Solitary juvenile polyp of the stomach.
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Biomedical subjects
Publications and source records attributed to F Pallone.
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Clinical and experimental evidence indicates that ureterosigmoidostomy is associated with a high risk for the development of colonic cancer, while there is no reported evidence of increased risk in patients who undergo urinary diversion of other types. In the present study the histochemical and lectin binding characteristics of goblet cell mucin were investigated in biopsy specimens from patients who had undergone ureterosigmoidostomy and from patients who had undergone rectal bladder surgery. Specimens from transitional mucosa surrounding colonic cancers and from normal rectal mucosa were also studied. For histochemical studies the high iron diamine-Alcian blue method was used. FITC-conjugated Dolichus biflorus agglutinin (FITC-DBA) and Arachis hypogaea agglutinin (FITC-PNA) were used for the study of lectin binding characteristics. In contrast to the striking increase in numbers of sialomucin-containing goblet cells found in the patients who had undergone ureterosigmoidostomy, the mucin proved to be histochemically normal in the rectal bladder surgery group. Abnormal lectin binding patterns were observed in colorectal mucosa after urinary diversion of both types, with the abnormalities consisting of dramatic decreases in FITC-DBA labeling (compared with controls) and the appearance of substantial numbers of FITC-PNA-labeled goblet cells. These findings indicate that the pattern of mucin secretion is definitely abnormal in patients who have undergone urinary diversion. Whether this abnormality is an indicator of premalignant changes remains to be established. These data, however, confirm that endoscopic and histologic follow-up studies may be of value in assessing the risk for the development of cancer in these patients.
The serum levels of IgM-Rheumatoid Factor and of anti-F(ab')2 autoantibodies were investigated in patients with inflammatory Bowel Disease (IBD) by sensitive radioimmunoassays. Serum levels of the 2 autoantibodies were significantly increased in active IBD. In patients with Crohn's Disease raised titers of the 2 antibodies appeared to be also related to colonic involvement. There was, in Crohn's Disease, a significant association between concordantly positive results with the 2 assays and the occurrence of systemic complications. Immunocomplexes detected by the C1q-SP method were higher in sera of Crohn's Disease patients with raised IgM-RF than in the others. Data from the present investigation indicate that in active IBD and particularly in Crohn's Disease autoantibodies directed against different parts of the immunoglobulin molecule may be produced. These findings add support to the concept that an in vivo polyclonal B-cell activation may occur in these patients.
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The relationship between duodenitis and the outcome of duodenal ulcers was prospectively investigated by evaluating the frequency and extent of bulbar duodenitis before and after short-term medical treatment of the ulcer. Duodenitis appeared to be more frequent and more severe in the bulbar area close to the ulcer and was more widespread in the bulb of patients whose ulcer did not respond to treatment. After medical treatment, duodenitis improved only in the ulcer area and only in patients with complete ulcer healing. While confirming that, in some patients, duodenitis may well be an inflammatory reaction to the presence of the ulcer, data from the present study indicate that, in other patients, duodenitis, throughout the bulb, does not seem to be influenced by the outcome of the ulcer or the treatment. These findings suggest that there are subpopulations of duodenal ulcer patients who differ according to the pattern of bulbar duodenitis.
In patients with constipation the prevalence of melanosis in rectal biopsies was evaluated in an attempt to correlate its occurrence with laxative consumption and intestinal stasis. Melanosis was present in 58 percent of the patients and in none of a control group. Melanosis was present in 73.4 percent of patients consuming anthracene laxatives and in 26.6 percent of those not consuming anthracene laxatives (P less than 0.01). No correlation was found between the occurrence (and grading) of melanosis and pattern of transit through the large bowel, bowel movements, and duration of symptoms. Results of this study seem to indicate that intestinal stasis is not a cause of melanosis of the colon and rectum and confirm that melanosis may well be due only to the consumption of anthracene laxatives; melanosis coli does not appear to be a sensitive marker of impairment of motor function in the "cathartic colon."
In patients with Crohn's disease (CD) we investigated the C3 conversion of zymosan-activated serum (ZAS) and looked for the occurrence of chemotactic factor inactivation (CFI). We also studied the cell-directed inhibitory effect (CDI) of the CD patients' plasma and, in the same group, complement activation and complement-mediated deactivation. The mean value of ZAS C3 conversion in CD was no different from that of healthy controls, but in steroid-treated patients it was lower than in untreated CD. CFI occurred in 1 of the 23 CD sera tested, and CDI was observed in 6 out of the 22 patients tested. EDTA C3 conversion was present in 12 patients, and complement-mediated deactivation was associated with high values of EDTA C3 conversion. Our findings indicate that complement dysfunction and inhibitory factors of neutrophil chemotaxis are present in CD. These findings could explain the defective neutrophil migration into skin windows. Whether they are relevant to the pathogenesis of tissue injury or of infectious complications and are specific for CD, however, remains to be established.
