Intestinal tuberculosis: clinicopathologic analysis and diagnosis by endoscopic biopsy

OBJECTIVES: Tuberculosis is still an important cause of granulomatous colitis in developing countries. If we can diagnose tuberculosis using endoscopic biopsy material, clinicians can avoid invasive diagnostic procedures and needless operations. For this purpose, we evaluated clinical manifestations, pathological findings, and diagnostic methods in endoscopically biopsied intestinal tuberculosis patients. METHODS: From January 1991 to December 1996, 42 patients with intestinal tuberculosis were endoscopically examined and tissue culture, immunohistochemical stain, Ziehl-Neelsen stain, and polymerase chain reaction in fresh and fixed tissue were applied. The pathological findings were analyzed and compared with the results of the other diagnostic methods. RESULTS: In tuberculosis patients, transverse ulcers with surrounding hypertrophic mucosa and multiple erosions were usual colonoscopic findings. The granulomas were found in 74% of the cases. The positivity ranged from 30-45%. There were no significant differences in the positivity among those diagnostic methods (p > 0.05). The positivity of Ziehl-Neelsen stain in fixed tissue was higher in the group having granulomas and it was reversed in PCR (p < 0.05). The increasing number of biopsy particles raised the positivity of Ziehl-Neelsen stain and PCR in fixed tissue (p < 0.05). CONCLUSIONS: Transverse ulcers were the most characteristic colonoscopic finding and granulomas were frequent pathological findings in intestinal tuberculosis. Higher positivity and reliable results were found in tissue culture, Ziehl-Neelsen stain, and polymerase chain reaction. To increase the diagnostic rate, the endoscopist should take enough tissue and deep biopsy material from ulcer bases and diseased mucosae.     

Determination of ginsenoside Rf and Rg2 from Panax ginseng using enzyme immunoassay

We have developed an enzyme immunoassay (EIA) to quantify trace amounts of ginsenoside Rf (Rf), one of the glycosides of protopanaxatriol from Panax ginseng. A carrier protein of bovine serum albumin (BSA) was coupled to the carbohydrate component of Rf using the periodate oxidation method. Antibodies were raised in rabbits using Rf-BSA conjugate as the immunogen and competitive indirect EIA was used for the determination of Rf. The working range was 0.01-10 ng per assay. The anti-Rf antiserum cross-reacted with ginsenoside Rg2 (105%), which is also a component of Panax ginseng and has a very similar chemical structure to Rf. These results suggest that the anti-Rf antiserum could also be used for the quantitation of ginsenoside Rg2 as well as ginsenoside Rf. In a comparison of EIA and HPLC the linear regression equation and correlation coefficient for the two methods were y(EIA) = 1.31x (HPLC)-11.48 and 0.98, respectively.     

Species differences in regional patterns of 3H-8-OH-DPAT and 3H-zolpidem binding in the rat and human brain

A series of brief office counseling interventions for the prevention and treatment of violence is reviewed in this article. Primary prevention strategies throughout the pediatric age span cover topics from gun storage to nonviolent handling of a potential street fight. Secondary prevention strategies deal with patients who have been injured by violence or patients who engage in street violence, weapon carrying, or dating violence.     

Effect of clozapine on motor function in schizophrenic patients

It is well established that clozapine is less likely than typical antipsychotic drugs to cause clinically discernible extrapyramidal side-effects. There is a paucity of data, however, on clozapine's motor effects. In this report we compare normal controls to groups of chronic schizophrenic patients treated with either typical antipsychotic drugs or with clozapine. Motor function was measured with a target-matching task, a test relying on submaximal sustained force control. Results indicated that patients on clozapine performed with significantly lower accuracy (greater variability) of force control. Even though the clozapine patients were treatment resistant to typical antipsychotic drugs, and many had a history of tardive dyskinesia, we postulate that the observed deficit is likely due to clozapine treatment rather than to earlier treatments or other factors. The observed force control deficit may be the result of an increase in myoclonus and a generally lower level of overall motor activity.     

The intermolecular cross-links in uterine collagens of guinea pig, pig, cow, and human beings

The intermolecular cross-links have been studied in the uterine insoluble collagen of guinea pig, pig, cow, and human beings with a single given procedure. After NaB3H4 reduction, there are three intermolecular cross-links; namely, dihydroxylysinonorleucine, hydroxylysinonorleucine, and histidinohydroxymerodesmosine. In human uterine collagen samples these reduced cross-links are present in equal amounts. The reduced intermolecular collagen cross-links of uterine leiomyoma are very similar to those of the normal uterine tissue. Dihydroxylysinonorleucine is the principal reduced cross-link in uterine collagen of guinea pig, pig, and cow. Alkaline hydrolysis reveals that dehydrodihydroxylysinonorleucine and dehydrohydroxylysinonorleucine occur in vivo as glycosylated derivatives.     

