The liver transport of polymeric IgA (pIgA) from plasma into bile and the immunohistochemical distribution of secretory component (SC) in the liver were studied in dogs, and compared to those in humans, rats, and rabbits. Results were as follows: (i) according to bile and serum protein concentrations and specific activities, plasma pIgA in dogs, like in humans, is transported into bile approximately 10 times more efficiently than albumin, as compared to 320 and 1060 times in rabbits and rats, respectively. (ii) Only approximately 1% of an i.v. dose of [125I]pIgA is transported into bile over 8 hr in dogs, like in humans, as compared to approximately 50% over 3 hr in rats and rabbits. These results agree with much smaller daily fractional catabolic rates of intravascular pIgA in dogs (0.28) and humans (0.48) than in rats (24.0). (iii) Total bile IgA contributes daily about 1.5 mg per kg to intestinal pIgA in dogs, a figure similar in humans (0.8 mg per kg) but much smaller than in rats (38 mg per kg) and rabbits (35 mg per kg). (iv) Biliary obstruction in dogs, like in humans, results only in minor and late increases in serum pIgA levels, contrasting with greater than 8-fold increases within 24 hr in rats and rabbits. (v) Unlike in rats and rabbits, SC in dog liver as well as in human liver cannot be detected in hepatocytes although clearly present in bile duct cells. To conclude: (i) major species differences in plasma-to-bile transport of pIgA exist, most probably related to species differences in the ability of hepatocytes to synthetize SC.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

Anal lesions in hematologic diseases.

Of 514 patients hospitalized for miscellaneous hematologic diseases, 31 had severe anal lesions (5 per cent); these complications were most commonly observed in agranulocytosis, acute myeloid leukemia, and medullar aplasia. They included infiltration of the perianal area, ulceration, and abscesses. In 20 per cent of the 31 patients, the anal lesion was the first manifestation of the hematologic disease. In all instances, the prognosis of the condition was closely related to the type and severity of the underlying hematologic disease. Surgical therapy, which was applied to the majority of the abscesses, was followed in all instances by rapid symptomatic improvement and was never associated with local or general complications.

Abscess↗

PubMedDate not supplied

Dynamic CT in pancreatic lymphoma.

We retrospectively reviewed the dynamic CT examinations of eight patients with pancreatic lymphoma. Four tumors were rounded masses with well-defined contours, four were more infiltrating lesions. The median cross-sectional diameter of the tumors was 6 cm (range 2.5-12 cm). At dynamic CT, the tumors were hypodense (n = 8) and somewhat heterogeneous (n = 6). Additional features were enlarged lymph nodes, 1-3 cm in diameter (n = 5), dilatation of the biliary tract and pancreatic duct (n = 5), abnormalities in the fat around the celiac trunk and/or the superior mesenteric artery (n = 4), and venous stenosis or occlusion (n = 7). The CT findings of pancreatic lymphoma are more various than has been previously reported. Findings such as small tumor size, well-defined contours, tumor heterogeneity, pancreatic duct dilatation, and venous invasion may be seen. Pancreatic lymphoma cannot be reliably distinguished from pancreatic carcinoma by CT findings alone.

Adipose Tissue↗

PubMedDate not supplied

Anti-cholera toxin IgA-, IgG- and IgM-secreting cells in various rat lymphoid tissues after repeated intestinal or parenteral immunizations.

Single antibody-secreting spot-forming cells (SFC) of the 3 main isotypes were counted in lymphoid cells from the gut lamina propria (LP), Peyer's patches (PP), mesenteric nodes (MN) and spleen (SP) of rats immunized 2-6 times intraduodenally (ID) or intraperitoneally (IP) with cholera toxin (CT). Responses for all isotypes peaked in all tissues after 4 ID- or IP-immunizations at much larger values than previously reported, and significantly decreased thereafter, except in LP and PP after IP-injections, where IgA- or IgG-SFC, but not IgM-SFC, only appeared or increased after 6 IP-doses. The highest IgA-SFC numbers (17% of tested cells) were in LP after 4 ID-doses. The isotype ratio was IgA greater than IgG greater than IgM in LP and PP after ID-injections, but IgG greater than IgA greater than IgM in MN and SP after both ID- and IP-routes. The isotype dispersion was much larger in LP and PP than in MN and SP. Our data show that at least 4 IP CT-doses were required to only elicit a few IgG- and almost no IgA-SFC in LP and PP, outlining the need for intestinal CT-immunizations to induce strong mucosal IgA-SFC responses. We also show good systemic responses elicited both by enteral and parenteral routes, and the small contribution of PP in total SFC, particularly after parenteral immunizations.

Animals↗

PubMedDate not supplied

[Surgery in chronic pancreatitis. A survey of a homogenous series of forty cases (author's transl)].

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Adult↗

PubMedDate not supplied

[Current advances in the physiopathology of primary motility disorders of the esophagus].

The authors review the recent literature about the classification of primary motor disorders of the oesophagus: achalasia, diffuse oesophageal spasm, nutcracker oesophagus, hypertensive lower oesophageal sphincter and non-specific intermediary disorders. In fact these motility disorders belong to a spectrum of diseases closely related, with chronological transformation of a specific disorder to another one or to intermediary disorders. Most of the recent pathophysiological research concerned primary achalasia, secondary achalasia syndromes being a kind of experimental model. These studies point to a morphological or functional deficiency of postganglionic nerves inhibiting the lower oesophageal sphincter (LOS) through noncholinergic nonadrenergic neurotransmitters. Recent advances in the treatment of achalasia and other motility disorders are not yet based on these findings. Although calcium channel blockers, like nifedipine, lower LOS basal pressure, they are not very useful on long term relief of symptoms of achalasia. Pneumatic dilatations or cardiomyotomy still remain the best methods of treatment of this disease.

