Conservative management of esophageal leaks by transluminal endoscopic drainage of the mediastinum or pleural space.

BACKGROUND: The management of postoperative leaks into the mediastinum or pleural cavities after esophageal surgery yields unsatisfactory results. A recently described method, drainage of the mediastinum or pleural cavity through suture line defects, has been used in our department with eight patients. METHODS: A suction tube was advanced over an endoscopically placed guide wire into the abscess from inside the esophagus, and gentle aspiration was used to remove saliva and secretions. Intravenous antibiotics and total parenteral nutrition were also given. RESULTS: The sepsis was rapidly controlled, and the abscess cavity progressively collapsed in all cases. Seven patients recovered and were discharged 34 to 61 days after operation; one died of concomitant complications. CONCLUSIONS: This method seems promising for the management of intrathoracic esophageal leaks.

Therapeutic embolization of bronchial artery: a successful treatment in 209 cases of relapse hemoptysis.

Still today bronchial artery embolization (BAE) is an important procedure in the management of hemoptysis, as an alternative to, or in association with, surgical or medical therapy. From 1974 to 1990, BAE was performed in 209 patients who suffered from hemoptysis with different etiopathogeneses and severity. Bronchiectasis were the most frequent indication (46%) followed by tuberculosis (31%), cystic fibrosis (16%), lung cancer (4%), and aspergillosis (3%). BAEs were performed by means of polyvinyl alcohol particles and absorbable gelatin sponge. In a few cases complete occlusion of the main truncus of particularly large bronchial arteries was obtained by use of Gianturco steel coin (5 mm o) technique. In the last seven years, together with the traditional angiographic techniques, selective digital angiography (SDA) was performed, above all in preliminary control phases, to evaluate occlusion during embolization. SDA reduced catheterization time and the mean quantity of contrast administered, decreasing side effects; 98% of hemoptysis was controlled in the first twenty-four hours, the other 2% in the following forty eight hours; 16% relapses occurred within the first year; 27 patients needed reembolization (15 patients twice, 11 patients three times, 1 patient five times). No complications were seen. If diagnosis, therapeutic indications, operative technique, and equipment selection are adequate, BAE has a high reliability in patients affected by relapsing hemoptysis, which is difficult to resolve.

Binding of the novel ligand [4,5-3H-Leu10]substance P to high-affinity NK-1 receptors on guinea pig lung membranes: modulation by GTP analogs and sulfhydryl modifying agents.

A novel ligand, [4,5-3H-Leu10]substance P ([3H]SP), with high specific activity (137 Ci/mmole) was utilized to investigate the properties of NK (neurokinin)-1 receptors on guinea pig lung membranes (GPLM) and compared them to NK-1 receptors on rat submaxillary glands (RSGM). In the presence of a neutral endopeptidase inhibitor, thiorphan (100 microM), [3H]SP bound with high specificity (greater than 95%), rapidly (k1 = 0.116 nM-1 x min-1) and in a reversible (k-1 = 0.012 min-1) manner to a single class of high-affinity (Kd = 0.16 nM) and saturable (Bmax = 256 fmol/mg protein) receptors. High specific binding with higher density (5-fold) was also detected in RSGM, albeit with a lower affinity (Kd = 1.36 nM). Guanyl-5'-yl-imidodiphosphate and guanosine-5'-O-3-thiotriphosphate inhibited binding to GPLM (and RSGM) in a concentration-related manner. In GPLM, this effect was mediated by a reduction in affinity, mainly via enhancement of ligand dissociation rates and appearance of a lower affinity state (Kd = 3.4 nM). Preincubation of GPLM with sulfhydryl modifying agents (p-chloromercuriphenyl sulfonic acid and N-ethylmaleimide) reduced receptor density and affinity in a time- and concentration-dependent manner. Competition experiments with tachykinins and analogs illustrated a rank order of potency of: SP greater than or equal to [Sar9,Met(O2)11]SP greater than SP-methyl ester greater than or equal to physalaemin greater than SP(6-11) much greater than kassinin greater than neurokinin A = eledoisin much greater than neurokinin B greater than Nle10-NKA(4-10), clearly demonstrating that these receptors are of NK-1 type. Moreover, analysis of over 30 peptide and non-peptide hormones and antagonists demonstrated exquisite selectivity (greater than 10,000-fold) towards NK-1-selective agonists (vs. other ligands. A highly significant (P less than .005) linear correlation (r = 0.924) exists between agonist affinities in GPLM and RSGM. Combined, the data suggest that [3H]SP labels a nearly homogeneous population of high-affinity, G-protein coupled NK-1 receptors on GPLM and RSGM, with very high degree of selectivity.

