Biomedical subjects

R Sim

Publications and source records attributed to R Sim.

At least 19 recordsLinked to original sources

PubMed2007

Prospective randomized, double-blind, placebo-controlled study of pre- and postoperative administration of a COX-2-specific inhibitor as opioid-sparing analgesia in major colorectal surgery.

PURPOSE: To demonstrate the opioid-sparing effect and reduction in postoperative ileus obtained with valdecoxib 40 mg administered pre- and postoperatively in patients undergoing colorectal resection. METHODS: Patients for elective colorectal resection from December 2002 to June 2004 were randomized to receive either valdecoxib or placebo with standard patient-controlled analgesia (PCA) morphine. In the study arm, the first dose of valdecoxib 40 mg was administered orally as close as possible to 1 h prior to the start of surgery. Each subsequent dose was administered at 24-h intervals up to 120 h. Patients in the control arm were served placebos at the same time-points. RESULTS: Forty patients were enrolled in the study arm and 39 (excluding one protocol violation) in the control arm. The groups were comparable in age, sex, American Society of Anesthesiology status, body mass index, incision length, and duration and types of operations. Mean PCA doses at 12 and 24 h were 18.6 and 28.3 mg in the study arm vs 26.2 and 41.2 mg in controls, representing a one-third opioid reduction. Bowel sound and movement first appeared at medians of 12 and 72 h in the study arm vs 24 and 84 h, respectively, in controls (P < 0.05). Tolerance of solid diet was at a median of 60 h and discharge at a median of 4 days in the study arm vs 72 h and 6 days in controls (P < 0.05 and P < 0.01, respectively). Seven (18%) morbidities occurred in the control vs six (15%) in the study arm. CONCLUSIONS: Patients treated with a cyclo-oxygenase 2-specific inhibitor have a shorter recovery time when compared with patients on a standard postoperative PCA morphine-only regimen after colorectal resection.

Adult↗

PubMed2006

Primary retroperitoneal mucinous cystadenocarcinoma in a male patient.

Primary retroperitoneal mucinous cystadenocarcinomas (PRMCs) are rare. This is the first reported case in the literature in English of PRMC in a man. The 64-year-old man presented with a large retroperitoneal cystic tumour measuring 24 x 20 x 16 cm3, which was removed intact. Areas ranging from a benign mucinous cyst to borderline mucinous tumour to mucinous cystadenocarcinoma were observed on microscopy. Strong patchy staining for cytokeratins 7 and 20 and strong diffuse staining for MUC2 and MUC5AC core peptides, similar to staining patterns in ovarian mucinous tumours, were shown in the benign and atypical epithelium. Staining for CA19.9 and carcinoembryonic antigen was also shown by both components. The theory of its origin from the mucinous metaplasia of peritoneal (mesothelial) inclusion cysts, rather than from ectopic ovarian tissue or ovarian teratomas, is supported by the occurrence of such a tumour in a male patient.

Cystadenocarcinoma, Mucinous↗

PubMed2005

Use of a ProSeal laryngeal mask airway and a Ravussin cricothyroidotomy needle in the management of laryngeal and subglottic stenosis causing upper airway obstruction.

We report the successful use of a ProSeal laryngeal mask airway (PLMA) as a dedicated airway to allow fibre-optic inspection and passage through a tightly stenosed glottic and subglottic lesion, before fibre-optic-guided transtracheal placement of a Ravussin needle and jet ventilation. The described technique avoided both tracheostomy and the potential of 'seeding' the tumour by passage of the needle through the mass. The PLMA may be a useful 'dedicated airway' and has several advantages over the classic LMA(double dagger) and intubating LMA when used for this purpose. These include improved airway seal and reduced risk of aspiration. Four other cases of use of the PLMA as a dedicated airway during management of difficult airways are discussed. double daggerLMA is the property of Intavent Ltd.

Aged↗

PubMed2005

Laparoscopic-assisted colon and rectal surgery - lessons learnt from early experience.

