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A unique case of eosinophilic enteritis with predominant serosal involvement and mucosal sparing, ascites and abdominal adenopathy is reported with computed tomography (CT) and barium study correlation. The clinical presentation may mimic lymphoma or granulomatous disease, (e.g. tuberculosis) but peripheral eosinophilia is a strong differentiating point.
Unlike most Hox cluster genes, with their canonical role in anterior-posterior patterning of the embryo, the Hox3 orthologue of insects has diverged. Here, we investigate the zen orthologue in Oncopeltus fasciatus (Hemiptera:Heteroptera). As in other insects, the Of-zen gene is expressed extraembryonically, and RNA interference (RNAi) experiments demonstrate that it is functionally required in this domain for the proper occurrence of katatrepsis, the phase of embryonic movements by which the embryo emerges from the yolk and adjusts its orientation within the egg. After RNAi knockdown of Of-zen, katatrepsis does not occur, causing embryos to complete development inside out. However, not all aspects of expression and function are conserved compared to grasshopper, beetle, and fly orthologues. Of-zen is not expressed in the extraembryonic tissue until relatively late, suggesting it is not involved in tissue specification. Within the extraembryonic domain, Of-zen is expressed in the outer serosal membrane, but unlike orthologues, it is not detectable in the inner extraembryonic membrane, the amnion. Thus, the role of zen in the interaction of serosa, amnion, and embryo may differ between species. Of-zen is also expressed in the blastoderm, although this early expression shows no apparent correlation with defects seen by RNAi knockdown.
Distal pancreatectomy to manage disruption of the body and tail of the pancreas is a well-established surgical procedure. Fistula formation after distal pancreatectomy for injury may be as high as 24 per cent, and its treatment, although non-operative, prolongs hospitalization and increases the patient's discomfort. We describe the gastric serosal patch technique designed to cover the pancreatic stump after distal pancreatectomy in injured patients. Although this procedure has been previously described, it did not receive appropriate acclaim. Our experience suggests that this technique may eliminate fistula formation and other complications, thereby reducing patient discomfort, morbidity and hospital stay.
Rats turned diabetic by treatment with alloxan exhibit a significant reduction in serosal mast cell numbersin parallel with decreased insulin levels in the plasma. Our aim was to investigate the putative involvement of endogenous glucocorticoid hormone in this phenomenon. The findings indicated that rats treated with alloxan responded with an increase in levels of serum corticosterone concomitantly with decreased mast cell numbers in the pleural space. We found that either surgical bilateral adrenalectomy or pretreatment with the steroid antagonist RU 486 (20 mg/kg, i.p.) impaired the drop in pleural mast cell counts in alloxinated rats. Administration of insulin (15 U/kg) prevented the increase in corticosterone levels and restored pleural mast cell levels in diabetic animals. In addition, treatment of naive rats with corticosterone (0.5 mg/kg, s.c.) or dexamethasone (0.1 mg/kg, s.c.), for 3 consecutive days, led to a reduction in the number of mast cells recovered from the pleural cavity as noted in diabetic animals. In contrast, insulin reduced serum corticosterone levels and induced a significant elevation in pleural mast cell numbers in naive rats. We conclude that there is a causative relationship between increased levels of glucocorticoids and down-regulation of mast cell numbers associated with the diabetic state, both phenomena clearly sensitive to insulin.
OBJECTIVES: Thermal balloon endometrial ablation is a new method for treating menorrhagia. The technique appears to be less difficult compared to standard hysteroscopic ablation techniques and to be significantly safer. The influence into the uterine wall of the thermal balloon ablation procedure was investigated with special reference to the ability of total destruction of the endometrium and the thermal action on the myometrium and the serosa. STUDY DESIGN: Temperatures were measured at the uterine serosal surface during thermal balloon endometrial ablation for 8-16 min in eight patients. After subsequent hysterectomy the extent of thermal damage into the myometrium was assessed by light and electron microscopy. RESULTS: The highest temperature measured on the uterine serosa was 39.1 degrees C. Coagulation of the myometrium adjacent to the endometrium could be demonstrated by light microscopy in all patients, with a maximum depth of 11.5 mm. By electron microscopy no influence of heat could be demonstrated beyond 15 mm from the endometrial surface. CONCLUSION: Up to 16 min of thermal balloon endometrial ablation therapy can destroy the endometrium and the submucosal layers. The myometrium is only coagulated to a depth where full thickness necrosis or injury is unlikely.
