Recanalization of iatrogenic dissection of the superior mesenteric artery: a case report.

We present a case of acute abdominal pain due to a long-segment iatrogenic superior mesenteric artery dissection, which was immediately treated successfully with balloon fenestration of the intimal flap, resulting in complete resolution of the symptoms without recurrence during the 2-year follow-up period.

A study on bone mineral density in patients with Crohn's disease.

Decreased bone mineral density is a complication to which we should always pay attention in the treatment of Crohn's disease (CD). However, there is still no clear consensus with regard to evaluation methods and the appropriate observation period for its detection. In the present study, we measured the bone mineral density of 30 CD patients who were treated at the outpatient clinic of our institution and investigated its relationship with various clinical characteristics including sex, age, duration of illness, history of enterectomy, total steroid consumption, body weight, and body mass index (BMI) and with bone metabolism markers. A decreased bone mineral density was detected in 9 patients (30%). The bone mineral density did not correlate with total steroid consumption, but showed a negative correlation with the Crohn's disease activity index (CDAI).When bone metabolism markers were investigated, the bone mineral density showed a negative correlation with Glu-osteocalcin (Glu-OC) and serum type I collagen cross-linked N-telopeptide (NTx) in patients with a low bone mineral density. Based on these results, the decrease of bone mineral density in CD patients was considered to the underlying disease itself. Therefore, control of disease activity is very important in CD patients, and periodic measurement of bone mineral density in combination with bone mineral markers (Glu-OC and serum NTx) may be useful for predicting a decrease of bone mineral density.

MDR1 mRNA expressions in peripheral blood mononuclear cells of patients with ulcerative colitis in relation to glucocorticoid administration.

Overexpression of multidrug resistance (MDR) protein, P-glycoprotein (P-gp), on lymphocytes has been suggested to be implicated in the failure of glucocorticoid (GC) therapy in patients with ulcerative colitis (UC). However, whether the overexpression of P-gp in a class of patients with inflammatory bowel disease (IBD) is intrinsic or related to the administration of GC is unknown. Relative amounts of MDR1 mRNA expressed in peripheral blood mononuclear cells (PBMCs) were measured using the reverse-transcriptase polymerase chain reaction (RT-PCR) technique in 25 UC patients having no history of GC administration, 25 UC patients having experienced GC therapy, 19 patients with Crohn's disease (CD) with no history of GC therapy, and 27 healthy subjects. Relative amounts of MDR1 mRNA expressed in PBMCs were compared among the groups. The relationship between the amounts of MDR1 mRNA expressed, as well as the total dose of GC administered or the period of GC therapy in UC patients, was examined. The relative amounts of MDR1 mRNA expressed in PBMCs were not significantly different between the healthy subjects and CD patients or UC patients having no history of GC therapy. However, the mean MDR1 mRNA amount in PBMCs of UC patients having experienced GC therapy was significantly greater than that in PBMCs of UC patients with no history of GC administration (p = 0.0375). The amounts of MDR1 mRNA in PBMCs of UC patients having experienced GC therapy significantly correlated with the total dose of GCs administered (p = 0.0175). Overexpression of MDR1 mRNA in PBMCs of IBD patients is not intrinsic. However, high-dose administration of GCs for the treatment of UC may result in an increased expression of MDR1 mRNA, which may impair successful GC therapy in these patients.

Comparison of four microbial enzymes in Clostridia and Bacteroides isolated from human feces.

The activities of four microbial enzymes (azoreductase, nitroreductase, beta-glucuronidase, and beta-glucosidase) in major anaerobic members of human fecal microflora were quantified and the influence of the host factors on expression of these microbial enzyme activities was also investigated. Clostridium paraputrificum and C. clostridiiforme showed much higher activities than other fecal anaerobes tested. Nitroreductase activity in C. paraputrificum isolated from fecal specimens of patients with colon cancer was significantly (P < 0.05) higher than that in the clostridia isolated from healthy subjects and the subjects given high beef diets. However, the activities of some microorganisms tested showed marked differences in each strain.

Immunosuppressant pharmacodynamics on peripheral-blood mononuclear cells from patients with ulcerative colitis.

We investigated peripheral-blood mononuclear cell (PBMC) response to immunosuppressive drugs and its influence on glucocorticoid therapy in ulcerative colitis (UC). IC50s of immunosuppressive drugs on in vitro blastogenesis of PBMCs stimulated with concanavalin A were estimated in 76 UC and 146 healthy subjects. Individual differences in IC50s for prednisolone, methylprednisolone, cyclosporine, and tacrolimus on blastogenesis of PBMCs from UC patients were spread from 11.0 to 1000, 0.6 to 1000, 0.01 to 1000, and 0.001 to 4.6 ng/ml, respectively. Normal upper thresholds for IC50s of these drugs were estimated from the mean + 2 S.D. of the IC50s of healthy PBMCs, and the patients exhibiting IC50s over these levels were arbitrarily considered as resistant. The incidences of resistance to glucocorticoids and cyclosporine in UC were significantly higher than those in healthy subjects (p < 0.0005). In 14 UC patients, there was a significant correlation between amounts of prednisolone (p < 0.05) or period of prednisolone administration (p < 0.05) for UC treatment and prednisolone IC50. The results showed that large individual deviations in PBMC response to the drugs were observed in UC, and UC patients exhibiting low PBMC sensitivity to prednisolone required a high prednisolone amount as well as long period of prednisolone administration for treatment. Thus, the drug sensitivity tests could be informative to single out refractory patients to the immunosuppressive therapy.

Expression of mRNA for glucocorticoid receptors in peripheral blood mononuclear cells of patients with Crohn's disease.

BACKGROUND: The amount of glucocorticoid (GC) receptors (GR) in immune cells might be critical for successful GC treatment of patients with Crohn's disease (CD). However, little is known about the expression of GR in CD; therefore, we carried out quantitative analyses for GR messenger (m)RNA expression in peripheral-blood mononuclear cells (PBMC) of CD. METHODS: Seventeen patients with CD and 33 healthy subjects entered into this study. We measured the GRalpha mRNA level in the PBMC of these subjects by a reverse transcription-competitive polymerase chain reaction procedure. Relative amounts for GRbeta mRNA were obtained semiquantitatively. RESULTS: The amounts of GRalpha-mRNA in the CD patients and healthy subjects were 0.053 +/- 0.052 and 0.130 +/- 0.108 (copies/copies of beta-actin mRNA), respectively. The former value was significantly lower than that of the latter (P < 0.01). The rates of the CD patients and healthy subjects expressing GRbeta-mRNA in PBMC were 41.2% and 45.5%, respectively, and there was no significant difference in the rates between the two groups (P = 0.339). However, the relative amounts of GRbeta-mRNA in the PBMC were estimated to be 1.053 x 10-5 +/- 2.540 x 10-5 for the CD patients, and 1.872 x 10-5 +/- 3.252 x 10-5 (fluorescence intensity/copies of beta-actin mRNA) for the healthy subjects, and the former was significantly smaller than the latter (P < 0.05). Moreover, there was an inverse correlation between the duration of disease (year) and the amounts of GRalpha-mRNA in the PBMC of the CD patients (P < 0.05). CONCLUSIONS: The amounts of GRalpha-mRNA and GRbeta-mRNA in the PBMC of the CD patients were lower than those of the healthy subjects. The duration of disease correlated with decreased amounts of GRalpha-mRNA in the PBMC. Furthermore, the clinical significance of the GR-mRNA status in the PBMC remains to be elucidated.