INTRODUCTION: Current evidence shows that laparoscopic bowel surgery is associated with a lower incidence of postoperative ileus, lower postoperative pulmonary and wound complication rates, shorter hospital stays and a quicker return to activity than open surgery. This paper aims to report our early experience with laparoscopic-assisted colorectal procedures in our Centre for Advanced Laparoscopic Surgery and the important lessons we have learnt from this. MATERIALS AND METHODS: All laparoscopic-assisted colon and rectal surgical (LAC) procedures performed between January 2000 and December 2003 were reviewed. Clinical and operative records of these patients were reviewed. Data retrieved included patient demographics, selected intraoperative parameters, and postoperative outcomes. In order to provide a comparable reference, an equal number of matched open procedures over the same period were accrued and similarly analysed. All patients were managed on a standard carepath. All data were entered into a database and analysed using a statistical software package. RESULTS: Forty-two laparoscopicassisted colorectal procedures were performed from June 2000 to December 2003. A similar number of diagnosis-matched patients with open colorectal procedures were used as comparison. The diagnoses included cancer (68.5% versus 73.8%), diverticulosis (5.7% versus 9.5%) and polyps (14.3% versus 9.5%). Seven were converted to open surgery because of bleeding, adhesions and locally advanced disease. Laparoscopic-assisted procedures performed included 1 right hemicolectomy, 5 left hemicolectomies, 9 anterior resections, 1 abdominal-perineal resection, 3 sigmoid colectomies, 11 colostomies and 1 Hartmann's procedure. Mean perioperative time (146 min versus 125 min, P = 0.173) was comparatively longer. Mean duration for analgesic requirement (2.25 days versus 2.64 days, P = 0.05), mean length of stay (5.31 days versus 9.07 days, P < 0.05), mean time to commencement of diet (2.91 days versus 4.05 days, P < 0.001) and mean time to first bowel movement (2.57 days versus 4.10 days, P < 0.001) were all comparatively shorter. General morbidity rates (17.1% versus 21.4%, P = 0.35) were lower. No local wound complications were found in our laparoscopic-assisted group. Patients who had undergone open surgery instead of the planned laparoscopic-assisted procedures fared more poorly. CONCLUSIONS: Laparoscopic-assisted colorectal procedures performed in well-selected patients are associated with shorter hospital stays, quicker return of bowel function and lower morbidity when compared to the matched open procedures. Early experience should be acquired from performing technically simple procedures in patients with benign conditions before progressing to definitive resections in those with cancer.

Adult↗

PubMed2004

Spontaneous T(H)1 cytokine production by intraepithelial but not circulating T cells in infants with or without food allergies.

BACKGROUND: It has been established that the maintenance of immunological tolerance to dietary antigen and the intestinal flora (oral tolerance) is an actively-maintained process dependent upon mucosal lymphocyte populations. Early life exposures appear critical in the development of such tolerance. However little is known about the activation status of mucosal lymphocytes in human infancy and childhood. PATIENTS AND METHODS: We have performed flow cytometric analysis for cell lineage and cytokine-production status in peripheral blood and duodenal intraepithelial lymphocytes taken during endoscopy from 20 children [median age 2.9 +/- 0.6 years (median +/- SE)] in whom investigation found no intestinal abnormalities (histologically normal controls) and 30 children (median age 1.6 +/- 0.4 years) with confirmed allergy to cow's milk and other dietary antigens. RESULTS: Regardless of clinical status, spontaneous production of cytokines was low or undetectable in peripheral blood cells. By contrast, intraepithelial CD4 and CD8 cells isolated from the small intestine were often activated, with 5% or more showing spontaneous production of T(H)1 type [interleukin-2, interferon (IFN)-gamma] cytokines in both normal controls and food-allergic children. Stimulation in vitro strongly induced cytokine production in peripheral blood but not intraepithelial lymphocytes. Immunohistochemistry showed similar density of IFN-gamma(+) intraepithelial lymphocytes in controls and allergic children. CONCLUSIONS: Duodenal intraepithelial lymphocytes in human infants show a state of increased spontaneous activation compared with peripheral blood lymphocytes, and show no significant impairment of T(H)1 responses in food allergic children.

Child↗

PubMed2003

Delayed diagnosis of foreign body aspiration in children.

Foreign body aspiration in children is common and usually presents with an initial episode of choking with subsequent respiratory symptoms. There may be cough, wheeze, or stridor, with decreased or abnormal breath sounds on examination. However, it can mimic other illnesses and cause difficulty in diagnosis. Radiological investigations may help to confirm aspiration but should not be used to exclude it. Three cases are presented of foreign body aspiration with a delay in diagnosis ranging from days to weeks. It is believed that delay could have been avoided with a more careful approach to the history and more appropriate use of investigations. These cases demonstrate that children with a history of choking and subsequent symptoms should be referred for bronchoscopy.

Bronchi↗

PubMed2001

Non-radioactive digoxigenin DNA labeling and immunologic detection of HSV PCR products.