New method to measure the retention of viscoelastic agents on a rabbit corneal endothelial cell line after irrigation and aspiration

BACKGROUND/AIMS: Murine and human studies have documented the existence of subpopulations of lymphocytes in particular tissues that differ phenotypically and functionally from those in peripheral blood and may mature locally. Since little is known about lymphocyte subpopulations in the normal human liver, we have analysed the surface phenotypes of lymphocytes isolated from liver specimens taken from 15 donors at the time of liver transplantation, and compared these with those of peripheral blood lymphocytes. METHODS: Hepatic lymphocytes were prepared by mechanical dissociation and enzymatic digestion of liver tissue. The cells were stained with a panel of monoclonal antibodies (CD3, CD4, CD8, CD19, CD56, gammadeltaTCR, alphabetaTCR, CD8alpha-chain, CD8alphabeta dimer), and analysed by flow cytometry. In situ characterisation of hepatic lymphocytes was by haematoxylin and eosin staining of fixed liver sections and by immunohistochemical staining for common leukocyte antigen and CD3. RESULTS: Significant numbers of hepatic T lymphocytes were localised to the portal tracts and parenchyma of normal liver specimens. Flow cytometry revealed that the CD4/CD8 ratio (1:3.5) was consistently reversed compared with that in peripheral blood (2:1). Other lymphocyte populations identified include double positive CD3+CD4+CD8+ cells which accounted for a mean of 5.5% (range 3-11.6%) of hepatic CD3+ cells compared with 1.3% in blood (range 0.7-3.6%; p < 0.007), and double negative CD3+ CD4-8- cells (14.5%; range 2.7-29% compared with 5.0%; range 2.1-10.8%, p < 0.02). Over 15% (range 6.8-34%) of all hepatic CD3+ cells expressed a gammadeltaTCR compared to 2.7% (range 0.9-4.7%) of CD3+ peripheral blood lymphocytes (p < 0.004) and almost 50% of these coexpressed CD8. The CD8 alpha-chain was expressed without the beta-chain (CD8alpha+beta-) by 15.4% (range 4-29.1%) of hepatic T cells, but this phenotype was undetectable among peripheral blood lymphocytes (p < 0.009). Cells expressing both the T cell marker CD3 and the natural killer cell marker CD56 constituted 31.6% (range 14-54%) of all hepatic CD3+ lymphocytes but were rarely present amongst peripheral blood lymphocytes (0-6%; p < 0.0001). CONCLUSIONS: These data are the first to describe and quantify unconventional T lymphocyte subpopulations in the normal adult human liver which may have specialised functions in regional immune responses and which may differentiate locally. These findings have important implications for our understanding of hepatic immunoregulation and the pathogenic mechanisms involved in viral and immune-mediated liver disease and allograft rejection.     

Ankle arthrodesis with cross screw fixation. Good results in 36/40 cases followed 3-7 years

From May 1991 to May 1994, Lyme borreliosis was studied prospectively in 301 residents living on Asp?, a highly endemic area for the disease. The study included annual questionnaires and blood samples for serology. Immunoglobulin G (IgG) antibodies to Borrelia burgdorferi sensu lato were detected by enzyme-linked immunosorbent assay in 63/301 (21%) of the residents at the start of the study. Seropositivity rates increased with time, and 3 years later 101/301 (34%) were positive. A total of 34 individuals developed physician-verified manifestations of Lyme borreliosis during the study period. Nine individuals developed an erythema migrans, despite a previously treated Lyme borreliosis or pre-existing high levels of IgG antibodies to B. burgdorferi s.l.     

