Accumulation of human EGF in nectar of transformed plants of Nicotiana langsdorffii x N. sanderae and transfer to honey by bees.

Honey has been used successfully in wound healing for thousands of years. The peptide hormone human epidermal growth factor (hEGF) is also known to have a beneficial effect in various wound healing processes via mechanisms that differ from those for honey. In this study, we show that hEGF can be incorporated into honey via nectar. Plants of Nicotiana langsdorffii x N. sanderae were transformed with the gene for hEGF, equipped with a nectary-targeted promoter and a signal sequence for secretion to nectar. These plants accumulated hEGF in the nectar. The maximum hEGF concentration recorded with ELISA in these plants is 2.5 ng·ml⁻¹. There is a significant linear relationship (P<0.001) between hEGF concentration and induction of hEGF-receptor phosphorylation. Since the flower morphology of these plants did not allow production of honey from their nectar, we used feeding solutions, spiked with synthetic hEGF, to study transfer of this peptide into honey through bee activity. Transfer of hEGF from a feeding solution to honey by bees occurred with retention of the hEGF concentration and the capacity to induce hEGF-receptor phosphorylation. These observations indicate that plants can function as a production platform for honey containing biologically active peptides, which may enhance wound healing and other biological processes.

Cutaneous histoplasmosis in AIDS.

A patient with human immunodeficiency virus (HIV) infection presented with multiple cutaneous lesions on upper extremities, trunk, face and with ulcers involving oral mucosa. Histoplasma capsulatum was isolated in culture from scrapings from both cutaneous as well as oral mucosal lesions. The patient responded well initially to the treatment with Amphotericin B followed by itraconazole; however, lesions recurred after three months with the further deterioration of immune status of the patient indicated by decline in CD4 counts. The same treatment was restarted and the patient is still being followed-up.

Effective biomodulation by leucovorin of high-dose infusion fluorouracil given as a weekly 24-hour infusion: results of a randomized trial in patients with advanced colorectal cancer.

PURPOSE: To determine whether high-dose infusional fluorouracil (FU) is effectively modulated by leucovorin (LV), interferon (IFN) alpha-2b, or both when given to patients with metastatic colorectal cancer. PATIENTS AND METHODS: Patients (n = 236) with progressive, measurable disease were randomized to three groups and received FU 2,600 mg/m2 as a 24-hour continuous infusion (CI) weekly for 6 weeks with 2 weeks rest (FU24h) and LV 500 mg/m2 as a 2-hour infusion before FU or IFN 3 x 10(6) U subcutaneously 3 times weekly or both. Treatment continued until progressive disease or unacceptable toxicity was observed. Pairs of treatment arms were analyzed sequentially to detect equivalence or a 25% difference in response rates. RESULTS: The rate of objective remission in patients who received FU24h/LV (44%; 40 of 91) was significantly higher than in patients who received FU24h/IFN (18%; 16 of 90; P < .05). The response rates of patients who received FU24h/LV versus FU24h/LV/IFN (27%; 13 of 49) were statistically equivalent. Significant differences were observed for time to tumor progression (TTP) (FU24h/LV, 7.1 months; FU24h/IFN, 3.9 months; FU24h/LV/IFN, 6.3 months; global P value < .009) and survival (16.6 months, 12.7 months, 19.6 months, respectively; global P value < .04). Unpredictable and life-threatening toxicity in the FU24h/LV/IFN arm required dose reduction of FU to 2,000 mg/m2/day and early stoppage of this arm. Toxicity was manageable in patients who received both FU24h/LV (grade 3 to 4 diarrhea, 21%) and FU24h/IFN (grade 3 to 4 diarrhea, 15%). CONCLUSION: Response rate, TTP, and overall survival were superior for LV-containing regimens compared with IFN modulation alone. The addition of IFN to high-dose infusional FU plus LV offers no advantage and may increase toxicity. The regimen of high-dose infusional FU24h/LV warrants further evaluation in patients with metastatic colorectal cancer.