BACKGROUND: Herpes simplex virus (HSV) is a common cause of human skin and mucous membrane infections, and also causes sporadic meningoencephalitis. As a new method for rapid HSV diagnostics, polymerase chain reaction (PCR) has been introduced in clinical laboratories. Radioactive labeling of DNA probes has become a common practice in experimental laboratories. To avoid radioactive labeling of HSV oligonucleotide probes or PCR products, non-radioactive compounds, which are easily detected by enzyme or immunoassay techniques, are introduced. OBJECTIVES: The aim of our study was (1) to introduce non-radioactive labeling of HSV DNA probe by digoxigenin-labeled dUTP; (2) to establish a rapid and reliable laboratory method for rapid HSV diagnostics; (3) to compare the PCR method with the standard virology techniques, such as cell culture virus isolation and HSV direct fluorescent antibody test (DFA). STUDY DESIGN: We have tested the efficiency of PCR method and non-radioactive labeling of HSV DNA probe for detection of HSV from 30 clinical specimens (skin and mucous membrane swabs). HSV was detected in the specimens by standard virology techniques and PCR. Replicated HSV DNA was non-radioactively labeled by random incorporation of digoxigenin-labeled deoxyuridine triphosphate (DIG-dUTP), and the hybrids were detected by the antibody conjugates and the appropriate enzyme-mediated staining reaction (DIG DNA labeling and detection kit non-radioactive, Boehringer Mannheim GmbH). RESULTS: Non-radioactive labeling of hybridization DNA probes with digoxigenin-dUTP was obtained. HSV DNA was successfully multiplied and detected in the HSV-infected cell culture supernatant; however, it was not detected in the clinical specimen supernatant or sediment. HSV DNA was detected by direct PCR method in non-centrifugated clinical specimens. CONCLUSIONS: The PCR method could be successfully used for diagnoses of HSV infections. Since the sensitivity of this method is partly limited by the virus quantity in the specimen, we recommend cultivating the virus in the cell culture at least 24 h prior to PCR. The use of non-radioactive labeling of hybridization DNA probes, such as random primed DNA labeling with digoxigenin-dUTP, has proven both sensitive and specific, and more appropriate for diagnostic purposes than radioactive DNA labeling to be used until standardized commercial tests appear.

Culture Media↗

PubMed2000

Beta(beta)3-adrenergic receptors in human pancreatic islet and duodenal somatostatin neuroendocrine cells.

BACKGROUND: We previously localized beta3-adrenergic receptors immunohistochemically in human gastrointestinal smooth muscle and incidently found a population of human pancreatic islet cells and duodenal epithelial neuroendocrine cells that also expressed beta3-adrenergic receptors. AIM: To identify the nature of the islet and duodenal cells that stained positive for beta3-adrenergic receptors. METHODS: Paraffin sections of human pancreas and duodenum and Chinese hamster ovary cells transfected with the human beta3-adrenergic receptor were immuno-stained for beta3-adrenergic receptors using an affinity-purified rabbit polyclonal antibody (anti-P12) raised against a 15 amino acid sequence (P12) of the human receptor. Immunohistochemical staining for the receptor was carried out in the presence and absence of P12 peptide and both somatostatin 14 and 18 peptides. beta3-adrenergic receptor-stained sections were also double-immunostained with anti-insulin, -glucagon, -somatostatin and -pancreatic polypeptide antibodies. RESULTS: A subpopulation of human pancreatic islet cells and duodenal epithelial cells expressed positive cytoplasmic beta3-adrenergic receptor immunostaining. Using distribution and double-staining techniques, these cells were found to be somatostatin-positive D cells but not A or B cells. The positive staining of D cells with anti-P12 antibody was inhibited by prior incubation of the antibody with P12 peptide but not somatostatin-14 or -28 peptides. Pancreatic vascular smooth muscle and duodenal vascular and non-vascular smooth muscle also stained with anti-P12 antibody. Transfected Chinese hamster ovary cells showed positive membrane staining. CONCLUSION: We have identified a population of neuroendocrine cells in the human pancreas and duodenum that express beta3-adrenergic receptors. These cells appear to be somatostatin D cells.

Animals↗

PubMed2000

Quinine induced coagulopathy--a near fatal experience.

