Biomedical subjects
Publications and source records attributed to Z Steiner.
Combined penetrating trauma of the rectum and urinary bladder is rare, and constitutes a diagnostic and therapeutic challenge. Most of the literature discusses trauma to either urinary bladder or rectum alone. The combination of penetrating trauma to both rectum and the urinary system is associated with high morbidity and mortality. There is controversy regarding the preferred approach to this type of combined trauma.
Primary pancreatic hydatid disease is rare. The diagnosis may be difficult when the presentation is that of an unexplained epigastric mass, despite suggestive radiological and ultrasonic features. We describe a 12-year-old girl in whom the definitive diagnosis was only made at repeat operation, when appropriate surgical therapy was effected.
A 10-year-old girl had hemobilia and a biliocutaneous fistula after blunt abdominal trauma. Embolization of the right hepatic artery occluded the hepatic artery aneurysm, but the cutaneous biliary fistula persisted despite prolonged (8 months) conservative management including sphincter decompression with an endoscopically placed biliary stent. Roux-en-Y fistuloenterostomy eventually cured the bile leak.
This article presents a new manual daily worksheet for recording data on a patient's status in an Intensive Care Unit. It permits a rapid view of the whole picture of the patient's condition at a certain hour since the system of recording is based on the time an event happened. Only one single page is used for each day. Space is provided for essential data, ventilatory parameters, laboratory results, fluid balance, drug therapy and special treatments. Attended staff, invited consultants as well as nurses add written notes which complete the picture provided by numbers. It does not replace the computerized interpretation, statistical analysis or storage of data, but it comes as an easy-to-use daily tool at the bedside.
Twenty-five patients who had undergone splenectomy were investigated. Splenectomy was performed in 16 patients because of traumatic rupture of the spleen, in 6 due to idiopathic thrombocytopenic purpura (ITP) and in 3 because of other causes. The absolute numbers of T-cell subclasses--helper/inducer (CD4+) and suppressor/cytotoxic (CD8+)--and of B-cells were determined in peripheral blood. The CD4+/CD8+ was decreased in 7 patients and inverted in 10. The change in the ratio was not due to a decreased number of CD4+ cells but to an increase of CD8+ cells. Sex, age, and the time at which splenectomy was performed bore no relation to the CD4+/CD8+ ratio. In 13 of the 25 patients a significant increase in the number of polyclonal B-cells was found. None of the patients had severe infections. These observations suggest that splenectomy is responsible for the change in the CD4+/CD8+ ratio. Susceptibility to infections seems to correlate with the absolute decrease of CD4+ cells rather than with the change of the ratio.
Diminished immune responses in aging may be partially due to alteration of the lipid composition of membrane and a decrease in membrane fluidity. The effect of a daily diet of 10 g active lipid (AL 721) on the mitogen responsiveness of peripheral blood mononuclear cells (PBMC) from aged volunteers was studied. AL 721 is a mixture of lipids from hen egg yolk which was formulated for in vivo rectification of rigidified cell membranes in an attempt to restore proper physiological function. After 3 weeks on the diet, six aged participants displayed a significant increase in lymphocyte responsiveness to mitogens, while in four the responsiveness was unaffected, or increased insignificantly. In all six participants, a decline in lymphocyte responsiveness was observed a week after termination of the diet. Our preliminary results indicate that improvement of immune functions in the aged may be achieved by dietary manipulation of lipids. This innocuous approach seems to be of potential value and merits further studies.
Lymphocytes separated from surgically resected tumor tissue, uninvolved lung tissue, and peripheral blood of lung cancer patients were investigated for cytotoxic potential and analyzed for their phenotypes at the time of surgery and after having been propagated for 4 to 5 wk in the presence of interleukin-2. Most of the tumor lymphocyte infiltrates examined were shown to have a shift in favor of T8 subsets from those found in peripheral blood. No natural killer activity and low cytotoxicity against the autologous tumor were found to characterize the tumor-derived lymphocyte population. Propagation of lymphocytes from the different tissues of the cancer patient in the presence of interleukin-2 preparation induced widespread lytic activity against K562 cells, autologous and allogeneic tumors, but not autologous normal lung or lymphoblasts. However, cytotoxic activity against autologous tumor cells exerted by cultured tumor-infiltrating lymphocytes was found to be significantly higher than the activity of cultured lymphocytes isolated from peripheral blood or uninvolved lung tissue of the same patient. The elevated lytic activity of cells derived from the tumor tissue indicates the accumulation at the tumor site of precursors of natural killer-like cells and specifically stimulated antitumor effectors. Our results suggest the coexistence of two types of anti-autotumor cytotoxic lymphocytes at the tumor site: natural killer-like and specific cytotoxic T-cells.