A placebo-controlled study of intravesical pentosanpolysulphate for the treatment of interstitial cystitis.

OBJECTIVE: To evaluate the therapeutic efficacy of intravesical pentosanpolysulphate (PPS) compared with placebo in patients with interstitial cystitis (IC). PATIENTS AND METHODS: Twenty patients who fulfilled the diagnostic criteria for IC participated in a double-blind placebo-controlled study; 10 received intravesical PPS (300 mg in 50 mL of 0.9% sodium chloride) applied twice a week for 3 months and the other 10 received a placebo. Symptomatic relief and objective variables (bladder capacity voiding volumes and urinary frequency) were assessed after 3 months and the long-term outcome of those continuing treatment was determined. RESULTS: Of the patients treated with PPS, four gained significant symptomatic relief compared with only two receiving placebo. Only the urodynamic bladder capacity showed a statistically significant increase in patients treated with PPS (P = 0.047). At 18 months from the start of the study, the symptoms were relieved in eight patients while still receiving PPS instillations and in four without treatment. CONCLUSIONS: These results suggest that intravesical PPS is an effective option for the treatment of IC and shows that the intravesical application of PPS is a safe treatment with no important side-effects.

Is the diet of patients with interstitial cystitis related to their disease?

OBJECTIVE: The dietary habits of interstitial cystitis (IC) patients compared to the average food and fluid consumption of the general population were evaluated and any spontaneous preference or avoidance of specific foodstuffs and fluids of IC patients was investigated. METHODS: A verbal interview with 16 IC patients provided information on the consumption of foodstuffs and fluids as well as dietary habits. Prior to the dietary interview none of the IC patients were aware of any possible dietary measures in relation to their IC symptoms. The results were compared to the averages of the general population. RESULTS: IC patients consumed statistically significantly less calories and fat (p < 0.05), and statistically significantly more fibers (p < 0.01) than the general population. Among the IC patients there were significantly fewer consumers of coffee (p < 0.01) and significantly more consumers of (herbal) tea (p < 0.05). The difference in orange juice consumption was not significant. CONCLUSIONS: According to general standards, IC patients had a more healthy daily diet than the general population. The observation that IC patients consumed less coffee (caffeine) than the general population is consistent with previous reports on irritative IC symptoms exacerbating after caffeine consumption. No rationale for other dietary or fluid intake changes was found.

Increased urinary levels of Tamm-Horsfall glycoprotein suggest a systemic etiology of interstitial cystitis.

PURPOSE: We investigated the role of Tamm-Horsfall protein in interstitial cystitis. MATERIALS AND METHODS: Urinary Tamm-Horsfall protein excretion was analyzed in interstitial cystitis patients and controls, and bladder biopsy specimens were stained immunohistochemically for Tamm-Horsfall protein. RESULTS: Urinary Tamm-Horsfall protein levels in 28 women with interstitial cystitis were statistically significantly greater than those in 25 female controls. No positive staining for Tamm-Horsfall protein was demonstrated in the bladder tissue from 10 interstitial cystitis cases. CONCLUSIONS: The results support the notion that interstitial cystitis may have a systemic etiology. In addition, this assay might have clinical value in the diagnosis of interstitial cystitis.

Interstitial cystitis in The Netherlands: prevalence, diagnostic criteria and therapeutic preferences.

PURPOSE: We determine the prevalence of interstitial cystitis in The Netherlands, and analyze the most common diagnostic and therapeutic approaches among Dutch urologists. MATERIALS AND METHODS: A questionnaire was completed by urologists and analyzed with the help of a statistical computer program. RESULTS: The prevalence of interstitial cystitis was calculated to be 8 to 16/100,000 female patients. Pathology of bladder biopsies and the presence of mast cells were the main diagnostic criteria. Dimethyl sulfoxide instillations, bladder hydrodistension and surgery were the most frequently applied therapies. CONCLUSIONS: The prevalence of interstitial cystitis in The Netherlands is in line with that of other reports from Europe but low compared to the United States findings. The importance of pathology and the presence of mast cells in the diagnosis, as well as less awareness might contribute to this difference.

