EUS Meets Voxel-Man: three-dimensional anatomic animation of linear-array endoscopic ultrasound images.

Endoscopic ultrasonography (EUS) is a widely used imaging modality in gastroenterology. The development of linear-array endoscopic ultrasound transducers, with facilities for EUS-guided diagnostic and therapeutic procedures, led to increasingly widespread use in different areas of the body. Examiners need to have excellent knowledge of anatomy. Orientation in linear EUS is more difficult and the learning curve is long. In an effort to shorten the training, reducing the risk to the patient and to allow a faster learning of the basic anatomic structures EUS meets VOXEL-MAN, an interactive three-dimensional anatomic simulation program has been developed for linear EUS for the purposes of private and independent study.

Peritonitis and massive granulocytic infiltration of the spleen in adult Still's disease.

A case of adult Still's disease is described which, in addition to the more common manifestations, also included abdominal discomfort. Upon laparoscopy, peritonitis was disclosed; a biopsy showed massive granulocytic infiltration of the spleen which could not be attributed to an infectious disease. The patient did not improve on conventional therapeutic modalities but required intensive combination therapy consisting of high dose acetylsalicylic acid, prednisone, and slow-reacting substances before entering remission.

[ERCP: which contrast medium is suitable?]. / ERCP: Welches Kontrastmittel ist geeignet?

To evaluate, wether a new non-ionic contrast medium decreases the complication rate of endoscopic retrograde cholangiopancreaticography (ERCP), we performed a prospective randomized study in 46 indoor patients with suspected pancreatic or bile duct related disease. The low-osmolar low-viscosity non-ionic Iopromid (Ultravist, n = 15), the low-viscosity high-osmolar Ioglicinate (Rayvist, n = 18), and the conventional dissociable high-viscosity Ioxaglinate (Heaxbrix, n = 13), each presenting a iodine content of 300-320 mg/ml were compared. All three contrast solutions gave excellent imaging of pancreatic and bile ducts. No complications, particularly no pancreatitis were observed. Hexabrix caused significant elevations of gamma-GT from 126 U/l to 178 U/l and mof lipase from 144 U/l to 418 U/l (p less than 0.01), respectively. Following Rayvist or Ultravist injections, no significant changes of the leucocytes, SGOT, SGPT, gamma-GT, AP, lipase and amylase were observed. We conclude that ERCP performed by skilled investigators is a low risk procedure. Selection of suitable contrast media may diminish hepatotoxic and pancreatotoxic side effects. According to our results, we recommend low-viscosity contrast media (Rayvist, Ultravist). The presumed benefit of the non-ionic solution (Ultravist) could not be demonstrated.

Immunoelectron microscopic observations on the inflammatory infiltrates and HLA antigens in hepatitis B and non-A, non-B.

The present knowledge of the inflammatory reaction occurring in situ during hepatitis B favors a T cell-dependent MHC-restricted immune response. However, the reports in the literature are primarily based on the application of monoclonal antibodies directed at different lymphocyte subsets which discern only lymphocytic phenotypes and do not reflect the actual situation adequately. Therefore, we investigated the liver biopsies of patients with hepatitis B (28 patients) and non-A, non-B (21 patients) by immunoelectron microscopy with monoclonal antibodies directed at lymphocyte subtypes (pan-B, pan-T, T8, T4 and NKH1) and at activation epitopes (IL-2 receptor, TA1 and T11/3) as well, in order to determine the phenotype in association with the activation status of the lymphocytes that are in close contact with hepatocytes; thus, establishing an effector-target cell relationship on the ultrastructural level. We were able to confirm the central role of T8 lymphocytes being the predominant type of lymphocytes in close contact with liver cells in the space of Disse. A certain percentage of these cells expressed "activation" markers as IL-2 receptor, TA1 and T11/3. In acute hepatitis, the NK lymphocytes made up a fifth of all lymphocytes, whereas their number dropped below 10% in the chronic stage. There was a vague correlation between the inflammatory activity of the disease and the expression of HLA antigens (both classes I and II) on inflammatory cells and also on hepatocytes. The results did not show significant differences between hepatitis B and non-A, non-B.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of liver-specific protein LSP using murine monoclonal antibodies.