We studied the class-specific antibody response to the cow's milk antigen beta-lactoglobulin (beta-LG) in sera from patients with ulcerative colitis and Crohn's disease. IgG and IgM to beta-LG were significantly higher in patients when compared to healthy non-atopic controls, whereas IgA values were similar, and specific IgE absent in all groups. No correlation between IgG- or IgM-containing immune complexes was found with the corresponding isotype of antibody to beta-LG; however, IgM complexes correlated with serum total IgM in ulcerative colitis. In these patients, IgG antibodies were higher in active cases, whereas IgM increased in patients without signs of disease activity. Antibody titers did not correlate with disease duration or administration of antiinflammatory drugs. This pattern of anti-beta-LG reactivity suggests that the presence of intestinal lesions may be revealed by the selective increase of some antibody isotypes to orally administered antigens. Enhanced mucosal permeability may be studied by this type of serological analysis.
We studied the expression of early activation antigens (4F2, transferrin receptor, IL-2 receptor) on peripheral lymphocytes (PBL) of patients with Crohn's Disease. We have found that the proportion of PBL expressing these antigens was significantly higher in patients than in controls. The expression of the 4F2 antigen was more pronounced than that of other activation antigens directly involved in promoting cell growth (e.g. transferrin receptor, IL-2 receptor). These results indicate that CD patients have an increased number of T cells in a very early phase of activation.
The aim of the present study was to investigate whether an imbalance of peripheral blood immunoregulatory T cells is a feature of Crohn's disease. The cluster of differentiation antigens 3,4 and 8 were investigated and the relative prevalence of PBL expressing each antigen was defined using a panel of three monoclonal antibodies (OKT3, OTK4 and OKT8). A significant decrease in the OKT3 and OKT4 positive cells was found in CD patients as compared with healthy controls. No significant difference was observed between patients and controls in the proportion of T8 positive cells and in the T4/T8 ratio. While confirming a significant decrease of circulating total resting T cells in patient with CD, the results of this study indicate that the disease is not primarily related to an imbalance of the proportion of the T cells subsets.
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Cellular samples from human gastric endoscopic biopsies were analysed in order to detect possible DNA content alterations as markers of cancerous and precancerous lesions of the digestive tract. Samples were derived from the stomach of normal donors (17 cases), and from patients clinically classified as affected by stomach adenocarcinoma (18 cases), chronic atrophic gastritis (20 cases), or other nonneoplastic lesions (17 cases). Sample processing was performed by mechanical and enzymatic treatment to obtain monodispersed cells. Staining for flow cytometric analysis was achieved with ethidium bromide and mithramycin. Samples from normal donors constantly exhibited a single cell population with diploid DNA content. All but three neoplastic specimens exhibited both a diploid and an aneuploid cell subpopulation, with the DNA index of the aneuploid peak ranging from 1.10 to 1.85 (except a single instance with a value of 3.13). The presence of a recognizable aneuploid subpopulation was also observed in 9 out of 20 chronic atrophic gastritis specimens. Such aneuploidy is similar to that observed for the adenocarcinoma, even if the fraction of aneuploid cells appears to be generally higher in the tumor than in the gastritis cases. All other cases of gastritis and of nonneoplastic disease exhibited diploid cells only. The meaning of aneuploidy in some gastritis specimens is a phenomenon not yet fully explained. Still, aneuploidy appears to be a useful marker for recognizing the presence of suspect malignant cells in gastric lesions.
Colonic epithelial mucin was investigated histochemically in biopsy specimens from a group of patients who had undergone ureterosigmoidostomy. For comparison, colonic biopsy samples from uninvolved mucosa adjacent to carcinomas from another group of patients and from a group of patients undergoing sigmoidoscopy for hemorrhoids were also studied. The high-iron diamine-alcian blue (HID-AB; pH 2.5) method was used, and the proportions of HID-positive and AB-positive cells were assessed semiquantitatively. In both ureterosigmoidostomy and cancer groups, highly significant increases in the proportions of AB-positive cells (sialomucins) were observed, particularly in the middle and lower segments of the crypts. Ureterosigmoidostomy introduces a high risk for the development of colonic carcinoma. Morphologic features that could account for such a high risk were investigated, and an abnormal pattern of colonic mucin secretion after ureterosigmoidostomy was demonstrated. Although this abnormality cannot be related specifically to ureterosigmoidostomy, data from the present investigation suggest that histochemical studies of colonic specimens from patients who have undergone ureterosigmoidostomy may provide a useful tool for follow-up studies.
