Pseudomembranous colitis without diarrhea presenting clinically as acute intestinal pseudo-obstruction.

Pseudomembranous colitis usually presents with diarrhea in a clinical setting of recent antibiotic use. It is uncommon to see it as a cause of obstipation and colonic pseudo-obstruction. We report an unusual case of an elderly woman with hypertension, congestive heart failure, chronic obstructive pulmonary disease, chronic renal insufficiency, and diabetes mellitus, who was admitted with fever, abdominal pain, and distension without diarrhea. She presented with decreased stool frequency and obstipation. She did not respond to conservative management. Colonoscopy revealed a picture of pseudomembranous colitis, and Clostridium difficile toxin was positive. She responded well to metronidazole therapy.

House dust mite, cat, and cockroach allergen concentrations in daycare centers in Tampa, Florida.

BACKGROUND: Allergen exposure in early childhood is a risk factor for sensitization and the development of asthma. Studies performed in Europe, New Zealand, and Singapore indicated the presence of indoor allergens in childcare centers and schools. However, the importance of indoor allergens in daycare centers in humid and warm regions of the world is not known. OBJECTIVE: To measure total mite counts, Der p 1, Der f 1, Fel d 1, and Per a 1 allergens in dust samples and mite allergen airborne concentrations in daycare centers in Tampa, Florida, United States. METHODS: Twenty daycare centers were surveyed for mite, cat, and cockroach allergens in Tampa, FL. One dust and two air samples (one during the day and one during the night) were collected in each center. Dust samples were extracted and analyzed for mite (Der p 1 and Der f 1), cat (Fel d 1), and cockroach (Per a 1) allergens. Mite airborne allergen concentrations were analyzed by RAST inhibition and expressed in standardized mite allergen units per m3 of air (AU/m3). RESULTS: Mites were identified in 15 samples, and concentrations ranged from 10 to 1,200 mites/g (298 +/- 355.2). The most prevalent mite species was Dermatophagoides pteronyssinus ( Der p 1). Der p 1 and/or Der f 1 were detected in 10 daycare centers. Der p 1 was detected in eight centers and ranged from I to 21.8 microg/g of dust (5.4 +/- 6.9); Der f 1 was detected in 3 centers and ranged from 0.2 to 2.1 microg/g of dust (1.3 +/- 0.9). Per a 1 and Fel d 1 were detected in all centers in small quantities; Per a 1 ranged from 8 to 1,806 ng/g (263.1 +/- 449.7) and Fel d 1 from 0.2 to 120 U/g of dust (16.6 +/- 31.7), respectively. Airborne mite allergen was detected in 18 centers and ranged from 0.01 to 2.7 AU/m3 during the day (0.2 +/- 0.6) and from 0.01 to 0.12 AU/m3 during the night (0.06 +/- 0.03), P = 0.001. CONCLUSIONS: Mite, cat, and cockroach allergens are present in daycare centers in Tampa, FL. Mite allergen concentrations exceeded levels that have been associated with sensitization and symptoms in allergic subjects in 40% of these centers.

Serial determinations of Der p 1 and Der f 1 show predominance of one Dermatophagoides species.

One dust sample each month was collected for an average of 11 months throughout the year from the bedroom carpet of 39 mite allergic, asthmatic individuals living in the Tampa Bay area of Florida. Dust samples were collected from a square meter area from the bedroom carpet for 2 min using a portable vacuum cleaner and analyzed using two-site monoclonal antibody assays. The geometric mean of Dermatophagoides allergens Der p 1 and Der f 1 levels measured in each individual home was used in the statistical analysis of the results and reflects the average allergen level per year per home. Der p 1 levels were greater than Der f 1 in 21 homes; five homes had between 1.1 and 5 times more; one home had between 5 and 10; and 15 had between 10 and 175. Der f 1 levels were greater than Der p 1 in 18 homes; seven homes had between 1.1 and 5 times more; four had between 5 and 10; and seven homes had between 10 and 44. Spearman rank analysis of the results yielded a negative correlation coefficient (Rho) = -0.213 (p = 0.19) between Der p 1 and Der f 1 levels. These data suggest that when mite allergen levels reach a geometric mean value of approximately 2 micrograms/gram of dust throughout a year, one mite species predominates over the other.

Spetial and temporal distribution of house dust mite (Astigmata:Pyroglyphidae) allergens Der p 1 and Der f 1 in Barbadian homes.