A 67 year old man presented to his local dentist for restorative treatment. He stated he was fit and well and denied taking any medications. When he was given an inferior alveolar nerve block, excessive bleeding was noted at the injection site and the dentist advised the patient see an oral and maxillofacial surgeon. An appointment was made for the patient but he did not attend. Three days later, he presented with evidence of massive deep haemorrhage to the point of airway compromise. He underwent hospital admission, early intubation, intensive care for nine days and hospitalization for six weeks. The cause of his bleeding was a severe thrombocytopoaenia, induced by chronic ingestion of quinine. He was self-medicating with this to relieve muscular cramps. Despite this experience, the patient continued to deny that quinine was the cause of his problem and that he had failed in his obligations to advise the dentist of his drug history. Dentists need to be alert to the risk that patients may not reveal their true medical history. There are, however, obligations on the dentist to ensure the accuracy of information the patient gives and to ensure that patients whom they believe are at risk follow their advice. Teamwork and skillful airway management prevented this patient's demise.

Aged↗

PubMed2000

Heterogeneous recognition of beta 2-glycoprotein I by antibodies from antiphospholipid syndrome patients.

Beta 2-glycoprotein I plays a pivotal role in the binding of antiphospholipid antibodies to phospholipid in patients with antiphospholipid syndrome. In this study the nature of the epitopes on beta 2-glycoprotein I (beta2-GPI) recognised by sera from antiphospholipid syndrome (APS) patients (n = 15) was investigated and compared to rabbit polyclonal and mouse monoclonal anti-beta2-GPI antibodies. beta2-GPI was only recognised when bound to a high affinity binding support. The antigenic epitope on beta2-GPI recognised by all APS patients was also dependent on disulphide bond integrity. Digestion of beta2-GPI with elastase rapidly destroyed the epitope(s) on beta2-GPI recognised by antibodies in 91% of APS patients. The main cleavage occurred at tryptophan316-lysine317 in the fifth domain. Digestion with staphylococcal V8 protease resulted in a 50% reduction in antibody binding in 81% of patients and the cleavage sites mainly involved the first domain of the molecule. There was considerable variability in the recognition of six different species of beta2-GPI by serum from APS patients. The epitopes on beta2-GPI bound by APS sera appear conformationally determined in all patients but are quite heterogeneous in the regions of beta2-GPI that are recognised.

Adsorption↗

PubMed2000

Squamous cell carcinoma of the temporal bone: diagnosis, treatment and prognosis.

Squamous cell carcinoma of the external ear canal is an uncommon condition that is associated with a poor outcome. The development of an accepted staging system has not been forthcoming and this has inhibited the formation of an evidence-based therapeutic protocol. We report the findings in 14 patients with squamous cell carcinoma of the external ear canal treated in our institutions. The most common presenting symptoms were otorrhoea and otalgia. Four patients had a history of chronic ear discharge and one had previous radiotherapy for nasopharyngeal carcinoma. Five patients had facial palsy which was a poor prognostic sign. Only one patient had clinical neck disease. Pre-operative imaging with CT or MRI scans was accurate in determining the extent of tumour involvement. The initial T-staging relied heavily on these findings. With combination treatment involving surgery, radiotherapy and chemotherapy, disease free survival achieved was 69% (9 of 13) over a mean follow-up period of 24.7 months. One patient absconded treatment. Patients with early stage tumours faired better than patients with advanced tumours (100% vs 33%). There was low incidence of involvement of the parotid gland (1 of 7 patients). Patients with facial nerve involvement had a significantly poorer outcome (p = 0.035).

Adult↗

PubMed2000

Laparoscopic colectomy for malignancy.

It is clear from published series that laparoscopic colectomy for cancer can be performed safely by experienced surgeons, but there is a considerable learning curve for the procedure. Although surgeons have shown that an equivalent resection can be performed, it is not clear yet that this translates into equivalent recurrence and survival rates. Most of the expected benefits of minimal access surgery are being provided by laparoscopic colectomy, although these benefits have not been as readily achievable as those seen with other procedures. Even the early results of laparoscopic colectomy for cancer are encouraging, although the fate of this procedure rests with the long-term analysis of a number of trials currently underway. Laparoscopic techniques are continuing to evolve and improve secondary not only to technological breakthroughs but also advances in basic science and clinical research. This article provides technical descriptions to illustrate key concepts in laparoscopic resection of the right colon and rectosigmoid for cancer and reviews the results of recent prospective randomized trials.

Colectomy↗

PubMed1999

Haemorrhage into non-functioning adrenal cysts--report of two cases and review of the literature.

