Biomedical subjects
Publications and source records attributed to R Kleinman.
Communicating cavernous ectasia of the intrahepatic bile ducts (Caroli's disease) is frequently accompanied by calculus formation. Percutaneous choledocholithotomy was successfully performed using a choledochoscope in a young adult with multiple calculi. To our knowledge this is the first reported case of choledocholithotomy using this technique in Caroli's disease.
Recent studies suggest that cholesterol gallstone (GS) formation is characterized by altered gallbladder epithelial ion transport and increased gallbladder (GB) luminal Ca2+. Moreover, intracellular Ca2+ has been reported to be an important modulator of intestinal ion transport. The aim of the present study was to determine the effects of Ca2+ channel inhibition on GB ion transport. Prairie dog GBs were mounted in a Ussing chamber and bathed in warm oxygenated Ringer's solution, and short-circuit current (Isc), transepithelial potential difference (Vms), and tissue resistance (Rt) were recorded. Following stabilization, the mucosal surfaces of the GBs were exposed to 1 or 0.1 mM verapamil (VER). Effects on Isc were apparent within 10 sec with nadir values reached in 5 +/- 1 min. Profound (76%) inhibition of Isc was seen with 1 mM verapamil exposure (26 +/- 6 microA.cm-2) as compared to baseline values (170 +/- 6 microA.cm-2) (P less than 0.001). Verapamil exposure (1 mM) also led to a marked inhibition of Vms (P less than 0.001, vs baseline) and a significant increase in Rt (P less than 0.05 vs baseline). Similar trends were seen using 0.1 mM verapamil (Isc nadir 133 +/- 13 microA.cm-2). Verapamil-induced effects on gallbladder electrophysiology were largely reversible (75-90% recovery of baseline Isc after tissue washing). These data suggest that (1) verapamil induces rapid but reversible inhibition of ion transport and (2) Ca2+ channel blockade inhibits ion transport in a dose-dependent fashion. We would propose that intracellular Ca2+ may be a regulator of GB ion transport.
This report describes unusual radiologic and pathologic findings in a patient with multiple small bowel metastases from squamous cell carcinoma of the lung. The diagnostic work-up revealed a large, pleural-based, right lung mass, a large left adrenal mass, two ulcerated small bowel masses, and a unique giant peduncular mass that caused intermittent intussusception. A pertinent review of the literature is presented.
Obstructive jaundice occurred 3 years after cholecystectomy in a 49-year-old man. At surgery a large stone was discovered in the common bile duct. Pathologic examination showed that the stone had formed around an open vessel clip. Migration of an open vessel clip to the biliary system with subsequent stone formation has not been reported previously.
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The histopathological changes associated with ultrasonic heating of normal cat brain have been correlated with thermal distributions. Ultrasound energy was applied for 50 min at different intensities to generate tissue temperatures from 42 to 48 degrees C. Animals were sacrificed at various intervals from 1 to 56 days. The organization and resolution of thermal damage was characterized by three stages of histopathological changes within the nervous tissue. The acute stage (Days 1-3) was defined by (1) extensive coagulation necrosis, (2) pyknosis of neuronal elements in the gray matter, (3) edema and vacuolation in the white matter, and (4) polymorphonuclear leukocytes. The subacute stage (Days 3-21) was characterized by (1) the appearance of lipid-laden macrophages, (2) liquefaction of the necrotic regions, (3) fibroblastic proliferation, and (4) vascular proliferation with some perivascular inflammatory infiltration (lymphocytes). Lastly, the chronic stage (Days 21-56) was defined by (1) fibrosis (reticulin and collagen formation) and (2) gliosis (reactive astrocytic proliferation) occurring around the fluid-filled necrotic center. Analysis of these data has also included a study of the lesion size versus the dose (temperature for 50 min) of heating. The results demonstrate a significant linear dose-response correlation. The results of this study indicate that the histological appearance and time course of repair of thermal injury in the normal brain tissue are analogous to acute brain necrosis resulting from cerebral infarction, except the thermal damage does not result in significant hemorrhage.