Lymphocytes, derived from surgically resected lung carcinoid tissue, were stimulated in mixed culture with irradiated autologous tumor cells (MLTC). The autologous MLTC-stimulated lymphocytes were found to have killing activity against both autologous tumor cells and NK-sensitive target cells. The lymphoblasts generated during MLTC were isolated and cloned under limiting dilution conditions in the presence of interleukin 2. The cloned cell lines were analyzed for cell phenotype and tested for cytotoxic activity. Three cloned cell lines, out of 19 tested, were found to be cytotoxic either against NK-sensitive target cells (natural killers) or the autologous tumor cells. Two clones, having OKT8 phenotype, caused no lysis of the autologous tumor cells, though both exerted NK-like activity against K562 cells. Only one clone with OKT4 phenotype showed specific cytotoxic activity against the autologous tumor, but no NK-like activity against a panel of tumor target cells. These results suggest the coexistence of two types of antitumor cytotoxic lymphocytes at the tumor site: precursors of NK-like cells and specific cytotoxic T cells. Target cell specificity provided a means of distinguishing between the two types.
A 17-year-old girl with refractory, but nonmalignant, hypertension and hypokalemia is presented. A state of primary hyperreninism and secondary hyperaldosteronism was found to exist, together with a renin-producing Sertoli cell ovarian tumor. Upon removal of the tumor, this patient attained both a normotensive and a normokalemic state. A brief review is given of renal and nonrenal renin-producing tumors.
The entity of postoperative acute cholecystitis has striking features that demand special attention. The process may follow intra- and extra-abdominal procedures, and the diagnosis may be especially difficult after recent abdominal operations. The course of the disease is frequently obscure and fulminant, progressing rapidly to gangrene and perforation of the gallbladder, with a high mortality rate. Six such patients, aged 69 to 83 years, were managed in our department, with one death. The cause of this complication is probably multifactorial and includes: stasis of bile of high viscosity induced by dehydration, hypovolemia, fever, and shock; obstruction at the sphincter of Oddi following starvation, anesthesia, narcotics or other possible factors such as pigment load following blood transfusion; and impaired circulation to the gallbladder secondary to sympathetic stimulation or blood-borne toxic factors induced by septicemia. The key to successful treatment is awareness, early diagnosis, intensive preoperative treatment with fluids and antibiotics, and percutaneous drainage or immediate cholecystectomy.
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Kaposi's sarcoma (KS) and angioimmunoblastic lymphadenopathy (AILD) are exceptionally rare neoplastic diseases, although the former has recently been more frequently reported among certain populations, and is lately a topic for extensive medical and investigational interest. This case is unique in that it describes an association between KS and AILD. Such an association raises the question of a common pathogenic mechanism. The authors believe that predisposition to each of both diseases may be related to acquired immune deficiency which in turn may be induced by specific viral infections.
Over a 14-year period, 26 patients with adrenal insufficiency of multiple etiology were evaluated. Eight were diagnosed at autopsy, six of whom had acute bilateral adrenal hemorrhage. Nine had chronic adrenal insufficiency. Of these, five were idiopathic and three had polyglandular disorders. Four others had tuberculosis. Six of nine patients with chronic adrenal insufficiency were hyperpigmented. Unusual manifestations of adrenal hypocorticism included hypercalcemia, flaccid paralysis, and joint contractures. The presence of multiple hormonal deficiencies focused the diagnosis on hypopituitarism. Two cases of isolated ACTH deficiency were detected. Patients with familial Mediterranean fever with amyloidosis commonly presented with reduced adrenal reserve rather than overt insufficiency. Metastatic cancer of the adrenal glands was a rare cause of reduced adrenal reserve.
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The effect of ageing on cellular immunity in humans was investigated. Human T cell cytotoxicity (CMC) measured by an in vitro xenogeneic assay was found previously to be depressed in individuals greater than 60 years old (group 2) compared to individuals less than 50 years old (group 1). Removal of plastic-adherent cells prior to sensitization in the xenogeneic CMC assay of human peripheral blood mononuclear cells (HPBM) resulted in a significantly higher rise (P less than 0.001, Wilcoxon rank test) in CMC activity in group 1 compared to group 2. Replacement of plastic-adherent cells (greater than 35% monocytes) to HPBM depleted of monocytes returned the CMC activity to the level observed with unseparated HPBM. Separation of HPBM on Percoll density gradients into monocyte-enriched (less than 75%) and monocyte-depleted (less than 3%) fractions indicated that monocytes were responsible for suppressing CMC in group 1. These results are consistent with the hypothesis that monocyte suppressor function for CMC response declines in ageing humans. When indomethacin (1 microgram/ml) was added to HPBM the Con A- and PHA-induced DNA synthetic response rose in groups 1 and 2. Indomethacin induced a significantly larger (P less than 0.01) rise in suboptimal PHA mitogenesis in group 1 compared to group 2. Individuals whose CMC response rose following adherent cell depletion were examined for the effect of indomethacin on the CMC response of their HPBM. In nine of 13 cases, addition of indomethacin also resulted in increased CMC activity.
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Hyperparathyroidism during pregnancy is rare and very few cases have undergone parathyroidectomy during the course of gestation. In reviewing the literature it is apparent that surgery during the second trimester should be the treatment of choice. The complication rate of untreated cases may reach 80% and include spontaneous abortion, fetal death and neonatal tetany. The paper is illustrated with appropriate cases.