Adrenal cysts are a rare condition and are usually non-functioning and asymptomatic. Most of the reported cases were incidental findings or discovered at autopsy. However, large cysts have a tendency to develop complications such as intracystic haemorrhage and rupture, which can present as an acute surgical emergency. We report two cases of adrenal cysts with intracystic haemorrhage. One patient presented with persistent non-specific upper abdominal pain, investigations with ultrasound (US) scan and computed tomographic (CT) scan revealed a left adrenal cyst and gallstones. Simultaneous cholecystectomy and adrenalectomy was performed with resultant relief of symptoms. The second patient presented with acute abdominal pain simulating acute surgical abdomen. Preoperative CT scan showed a large cystic lesion in the region of the tail of the pancreas with radiological evidence of haemorrhage but was unable to confirm its origin. The cyst was found to have arisen from the left adrenal gland at laparotomy; left adrenalectomy with complete excision of the cyst was done. Histology showed pseudocyst with haemorrhage in both cases. Pseudocyst is the commonest histological type encountered clinically. We believe the second case is related to pregnancy and childbirth as the patient presented during puerperium and the cyst, even though very large in size (25 x 15 x 15 cm), was not noted during antenatal screening with US scan.

Adrenal Gland Diseases↗

PubMed1998

Absence of Escherichia coli, Listeria monocytogenes, and Klebsiella pneumoniae antigens within inflammatory bowel disease tissues.

BACKGROUND: Escherichia coli, listeria, and streptococcal antigens have been found in Crohn's disease tissues. Antibodies to Klebsiella pneumoniae have been found in patients with inflammatory bowel disease and ankylosing spondylitis. The presence of these bacterial antigens in Crohn's granulomas would be of aetiological interest, while their presence in ulcers alone would be more likely to indicate secondary infection. AIM: To investigate inflammatory bowel disease tissues for the presence of these bacteria. METHODS: Formalin fixed, paraffin processed sections from 53 patients (19 ulcerative colitis, 23 Crohn's disease; 11 normal tissues from cancer resections) were studied by immunohistochemistry. Control tissue consisted of normal human small bowel injected submucosally with either E coli, Listeria monocytogenes, Proteus mirabilis, or Klebsiella pneumoniae serotypes K2, 3, 17, 21, 26, 36, and 50, and colonic biopsies from a child with E coli 0114 infection. Tissues were stained by Gram-Twort, and with specific antibodies for E coli (Dako B357), L monocytogenes (Difco 2302-50), and K pneumoniae (Biogenesis 5580-5208) using an immunoperoxidase technique. RESULTS: Positive staining for E coli was observed on the luminal surface epithelium and in ulcers in 35% of Crohn's disease patients, 26% of ulcerative colitis patients, and no normal controls. Superficial staining for L monocytogenes was observed in one case of ulcerative colitis only. Staining for K pneumoniae was observed in one case of ulcerative colitis and one of Crohn's disease. No granulomas, giant cells, or germinal centres stained positively for any of the three bacterial antigens. CONCLUSIONS: These data do not support a primary role for E coli, L monocytogenes, and K pneumoniae in inflammatory bowel disease. The presence of E coli antigens in ulcers suggests secondary infection in these lesions.

Antigens, Bacterial↗

PubMed1998

Abdominal surgery in human immunodeficiency virus (HIV) infected patients--early local experience.

The prevalence of human immunodeficiency virus (HIV) infection is increasing in Singapore. The surgical experience, however, remains limited. A retrospective review of 13 HIV-positive patients requiring abdominal surgery within Singapore was done. There were 4 females and 9 males with age ranging from 21 to 44 years. Operations included appendicectomy, colectomy, splenectomy, intestinal bypass, gastrostomy and exploratory laparotomy. Pathologic findings directly related to HIV infection were found in two-fifths (5 out of 13) of these patients. A low CD4+ count or signs of full-blown acquired immunodeficiency syndrome (AIDS) were not associated with a higher likelihood of HIV-related pathology; neither did it preclude a successful outcome. There were 2 early postoperative deaths, both with HIV-related pathology. Five of our patients who survived their abdominal surgery died on follow-up with a median survival of 17 months. In patients with typical surgical problems, e.g. appendicitis and torsion of the ovary, early surgery allows for rapid recovery similar to normal surgical patients. Care of these patients is best provided by surgeons with experience and interest in this condition together with infectious diseases physicians. Even palliative surgery offers a respite from acute and often severe problems and improves the quality of life significantly. Two patients with AIDS presented with sepsis and diffuse abdominal tenderness. Subsequent laparotomy revealed only primary bacterial peritonitis. For patients with AIDS and non-localizing abdominal signs, alternative non-invasive diagnostic modalities such as computed tomographic (CT) scan should be considered.