House features contribute to house dust mite abundance and, therefore, exposure to mite allergens. Our study assessed the hypothesis that modernization of the domestic environment in a tropical setting may lead to a level of allergen from the house dust mites Dermatophagoides pteronyssinus (Trouessart) and D. farinae Hughes that previously has been defined clinically as at risk for people who suffer from allergic disease. Allergen (Der p 1 and Der f 1) levels were measured at 4 sites (mattress, bedroom floor, living room floor, and furniture) in 17 houses in Barbados during dry and rainy seasons. Der p 1(17 of 17 homes) at all 4 sites did not vary significantly from the dry to rainy season. Allergen levels varied according to site, and were highest in living room furniture in both seasons (geometric mean 40.37 and 64.17 micrograms/g, respectively). Concentration of Der p 1 allergens were higher in concrete than in wood or mixed concrete and wood houses. Der f 1(9 of 17 homes) levels were lower than Der p 1 by 1/1,000 (both seasons). Results indicate that season is less important in regard to levels of Der p 1 than house construction and confirm other studies that implicate D. pteronyssinus as a more abundant source of allergen than D. farinae in this tropical setting.

Spetial and temporal distribution of house dust mite (Astigmata: Pyroglyphidae) allergens Der p 1 and Der f 1 in Barbadian homes

Houses features contribute to house dust mite abundance and, therefore, exposure to mite allergens. Our study assessed the hypothesis that modernization of the domestic environment in a tropical setting may lead to a level of allergen from the house dust mites Dermatophagoides pteronyssinus (Trouessart) and D. farinae Hughes that previously has been defined clinically as at risk for people who suffer from allergic disease. Allergen (Der p 1 and Der f 1) levels were measured at 4 sites (mattress, bedroom floor, living room floor, and furniture) in 17 houses in Barbados during dry and rainy seasons. Der p 1 (17 of 17 homes) at all 4 sites did not vary significantly from the dry to rainy season. Allergen levels varied according to site, and were highest in living room furniture in both seasons (geometric mena 40.37 and 64.17 micrograms/g, respectively). Concentration of Der p 1 allergens were higher in concrete than in wood or mixed concrete and wood houses. Der f 1 (9 of 17 homes) levels were lower than Der p 1 by 1/1,000 (both seasons). Results indicated that season is less important in regard to levels of Der p 1 than house construction and confirm other studies that implicate D. pteronyssinus as a more abundant source of allergen than D. farinae in this tropical setting.(AU)

Mite sensitivity and exposure in the city of Santa Fe, Argentina.

Little information is available on mite allergen levels and rates of sensitization to domestic mites in South America. The purpose of this study was to establish the rate of sensitization to domestic mites in asthmatics and measure mite allergen levels in pillows and mattresses of mite allergic individuals in Santa Fe, Argentina. Dust samples were collected from the pillows and mattresses of 56 asthmatics (24 females and 32 males, mean age 17.6 +/- 11.5 years), who had been previously skin tested with standardized extracts of Dermatophagoides pteronyssinus, Dermatophagoides farinae and (1:50 w/v) extracts of Aleuroglyphus ovatus, Blomia tropicalis, Chortoglyphus arcuatus. A wheal > or = 3 mm was considered positive. Sensitization to Lepidoglyphus destructor and Euroglyphus maynei was determined by RAST and considered positive when a serum bound > or = 1% of the total counts added. Forty six individuals had a positive skin test to D. pteronyssinus, 43 to D. farinae, 27 to A. ovatus, 38 to B. tropicalis, 27 to C. arcuatus; 38 of 54 individuals had a positive RAST to E. maynei and 22 of 54 to L. destructor. The mean Group 1 (Der p 1 + Derf 1) level in pillows (n = 48) was 6.7 micrograms/g (1-55.4) and in mattresses (n = 52) 4.3 micrograms/g (1-38.8). There is a high degree of sensitization to domestic mites among asthmatics in Santa Fe. High mite allergen levels (> 2 micrograms/g) can be detected very often in pillows and mattresses.

High-sensitivity detection of minimal residual breast carcinoma using the polymerase chain reaction and primers for cytokeratin 19.

We have developed a reverse transcriptase-polymerase chain reaction (RT-PCR) assay to identify breast carcinoma cells in bone marrow aspirates with high sensitivity and specificity. This assay relies on the detection of cytokeratin 19 (K19) RNA by nested primer PCR followed by annealing to a (32P)-labeled internal sequence probe and autoradiography. In reconstitution experiments, this assay is capable of detecting 10 fg of admixed mammary tumor RNA in 1 microgram of normal marrow RNA (a dilution of 1:10(7)). Thirty of 30 primary breast tumor specimens, 19 of 19 cytologically positive bone marrow aspirate specimens, and three of 11 aspirate negative/biopsy positive specimens showed detectable K19 transcript. This assay shows high specificity, with 50 of 52 negative control aspirates showing no detectable amplification product. False-positive amplification was noted in two of 18 aspirates obtained from patients with active chronic myelogenous leukemia. Of stage II and III postsurgical breast carcinoma patients with histologically negative bone marrows and no radiographic bone disease, 14 of 30 were K19 positive by PCR. RT-PCR analysis of K19 transcript is a highly sensitive and specific method of detecting and monitoring low-level metastatic disease in patients with primary carcinoma of the breast. The presence of K19 RNA in histologically negative bone marrows suggests that this assay may prove a powerful monitor for patients undergoing curative therapy as well as a novel prognostic indicator.

