Comparison of contrast-enhanced ultrasonography with grey-scale ultrasonography and contrast-enhanced computed tomography in diagnosing focal fatty liver infiltrations and focal fatty sparing.

PURPOSE: Fatty liver infiltrations and fatty sparing impair diagnostic performance of grey-scale ultrasonography in differentiating malignant and benign focal liver lesions. In the study, we present our experience in diagnosing focal fatty liver infiltrations and focal fatty sparing with contrastenhanced ultrasonography (CEUS) in comparison to grey-scale ultrasonography and contrast-enhanced computed tomography (CECT). MATERIAL AND METHOD: The retrospective study group (n=82 patients), included 44 (53.7%) men, 38 (46.3%) women (aged 29- 81 years, mean 55.8 years) with 48 focal fatty liver infiltrations and 34 focal fatty sparing. All patients underwent grey-scale ultrasonography (US), CEUS using SonoVue® and CECT executed within the 7 days. RESULTS: With US, CEUS and CECT focal fatty liver infiltrations were diagnosed in 22, 46 and 44 cases, respectively. The following values were obtained: sensitivity - 45.8%, 95.8% and 91.7%, specificity - 100% for all, accuracy - 95.2%, 99.6% and 99.3%, respectively. Focal fatty sparing was diagnosed in 16, 31 and 30 cases, respectively. The following values were obtained: sensitivity - 47.1%, 91.2% and 88.2%, specificity - 99.8%, 100% and 100%, accuracy - 95.6%, 99.4% and 99.3%, respectively. No statistically significant differences were found in sensitivity of diagnosing focal fatty liver infiltrations and focal fatty liver sparing between CEUS and CECT. Sensitivity of grey-scale ultrasonography was significantly lower when compared to those of CEUS and CECT (p<0.001). CONCLUSION: CEUS is as sensitive as CECT in focal fatty infiltrations and focal fatty sparing diagnosing. However, CEUS provides more information than CECT about the vasculature and enhancement pattern of focal fatty liver infiltrations.

Role of endogenous nitric oxide in the control of exocrine and endocrine pancreatic secretion in humans.

BACKGROUND: Nitric oxide (NO) is an unstable vasodilator formed by NO synthetase (NOS) from L-arginine (L-Arg) in various cells but its role in the control of pancreatic secretion in humans has not been examined. AIMS: This study was designed to determine the role of endogenous NO in the control of exocrine and endocrine pancreas using NOS inhibitor, NG-monomethyl-L-Arg (L-NMMA). METHODS: Pancreatic secretion was stimulated by intravenous infusion of secretin (80 pmol/kg/h) plus caerulein (50 pmol/kg/h) and duodenal content was aspirated by gastroduodenal tube. Two series of tests with secretagogue infusion were performed, one, with addition of graded doses of L-NMMA and, another, with addition of a constant dose of L-Arg alone followed by L-NMMA alone and finally by a combination of L-Arg and L-NMMA. RESULTS: Addition of L-NMMA in graded doses (2-8 mumol/kg/h) reduced dose dependently the secretin-caerulein stimulated pancreatic enzyme secretion without alterations in the volume flow and bicarbonate outputs. The addition of L-Arg to L-NMMA reversed the inhibitory action of L-NMMA on protein enzyme response to secretin-caerulein in these subjects. Secretin-caerulein infusion caused significant increase in plasma insulin and pancreatic polypeptide levels but without changes in plasma glucagon or somatostatin levels. L-NMMA alone resulted in a significant fall in plasma insulin and pancreatic polypeptide levels, while L-Arg added to pancreatic secretagogue infusion caused a significant increase of plasma insulin and pancreatic polypeptide levels above those attained with secretagogues alone. After the addition of L-Arg to L-NMMA, both plasma insulin and pancreatic polypeptide levels rose significantly above the levels observed with L-NMMA plus secretin-CCK stimulation. CONCLUSION: This study provides evidence that the suppression of NOS reduces pancreatic enzyme secretion and the plasma insulin and pancreatic polypeptide levels suggesting that endogenous NO affects both exocrine and endocrine pancreatic secretion in humans.