Five highly soluble, chymotrypsin-like, neutral serine proteases, with molecular masses in the range 30-33 kDa, were isolated from Trichinella spiralis-infected mouse small intestine. These enzymes were closely related antigenically on Western blotting and by Ouchterlony double diffusion using a polyclonal, cross-absorbed, sheep antibody raised against mouse mast cell protease-1 (MMCP-1) and on the basis of N-terminal amino acid sequence analysis, were identified as variant forms of MMCP-1. Substrate and inhibitor analysis confirmed that the five variants (MMCP-1 A-E) had similar characteristics, although highly significant (P = 0.025 to P < 0.0001) variations in Km and kcat, were detected. Against human alpha 1-proteinase inhibitor the Ki for MMCP-1C (45 pM) was significantly (P < 0.0001) greater than those for the other proteases (0.76-2.2 pM). The differences in electrophoretic mobility are probably a result of variable glycosylation, since removal of N-linked carbohydrate produced a polypeptide of approx. 28 kDa in each case which was, like the native enzyme, immunoreactive on Western blotting. A much less soluble 28 kDa enzyme was isolated from serosal mast cells and identified as MMCP-4 by N-terminal amino acid sequencing. Like MMCP-1 it has chymotrypsin-like substrate specificities with activity at neutral pH. However, it was antigenically distinct from MMCP-1 and, using sheep anti-MMCP-1, was not detected on Western blotting or by Ouchterlony double diffusion, e.l.i.s.a. or immunohistochemistry. This last technique established that the MMCP-1 variants were uniquely present in enteric mast cells, thereby providing a highly selective means of distinguishing the mucosal and connective tissue mast cell subsets in the mouse.
Isolated perfused intestine of rat was used to demonstrate the glucose-stimulated release of glucagon-like immunoreactivity (GLI) into serosal secretions. The released GLI was characterised using immunoaffinity chromatography on columns of immobilised antibodies specific for the N (residues 1 to 18) and for the C (residues 19-29) terminal portions of glucagon followed by gel-filtration. The immunoreactivity was present in a variety of molecular species. These include a large GLI which has a molecular weight about 12000 and binds to antibodies specific for the N-terminal portion of glucagon and two polypeptide fractions with molecular weight closer to that of glucagon. While one fraction of the small GLI boun both to antibodies specific for the C-terminal and N-terminal portions of glucagon the other bound only to the former antibodies. The relevance of these findings to the origins of circulating GLI and the possible precursor relationship between large and other forms of GLI is discussed.
This report describes the laparoscopic features of two patients with serosal eosinophilic gastroenteritis. In one case only hyperemia of the peritoneal serosa was found. In the other the laparoscopic picture resembled peritoneal carcinomatosis. We show that laparoscopy and peritoneal biopsy may permit diagnosis of the disease without the need for laparotomy.
Localized fibrous tumor of the serosal cavities (localized fibrous mesothelioma) is a generally benign spindle cell neoplasm of uncertain histogenesis. Fourteen histologically similar primary tumors from different mesothelium-lined sites (11 pleural and 1 each in the pericardium, peritoneal cavity, and pouch of Douglas) and 2 recurrences of those tumors (pericardium and pouch of Douglas) were examined histopathologically and by flow cytometry to relate histologic features and DNA ploidy to biologic behavior (follow-up, 48-255 months among 13 patients). All 16 tumors (14 primaries and 2 recurrences) displayed diploid DNA pattern, and none of 13 patients died of disease (1 patient was lost to follow-up). To elucidate the histogenesis, seven primary tumors were examined for vimentin and keratin immunostaining and six primary tumors were assessed by electron microscopy. All cases exhibited spindle-fibroblastic cell proliferation with a prominent hemangiopericytic pattern. All cases so examined had positive results for vimentin and negative results for keratin. Ultrastructurally, the tumor cells showed mesenchymal-fibroblastic features. These results support a mesenchymal origin, most likely from submesothelial fibroblasts. Further, this neoplasm may recur but retain its basic histologic features, diploidy, and benign outcome.
