Characterization of cytokine expression in the rectal mucosa of ulcerative colitis: correlation with disease activity.

OBJECTIVE: Mucosal inflammation in ulcerative colitis (UC) is presumed to be regulated by Th2-like cytokines. The aim of this study was to characterize local expression of various cytokines mRNA. METHODS: Total RNA was extracted from rectal biopsy specimens in 61 patients with UC, 18 inflammatory controls, and 16 noninflammatory controls. Reverse-transcription polymerase chain reaction (RT-PCR) was used to determine mRNA expression of interleukin (IL)-2, interferon (IFN)-gamma, IL-4, IL-10, IL-13, and IL-15. RESULTS: Expression of IL-10 was more frequent in UC (75.4%) than in noninflammatory controls (37.5%, p < 0.01). IL-4 was more frequently positive in UC (41%) than in inflammatory controls (5.6%, p < 0.01) and in noninflammatory controls (6.3%, p < 0.01). Positive expressions of IL-4 (66.7% vs 20.6%, p < 0.01) and IL-13 (63.0% vs 29.4%, p < 0.01) were higher in active UC than in inactive UC. The positive rate of IL-2, interferon (IFN)-gamma, and IL-15 expression showed no difference among the groups divided by clinical, endoscopic, and histological grade of inflammation. CONCLUSIONS: These findings suggest that in active UC, IL-4 is pivotal, in combination with other Th2-like cytokines. In contrast, Th1-like cytokines and IL-15 bear no definite relation to local inflammation of UC.

Juvenile polyposis occurring in hereditary hemorrhagic telangiectasia.

Various extraintestinal manifestations may occur in juvenile polyposis, but hereditary hemorrhagic telangiectasia has rarely been reported in this type of polyposis. The authors treated a 14-year-old girl with rectal bleeding and anemia who had multiple polyps of the colorectum. Large polyps were removed and histologically diagnosed as juvenile polyps. She was later diagnosed as having telangiectasia of the skin, and arteriovenous malformations in the lung and in the liver, all of which were compatible with the diagnosis of hereditary hemorrhagic telangiectasia. At age 32, she had multiple ulcers in the ileum and in the colon. The coexistence of juvenile polyposis and hereditary hemorrhagic telangiectasia may be a clue for the understanding of the histopathogenesis of juvenile polyposis.

A case of systemic malignant lymphoma with intestinal involvement of lymphomatous polyposis type.

Multiple lymphomatous polyposis is a rare type of intestinal lymphoma characterized by non-Hodgkin's lymphoma of follicular mantle cell origin and extremely poor prognosis. We report a case of systemic lymphoma with the intestinal involvement of multiple lymphomatous polyposis. Although radiographic and endoscopic features of the case were compatible with multiple lymphomatous polyposis, histologic evidence suggested the diagnosis of diffuse large cell lymphoma rather than mantle cell lymphoma. Our case seems to be unique in its histologic findings and also in its prognosis, because the patient has been alive for more than 50 months after diagnosis.

Esophageal Candida infection and adherence mechanisms in the nonimmunocompromised rabbit.

Candida infection of the esophagus has been reported not only in immunocompromised hosts but also in healthy individuals. However, its mechanisms of action in healthy individuals have not been clarified. Our previous study suggested that physical contact was an important factor for the adherence of Candida albicans. The aim of the present study was to test our hypothesis and clarify the adherence mechanisms. Suspensions of Candida albicans cells were given to rabbits in drinking water without the use of immunosuppressive drugs and/or antibiotics, and the esophagus was examined. Candidial lesions were observed in 14 of 15 rabbits given the suspensions held in water with and without 30% sucrose for 13 days. The number of Candida albicans cells adhering to the esophagus per square millimeter by subepithelial cell insertion was significantly larger than that adhering by attachment. These results indicate that adherence of Candida albicans to the esophagus occurs by sustained physical contact alone under a nonimmunosuppressive state, and that subepithelial cell insertion results in greater attachment on adherence. Our findings provide a clue that may help clarify the mechanism of Candida infection in healthy individuals.