Abdomen↗

PubMed1998

Surgical treatment of thyroid cancer: the Singapore General Hospital experience.

Patients with differentiated thyroid cancers generally have a good prognosis. This should be considered when deciding the extent of surgical resection. Radical surgery, however, may be appropriate in the control of locally advanced disease. An audit of 149 cases of thyroid cancer treated in the Department of General Surgery, Singapore General Hospital between October 1988 and June 1994 is presented. Particular attention is drawn to eight patients who underwent radical surgery. There were 111 (74.5%) women and 38 (25.5%) men. The median age was 45 years (range 12 to 83 years) and 80.5% of the cancers were papillary carcinomas, 14.8% follicular, 2.7% medullary and 2.0% anaplastic. Total or near-total thyroidectomy was the most common procedure for primary disease in about 75% of patients. Eight patients (5.4%) underwent radical surgery-four laryngectomy, one pharyngectomy and three median sternotomy-for tumour clearance. Morbidity included: wound complications in 2%; hypocalcaemia, transient in 16.8% and permanent in 3.4%; and hoarseness of voice in 8.1% with 4.7% having proved recurrent laryngeal nerve palsy. All three patients with anaplastic thyroid cancer died within 3 months. Of the eight who underwent radical surgery, three (37.5%) are alive and disease-free at median follow-up of 20 months. In a correctly selected group of patients with locally invasive differentiated thyroid cancer, aggressive surgery is appropriate, with acceptable morbidity and mortality.

Adolescent↗

PubMed1998

Ambulatory anorectal surgery--is it feasible locally?

Currently, anorectal procedures are done in an inpatient setting in most local hospitals. This study examines the feasibility of performing these procedures in an outpatient setting. Patients (age range 16 to 65 years) with anorectal complaints requiring surgery were randomized into 2 groups of 40 patients each. Procedures performed included haemorrhoidectomy, fistulotomy, lateral sphincterectomy, excision of rectal polyps and examination under anaesthesia. The first group was managed in the conventional inpatient setting with regional anaesthesia. The second group was done on an ambulatory basis with local anal block. Intravenous and oral ketorolac was used for postoperative pain control and patients were discharged about 4 hours postoperatively. No complications were noted in the second group while the first group had 2 cases of acute urine retention requiring temporary catheterisation and 2 cases of significant bleeding requiring hospitalisation. Pain and satisfaction scores for both groups were similar. Anorectal surgery can be performed in an outpatient setting locally with safety and efficacy. The cost savings can be significant.

Adolescent↗

PubMed1997

In situ immune responses in Crohn's disease: a comparison with acute and persistent measles virus infection.

The implied aetiological association of measles virus with Crohn's disease would be supported by detection of an immune response to infected cells in affected tissues. This study sought to detect and characterise in situ immune responses to measles virus in both acutely and persistently infected tissues, and in particular, Crohn's granulomata. Tissue sections from patients with Crohn's disease (n = 17), tuberculosis (n = 9), acute intestinal ischaemia (n = 5), acute measles pneumonitis (n = 2), acute measles appendicitis (n = 1), subacute sclerosing panencephalitis (SSPE; n = 1), and measles inclusion body encephalitis (MIBE; n = 1), were examined. Single and double immunohistochemical labelling was performed to identify both cytotoxic lymphocytes (CD8, TIA, perforin, Leu 7, CD45RO, CD45RA) and macrophages (KP1). The relationship of these cells to measles infected cells was examined by double immunolabelling with antimeasles virus nucleoprotein antibody. In both acute measles appendicitis and SSPE, CD8+/TIA cytotoxic lymphocytes (CTL) targeted infected cells. In the cases of Crohn's disease (13/17), MIBE, fatal pneumonitis, and one tuberculous granuloma, that were positive for measles virus, infected cells appeared to be targeted by macrophages rather than CTL. CTL in both tuberculous and Crohn's granulomata were similar in their peripheral distribution, number, and phenotype. The data suggest that measles-specific CTL responses may be attenuated in Crohn's disease compared with acute measles appendicitis and SSPE, and secondly, that an abnormal macrophage response to persistent measles virus infection of the intestine may result in granulomatous inflammation.

Acute Disease↗