Expression of an oncofetal 65-kDa phosphoprotein in lymphocytic and granulocytic leukemias.

We examined the expression of an oncofetal 65-kDa phosphoprotein, termed p65, in patients with lymphocytic and granulocytic leukemia. This protein was previously identified in rat fetal tissues and in epithelial cancers of rat and human origin. Using the anti-p65 monoclonal antibodies MB2 and MF11 in a double-antibody sandwich enzyme-linked immunosorbent assay (ELISA), we analyzed the expression of the protein in sera of 80 normal, healthy controls and in 61 patients with benign, nonneoplastic diseases. We established that the upper level of normal p65 concentration is 115 U/ml p65 (mean plus two standard deviations above the mean in a control group). We also analyzed p65 levels in sera of 71 patients with leukemia in different stages of development. The level of p65 was well above normal in 95% of acute lymphocytic leukemia (ALL; 19 cases), 83% of acute myeloblastic leukemia (AML; 23 cases), 37% of chronic lymphocytic leukemia (CLL; 19 cases), and 30% of chronic myelogenous leukemia (CML; 10 cases). MB2 monoclonal antibodies were used for immunocytochemical staining of isolated lymphocytes from normal peripheral blood and from blood of leukemic patients (in 12 CLL patients, the p65 positivity was 83%, in 2 ALL patients, 100%, and in 4 AML patients, 75%). Our data suggest that p65 protein may be of use as a tumor marker in leukemia.

[Roxithromycin (Rulid) in treatment of Chlamydia trachomatis genital infections in women]. / Roxithromycyna (Rulid) w leczeniu zakazen Chlamydia trachomatis narzadów plciowych u kobiet.

New macrolide antibiotic, roxithromycin (erythromycin--like group), was tested in treatment of chlamydial genital infection in women. In comparison with doxycycline, roxithromycin showed higher clinical efficiency with fewer sides effects.

Cholecystokinin (CCK) in the amino acid uptake and enzyme protein secretion by the pancreas in humans.

Activation of type A receptors by CCK or cerulein is known to stimulate pancreatic enzyme secretion, but its role in the amino acid (AA) consumption and enzyme synthesis remains unclear. In our study, we used loxiglumide, a potent CCK-A-receptor antagonist, to investigate the role of CCK-A receptors in pancreatic consumption of circulating AAs and enzyme secretion. Five healthy male volunteers were intubated with double-lumen duodenal tube, and duodenal aspirates were collected during 60-min basal periods and then during pancreatic stimulation with iv infusion of secretion (80 pmol/kg/h) plus cerulein (50 pmol/kg/h) during three consecutive 30-min periods. The same procedure was repeated, but secretin-cerulein infusion was combined with a constant dose of loxiglumide (20 mumol/kg/h). The volume and outputs of HCO3-, protein and enzymes (amylase and trypsin) in duodenal aspirates and gallbladder volume (by sonography) were determined at 30-min intervals. Plasma samples were drawn for total plasma AA assay by ninhydrin method to assess the pancreatic uptake of free AAs. Infusion of secretin plus cerulein caused a several-fold increase in the volume of duodenal aspirate and the outputs of HCO3-, protein, and enzymes. During those periods, plasma AA level decreased from initially 2.20 +/- 0.3 mmol/L to 1.09 +/- 0.3 mmol/L (p < 0.01) and the gallbladder volume from initially 28 +/- 8 mL to 2 +/- 0.4 mL. This increase in pancreatic secretory outputs was accompanied by significant increments in plasma insulin, glucagon, PP, and somatostatin.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of the effectiveness of the preparation Panzytrat 20,000 U in the substitute treatment of chronic pancreatitis]. / Ocena skutecznosci preparatu Panzytrat 20,000 j w leczeniu substytucyjnym przewleklego zapalenia trzustki.