Endoscopic detection of ectopic multiple minute sebaceous glands in the esophagus. Report of a case and review of the literature.

This case report describes a patient with a rare form of ectopic sebaceous glands. The patient was a 53-year-old woman complaining of prolapse of a polyp through the anus who was admitted for polypectomy of the rectal polyp. After polypectomy, esophagogastroduodenoscopy was performed to detect other lesions. Although she had no symptoms from an upper gastrointestinal series, such as dysphagia, heartburn, or epigastric pain, multiple yellow rounded elevated lesions arranged in rows, 0.5 mm in diameter and more than 100 in number were observed in the middle and lower esophagus. Histological examination of the biopsied specimens taken from the lesions endoscopically revealed a structure with the characteristics of a sebaceous gland including an excretory duct.

Significance of modes of adherence in esophageal Candida albicans.

Although esophageal candidiasis is the most common form of Candida infection in the gastro-intestinal tract, little attention has been directed toward determining the mechanism of its infection. We have already clarified the existence of four modes of adherence of Candida albicans to the esophagus; attachment, subepithelial cell insertion, cavitation, and invasion. This study was undertaken to clarify the significance of each of these modes. Scanning electron microscopic observations were made of esophageal specimens from 8-week-old rabbits infected with Candida albicans IFO 1060. In this study, attachment and subepithelial cell insertion were found to be the most frequent modes of adherence. Cavitation occurred following subepithelial cell insertion, while invasion occurred following attachment and subepithelial cell insertion. These results suggest that attachment and subepithelial cell insertion play the most important role in the initial stage of adherence. The ratios of these modes for living yeast cells were similar to those for dead yeast cells and beads. This suggests that Candida albicans can gain a foothold on the esophageal epithelium solely by physical contact, after which colonization occurs.

A carcinoid tumor of the rectum removed by strip biopsy.

In a 29-year-old male complaining of constipation, total colonoscopy revealed a 5 mm yellowish submucosal tumor at a distance of 6 cm from the anal ring. The histologic diagnosis of specimens obtained by biopsy was rectal carcinoid tumor and transanal ultrasonography revealed the tumor localization within the submucosal layer in the rectum. A strip biopsy was performed. Histopathological examination confirmed the diagnosis and ascertained complete excision. Rectal carcinoid tumors should be removed completely and strip biopsy may be a suitable procedure for removal of rectal submucosal tumors less than 10 mm in diameter.

Candida albicans produces a cystatin-type cysteine proteinase inhibitor.

A cysteine proteinase inhibitor was found in culture media of Candida albicans. Purification to homogeneity of the inhibitor was performed by carboxymethyl-papain-Sepharose affinity, DE-52 ion-exchange, and reverse-phase high performance liquid chromatographies. The purified inhibitor had an M(r) of 15 kDa and a pI of 4.9. It was more stable to heat and pH than most proteins. The N-terminal sequence of the first 30 residues demonstrated high similarity with that of human cystatin A. Thus, C. albicans cysteine proteinase inhibitor seems to belong to the cystatin superfamily. The inhibitor activity of the yeast cellular form was 4.0 times higher than that of the hyphal cellular form in 7-day culture media. It is suggested that the inhibitor has regulatory functions similar to those of its counterpart proteinases in the invasion of host cells.

Remarkable improvement of growth and developmental retardation in Crohn's disease by parenteral and enteral nutrition therapy.

The patient, an 18-yr-old male (admission ht 153 cm, wt 30 kg), had been suffering from growth arrest and intermittent abdominal pain since he was 13 yr old, which was left untreated. Examinations on admission disclosed almost normal pituitary function, while levels of testosterone and somatomedin C were low. Roentgenological examination revealed extensive skip-stenotic lesions and longitudinal ulcers in the ileum, diagnostic of Crohn's disease. Therapy involving high-caloric parenteral and enteral alimentation resulted in a marked increase in both ht and wt, and improvement in roentgenological and colonoscopical findings. The interrelation between Crohn's disease and malnutrition with reference to some reports in the literature is discussed.