The observation of immunosuppressor(s) derived from cultured tumor cells and its partial neutralization with OK-432.

Malignant tumors such as brain tumors have been reported to be associated with immunosuppression caused by certain tumor-secreted cytokines. The reversion of tumor-derived immunosuppression has not been described. The use of OK-432, an immunomodulatory agent prepared from Su-strain of Streptococcus pyogenes A3, to activate peripheral blood mononuclear cells from a patient with glioblastoma multiforme has demonstrated a sharp rise in proliferative response. This proliferative response was compromised in the presence of living and irradiated autogeneic cancer cells. The conditioned media from cultured cells of glioblastoma multiforme, astrocytoma, and cholangiocarcinoma were tested for immunosuppressive ability. We found that conditioned media from 3 of 4 cases of glioblastoma, all 3 cases of astrocytoma, and 1 case of cholangiocarcinoma exhibited immunosuppressive activity toward the proliferative response of allogeneic peripheral blood mononuclear cells to phytohemagglutinin. This is the first report that cholangiocarcinoma produces soluble immunosuppressor(s). Our finding suggested that soluble substance(s) as well as direct cell-cell contact between tumor cells and mononuclear cells play roles in the observed tumor-derived immunosuppression.

Solitary rectal ulcer syndrome: two case reports.

Owing to its rarity, solitary rectal ulcer syndrome (SRUS) is often misdiagnosed as malignant ulcer, or ulcer in association with inflammatory bowel disease. We present two adult females with anorectal symptoms (i.e. pain, tenesmus and bowel habit changes). Both had normal levels of serum carcinoembryonic antigen. Barium enema revealed irregular mucosa with stricture of the lower rectum. An ulcer, 2.7 cm in diameter, was found in one patient but not the other. Rectal biopsy under sigmoidoscopy demonstrated non-specific inflammation, without evidence of malignancy. Because of the intractable symptoms and the inability to discriminate between malignant and benign conditions, exploratory laparotomy was performed, followed by low anterior resection of the rectum. Histological examination of both specimens showed submucosal rectal fibrosis with a non-specific ulceration in one. These findings were compatible with SRUS. The patients' symptoms improved dramatically after the resection and they remain well, five months and one year after surgery. Awareness of this rare anorectal condition is necessary for appropriate management particularly to avoid unnecessary abdomino-perineal resection.

Autonomic function test in patients with obstructive jaundice.

Objective : To investigate whether there is a dysfunction of the cardiovascular autonomic control in Jaundiced patients, which may be the cause of increased susceptibility to hypotensive crisis during surgery in these patients. Methods : Cardiovascular autonomic function was evaluated and compared in 17 patients with obstructive jaundice and 14 normal subjects. The tests performed were) postural blood pressure response, 2) postural heart rate response, 3) deep breathing, 4) valsalva maneuver, and 5) handgrip exercise. Results : No statistically significant difference was found between the patient and the control groups in all five tests. Conclusion : The autonomic nervous system of patients with obstructive jaundice is normal compared to the control group. However, further study is needed to confirm the lack of effect of jaundice on the autonomic nervous system in affected individuals.

Splenic abscess at Siriraj Hospital, Thailand.

Splenic abscess is an unusual disease and may be presented either as a localized area of infection in the spleen or as a part of generalized sepsis. Population-based autopsy studies have established the incidence of splenic abscess at between 0.2-0.7 per cent. An eleven-year retrospective study of cases of splenic abscess treated at Siriraj hospital, a total of 9 cases, is presented. Pseudomonas pseudomallei is the most frequent causative agent, found in one-third of the cases, especially if the patient is thalassemic or a resident in the Northeastern part of the country. Thalassemia is also the leading predisposing condition of this malady with the incidence of 33 per cent. There are some differences in the presenting clinical features in Thai patients compared with those reported in the literature. Splenectomy was performed in all but one who died of leukemia preoperatively. The mortality rate of this disease in this series is 11 per cent and we recommend splenectomy under antibiotic coverage as soon as the diagnosis of splenic abscess has been confirmed.