We describe twenty murine monoclonal antibodies directed against different antigenic determinants of human and rabbit liver-specific protein LSP. Among them, nine were directed against liver-specific epitopes as judged from immunohistological studies. Immunoelectronmicroscopy revealed that seven of these monoclonals recognized membrane determinants differing in staining of distinct areas of the hepatocellular surface. Eleven antibodies were directed against intracellular structures. Western blot analysis showed that the epitopes detected were displayed on either single or multiple protein bands with apparent molecular weights between 24,000 and 60,000. Further differences were observed with respect to the species specificity and (among the non-organ-specific antibodies) pattern of tissue cross-reactivity. Our results demonstrate the presence of several liver-specific determinants and membrane components within LSP. There are, however, a very much greater number of non-organ-specific epitopes and numerous determinants displayed on intracellular structures. This emphasizes the remarkable heterogeneity of the antigen preparation named LSP and warrants the use of clearly defined antigens in further studies dealing with auto-immune phenomena in liver diseases.

The effect of recombinant alpha-interferon treatment on serum levels of hepatitis B virus-encoded proteins in man.

The effect of alpha-interferon treatment on serum levels of hepatitis B virus-encoded proteins was analyzed in eight patients with chronic type B hepatitis who participated in a pilot study of interferon therapy. Three individuals became HBsAg-negative, 4 lost HBeAg but remained HBsAg-positive and 1 remained positive for both HBsAg and HBeAg. Initiation of interferon treatment was rapidly followed by reduction or loss of hepatitis B virus DNA in the serum but by little immediate change in hepatitis B virus antigen levels. Changes in hepatitis B virus antigens were usually delayed. Loss of HBsAg from the serum was preceded by the sequential disappearance of pre-S-encoded proteins (pre-S1 and polymerized human serum albumin) and HBeAg. In patients who lost HBeAg but remained HBsAg-positive, serum levels of pre-S1 and polymerized human serum albumin usually, but did not always, decrease. The individual who remained HBsAg- and HBeAg-positive had unchanged serum levels of pre-S1, polymerized human serum albumin and HBsAg. These results suggest that alpha-interferon inhibits hepatitis B virus DNA replication but has little direct effect on synthesis of hepatitis B virus gene products.

Liver cell damage caused by monoclonal antibody against an organ-specific membrane antigen in vivo and in vitro.

Monoclonal antibodies have been raised against different antigenic determinants of normal rabbit hepatocytes. One antibody (2D3) recognized a liver-specific 43 kDa protein displayed exclusively on the basolateral portion of the hepatocellular membrane. Purified monoclonal antibodies were injected intravenously into rabbits. Following the injection of antibody 2D3, a dose-dependent increase of liver enzyme activities in sera was observed. Within 8 h, marked morphological alterations of the hepatocytes, including multiple cell necroses, could be demonstrated by light and electron microscopy. When isolated vital rabbit hepatocytes in culture were used as targets, cytotoxic effects of this antibody could also be observed. This indicates that liver cell damage was not due to antibody-dependent cellular cytotoxicity, but was mediated by the antibody itself. Control antibodies did not show these effects. Thus, our results clearly demonstrate that humoral immune reactions against particular liver membrane antigens may play a role in the development of liver diseases, and provide a useful experimental approach for the investigation of their specificity.

Spontaneous and antibody-dependent cellular immune reactions to ethanol-altered hepatoma cells.

Spontaneous cell-mediated cytotoxicity (SCMC), antibody-dependent cellular cytotoxicity (ADCC) and proliferative lymphocyte stimulation in alcoholic liver disease (ALD) were investigated. Peripheral blood lymphocytes (PBL) from eight patients with advanced ALD and nine normal controls were tested against hepatoma cells (PLC/PRF/5) as targets. Target cells were grown in either normal culture medium or medium supplemented with 1 and 5% ethanol, respectively, for 24 to 48 h. Ethanol-exposed hepatoma cells exhibited profound and characteristic morphological alterations. Ethanol preincubation, however, proved to be without effect on immune reactions. Provided that hepatoma cells are an appropriate model, we assume that the proposed immune reactions in ALD are based on metabolic interactions operative only in vivo but do not parallel morphological alterations of liver cells directly induced by ethanol.

