Listeria monocytogenes peritonitis: an unusual presentation and review of the literature.

Listeria monotogenes bacteria-ascites developed in a 73-year-old man who had cholangiocarcinoma and liver metastasis. Spontaneous bacterial peritonitis (SBP) is a frequent complication in patients with chronic liver disease and ascites. L. peritonitis has been reported in only <30 cases world-wide. Our patient represents a unique case of L. peritonitis without peritoneal fluid analysis consistent with spontaneous bacteria peritonitis. However, the culture of the ascitic fluid provided the final diagnosis in this case.

The diagnostic value of electron microscopy in human immunodeficiency virus-positive patients with gastrointestinal disease.

BACKGROUND: Our aim was to determine the diagnostic value of electron microscopy in evaluating the etiology of gastrointestinal disease in patients infected with the human immunodeficiency virus (HIV). METHODS: A retrospective review of electron microscopic and light microscopic results of all HIV-positive patients with gastrointestinal and liver diseases was made during a 3-year period from June 1995 to June 1998. RESULTS: A total of 145 HIV-positive patients had their electron microscopy specimens reviewed. Of these, 136 were investigated for diarrhea, and the other 9 for increased liver enzymes. Twenty-seven of the 145 (18.6%) HIV-positive patients had a pathogen identified by electron microscopy, compared with only 13 of 145 (9%) identified by light microscopy (P < 0.005). The sensitivity of light microscopy for detecting opportunistic pathogens was 68%. Twenty-one of the 27 (77.8%) patients diagnosed by electron microscopy had microsporidiosis, and the most commonly diagnosed species was Enterocytozoon bieneusi. Light microscopy failed to identify 12 cases of microsporidiosis and 2 cases of leishmaniasis. CONCLUSIONS: Electron microscopy contributes substantially to the identification of pathogens in HIV-positive patients. Light microscopy failed to identify one of every two pathogens diagnosed by electron microscopy.

A Brunner's gland adenoma as a cause of anemia.

Benign tumors of the small bowel are rare. They present with many different manifestations depending on the size and location, and also cause a variety of symptoms that are often nonspecific. These include abdominal pain, dyspepsia, nausea, vomiting, and gastrointestinal bleeding that may be melena or hematemesis. Most of the time patients are asymptomatic and the lesions are discovered as an incidental finding. When bleeding occurs, and it may be severe in certain situations, the patient may develop signs of anemia, such as dyspnea, fatigue, and even high-output cardiac failure. The authors present a patient who was evaluated for melena and who was found to have a duodenal polyp that proved to be a Brunner's gland adenoma on pathology.

Esophageal infections: etiology, diagnosis, and management.

With the advent of transplantation and the acquired immunodeficiency syndrome (AIDS), esophageal infections are now a common medical problem. The most common infections involving immunocompromised nonhuman immunodeficiency virus (HIV)-infected patients include viral disease (herpes simplex virus and cytomegalovirus) and Candida. In HIV-infected patients, Candida esophagitis is by far the most common infection; viral disease is seen less frequently. In contrast to other immunocompromised patients, these patients may have esophageal disease from a variety of other fungi and viruses. Immunocompromised patients in whom esophageal symptoms develop after transplantation usually undergo endoscopy for diagnosis because of the possibility that alterations in immunosuppressive agents will be required if an opportunistic infection is causative. In contrast, HIV-infected patients with new-onset esophageal symptoms are usually treated empirically with oral systemic antifungal therapy given the prevalence of Candida esophagitis. Barium esophagography may, however, be worthwhile, depending on the clinical setting, such as the possibility of a reflux-induced stricture. In HIV-infected patients, radiography is less often utilized in the setting of a low CD4 lymphocyte count given the likelihood of an opportunistic infection that requires endoscopic biopsy for a definitive diagnosis. Oral systemic antifungal therapy with either ketoconazole or fluconazole is very effective for the treatment of Candida esophagitis, and these agents have also shown efficacy in the prophylaxis of fungal infections following transplantation, as well as in patients with AIDS following oropharyngeal and esophageal candidiasis. Antiviral therapy with acyclovir for herpes simplex virus and ganciclovir and foscarnet for cytomegalovirus are effective. The efficacy rate for these antiviral agents appears similar in all immunocompromised patients. These agents have also been utilized prophylactically following transplantation. In summary, a variety of infections may involve the esophagus in immunocompromised patients. The diagnostic strategies utilized in these patients are similar; endoscopy and biopsy are the most cost-effective strategy given the need for mucosal biopsy for a definitive diagnosis. Importantly, efficacious therapy is available to treat these disorders. Nevertheless, in patients with AIDS, identification of an opportunistic esophageal disease portends a poor prognosis.

Characterization of human LH isohormones from fresh pituitary tissue.

The pattern of human LH (hLH) microheterogeneity was determined using freshly obtained pituitary tissue. Chromatofocusing across a pH 9-6 gradient produced several, distinct peaks of hLH immunoreactivity between pH 8.5 and 6.8, as well as a 'salt peak'. Chromatofocusing of the 'salt peak' across a pH 7-4 gradient yielded distinct peaks of hLH at pH 6.1, 5.6, and 5.4. Pituitary tissue obtained at surgery produced a virtually identical pattern. By gel filtration the elution volume of each major chromatofocusing peak was similar to that of intact hLH, rather than those of the hLH subunits. The bioactivity/immunoreactivity ratios of the major chromatofocusing peaks fell dramatically with decreasing pH, from approximately 8 at pH 8.5 to approximately 1 at pH less than 6. These results indicate that human pituitary LH exists in multiple, isomeric forms that differ markedly in charge and bioactivity. These differences appear to be inherent in the native, intact molecules and not the result of autolysis or of dissociation into subunits.