Since the introduction of cyclosporine and a multidisciplinary surgical/medical approach, survival has improved in children undergoing orthotopic liver transplantation. In many areas, liver replacement is being considered a genuine treatment option for progressive liver disease. Before this procedure is routinely accepted, however, it will be important to follow long-term outcome and to compare results with those of conventional treatment when there are more patients in each disease category. In addition to continued experimentation with immunosuppressive regimens, methods for monitoring immunosuppression and detecting rejection at early stages are needed. Finally, the changes in bodily processes accompanying liver replacement should be used to learn more about the function of the liver, its role in immunity and its pathobiologic involvement by specific disorders.
Various bacterial cell-wall components were tested for their ability to inhibit Escherichia coli 2 binding to lymphocytes. The binding was inhibited by outer membrane extracts of E. coli 2 but not by similar extracts from E. coli 0. In addition, mannose-binding protein, inner membrane or lipopolysaccharide extracts of E. coli 2 or lipoteichoic acid extracts of Bacillus globigii had no effect on lymphocyte-E. coli 2 interaction. The interaction did not appear to be mediated by fimbriae, since such structures could not be detected by electron microscopy. Comparison of the outer membrane proteins of a binder (E. coli 2) and a nonbinder (E. coli 0) bacteria revealed differences in their number and position.
Age-associated changes in reactivity to bacteria were tested at several levels. At the level of bacteria binding to lymphocytes, there were no significant differences between young and old mice, however the lymphocytes from adults bound less bacteria than the other age groups. Similarly, the lymphocytes from spleens of adult mice were less efficient in killing bacteria than all the other age groups. The lymphocytes of young mice had higher and longer range reactivity than the ones from old mice. Bacterial stimulation did not produce significant levels of thymidine incorporation in any of the age groups tested.
Out of twenty-nine strains of Acinetobacter calcoaceticus (A. calcoaceticus) only eight adhered to lymphocytes. The percentage of lymphocytes labeled with bacteria varied from 5 to 70%. Most of the labeled lymphocytes had large numbers of bacteria attached to them. The variation in the percentages of lymphocytes labeled in various individuals was minimal.
Crude lipoteichoic acid extracts of Staphylococcus aureus (SA-LTA) or Bacillus glogigii (Bg-LTA) inhibited cytotoxic reactions when added at day 0 to human or murine mixed lymphocyte reactions (MLR). The inhibition was dose dependent, and at low Sa-LTA concentrations it did not require reduction of thymidine incorporation into effector lymphocytes. In the murine system, Sa-LTA was a much more potent inhibitor than Bg-LTA. LTAs of both origin also could inhibit cytotoxic reactions when bound to stimulator cells. However, the LTA derivatized stimulator cells were much more inhibitory in the human than in the murine MLR. The inhibition of human cytotoxic reaction by Sa-LTA derivatized stimulator was not associated with a significant reduction of thymidine incorporation in effector cells.
Crude lipoteichoic acid (LTA)1 extracts were prepared from Bacillus globigii (Bg-LTA). The addition of Bg-LTA to mixed lymphocyte reactions (MLR) produced a dose dependent inhibition of specific cytotoxic reactions and of tritiated thymidine (3H-TdR) incorporation. Much less Bg-LTA was needed to inhibit the initiation (addition at day 0) than the effector phase (addition at day 6) of the cytotoxic reactions. None of the LTA quantities used had a toxic effect on the lymphocytes. LTA pretreated stimulator cells also had a modulatory effect on the cytotoxic reactions. Stimulators pretreated with very low or very high LTA concentrations had no effect; however, pretreatment with intermediate concentrations induced a drastic inhibition of cytotoxicity. LTA pretreated stimulator cells did not significantly affect 3H-TdR incorporation. Suppression of the cytotoxic reaction could also be obtained by LTA-pretreatment of the effector cells.
Pretreatment of lymphocytes with selected saccharides inhibited the binding of Bacillus globigii (B. globigii) to lymphocytes but had no effect on Escherichia coli 2 (E. coli 2) adherence. The binding of both bacteria was prevented by lymphocyte pretreatment with trypsin or pronase. Periodate treatment of lymphocytes inhibited the binding of E. coli 2 but not of B. globigii. This inhibition could be reversed by borohydrate treatment of lymphocytes. Trypsin, pronase or periodate treatment of bacteria had no effect on the binding to lymphocytes. The data obtained suggest that: (a) E. coli 2 and B. globigii have different mechanisms of binding to lymphocytes; and (b) the lymphocyte receptor for E. coli 2 is of a glycoprotein nature.
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