Discontinuation of immunosuppressive therapy in hepatitis B surface antigen-positive chronic hepatitis: effect on viral replication and on liver cell damage.

Immunosuppressive therapy was stopped in 12 individuals positive for hepatitis Be antigen (HBeAg) and hepatitis B surface antigen (HBsAg) and in 4 individuals positive for HBsAg but negative for HBeAg. Discontinuation of immunosuppressive therapy in HBeAg-positive patients was always associated with a bout of hepatitis and elimination of HBeAg in 8/12 patients. One patient died from liver failure and 2 patients experienced a decompensation of their liver disease indicating that this approach might be harmful if used therapeutically. A bout of hepatitis was not noted in any of the individuals negative for HBeAg when the immunosuppressive therapy was stopped, implying that this event is not potentially harmful to the patient.

[Neurocysticercosis. Diagnostic and therapeutic advances]. / Neurozystizerkose. Diagnostische und therapeutische Fortschritte.

A 42-year-old man of Croatian birth, with long-standing neurological symptoms, was found to have neurocysticercosis (a rare disease in Central Europe), as proven by positive antibody titres in serum and CSF and typical foci by computed tomography (CT). Ventriculo-cisternal drainage (after Torkildsen) controlled the acute symptoms of raised intracranial pressure. Postoperatively the CT revealed new low-density intracerebral foci, which responded to praziquantel.

Impaired cellular immune responses in chronic renal failure: evidence for a T cell defect.

Cellular immune responses in vitro were studied in 24 patients on chronic hemodialysis and 16 healthy volunteers with normal kidney function. Patients on maintenance hemodialysis had lymphopenia with diminished numbers of both T4+ and T8+ T-lymphocytes. The T4/T8 ratios were within the normal range. Peripheral blood lymphocytes (PBL) showed a diminished proliferative response upon stimulation with concanavalin A, phytohemagglutinin and pokeweed mitogen. When cell surface antigens were used for stimulation (mixed lymphocyte culture) uremic lymphocytes also showed a lower proliferation rate. Although without statistical conformation, there was a tendency by uremic PBL to produce less IL-2 as compared to healthy controls. Moreover, in a PWM driven system, peripheral blood lymphocytes from uremics produced significantly less IgG than PBL from normals. These results support the notion that a profound defect in lymphocyte function accounts at least, in part, for the observed immunodeficiency of uremic patients.

[Pancreas divisum: predisposition to chronic pancreatitis caused by chronic secretory stasis? Results of endoscopic intraductal pressure measurements]. / Pancreas divisum: Prädisposition zur chronischen Pankreatitis durch chronischen Sekretstau? Ergebnisse der endoskopischen intraduktalen Druckmessung.

In 6 patients with upper abdominal pain of unknown origin presenting with pancreas divisum, the pressure in the pancreatic duct was measured via the minor papilla into which in these patients the main part of the pancreatic duct system drains. For comparison intraductal manometry via the major papilla (papilla of Vater) was performed in 8 patients with normal pancreatic duct system. The pressure in the pancreatic duct of the control group was 10.5 +/- 0.9 (8-14) mm Hg, whereas in the patients with pancreas divisum it was 23.7 +/- 1.3 (20-28) mm Hg. The results demonstrate that in patients with pancreas divisum intraductal pressure may be largely increased even in the fasting state.

A case of Sjögren's syndrome with severe anemia due to myelitis.

An unusual case of Sjögren's syndrome presenting with severe anemia as the predominant clinical feature is described. Histological examination of a bone marrow biopsy specimen demonstrated that the patient's anemia was caused by myelitis and vasculitis of the small intraosseous vessels. Our report might stimulate a more thorough investigation of bone marrow in patients with connective tissue diseases and anemia.