Rat serosal mast cells contain secretory granules composed of a heparin proteoglycan matrix in which neutral proteases are embedded. Stimulation of the mast cells leads to granule exocytosis and formation of two pools of granules located extracellularly, firstly, granules expelled into the 'free' extracellular space and ultimately phagocytosed by the scavenging cells in the vicinity of mast cells and, secondly, granules which remain associated with their parent mast cells, and become internalized by them during recovery from stimulation. If mast cells are stimulated in the presence of macrophages in a low density lipoprotein (LDL)-containing medium, LDL is bound to the heparin proteoglycan component of the exocytosed granules whether they are expelled into the 'free' extracellular space or remain associated with the mast cells. The granules located in the 'free' extracellular space degrade, by the action of their neutral proteases, the apolipoprotein B component of the bound LDL. The proteolytic degradation of the granule-bound LDL results in its modification such that large fused LDL particles are formed on the granule surface. Phagocytosis, by macrophages, of the granules containing fused LDL particles leads to lysosomal degradation of LDL and cholesterol accumulation in macrophages as non-membrane-bound cholesteryl ester droplets, typical of foam cells. In contrast, the rapid internalization of the LDL-bearing, mast-cell-associated granules by recovering mast cells is not followed by lysosomal processing of LDL. Instead, it leads to cholesterol accumulation in mast cells, in the form of large, partially degraded, modified LDL particles, in the granule compartment.
Anemia may promote intestinal hypoxia. We studied the effects of progressive isovolemic hemodilution on jejunal mucosal (Po2muc), and serosal tissue oxygen tension (Po2ser, Clark-type surface electrodes), mucosal microvascular hemoglobin oxygen saturation (Hbo2muc), and hematocrit (Hctmuc; tissue reflectance spectophotometry) in a jejunal segment. Twelve domestic pigs were anesthetized, paralyzed, and mechanically ventilated. Laparatomy was performed, arterial supply of a jejunal segment isolated, and constant pressure pump perfused. Seven animals were progressively hemodiluted to systemic hematocrits (Hctsys) of 20%, 15%, 10%, and 6%. Baseline for Po2muc, Po2ser and Hbo2muc was 23.5 +/- 2.1 mm Hg, 57.5 +/- 4 mm Hg, and 47.0% +/- 6.4% which were not different from the five controls. Despite a significant increase in jejunal blood flow, jejunal oxygen delivery decreased and oxygen extraction ratio increased significantly at Hctsys 10% and 6%. Po2ser decreased significantly below or at Hctsys of 15%, whereas Po2muc and Hbo2muc were maintained to Hctsys of 10%, but less than 10% Hbo2muc and mesenteric venous pH decreased significantly, implying that physiological limits of jejunal microvascular adaptation to severe anemia were reached. Decrease of Hctmuc was less pronounced than Hctsys. In conclusion, redistribution of jejunal blood flow and an increase in the ratio of mucosal to systemic hematocrit are the main mechanisms maintaining mucosal oxygen supply during progressive anemia.
A 39-year-old woman undergoing immunosuppressive therapy following kidney transplantation for systemic lupus erythematosus presented with a uterine adenomatoid tumor that diffusely infiltrated the entire myometrium and contained a serosal papillary cystic component that resembled a cystic mesothelioma. This is the first reported case of an adenomatoid tumor showing both of these features. Although adenomatoid tumors are considered benign, the patient may be at risk for recurrence of the papillary cystic component (which is known to recur in 50% of cases) if this tumor reflects an inability to limit neoplastic processes.
PURPOSE: The flap valve mechanism is often the preferred technique for creating a continent catheterizable channel in bladder reconstruction. The umbilicus is usually the preferred site for stomal placement. However, it is not always possible to bring the conduit to the umbilicus when creating the flap valve mechanism at the bladder level. To prevent this problem, we applied the Ghoneim technique to construct the flap valve mechanism during ileal bladder augmentation. MATERIALS AND METHODS: A total of 10 patients (7 boys and 3 girls) 5 to 17 years old underwent ileocystoplasty in combination with an appendiceal Mitrofanoff procedure as a catheterizable channel. The U-shaped ileal segment was anastomosed to the bivalve native bladder, leaving redundant bowel on the right side. The musculomucosal edges of the redundant bowel were sutured together, forming the posterior wall of the tunnel. The appendix was positioned onto the musculomucosal suture line, and the proximal end was anastomosed to the reservoir with an advancement suture. The ileal segment was then imbricated over the appendix by interrupted silk sutures, forming a serosal lined extramural tunnel. The stoma was placed at the depth of the umbilicus. RESULTS: The underlying diagnoses included mylomeningocele (8) and posterior urethral valve (2). Mean followup time was 12.5 months (range 7 to 21). All patients were continent, and there were no stoma related complications such as stenosis or difficult catheterization. CONCLUSIONS: The Ghoneim technique creates an effective continence mechanism and allows the conduit to reach the umbilicus easily.