Panzytrat 20,000 U produced by Knoll is a modern galenic form of active pancreatic enzymes in the form of microgranules with uniform enzymatic composition. The studies of the preparation effectiveness were carried out in 88 patients with diagnosed exocrine failure in the course of chronic pancreatitis. The patients were taking Panzytrat 20,000 for 4 weeks in doses 3 x 1 capsule with main meals. Control examinations were performed two and four weeks after starting the treatment, assessing the patients' condition on the basis of history taking and medical examination; taking into account weight gain, duration and intensity of pain and dyspeptic symptoms, frequency and character of defeacations and possible undesirable effects. In a group of 37 patients, BNT-PABA test was also performed before the treatment and after one capsule of Panzytrat. The treatment with Panzytrat 20,000 caused a statistically significant reduction of the number of defecations, significant reduction of pain and dyspeptic symptoms. A statistically significant increase of PABA recovery in urine was also obtained after one capsule of the preparation. Practically, no unfavourable effects of the treatment were observed. The studies carried out point to the high effectiveness of Panzytrat in dose 3 x 20,000. U daily in the treatment of exocrine pancreatic failure in the course of chronic pancreatitis.

Comparison of tin and lead toxic action on erythropoietic system in blood and bone marrow of rabbits.

The aim of this work was to assess and compare morphological changes in blood and bone marrow of rabbits after per os (po) or intraperitoneal (ip) administration of equimolar doses of tin or lead. The experiment was performed on female rabbits that were divided into four groups of six animals each, and received stannous chloride SnCl2 x 2 H2O (Merck) or lead acetate Pb(CH3COO)2 (POCh Gliwice) in equimolar doses (ip--17/microM/kg) or per os (po--85/microM/kg). Group I was administered SnCl2 ip at the dose of 2 mg Sn/kg every day for 3 mo, group II Pb(CH3COO)2 ip at a dose of 3.5 mg Pb/kg every day for 3 wk, group III po SnCl2 (10 mg Sn/kg), and group IV po Pb(CH3COO)2 (17.5 mg Pb/kg), both for 4 mo. The morphological factors hemoglobin (Hb), hematocrit (Ht), erythrocyte (Ercs), and reticulocyte counts, MCV, MCH, MCHC, and erythropoietic system in bone marrow aspirates with sideroblast count, iron concentration, TIBC, and SI were estimated. Tin caused hemolytic anemia depending on abnormal iron utilization. After ip administration of tin, anemia was observed during the whole time of the study, whereas after po exposure, transient anemia was noticed. It has been proven that the mechanism of toxic action of tin on hematopoietic system is similar to the toxic effect of lead.

[Acute nonlymphoblastic leukemia as a secondary malignancy--demonstration of 15 patients]. / Ostra bialaczka nielimfoblastyczna jako drugi nowotwór--demonstracja 15 chorych.

Among 90,128 patients with malignancies in the years 1976-1989 acute non lymphoblastic leukaemia (ANLL) was diagnosed in 351 patients (0.4%) and in 15 (4.3%) of them ANLL was secondary neoplasm. Secondary ANLL occurred in 10% of all the 148 secondary malignancies observed at that period of time and constituted 6.7% of secondary malignancy in patients with solid tumours and 43% in patients with myeloproliferative syndromes as a first malignant neoplasm. In the treatment of first malignancy radiotherapy was applied in 11 persons, in combination with chemotherapy in 7 of them and chemotherapy alone was given to 4 patients. The appearance of the secondary ANLL was usually preceded by the myelodysplastic syndrome. Morphologically, secondary ANLL belonged mostly to M6 and M4 (8 patients) according to FAB classification. The course of ANLL was fulminant and the disease was completely resistant to the treatment.

[Alpha 1-antitrypsin as an endogenous marker of protein-losing enteropathies]. / Alpha 1-antytrypsyna endogennym markerem jelitowej ucieczki bialka.