Clinical significance of bone marrow metastases as detected using the polymerase chain reaction in patients with breast cancer undergoing high-dose chemotherapy and autologous bone marrow transplantation.

PURPOSE: The present study evaluates the clinical significance of detection of cytokeratin 19 (K19) in the bone marrow of patients with breast cancer undergoing high-dose chemotherapy (HDCT) and autologous bone marrow transplantation (ABMT). PATIENTS AND METHODS: We studied retrospectively cryopreserved bone marrow aspirates from 83 patients with high-risk stage II, III, and IV breast cancer obtained before bone marrow harvest but after induction chemotherapy. All samples were histologically negative for metastases. Polymerase chain reaction (PCR) for K19 was performed according to methods described previously and results were correlated with the probability of relapse following HDCT and ABMT. RESULTS: The incidence of occult metastases as defined by PCR for K19 message was 52% for 19 stage II, 57% for 14 stage III, and 82% for 50 stage IV patients (two-tailed P = .0075, chi 2 test). The probability of relapse at 3 years after ABMT was 32% and 94% for K19-positive stage II/III and stage IV patients, respectively, versus 10% and 14% for K19-negative stage II/III and stage IV patients, respectively. The difference was significant for stage IV patients (two-tailed P = .0002). CONCLUSION: It has been shown that PCR is a highly sensitive method to detect K19 message in the bone marrow. The incidence of K19 positivity in bone marrow increases significantly with advancing stage. In patients with breast cancer, especially metastatic breast cancer, undergoing HDCT and ABMT, the presence of K19 is associated with a poor prognosis.

Positive nasal challenge responses to Blomia tropicalis.

BACKGROUND: Blomia tropicalis, a dust mite commonly found in subtropical and tropical environments, is the fourth most common mite in the United States. Thirty-eight percent of 167 consecutive subjects evaluated for allergic respiratory symptoms in the Tampa Bay area had positive skin test responses to B. tropicalis. METHODS: Nasal challenges were performed in 19 subjects with allergic rhinitis; 12 had positive skin test responses to B. tropicalis (group I), and seven had negative skin test responses to B. tropicalis but positive skin test responses to Dermatophagoides pteronyssinus and D. farinae (group II). Subjects were challenged with a normal saline control solution and increasing concentrations of a 1 mg/ml in-house extract of B. tropicalis (1:125,000 vol/vol, 1:25,000 vol/vol, 1:5000 vol/vol, 1:1000 vol/vol, and 1:200 vol/vol). Inspiratory nasal airway resistance (was measured every 5 minutes for 15 minutes by posterior rhinomanometry at 50 Pa after each nasal challenge. RESULTS: Nasal challenge response was considered positive and stopped when the mean inspiratory nasal airway resistance was greater than twice the mean inspiratory nasal airway resistance after the normal saline challenge. Ten of 12 (83%) subjects in group I and none of seven (0%) subjects in group II had positive nasal challenge responses to B. tropicalis (p = 0.0024). CONCLUSION: B. tropicalis is allergenic and should be considered as a cause of allergic rhinitis when evaluating a patient who lives in an area where it is endemic.

Evaluation of hepatocellular function by way of receptor-mediated uptake of a technetium-99m-labeled asialoglycoprotein analog.

UNLABELLED: We have developed a quantitative functional imaging study of the liver using a radiolabeled asialoglycoprotein analog, Tc-galactosyl-neoglycoalbumin. Heart and liver time-activity data can be transformed by automated kinetic analysis into asialoglycoprotein hepatocyte receptor concentration. Twenty-eight healthy controls, 46 patients with noncholestatic chronic liver injury and 11 patients with primary biliary cirrhosis were studied. Liver function was also assessed by Pugh modified-Child-Turcotte criteria, 14C-aminopyrine breath test and indocyanine green clearance (24 patients). RESULTS: (a) In normal controls with a Child-Turcotte criteria score of 5, receptor concentration ranged from 0.63 to 1.19 mumol/L, with a mean 0.83 +/- 2 S.D. 0.06 mumol/L, which was significantly higher (p < 0.001) than that of the patient group (mean receptor concentration = 0.44 +/- 2 S.D. 0.04 mumol/L). In cirrhotic patients with Child-Turcotte criteria score of 5, the mean receptor concentration was 0.60 +/- 2 S.D. 0.07 mumol/L, which was significantly lower than controls (p < 0.01). In end-stage cirrhosis (Child-Turcotte criteria score 11 to 15), a group in which patients died or required orthotopic liver transplantation within 1 yr, the mean receptor concentration was 0.35 +/- 2 S.D. to 0.07 mumol/L. The sensitivity and specificity for receptor concentration in relation to liver disease, with values above 0.65 mumol/L being normal, were 0.96 and 0.88, respectively. Receptor concentration correlated well with Child-Turcotte criteria score (r = 0.78, p = < 0.001), with aminopyrine breath test (r = 0.75, p = < 0.001) and with indocyanine green clearance (r = 0.88, p = < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Sensitization to Blomia tropicalis: skin test and cross-reactivity studies.

