SEM) methods indicated that rapidly growing cells are significantly larger than very slowly growing cells. We have previously determined that during both rapid and slow growth over a range of L-glutamine provision rates (Gln PR) that specific monoclonal antibody (MoAb) secretion rate was not changed. In this study a constant MoAb secretion rate per unit of membrane area was found which may indicate that changing membrane area is not a rate-determining factor in MoAb secretion. SEM methods were of limited use for accurate determination of cell volume due to cell shrinkage and large coefficients of variations. In spite of this limitation, SEM stereology methods were useful in confirming that cells remained spherical over a wide range of specific growth rates and that hybridoma cells were not circular. Sequential SEM observations also revealed that surface membrane structure of the 9.2.27 murine hybridoma investigated was correlated with growth rate. Under conditions of very slow growth, hybridoma surface microvilli density appeared to be significantly reduced.

[Synovial cyst of the intervertebral joint as cause of a lumboradicular syndrome]. / Die Synovialzyste der Intervertebralgelenke als Ursache eines lumboradikulären Syndroms.

Synovial cysts of various joints and tendon sheaths (knee, elbow, hip, proximal interphalangeal joints are well known. Cysts arising from the zygapophyseal joints however are rare, but not unknown. 3 patients with lumbosciatic pain, due to nerve root compression by a synovial cyst of the zygapophyseal joints are described. The age ranged from 54 to 77 years. There are 2 men and 1 woman. The symptoms and signs involved the fourth (1 patient) and fifth (1 patient) lumbal nerve root and the first sacral nerve root (1 patient). X-rays showed degenerative changes of the facet joints in 2 cases and spondylolisthesis in 1 case. Myelography revealed compression of the fifth lumbar and the first sacral nerve root, but did not allow to make the exact diagnoses. CT scans however made the diagnoses possible in all 3 cases. Treatment was surgical excision of the cyst in 2 cases, 1 patient showed pain relief after steroid-infiltration in the affected facet joint.

[Atypical sciatica]. / Atypische Ischialgien.

A 46-year old patient had suffered from progressive nocturnal sciatica and motor weakness of the left lower extremity for three years. The physical examination revealed a discrete neurologic deficit of the left L5 and S1 root. By CT a small presacral mass between the L5 and S1 roots was found. During the CT-guided fine needle puncture the patient felt an electrifying pain radiating into the left lower extremity. The cytomorphological examination showed benign mesenchymal cells, indicative of a neurinoma. Since progredient neurological deficit is to be expected, exstirpation of the compressing tumor is the therapy of choice. Our patient however decided to postpone the operation because of only mild symptoms.

[Normal values of left ventricular function. Biplanar angiocardiography with reference to sex-specific differences]. / Normalwerte der linksventrikulären Funktion. Biplane Angiokardiographie, unter Berücksichtigung geschlechtsspezifischer Unterschiede.

Normal values of left ventricular function have been determined in 24 patients by means of biplane angiocardiography. Global parameters were chamber volume, ejection fraction and muscle mass. Regional ventricular function was determined by means of an orthogonal and radial axial system. Radial axis shortening parameters showed smaller standard deviations and smaller coefficient of variations than orthogonal parameters. The smallest coefficient of variation elicited regional area reduction methods. Women showed significantly lower chamber volumes and muscle mass than men. There was no difference between the two sexes in the ejection fraction and wall thickness.

1.5 T MRI, CT, ultrasonography and scintigraphy in hyperparathyroidism.

The enlarged parathyroid glands of twenty-four patients with primary, and 5 with tertiary, hyperparathyroidism were prospectively studied with MRI, CT, ultrasonography and subtraction scintigraphy prior to surgery. Sensitivities in a prospective study were 63, 60, 53 and 44% for the primary, and 71, 67, 44 and 11% for the tertiary, disease form. On MRI, diseased parathyroids showed the "typical" behaviour of tumours with high signal intensity on T2-weighted and low signal intensity in T1-weighted images. On CT, the lesions were hypodense and on US hypoechoic relative to the thyroid. Retrospective analysis of MRI and CT images yielded sensitivities of 87 and 85%, respectively.

[Fasciola hepatica infection. Successful therapy using triclabendazole]. / Infektion mit Fasciola hepatica. Erfolgreiche Therapie mit Triclabendazol.

We report a case of human fascioliasis treated successfully with a single dose of triclabendazole, a benzimidazole compound. The most obvious effect was the rapid cessation of faecal egg excretion, which had been refractory to two previous treatment courses of albendazole. Cure seems to be confirmed by the absence of Fasciola eggs in repeated stool examinations after six months, achievement of clinical wellbeing, and normalization of laboratory tests. The only side effect of the treatment was a brief episode of fever and right upper abdominal pain occurring four days after administration of triclabendazole. The syndrome was probably due to disintegrating dead parasites; further observations are needed to explain the pathogenesis of this episode.

[Extrapancreatic organ manifestations of pancreatic pseudocysts]. / Extrapankreatische Organmanifestationen von Pankreaspseudozysten.

Hepatosplenomegaly is seldom caused by cystic tumefactions. 4 cases are presented, in which pseudocysts of the pancreas invaded and enlarged the spleen or liver.

Mesenteric fibromatosis with ureteric stenosis.

We report a case of a 37 year old man who presented with vomiting and colicky abdominal pain and who was found to have microscopic haematuria. Radiological-examination showed a right hydronephrosis apparently caused by a paracaecal tumour extending to involve the right ureter. This was resected and proved histologically to be a mesenteric fibromatosis. The patient has none of the factors predisposing to the development of this lesion, in particular Gardner's syndrome. Eight months following surgery he appears to have made a full recovery. Previous publications on this rare intra-abdominal neoplasm are reviewed.