Peripheral blood mononuclear cells have been investigated in 43 patients with Crohn's disease (CD) by means of a panel of 4 monoclonal antibodies (UCHT1, UCHT4, 4F2, 5E9). A decrease of total T cells (UCHT1+) (p less than 0.01) and a slight increase of cytotoxic/suppressor T cells (UCHT4+) were observed. Evidence of T-cell activation, as shown by the highly significant increase of 4F2+ and 5E9+ cells, was also found. The latter finding lends support to the concept that cell-mediated immune phenomena are an important feature in CD.
The present prospective investigation was aimed at ascertaining the true incidence of duodenitis in the presence of duodenal ulcer, and the extent of bulbar involvement. In 54 consecutive patients 3 biopsy specimens were collected from preestablished sites during endoscopy. Endoscopic findings were defined as the presence or absence of definite inflammation. Biopsy specimens were evaluated blind, and the degree of duodenitis was classified from 0 to 3 in accordance with the criteria proposed by Whitehead; grade 1 was further classified into 1a (within the range of normal mucosa) and 1b (mild duodenitis). Only grades 1b, 2 and 3 were regarded as duodenitis. Reliable histologic evaluation of all 3 biopsies was possible in only 36 out of the 54 patients. Results show that endoscopic and histologic findings are in agreement in 82% of the patients, but endoscopic judgement of inflammation was false in 17 out of 54 (35%) observations of histologically normal mucosa. Histological duodenitis is more frequent and more severe close to the ulcer than in the mid-bulbar area, and the mucosa of the mid-bulbar area appears to be significantly more affected by the inflammatory process than the apex. Duodenitis is present predominantly in the areas of the duodenal bulb in which ulcers usually develop, and therefore it might not be merely a phenomenon induced by the presence of the ulcer.
The locomotor function of polymorphonuclear cells (cellular chemotaxis) and serum chemotactic activity (humoral chemotaxis) were studied in 51 patients with Crohn's disease using a method of migration under agarose gel. To study cellular chemotaxis patient's polymorphonuclear cells were challenged against normal Zymosan activated serum and humoral chemotaxis was evaluated testing the patient's Zymosan activated serum against normal polymorphonuclear cells. Cellular chemotaxis in the Crohn's disease group was normal (although 30% of the 51 patients had migration values out of the normal range), while humoral chemotaxis was significantly lower in Crohn's disease patients than in the control group. However, the value of humoral chemotaxis in the group of Crohn's disease patients treated with steroids was lower than that of patients not treated, thus accounting for the low mean value observed inthe Crohn's disease-group as a whole. The present results suggest that a defective chemotactic response may occur in some Crohn's disease patients, particularly during steroid treatment. These findings might be related either to a defective generation of complement derived chemotactic factors or to the presence of circulating inhibitors.
Circulating immune complexes (AgAb) were studied in 183 serum samples from 119 patients with Crohn's Disease. AgAb were studied by the solid phase C1q binding test in all sera and also by the conglutinin binding assay in 161 sera. A significantly higher prevalence of circulating AgAb was observed in Crohn's disease patients in comparison with the control population. About one half of the sera were AgAb positive when the results of both tests were combined whereas AgAb were found in about one third of the sera by each individual method. Complexes revealed by the C1q-SP appeared to be related to the disease activity and to the occurrence of complications. Such a correlation was not observed as far as conglutinin results are concerned. Data emerging from the present investigation indicate that circulating AgAb may be present in Crohn's disease and suggest that the AgAb material is heterogeneous. They also suggest the possibility that AgAb represent a secondary phenomenon.
In fasting control rats there was continuous basal gastric acid secretion, with a low plasma gastrin and antral G-cells full or immunofluroescent gastrin. After subcutaneous infusion of the gastric secretagogues, pentagastrin + carbachol, there was a six-hour period of gastric hypersecretion, but no change in plasma and G-cell gastrin. Pretreatment with the antihistamine derivative, Pfizer UK-9040, decreased both basal and stimulated acid secretion, whereas plasma gastrin levels increased and the antral G-cells were emptied of gastrin. These results suggest that this antihistamine derivative decreases gastric acid secretion by a direct action on the parietal cells and not by reducing gastrin release from the G-cells. The increased release of gastrin from the G-cells may be secondary to decreased gastric acid production, or more probably by a direct stimulation of the antral G-cells.