Prevention of acute and chronic allograft rejection by combinations of tolerogenic dendritic cells.

It is well known that adoptive transfer of donor-derived tolerogenic dendritic cells (DC) helps to reduce acute allograft rejection. However, this method cannot effectively prevent grafts from infiltration of inflammatory cells and fibrosis, and thus has minimal effect on chronic allograft rejection. In this study, we used mitomycin C (MMC) to generate tolerogenic DC and demonstrated that donor (Balb/c)-derived MMC-DC could induce hyporesponsiveness of recipient (C57BL/6) T cells in vitro, potentially by inducing T-cell apoptosis, decreasing IL-2 and IL-12 secretion, and increasing regulatory T-cell numbers and IL-10 secretion. Furthermore, anti-CD154 monoclonal antibody (mAb) treatment combined with donor-derived MMC-DC prolonged the survival of the allografts in vivo. The mechanisms were similar to those in vitro. Impressively, both acute and chronic rejection were prevented when donor and F1 generation (Balb/c × C57BL/6) derived MMC-DC were injected together with anti-CD154 mAb into recipients before heart allotransplantation. In summary, we showed that donor and F1-derived tolerogenic DC have a synergistic effect on induction and maintenance of T-cell regulation and the secretion of immunosuppressive cytokines. Moreover, adoptive transfer of these two types of DC could inhibit both acute and chronic transplant rejection in mice.

Evaluation of urease test, gram stain, culture, and histology in the detection of Campylobacter pylori.

To evaluate the commonly available tests for detection of Campylobacter pylori infection in the human stomach, we prospectively performed endoscopy and biopsy from the antrum of the stomach in 121 consecutive patients. Four tests, including the urease test, Gram stain, culture, and the hematoxylin and eosin (H & E) stain were used to detect the presence of C. pylori. A C. pylori positive was defined by a positive culture or positive results in two of the other three tests. The sensitivity of the urease test, Gram stain, culture, and H & E stain was 95%, 95%, 71%, and 97%, respectively, and the specificity of those tests was 96%, 100%, 100%, and 73%, respectively. For diagnosis, theoretically, all four tests should be performed from the biopsy specimens. In our experience, the culture was less sensitive, and the H & E stain was less specific, while the urease test and Gram stain were more rapid and had high sensitivity and specificity in the detection of C. pylori infection.

Gastrointestinal tract involvement in hepatocellular carcinoma: clinical, radiological and endoscopic studies.

Gastrointestinal tract involvement with hepatocellular carcinoma was observed in 8 out of 396 patients (2%) during the course of the disease. Histological involvement was confirmed in 6 cases. All 8 patients were men. The most common clinical presentation was frank gastrointestinal bleeding, which became evident in all cases. Esophageal varices were not seen in any patient. The sites of involvement were the stomach (3), duodenum (4), and jejunum (1). The median time between the diagnosis of primary tumors and gastrointestinal tract involvement was 4.5 months (range: 0 to 12 months). Hematogenous spread was presumed to have occurred in two patients with diffuse-type hepatocellular carcinoma, one of whom had main portal vein thrombosis. Direct invasion by contiguous neoplasm was the major mode of gastrointestinal tract involvement. This complication is more likely to develop in patients with large, subcapsular, massive type hepatocellular carcinoma treated by transcatheter arterial embolization and/or intra-arterial chemotherapy. The median survival after the diagnosis of gastrointestinal involvement was 1 month (2 weeks-4 months).

Incidence of massive rebleeding from nonbleeding visible vessels in benign gastroduodenal lesions and prospective study in assessing the efficacy of endoscopic hemostasis with local ethanol injection for prevention of rebleeding.

Twenty-seven patients presenting with massive upper gastrointestinal bleeding in whom endoscopy revealed nonbleeding visible vessels in benign gastroduodenal lesions were prospectively and nonrandomly allocated to receive endoscopic injection therapy with pure ethanol or conservative treatment. Those who received conservative therapy were used as a control group. The purpose of this study is to evaluate the incidence of massive rebleeding from the nonbleeding visible vessel which was defined by a more rigid criteria and to evaluate the efficacy of endoscopic pure ethanol local injection to prevent rebleeding. Nine out of the 10 (90%) controls had recurrent major bleeding, in contrast to the 2/17 (12%) of those who received hemostatic endoscopy (p less than 0.0002). Pure ethanol local injections also minimized further transfusion requirements (p less than 0.03). The complications of hemostatic endoscopy in this study are negligible. It is concluded that 1) by restrictive definition nonbleeding visible vessels in benign gastroduodenal lesions carry a high potential of recurrent massive bleeding; 2) rebleeding can be safely and effectively prevented by pure ethanol local injection.

[Gastroduodenoscopic findings and clinical analysis in patients with dengue fever].

The following is a report of the recent Dengue Fever epidemic in Southern Taiwan. From Sept, 1988 to Nov, 1988, 76 patients were clinically diagnosed with fever, leukopenia, thrombocytopenia and other classical signs and symptoms of Dengue Fever. Among them 26 cases were proven by serology. Analysis and discussion were emphasized on the gastroduodenoscopic findings, histopathologic findings and relationship between upper gastrointestinal tract bleeding and thrombocytes, oral medication and clinical symptoms. 655 patients having undergone endoscopy within the same period were used as a control group. It was concluded that: 1) 58.5% of the Dengue Fever Group disclosed hemorrhagic gastritis in their endoscopic findings and in the control group only 8.9% was noted. 2) Patients with thrombocytes less than 50000/mmc suffered from UGI bleeding at a detection rate of around 48.6%. On the other hand, the detection rate was around 29.7% in those patients with thrombocytes over 50000/mmc. Thus a significant difference was shown (p less than 0.025). 3) The thrombocyte count decreased significantly in patients who had had oral medication before endoscopy compared to those without oral medication. The detection rate of UGI bleeding was 40.6% and 26% respectively (p less than 0.025). 4) Most upper G-I bleeding cases occurred after the 4th day of onset, especially in the group without oral medication. 5) There was no significant relationship between UGI bleeding and symptoms of epigastralgia or cutaneous eruption. 6) In cases of presenting hemorrhagic gastritis and superficial plus hemorrhagic gastritis by endoscopy, the detection rate of UGI bleeding seemed higher but there was no statistical difference.(ABSTRACT TRUNCATED AT 250 WORDS)