This study evaluated the prevalence of positive percutaneous skin test results to Blomia tropicalis, Dermatophagoides pteronyssinus, and D. farinae in 167 consecutive persons (61 males, 106 females; mean age, 38.7 years; range, 14 to 75 years) with asthma or rhinitis, or both, in Tampa, Fla. Forty-nine had asthma with or without rhinitis, and 118 had rhinitis alone. RAST and RAST inhibition analysis of all three mite species were performed by using pooled patient sera. Prepared extracts of B. tropicalis and standardized D. pteronyssinus and D. farinae (1:50 wt/vol) were used for percutaneous skin tests. One hundred twelve subjects (67%) had a positive result to at least one mite species; 38%, 62%, and 60% reacted to B. tropicalis, D. pteronyssinus, and D. farinae, respectively. Positive skin test results to both D. pteronyssinus and D. farinae occurred in 96 subjects (57%); 56 of these subjects (58%) were also positive to B. tropicalis. Positive skin test results to B. tropicalis, D. pteronyssinus, or D. farinae alone occurred in four (2%), five (3%), and four (2%), respectively. RAST and RAST inhibition data indicate that B. tropicalis contains unique allergens. The high rate of skin test reactivity to B. tropicalis extracts, and its unique allergenic composition, warrants its use in the diagnosis and treatment of allergic disorders in Tampa.

Comparison of oral pulse methotrexate with placebo in the treatment of severe glucocorticosteroid-dependent asthma.

BACKGROUND: This study compared the efficacy of weekly oral administration of methotrexate and placebo in treatment of 24 subjects with chronic glucocorticosteroid-dependent asthma. METHODS: The 33-week randomized, double-blind, placebo-controlled crossover trial compared once weekly 15 mg doses of methotrexate with placebo. At the time of entry, the subjects' mean dosage of prednisone was 23.8 mg/day (range, 12.5 to 85 mg) and glucocorticosteroid therapy had been used continuously for a mean duration of 78 months (range, 5 to 360 months). RESULTS: Of the 21 subjects who completed the study, 13 tolerated lower daily prednisone doses during methotrexate treatment compared with placebo. When treated with methotrexate, subjects required 14.2% less prednisone than when treated with placebo (p = 0.0447), their subjective symptom scores improved 21.4% (p < 0.05), and mean forced expiratory volume in 1 second values tended to improve. Mean serum theophylline levels did not change significantly between the methotrexate and placebo arms of the study. Adverse effects were minimal, with nausea and headache occurring twice as often during methotrexate therapy compared with placebo. CONCLUSION: Short-term, low-dose, pulse therapy with orally administered methotrexate results in a decrease in the daily glucocorticosteroid requirement in a majority of subjects with severe asthma and is accompanied by improvement in subjective symptom scores without unacceptable side effects or deterioration of pulmonary function.

Measurement of functioning hepatocyte mass via [99mTc]galactosyl-neoglycoalbumin.

Technetium-99m-galactosyl-neoglycoalbumin (TcNGA) is a synthetic radiolabeled ligand specific for hepatic binding protein (HBP), a receptor that resides exclusively on hepatocytes. In vivo measurement of receptor concentration was obtained via kinetic analysis of liver and blood time-activity data obtained during the hepatic clearance of intravenously administered TcNGA. The purpose of this study was to assess receptor concentration as a measure of the functioning hepatocyte mass. Therefore, TcNGA and dual-injection indocyanine green maximal removal rate (ICG Rmax) studies were performed on nine patients with hepatic cirrhosis associated or not with hepatocellular carcinoma. Receptor concentration was compared with ICG Rmax, which is a validated method for the estimation of the functioning hepatocyte mass. The correlation coefficient was 0.76 (P = 0.017). It is concluded that HBP concentration ([HPB]o) as measured by functional imaging is a measure of functioning hepatocyte mass. This implies that measurement of an individual's receptor concentration by using nuclear medicine techniques provides an objective index of hepatic functional mass and supports attempts to rigorously evaluate [HBP]o for its clinical efficacy.