Gastric acid and histamine secretion in patients on continuous ambulatory peritoneal dialysis (CAPD)

Gastric secretion was measured in patients with chronic renal failure (CRF) on continuous ambulatory peritoneal dialysis (CAPD), non-uraemic patients with a duodenal ulcer (DU), and healthy volunteers (HV). Basal acid outputs were not significantly different in the three groups. Under pentagastrin stimulation, acid secretion was lower in CAPD patients than in DU patients (p < 0.02) but not different from HV controls. Between CAPD and DU, basal histamine secretion measured in the gastric juice was not different, but the concentration in blood plasma was significantly lower in the CAPD group (p < 0.05). Under pentagastrin stimulation, gastric histamine output and plasma histamine concentration were significantly lower in CAPD patients (p < 0.05, respectively). Both basal and pentagastrin-stimulated gastric acid and histamine outputs were directly related. These results suggest that CAPD patients do not have an increased risk of developing DU, but may need acid blockade if they are treated for hyperphosphataemia with aluminium containing drugs.

Monitoring Peach Harvest Workers Exposed to Azinphosmethyl Residues in Sutter County, California, 1991

Peach harvest workers were evaluated for exposure to azinphosmethyl residues by measuring foliar residues, urinary alkylphosphate metabolites, butyrylcholinesterase (BChE), acetylcholinesterase (AChE), and dermal residues using clothing and skin washes. Workers entered orchards 51 days after application and worked in treated fields for 10 of the next 17 days. Dislodgeable foliar residues ranged from 0.82 to 1.72 microg/cm2 and did not change significantly over the study period. Combined mean dermal exposure for the 3 consecutive monitoring days was 32 mg and ranged from 17.9 to 60.5 mg. Overall mean excretion levels for the 5 monitoring days were 1.7 mg dimethylphosphate and 1.9 mg dimethlythiophosphate. There was no significant difference in BChE between the exposed harvesters and minimally exposed sorters. The exposed group had significantly lower AChE values than the sorters for 2 post-exposure blood draws by three testing methods, while no significant difference was found for the pre-exposure blood draw. The AChE values for the post-exposure blood samples for the exposed workers decreased significantly about 10-20% over the 3-week exposure period but increased or remained constant for the sorters. Urinary metabolite excretion increased with continuous exposure and was inversely correlated with both AChE and BChE but was not correlated with dermal exposure measurements. High correlations were generally observed between AChE measurements taken in the field using a new spectrophotometric kit and laboratory AChE measurements.

Caesarean section in a diabetic patient with a recent myocardial infarction

This is a report of a 38-yr-old parturient with multiple medical problems including diabetes mellitus, bronchial asthma, chronic myelogenous leukaemia, pre-eclampsia and a recent myocardial infarction. After medical management in the coronary care unit, it was decided to proceed with a Caesarean section. The choice of anaesthetic was made by the patient and had to be modified in accordance with her medical condition. Cardiovascular monitoring included PA catheterisation and transoesophageal echocardiography. A general anaesthetic was performed using fentanyl, thiopentone and succinylcholine. The outcome was satisfactory for both parturient and baby.

Immunoepidemiology of intestinal helminthic infections. 3. Mucosal macrophages and cytokine production in the colon of children with Trichuris trichiura dysentery

Mucosal macrophages and accessory cells have been studied by immunohistochemistry in the lamina propria of the colon of children with Trichuris trichiura dysentery syndrome (TDS). No difference was found in the numbers of cells recognized by the monoclonal antibodies CD11c, CD68, or RFD7 between TDS children and local controls. However, large numbers of cells were recognized by an antibody against calprotectin (an anti-bacterial glycoprotein found in tissue infiltrating-monocytes) in TDS colonic mucosa, but few in control colon. Large numbers of cells containing tumour necrosis factor alpha (TNF alpha) were also seen in TDS mucosa; cells isolated from TDS mucosa secreted more TNF alpha than cells from control mucosa; and children with TDS had high levels of circulating TNF alpha. Non-specific macrophage-mediated inflammation and local cytokine production may therefore play a role in the pathogenesis of TDS.