A six-year-old, pluriparous German shepherd dog bitch was presented with an abnormal vaginal discharge of several weeks' duration. Clinical signs and radiographic and ultrasonographic findings supported an initial diagnosis of segmental cystic endometrial hyperplasia, and ovariohysterectomy was performed. Macroscopically, the uterus appeared normal except for one large and several smaller cysts attached to its antimesometrial side. These cysts were restricted to a small area of the left uterine horn. The histological diagnosis was serosal inclusion cysts. The clinical findings, gross pathology and histopathology are described and discussed.
The rabbit stomach serosal strip, was found to contract to adrenaline and noradrenaline but not to isoprenaline. The contractile response could be totally abolished by phenoxybenzamine but was not influenced by propranolol, indicating that the preparation has almost exclusively alpha-adrenoceptors. The responses to adrenaline and noradrenaline were markedly potentiated in the presence of monoamine oxidase inhibitors, guanethidine or reserpine, indicating the presence of MAO activity in the tissue and possible catecholamine stores. The functional state of the latter has not been conclusively established, since tyramine, an indirectly acting amine, was unable to elicit a response qualitatively similar to that of adrenaline, even in the presence of nialamide or tranylcypromine.
The transport of the dibasic amino acid L-lysine across the serosal pole of the intestinal epithelium has been studied using the vascularly perfused anuran small intestine. The exit of pre-loaded lysine into the vascular bed was inhibited by L-ornithine (2 mM) and L-arginine (10 mM) when pulsed through the lumen during the wash-out, while 2-aminoisobutyric acid (AIB), L-histidine, L-citrulline and L-cystine had no effect. Luminal L-leucine and L-alanine at a concentration of 10 mM markedly stimulated the unloading of lysine into the vascular bed and sarcosine, L-proline and beta-alanine also did so to a lesser extent. The instantaneous rate constant for lysine exit into the vascular bed was increased by the presence of L-arginine, L-ornithine, L-citrulline, L-histidine, AIB, L-leucine and L-alanine at a concentration of 10 mM in the vascular bed. L-proline had no effect. The simultaneously measured efflux of lysine into the lumen was unaffected by the presence of the other amino acids in the vascular bed. The uptake of lysine into the epithelium from the vascular bed was accelerated by L-ornithine and slightly by L-arginine when they were present in the lumen, while L-leucine, L-alanine, beta-alanine, L-proline, L-citrulline, sarcosine, L-histidine and AIB had no effect. The instantaneous rate constant for lysine wash-out into the vascular bed was transiently increased by the presence of L-leucine in the vascular bed at concentrations of 10, 0.10 and 0.01 mM. The steady-state transfer of lysine from the lumen to the vascular bed was stimulated in a biphasic manner by 5 mM-leucine in the lumen and by 0.5 mM-leucine in the vascular bed. The mechanisms for these interactions between lysine transport across the basolateral membrane of the enterocyte and other amino acids are discussed and a possible role for neutral amino acid stimulation of lysine exit is proposed.
Nine malignant mesotheliomas and 12 specimens of benign reactive mesothelial hyperplasia were examined using a specific antimesothelial cell antibody. Immunostaining intensity was subsequently estimated by means of image analysis. The mean and standard deviation of integrated optical density in the malignant mesotheliomas differed significantly from those in the mesothelial hyperplasias. In all mesotheliomas but one the integrated optical density was greater than in reactive mesothelial hyperplasia. No significant difference in optical density was observed between the two groups; the standard deviation was significantly higher in the reactive lesions. This technique may be adopted to complement the traditional morphological assessment of primary lesions of the serosal cavities.
The omission of sodium from the serosal incubation fluid in isolated frog skins inhibits transcellular Na transport. By the use of intracellular recording with microelectrodes, it has been demonstrated that this inhibition is associated with an increase of the basolateral membrane resistance, resulting in a depolarization of the short-circuited cells. This depolarization in turn accounts for the reduction of Na entry across the apical border. The resistance changes across the outer (apical) border are small in magnitude and unrelated to the inhibition of transcellular transport. The origin of the increase in basolateral membrane resistance, presumably due to decrease of K permeability, is unclear. These data do not support the hypothesis that intracellular Ca regulates the resistance of the apical and basolateral membranes.