Esophageal Achalasia↗

PubMedDate not supplied

A practical endoscopic procedure for jejunal intubation in presence of gastroparesia or (pseudo)-obstruction.

Patients with gastroparesia or intestinal pseudo-obstruction frequently have a motility disorder of the antro-pyloric region that makes the passage of tubes through the pylorus impossible or a very long procedure. We describe a rapid endoscopic method, inspired by the one used for nasobiliary drainage, that simplifies this procedure. In our manometric studies, we observed that spontaneous positioning needed a mean of 57 min (SD 34) in nondyspeptic subjects and a mean of 147 min (SD 68) in non-organic highly dyspeptic patients. Our method allowed us to shorten to a mean of 22 min (SD 5) the time needed to position the manometric tube and to start the recording of gastro-intestinal contractions in highly dyspeptic patients.

Endoscopy, Gastrointestinal↗

PubMedDate not supplied

[Ambulatory esophageal pH monitoring: critical review of methodology: (equipment, reproducibility, standards), clinical importance and personal experience].

The authors review the recent literature about the methodology of oesophageal pH monitoring, which has a high sensitivity and a high specificity for assessing gastro-oesophageal reflux. Combined electrodes offer most advantages. Ambulatory recording should be done in hospital under standard conditions (meals), particularly for clinical studies. The best clinical indication is to detect pathological reflux in case of atypical symptoms with negative oesophagoscopy. The authors give their normal values in a series of measurements with two systems as well as their results in a series of cases of oesophagitis of various grades.

Esophagitis↗

PubMedDate not supplied

Omeprazole in the treatment of patients with severe reflux oesophagitis not responding to H2-receptor antagonists and ineligible for surgery.

In 42 patients (25 men, 17 women, mean age 62 years) with severe erosive or ulcerative oesophagitis not responding to H2-receptor antagonist treatment over at least 3 months and ineligible for surgery, omeprazole was administered at an initial dose of 40 mg/day, subsequently reduced to 20 mg after healing of the lesions. Patients had monthly clinical, endoscopic, histological and laboratory assessment over the healing period, then were reevaluated 3-monthly over one year, then 6-monthly, during the maintenance treatment. Stages of oesophagitis were based on the Savary-Miller classification, modified for stage I (erosions must be present). With 40 mg omeprazole, healing was observed in 71%, 83% and 90% of the patients after 1, 2 and 3 months of treatment, respectively. After one month of treatment, a complete healing was less frequently observed in patients with stage IV oesophagitis pre-trial (55%) than in the patients with stages I, II and III pre-trial (90%) (p less than 0.05). Ninety per cent of the patients healed at one month were asymptomatic whereas 50% of the patients with incomplete healing still had symptoms, most often dysphagia, rarely heartburn. Maintenance treatment with 20 mg was sufficient in most patients, with a probability of remaining healed of 69% from 9 to 24 months after starting this dosage. In 9 patients with Barrett's oesophagus, the lengths of the circumferential metaplasia were found to be reduced after one year of treatment compared to pre-trial lengths (p less than 0.005). There was no further significant reduction of length after 2 years of treatment. Fasting gastrin was increased in most of the patients, although great inter-patient variability was observed; 50% of the patients had levels not exceeding 5 times the upper limit of normal. There was no consistent increase of enterochromaffin-like cell density in 29 patients investigated up to nearly 2 years of omeprazole administration. The treatment was well tolerated. By inducing a profound and sustained inhibition of acid secretion, as confirmed by pH monitoring, omeprazole promotes healing of the lesions of severe oesophagitis and prevents recurrence of lesions and symptoms. Omeprazole is therefore a valuable treatment for patients ineligible for surgery, particularly in the elderly.

Adolescent↗

PubMedDate not supplied

[Digestive system manifestations in Steinert's disease. Analysis of 19 cases of which 10 with digestive symptoms].

We studied digestive manifestations occurring during follow-up of 19 cases of myotonic dystrophy. GI symptoms occurred in 10 patients (53%), mainly dysphagia (n = 7). In patients undergoing investigations (n = 7), their digestive troubles were probably or definitively related to the neurological disease in 6 cases. Upper GI endoscopy was normal in 5 dysphagic patients. The oesophageal manometry was abnormal in 3 of 4 patients. Complications developed in 3 cases (16%). One patient presented two episodes of spontaneous pneumoperitoneum. A second one developed a chronic colonic pseudo-obstruction with megacolon treated by subtotal colectomy. Manometric studies revealed oesophageal aperistalsis, low amplitude of gastro-jejunal contractions but persistence of migrating motor complexes and a normal recto-anal reflex. A third patient developed an acute pseudo-obstruction with ischemic colitis. In conclusion, myotonic dystrophy frequently disturbs digestive tract motility and may cause complications such as intestinal pseudo-obstruction.

Adult↗

PubMedDate not supplied

[Palliative endoscopic treatment of cancer of the head of the pancreas using a biliary endoprosthesis; follow-up of 100 cases].

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Adult↗

PubMedDate not supplied

[Is immunosuppressor treatment effective in lymphocytic gastritis? Apropos of a case associated with an intestinal lymphoma].

We report the case of a patient with "lymphocytic gastritis" surprisingly associated with an intestinal lymphoma which was treated after intestinal resection by corticosteroids and a combination of antimitotic agents. Comparing gastric mucosa before and 3 months after therapy, we observed a striking reduction of inflammation. Such a case suggests the possibility of a beneficial effect of immunosuppressive therapy on "lymphocytic gastritis" and favors the hypothesis of an immunological disorder.

Antineoplastic Combined Chemotherapy Protocols↗