Overt behavior problems and serotonergic function in middle childhood among male and female offspring of alcoholic fathers

A large body of literature indicates that the serotonergic system is involved in behavioral regulation, as evidenced by the inverse relationship between impulsive aggression and serotonergic function found in adult alcoholics and nonalcoholics. However, studies of this relationship among child and adolescent offspring of alcoholics (COAs) have not previously been done. This study examines the potentially parallel relationship between behavioral dysregulation and low serotonergic function in young COAs. The relationship is of potential interest as a phenotypic marker of biological vulnerability to aggressiveness, which itself has been hypothesized to be a risk factor for later antisocial alcoholism. The present work is part of an ongoing prospective study of the development of risk for alcohol abuse/dependence and other problematic outcomes in a sample of families subtyped by the fathers' alcoholism classification. We examined the relationship between overt behavior problems in middle childhood (mean age = 10.5 +/- 1.7 years) and whole blood serotonin (5-HT) in a subsample of the offspring (N = 32 boys and 12 girls). Using a Child Behavior Checklist (CBCL) index of behavioral undercontrol, we obtained results indicating that high total behavior problem (TBP) children had lower levels of whole blood 5-HT than did low-TBP children (p < 0.01). These results support the hypothesis that there is an inverse relationship between whole blood serotonin levels and behavior problems in young male and female COAs. A father's alcoholism status was not significantly related to his child's 5-HT level, i.e., the child's phenotypic expression of behavioral dysregulation was more reliably connected to serotonergic function than was paternal alcoholism.     

Endoscopic application in aesthetic and reconstructive facial bone surgery

Twenty-three cases of endoscopically assisted facial bone surgery were performed over the past 3 years. Our series is consistent with 16 cases of aesthetic contouring surgery and 12 treatments of facial bone fracture, including three cases for recontouring of frontal bone, three cases for recontouring of zygoma, endoscopically assisted correction of three zygomatic and blowout fractures, four cases for rhinoplasty and septoplasty for deviated nose, and three cases for mandible contouring surgery. To accomplish this technique, a rigid 4-mm, 30-degree down-angled endoscope was used. The frontal bone or zygomatic arch was approached endoscopically through two or three small incisions on the frontal or temporoparietal scalp. All endoscopic instruments were then manipulated through these incisions. The approach for endoscopically assisted rhinoplasty is the same as with standard rhinoplasty procedures. The approach for zygoma complex and maxillary sinus needs an intraoral incision. Recontouring of zygoma, mandible, and nasal dorsum by an air-driven burr and rasp was performed with endoscopic visual assistance. A plate and screw fixation for zygomatic arch fracture requires an additional small skin incision over the plate for the trocar method. The duration of follow-up ranged from 6 months to 30 months. The postoperative course was satisfactory with a few complications. The extra time needed for the endoscopic procedures was less than 1 hour. Endoscopically assisted facial bone surgery can be performed with adequate visualization and direct manipulation of all facial bones. Complications usually associated with extensive incisions in the bicoronal approach may be avoided. Poor visualization in the conventional approach for operation of orbit, nose, maxillae, and mandible may be avoided by use of the endoscope. This technique may prove to be ideal for aesthetic surgery for facial skeleton with smaller scar and less morbidity.     

A comparison of internal eliminated sequences in the genes that encode two K(+)-channel isoforms in Paramecium tetraurelia

The Foundation for Growth Science has been controlling the use of GH by its registration system, which includes a scoring system for the eligibility for GH treatment according to the diagnostic criteria for GH deficiency (GHD) established by the Study Group for Hypothalamo-pituitary Disorder of the Ministry of Health and Welfare. Until 1995, 28,876 patients with GHD (19,432 boys and 9,444 girls) had been registered as eligible for GH treatment. The number of patients registered in a year increased gradually till 1990 due to the unlimited hGH supply by recombinant techniques and the change in the criteria for GH treatment and the number registered became stable after 1990. The frequency of GH-treated patients is calculated to be 55.2/100,000 persons (72.2/100,000 in boys and 37.1/100,000 in girls) in patients born between 1960 and 1990. The highest frequency was 148.4/100,000 persons (191.7/ 100,000 boys and 103.7/100,000 girls) in 1981, when 2,278 patients (1,508 boys and 770 girls) were born. Eligibility for GH treatment is assessed according to the scoring system which is basically dependent on peak GH values in provocation tests so that standardization of GH values measured with the various commercial GH kits is required to avoid inequality of patients' access to the treatment. In samples obtained by GRF test in 10 normal volunteers, hGH was measured with seven human GH (hGH) kits at a laboratory center. Since the RIA value has been used historically for the diagnosis of GHD, the mean of two RIA measurements was selected as the basis for the standardization procedure and the linear regression formula was used for each hGH kit. After the freely available supply of hGH obtained by recombinant DNA techniques, the role of the Foundation for Growth Science has changed to avoid hGH abuse. Even with this regulation, the frequency of registered patients may indicate a tendency to GH overuse.