A novelty of the present studies is the use of alpha 1-antitrypsin (A-1--AT) as an endogenous marker of enteric protein loss. Enteric clearance of alpha 1-antitrypsin was determined in 10 patients with the symptoms of PLE, and in 6 healthy individuals. Alpha 1-Antitrypsin concentration has been assayed in single, random samples of feces collected from 42 patients and 12 healthy individuals (normal values: 1.31 +/- 0.72 mg/g of feces). Markedly increased enteric clearance and A-1-AT concentrations in single, random samples of feces have been found in patients with enteric lymphangiectasis, Crohn's disease, ulcerative colitis, and constrictive pericarditis, slightly lower in coeliac, chronic diarrhoea, nonspecific hemorrhagic colitis, esophagitis, lambliasis, hypogammaglobulinemia, Wiskott-Aldrich syndrome, Rendu-Osler-Weber syndrome, hepatitis in newborn, and Gilbert's disease. Statistically significant positive clearance has been noted (r = 0.997; p less than .001). A single assay of A-1-AT in feces is simple, repeatable, and sensitive technique in the diagnosis and evaluation of these diseases in which the symptoms of enteric protein loss are seen.

[Diagnostic value of the NBT-PABA test in chronic pancreatitis]. / Wartosc testu NBT-PABA w diagnostyce przewleklego zapalenia trzustki.

The aim of this study was an assessment of the usefulness of indirect test NBT-PABA in evaluation of pancreatic exocrine function in patients from our department treated for chronic pancreatitis. The study was carried out on 67 persons divided in three groups: I - healthy controls (n = 23), II - patients with non-pancreatic diseases (n = 17), III - patients with chronic pancreatitis (n = 27). On the basis of degree of impairment of exocrine function in the secretin-pancreozymin test (SPT), group III was divided in three subgroups: with mild (A), moderate (B), severe (C) exocrine insufficiency. NBT-PABA test was performed using reagents (firm's Hoffman-La Roche) in accordance with the added instructions. In healthy persons (I) average PABA excretion in urine was 62% and lower normal limit was 30%. In patients with non-pancreatic diseases (II) mean urinary PABA excretion was 52% and in the group with chronic pancreatitis (III) markedly lower results were obtained (mean = 26%), p less than 0.05. In order to evaluate diagnostic sensitivity in relation to the degree of pancreatic insufficiency, results of NBT-PABA test were compared with the results of SPT. The results of both tests completely coincided in subgroups III B, and III C, but in subgroups III A, in only 43% of cases it was observed. The specificity of NBT-PABA test (i.e. frequency of normal results in controls and patients with non-pancreatic diseases) was 87%. Our results suggest that NBT-PABA test may be a useful procedure in diagnosis of chronic pancreatitis with severe and moderate exocrine insufficiency. In cases of mild exocrine dysfunction its value is limited.

Comparison of loxiglumide, a cholecystokinin receptor antagonist, and atropine on hormonal and meal-stimulated pancreatic secretion in man.

The effects of loxiglumide, a potent cholecystokinin (CCK)-receptor antagonist, and atropine, a muscarinic receptor blocker, on exocrine pancreatic secretion stimulated by hormones (secretin plus CCK) and a Lundh test meal were studied in healthy young volunteers. Loxiglumide infused intravenously in gradually increasing doses (2-16 mumol/kg-h) caused a dose-dependent inhibition of pancreatic enzyme secretion induced by intravenous infusion of a constant dose of secretin (82 pmol/kg-h) plus CCK-8 (85 pmol/kg-h) but had relatively smaller influence on duodenal volume flow and bicarbonate output. Atropine (20 nmol/kg) also caused a significant reduction in pancreatic enzyme secretion but failed to affect the volume flow or bicarbonate secretion induced by secretin plus CCK, possibly owing to the high doses of secretin and CCK used in these tests. Both loxiglumide and atropine inhibited the pancreatic enzyme response to a Lundh meal, but atropine was more effective in the early phase and loxiglumide in the late phase of the postprandial secretion. Neither loxiglumide nor atropine affected the plasma gastrin and CCK levels, but both antagonists reduced plasma pancreatic polypeptide responses to the Lundh meal. We conclude that 1) loxiglumide results in a relatively stronger suppression of the pancreatic enzyme than aqueous-alkaline secretion induced by secretin plus CCK, whereas atropine inhibits only enzyme secretion; and 2) both loxiglumide and atropine suppress the pancreatic enzyme responses to the meal stimulation without affecting the postprandial plasma gastrin and CCK responses.