Kinetic and pharmacologic analysis of [3H]leukotriene E4 binding to receptors on guinea pig lung membranes: evidence for selective binding to a subset of leukotriene D4 receptors.

The specific binding of [3H]leukotriene (LT) E4 to receptors on guinea pig lung parenchymal membranes was investigated and compared to that of [3H]LTD4. [3H]LTE4 bound slower than [3H] LTD4 (k1: 0.07 +/- 0.02 nM-1.min-1 vs. 0.13 +/- 0.01 nM-1.min-1, respectively) reaching equilibrium at lower binding levels (3-fold) than [3H]LTD4. Unlike [3H]LTD4, receptor-bound [3H]LTE4 could be rapidly (k-1 = 0.22 +/- 0.04 min-1) and fully dissociated by excess of both agonists (LTD4 and LTE4) and selective LTD4/LTE4 antagonist ICI 198,615. Equilibrium saturation analysis (paired) of specific [3H]LTE4 and [3H]LTD4 binding confirmed that [3H]LTE4 possesses lower affinity (kd values: 1.17 +/- 0.14 and 0.38 +/- 0.06 nM, respectively, n = 6, P less than .01) and lower density (maximum binding values: 524 +/- 46 and 988 +/- 66 fmol/mg, n = 6, P less than .01) binding sites. Binding of [3H]LTE4 was 3 to 4-fold more sensitive to inhibition by GTP analogs than has been demonstrated previously on [3H]LTD4. Drug competition assays illustrate that inhibition of [3H]LTE4 binding by agonists displays similar selectivity of (LTD4 greater than LTE4 much greater than LTC4) and stereoselectivity (5S,6R-LTD4 much greater than R,R greater than R,S greater than S,S) to the observed inhibition of [3H]LTD4, suggesting that [3H]LTE4 binds to LTD4 receptors. Selective LTD4 antagonists inhibited [3H]LTE4 binding with a relative potency [compound 1 (ICI 198,615 analog) greater than ICI 198,615 = ICI 204,219 greater than LTD4 greater than LTE4 much greater than FPL55712 = LY171,883] comparable to that obtained against [3H]LTD4.(ABSTRACT TRUNCATED AT 250 WORDS)

Guanyl-5'-yl-lmidodiphosphate regulation of ligand binding to LTD4 receptors on guinea pig lung membranes.

We investigated the mechanism of guanyl-5'-yl-imidodiphosphate (GppNHp) regulation of peptidoleukotrienes (LTs) and LT-antagonists binding to LTD4 receptors on guinea pig lung membranes (GPLMs). In saturation experiments, [3H]LTD4 saturable (maximum binding = 943 +/- 39 fmol/mg of protein) binding to GPLM was significantly (P less than .01) inhibited by GppNHp (60 nM, maximum binding = 446 +/- 113 fmol/mg of protein) in a concentration-dependent manner. No significant change in the affinity (Kd = 0.29 +/- 0.02 nM vs. 0.43 +/- 0.12 nM for control and treated GPLM, respectively) for [3H]LTD4 was observed. The binding affinity for the selective LTD4 antagonist ICI 198,615 (Ki = 0.13 +/- 0.04 nM) as determined by competition against [3H]LTD4, was not changed by GppNHp. Saturation analysis of [3H]ICI 198,615 binding confirmed that GppNHp did not change the apparent affinity or site-density for this ligand. In competition experiments against [3H]-ICI 198,615, GppNHp (1 microM) caused a significant (P less than .01) rightward shift of the inhibition by agonists (94-, 50- and 8-fold shifts for LTD4, LTE4 and YM-17690, respectively). In contrast, inhibition of [3H]ICI 198,615 by four LTD4 antagonists (ICI 198,615, 4-[5-cyclopentylcarbonylamino-1-[3-cyanobenzyl] indol-3-yl-methyl]3-methoxybenzoic acid, 4-[5-cyclopentylcarbonylamino-3-chloroindol-1-y-methyl]3-met hoxybenzoic acid and FPL55712) was not affected by GppNHp. Taken together the data suggest that LTD4 receptors are coupled to a G-protein that modulates the affinity of agonists but not antagonists binding.