A pelvic mass: bladder diverticulum with haemorrhage in Ehlers-Danlos patient.

We report on a case of haemorrhage in a large bladder diverticulum, impressing as a pelvic mass, in a patient with the Ehlers-Danlos syndrome. A review of the literature revealed 14 other cases of bladder diverticula and the Ehlers-Danlos Syndrome. Conservative treatment is first choice, unless complications occur.

The Hartmann procedure, five years' experience.

During a 5-year period (1985-1990) a Hartmann procedure was performed in 66 patients. Retrospective analysis was done to analyse circumstances influencing mortality, restoration of bowel continuity, prognostic value of per-operative peritonitis and results of open wound treatment. Thirteen patients (19.6%) died post-operatively. Colorectal continuity was subsequently restored in 27 patients of 44 potential candidates (61%). Peroperative purulent or faecal peritonitis and acute diverticulitis was found to significantly influence (p < 0.05) the mortality rate. Resection below the sigmoid level gave a significant lower frequency of reanastomosis. Open wound treatment in selected patients proved to be effective: only two (3.0%) cases of wound infection were seen in 66 patients.

Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988.

BACKGROUND: Cardiogenic shock resulting from acute myocardial infarction is a serious complication with a high mortality rate, but little is known about whether its incidence or outcome has changed over time. As part of an ongoing population-based study of acute myocardial infarction, we examined trends over time in the incidence and mortality rate of cardiogenic shock after acute myocardial infarction. METHODS: We studied 4762 patients with acute myocardial infarction who were admitted to 16 hospitals in the Worcester, Massachusetts, metropolitan area between 1975 and 1988. We determined the incidence of and short-term and long-term mortality due to cardiogenic shock in each of six years during this study period. RESULTS: The incidence of cardiogenic shock complicating acute myocardial infarction remained relatively constant, averaging 7.5 percent. Multivariate regression analysis that controlled for variables affecting incidence revealed significant though inconsistent temporal trends in the incidence of cardiogenic shock. As compared with the risk in 1975, the adjusted relative risk (with 95 percent confidence interval) was 0.83 (0.54 to 1.28) in 1978, 0.96 (0.63 to 1.48) in 1981, 0.68 (0.42 to 1.12) in 1984, 1.16 (0.70 to 1.92) in 1986, and 1.65 (0.99 to 2.77) in 1988. The overall in-hospital mortality rate among patients with cardiogenic shock was significantly higher than that among patients without this complication (77.7 percent vs. 13.5 percent, P less than 0.001). The in-hospital mortality among the patients with shock did not improve between 1975 (73.7 percent) and 1988 (81.7 percent). Long-term survival during the 14-year follow-up period was significantly worse among patients who survived cardiogenic shock during hospitalization than among patients who did not have shock (P less than 0.001). CONCLUSIONS: The results of this observational, community-wide study suggest that neither the incidence nor the prognosis of cardiogenic shock resulting from acute myocardial infarction has improved over time. Both in-hospital and long-term survival remain poor for patients with this complication.

[2 cases of primary sclerosing cholangitis--the ERCP documentation of a 3-year course of immunosuppressive therapy]. / Zwei Fälle einer primär sklerosierenden Cholangitis--ERCP-Dokumentation eines 3-jährigen Verlaufs unter immunsuppressiver Therapie.

X-ray characteristics of two cases of primary sclerosing cholangitis are described. A discussion of clinical, immunological and histological features of the disease and the 3-years progress of a 40 year old man during treatment with immunesuppressive therapy (Imurek at the beginning with cortison) is shown. The stop of the progression of the disease is supposed.