[Occurrence of Clostridium difficile in feces of children with dysfunction of the digestive tract and other disorders]. / Wystepowanie Clostridium difficile w kale dzieci z dysfunkcja przewodu pokarmowego oraz innymi zespolami chorobowymi.

Thousand and six hundred ninety two fecal samples from children of few weeks old up to over ten years were tested for the presence of Clostridium difficile. Most of them were treated with antibiotics and showed diarrhea symptoms. Hundred and twenty three strains of C-difficile were submitted to serological typing and their sensitivity to 10 selected antibiotics and chemotherapeutic agents was determined. Among 109 strains of C. difficile tested for enterotoxin production by latex test 82 strains (75.2%) were positive. Almost half (48%) of the isolated strains belonged to serotype C. Most of the strains were resistant to cefoxitin (88%) and clindamycin (76%). Over 90% of strains were sensitive to vancomycin and azlocillin and 86% to chloramphenicol and metronidazole. In the majority of patients with positive C. difficile cultures diarrhea was present, however, it was difficult to find a direct link between these symptoms and antibiotic therapy.

[Ferritin levels in blood serum and mononuclear cells of peripheral blood in lymphatic neoplasms of low and medium degrees of malignancy]. / Stezenie ferrytyny w surowicy i komórkach jednojadrowych krwi obwodowej w chorobach nowotworowych ukladu chlonnego o malym i srednim stopniu zlosliwosci.

Ferritin levels in blood serum and mononuclear cells of the peripheral blood were determined in 60 patients with chronic lymphatic leukemia (group I), and 31 patients with other lymphomas of the low and medium degree of malignancy (group II). Significantly higher blood serum and mononuclear cells ferritin was found in the examined patients than in 54 healthy individuals. Particularly high ferritin levels were seen in blood serum of patients of group II in whom clinical stage of the disease was high. Moreover, moderate correlation of ferritin content in mononuclear cells and absolute leucocytosis was found in group I. This parameter correlated well with the percentage of poorly differentiated cells (group II).

[Disorders of lipid and lipoprotein metabolism in patients with chronic lymphocytic leukemia. I. Preliminary evaluation of lipemia and HDL fractions in various stages of the disease]. / Zaburzenia metabolizmu lipidów i lipoprotein u chorych z przewlekla bialaczka limfatyczna. Cz. I. Wstepna ocena lipemii i frakcji HDL w róznych okresach choroby.

The study comprised 128 patients with chronic lymphocytic leukemia (CLL) aged 65.7 +/- 8 years, 59 women and 69 men. Among the patients studied 70 were treated and 58 yet not underwent therapy. The Rai classification of patients with CLL has been used. The control group consisted of 68 subjects aged 56.8 +/- 14 years, 35 women and 33 men, showing no diseases affecting the blood lipid disturbances. The following determinations have been performed in the blood serum: apo B, CH, TG, PL, and CH or PL in the isolated HDL fraction; LDL-CH ratio has also been calculated. In patients with CLL the total CH concentration has been noted which advanced parallel to the disease progress. It resulted first of all from the decrease in LDL-CH (p less than 0.05). Similar alterations have been noted so far as apo B is concerned. It has been demonstrated that the decrease in HDL-CH (p less than 0.05) is also dependent on the disease stage. The simultaneously increasing index HDL-PL/HDL-CH indicate on changes within the HDL2 and HDL3 subfractions suggesting a deficiency of the HDL2 subfraction. The total lipemia and the lipoprotein fraction alterations observed make the diagnostic value of the atherosclerotic threat in patients with CLL doubtful with the use of that parameters.

The coexistence of chronic lymphocytic leukaemia and polycythaemia vera terminating in acute myeloid leukaemia.

A 67-year-old man with the coexistence of CLL and PV converted after 4 years to AML is described. This rare simultaneous occurrence of both chronic lymphoid and myeloid proliferations as well as nonlymphoblastic leukaemia developing in a patient with CLL is discussed in the light of literature data.