Adenylate cyclase and cyclic AMP phosphodiesterase in Bradyrhizobium japonicum bacteroids.

Adenylate cyclase and cyclic AMP (cAMP) phosphodiesterase have been identified and partially characterized in bacteroids of Bradyrhizobium japonicum 3I1b-143. Adenylate cyclase activity was found in the bacteroid membrane fraction, whereas cAMP phosphodiesterase activity was located in both the membrane and the cytosol. In contrast to other microorganisms, B. japonicum adenylate cyclase remained firmly bound to the membrane during treatment with detergents. Adenylate cyclase was activated four- to fivefold by 0.01% sodium dodecyl sulfate (SDS), whereas other detergents gave only slight activation. SDS had no effect on the membrane-bound cAMP phosphodiesterase but strongly inhibited the soluble enzyme, indicating that the two enzymes are different. All three enzymes were characterized by their kinetic constants, pH optima, and divalent metal ion requirements. With increasing nodule age, adenylate cyclase activity increased, the membrane-bound cAMP phosphodiesterase decreased, and the soluble cAMP phosphodiesterase remained largely unchanged. These results suggest that cAMP plays a role in symbiosis.

[Ovarian lymphoma. Findings with ultrasonography, computerized tomography and magnetic resonance]. / Linfoma ovarico. Aspetti con ecografia, Tomografia Computerizzata e Risonananza Magnetica.

PURPOSE: Lymphomatous ovarian involvement is an uncommon event, both for primary and systemic lymphoma. It presents different diagnostic and therapeutic implications from the more common ovarian epithelial cancer. We investigated the role of imaging techniques in the diagnosis of these lesions. MATERIAL AND METHODS: Eight patients, aged 13 to 70 years (mean: 47) were selected from all the CT examinations performed from 1986 to 1996 to assess the most typical imaging patterns. All the patients underwent a CT examination, with contiguous 8 or 10 mm thick slices and thin (4-5 mm) detailing slices; iodinated contrast agents were administered in 6 cases. Six patients were also examined with sonography (US). Lastly, 3 patients underwent a MR examination, 2 of them with paramagnetic contrast agent. RESULTS: All the patients were affected with non-Hodgkin lymphoma (6 diffuse lymphomas--1 lymphoplasmocytoid, 2 Burkitt, 1 large cells, 1 large and oat cells, 1 immunoblastic large cells, 2 follicular large cells lymphomas). Two patients had primary lesions and the other 6 had a systemic lymphoma; ovarian involvement was bilateral in 6 cases. The lesion size always exceeded 5 cm. Ascitis was present in only one case. The US patterns of the lesions were aspecific, homogeneous and hypoechoic; color Doppler US showed mild vascularization. CT showed clear-cut lesions, hypodense and with mild contrast enhancement in all cases. Spin-echo MRI showed homogeneous masses which were moderately hypointense on T1-weighted images and slightly hyperintense on T2-weighted images. Gd-T1-weighted images showed mild enhancement. DISCUSSION: The differential diagnosis of ovarian primary lymphoma is usually made with ovarian epithelial neoplasms, which normally have a complex structure with cystic or necrotic areas and solid components usually enhancing after contrast agent administration. Also sarcomas and, in children, neuroblastomas usually have an inhomogeneous structure. In ovarian involvement with systemic lymphoma the concrurrent finding of adenopathy can help the diagnosis. CONCLUSIONS: Despite the absence of typical imaging patterns, we emphasize the importance of considering ovarian lymphoma in the differential diagnosis of ovarian cancers, especially if bilateral and homogeneous, without ascitis. These findings, uncommon in ovarian epithelial tumors, can help to make the correct diagnosis.

Correlation between ultrastructural and histochemical parameters in lymphokine-activated killer (LAK) cells reacting with target cells in vitro.

Ultrastructural and fluorescence data allowed us to study the most important moments of the interaction between lymphokine-activated killer (LAK) cells against target cells (Chang) in vitro. The LAK cells, maintained at low doses of recombinant interleukin-2, were able to recognize, bind and destroy the tumoral cells. Before the attack, the LAK cells were characterized by a cytoplasm with a high ribosomes content; after the identification and the interaction cell-cell, a degeneration of the tumoral cell was observed. These observations allowed us to suppose that the interaction between the two types of cells may be mediated by a receptoral membrane system without the action of lytic enzymes.