Ontogeny of the gut-associated lymphoid system in man

Immunoperoxidase histochemistry using monoclonal antibodies to lymphoid/myeloid cells has been used to study the development of the human mucosal immune system in frozen sections of foetal human intestine at different ages. A steady progression of development was seen between 11 and 19 weeks' gestation. At 11 weeks, Peyer's patches were identifiable only as aggregates of strongly HLA-DR+ cells. By 16 weeks these aggregates became colonized with T and B cells, without distinct cellular zonation. By 19 weeks primary B-cell follicles were seen and T cells occupied the inter-follicular zones. There was also a steady increase in the numbers of lamina propria and epithelial T cells between 11 and 19 weeks' gestation. As in postnatal bowel, CD8+ cells predominated in the epithelium and CD4+ cells predominated in the lamina propria. Thus the important T- and B-cell compartments of the mucosal immune system are well established in the human foetal intestine by mid-gestation.

What is needed from imaging? The surgeon's point of view

Abdominal sepsis after surgery is decreasing in incidence but has a high mortality, especially in those with other complicating factors. The most difficult abscesses to localize are those in intermesenteric folds. Pyrexia of unknown origin is much less of a clinical problem since the advent of ultrasound and computerized tomography (CT) scanning. Laparotomy still has an occasional role but laparoscopy should precede it and may be therapeutic using minimally invasive surgical techniques; for example, in appendicitis and cholecystitis. Pancreatitis remains a serious clinical problem in which imaging plays an important role. Percutaneous drainage has a similar morbidity and success rate to open drainage. In certain cases of diverticular disease it may obviate altogether the need for surgical resection. The differentiation between abscess and necrotic tumour is important, and CT is most helpful in this area.

Timing of discharge from hospital of patients admitted with asthma: a district general hospital experience

How soon can one safely discharge patients admitted to hospital with an exacerbation of asthma? Criteria for discharge were published by the British Thoracic Society in 1990 and revised in 1993. We have reviewed a cohort of patients with asthma discharged over a 12-month period from a busy district general hospital. Most patients were discharged without meeting all the BTS criteria. Outcome measures suggest that this may not matter at least in patients who have received education from a specialist chest liaison nurse and were discharged on oral and inhaled steroids.

Cyclosporin A enhances T cell-mediated induction of E-selectin

In a fetal intestinal organ culture model of intestinal inflammation, activation of T cells by a lectin, superantigen or anti-CD3 antibodies induces E-selectin expression which peaks 6-10 h after activation and disappears by 24 h. We now show that addition of cyclosporin A (Cys A) increases the number of E-selectin-expressing endothelial cells and the intensity of expression, and it prolongs expression up to at least 60 h after stimulation. The dynamics of E-selectin expression on tumor necrosis factor activated human umbilical vein endothelial cell cultures is not affected by Cys A. Furthermore, other immunosuppressive agents FK506 and dexamethasone inhibit E-selectin expression, indicating that the enhancement observed in the presence of Cys A is not a consequence of general immunosuppression.

The response of cells from low-grade B-cell gastric lymphomas of mucosa-associated lymphoid tissue to Helicobacter pylori

An association has been shown between colonisation of gastric mucosa by Helicobacter pylori, acquisition of mucosa-associated lymphoid tissue (MALT), and occurrence of primary B-cell gastric MALT lymphoma. We investigated the immunological response of cells from 3 low-grade primary B-cell gastric MALT lymphomas to H pylori type NCTC 11637 and 12 isolates of H pylori from patients without lymphomas. After co-culture of tumour cells with bacteria, cells were examined for phenotypic evidence of activation and proliferation, and supernatant assayed to detect tumour-derived immunoglobulin and interleukin-2 (IL-2). Neoplastic B cells and non-neoplastic T cells proliferated, and IL-2-receptor expression by most cells in the cultures was increased with stimulating strains of H pylori. There were also increases in tumour immunoglobulin and IL-2 release when activation and proliferation were seen in response to stimulating bacteria. Removal of T cells from the tumour cell suspension reduced proliferation and IL-2-receptor expression. In comparison, no responses were seen in cells from high-grade gastric MALT lymphomas or low-grade B-cell MALT lymphomas of other sites. The response of low-grade B-cell gastric MALT lymphomas to stimulating strains of H pylori is dependent on H-pylori-specific T cells and their products, rather than the bacteria themselves.

Incorporation of ethnographic methods in occupational therapy assessment

Many constructs of interest to occupational therapists can only be studied through qualitative methods. Such constructs include meaning of activity or the illness experience and the context in which these occur. The purpose of this paper is to describe how ethnographic methods used in research can be generalized and applied to clinical practice. Ethnography is compared with other qualitative research approaches and a model clinical ethnographic assessment process is described.