A Case Report of Acute Cellular Rejection Following Intestinal Transplantation Managed With Adalimumab.

There is a higher incidence of acute cellular rejection (ACR) in small bowel transplantation (SBT) compared with transplantation of other solid organs. Although there are reports on the use of infliximab to successfully treat ACR refractory to other treatments, there are no reports, to our knowledge, regarding the use of adalimumab. We present a case of a female patient with a history of Crohn's disease who underwent an isolated SBT and developed an episode of severe ACR. She was initially treated with methylprednisolone, thymoglobulin, basiliximab, and a dosage adjustment of tacrolimus. Results of repeat endoscopies and biopsies revealed no significant improvement. The patient initiated treatment with adalimumab every 2 weeks for a total of 6 months, in addition to maintenance treatment with prednisone and tacrolimus. Subsequent evaluations showed gradual improvement to normal mucosa and villi without ulceration. A regimen that incorporates adalimumab can thus be used to treat ACR after intestinal transplantation. Larger multicenter studies are needed to show the full efficacy of this therapeutic regimen.

Platelet cyclooxygenase expression in normal dogs.

BACKGROUND: Human platelets express both cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). Variation in COX-2 expression could be a mechanism for variable response to aspirin. HYPOTHESIS/OBJECTIVES: The hypotheses were that circulating canine platelets express COX-1 and COX-2, and that aspirin alters COX expression. The objective was to identify changes in platelet COX expression and in platelet function caused by aspirin administration to dogs. ANIMALS: Eight female, intact hounds. METHODS: A single population, repeated measures design was used to evaluate platelet COX-1 and COX-2 expression by flow cytometry before and after aspirin (10 mg/kg Q12h for 10 days). Platelet function was analyzed via PFA-100(®) (collagen/epinephrine), and urine 11-dehydro-thromboxane B(2) (11-dTXB(2)) was measured and normalized to urinary creatinine. Differences in COX expression, PFA-100(®) closure times, and urine 11-dTXB(2 ): creatinine ratio were analyzed before and after aspirin administration. RESULTS: Both COX-1 and COX-2 were expressed in canine platelets. COX-1 mean fluorescent intensity (MFI) increased in all dogs, by 250% (range 63-476%), while COX-2 expression did not change significantly (P = 0.124) after aspirin exposure, with large interindividual variation. PFA-100(®) closure times were prolonged and urine 11-dTXB(2) concentration decreased in all dogs after aspirin administration. CONCLUSIONS AND CLINICAL IMPORTANCE: Canine platelets express both COX isoforms. After aspirin exposure, COX-1 expression increased despite impairment of platelet function, while COX-2 expression varied markedly among dogs. Variability in platelet COX-2 expression should be explored as a potential mechanism for, or marker of, variable aspirin responsiveness.

Shunt failure in idiopathic intracranial hypertension presenting with spontaneous cerebrospinal fluid leak.

A case of spontaneous cerebrospinal (CSF) fluid leak after ventriculoperitoneal shunt (VPS) failure in a patient with idiopathic intracranial hypertension (IIH) is reported. This is the first report of spontaneous CSF leak in an IIH patient without a history of trauma, sinus surgery, or intracranial surgery. The diagnosis was confirmed using thin-sliced post-contrast computed tomography, which revealed a micro-dehiscence of the cribiform plate at the superior aspect of the ethmoid sinus. The patient underwent VPS revision without complication, resulting in complete amelioration of symptoms and cessation of CSF rhinorrhoea at 1 year follow up.

Molecular detection of a bacterial contaminant Bacillus pumilus in symptomless potato plant tissue cultures.

An aberrant random amplified polymorphic DNA (RAPD) marker in genomic DNA of tissue culture plantlets was frequently observed during a comparison of DNA fingerprints derived from potato germplasm grown in tissue culture and the field. The RAPD marker was cloned, sequenced and determined to be of bacterial origin. A bacterial contaminant was isolated from the tissue culture plants and identified as a Bacillus pumilus. A set of sequence characterised amplified region (SCAR) primers were designed from the sequence of the cloned fragment and tested for the specific detection of B. pumilus. Polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLPs) were also used to generate B. pumilus profiles specific to our isolate in order to test and confirm the sequence homology of amplified markers generated from a range of DNA samples isolated from tissue culture plants and pure isolates of B. pumilus-like bacteria.

The structural basis for water exchange between the female cockroach (Blattella germanica) and her ootheca.

Female German cockroaches usually carry their oothecae until they hatch. The success of embryogenesis may be dependent on the water-balance relationship between females and their developing oothecae. Oothecae detached from females early in embryogenesis often fail to develop, especially in low-humidity environments. Experiments reported here using tritiated water have confirmed the transport of a significant amount of water to the ootheca from the female during embryogenesis; 18% of the tritiated water injected into gravid females was recovered in their oothecae after 24 h. We describe a structural basis of water absorption by the oothecae. An area located on the proximal end of the ootheca (adjacent to the 'escutcheon-shaped vaginal imprint') contains small pores that penetrate the oothecal covering to access regions of the chorion lying beneath these pores. Experiments using microparabiotic chambers to examine transport of tritiated water and water-soluble materials across the escutcheon region of the oothecal covering, along with dark-field birefringent microscopy of the chorion, support the hypothesis that this chorionic network is capable of conducting water throughout the interior of the ootheca. Furthermore, the structural arrangement and intimate association of the female vestibulum with the oothecal pore field contained in the region of the escutcheon-shaped vaginal imprint appear to provide an efficient conduit to the chorion. The overall structural relationship might be a means for maintaining water balance between females and their oothecae during embryonic development. Evidence presented here supports observations that this species represents an important link in the transition from oviparity to ovoviviparity by internalization of cockroach oothecae.

Study of the functional anatomy of bovine oviductal mucosa.

The oviducts of 31 cyclic cows were examined to study the structure and nature of the oviductal mucosa. The general distribution of spermatozoa within the oviductal mucosa was studied in five additional cows. The oviductal infundibulum is an asymmetric funnel-shaped structure surrounding the ostium. It is divided along the free boarder of the mesosalpinx and presents one wide and one narrow side. The mucosa of the wide side possesses a system of low interconnected cords that converge distally forming primary folds. The folds on the narrow side start sharply from the free margin and fuse toward the ostium abdominale. Areas between folds throughout the lumen of the oviduct show a high degree of complex organization. Interfold spaces are occupied by secondary and small interconnected folds which join to form a system of cul-de-sacs. In the infundibulum, these cul-de-sacs open toward the ovary, while cul-de-sacs present in the caudal isthmus and in the UTJ open toward the uterus. Marked variations were observed in the oviductal epithelium depending on the oviductal segment, basal or apical areas of the folds, and phase of the oestrous cycle. Near to the time of ovulation, numerous spermatozoa were found in the periphery of the caudal isthmus within pockets of basal interfold areas, as well as within pockets and cul-de-sacs of the tubo-uterine junction. Individual spermatozoa were also observed in peripheral areas of the ampullary-isthmic junction and ampulla. The topography of the oviduct provides a complex system of regulation which may influence not only the passage of gametes and/or embryos, but also movement of fluid within the oviductal canal.

Malignant ependymomas in a patient with Turcot's syndrome: case report and management guidelines.

BACKGROUND: Turcot's Syndrome is the association of multiple adenomatous polyps of the colon with a primary tumor of the central nervous system. We present the first reported case of Turcot's Syndrome in a patient with malignant ependymomas. Recent advances in the elucidation of the genetic basis for the hereditary forms of colon cancer have provided a clearer understanding of the etiology of Turcot's Syndrome. This new information is relevant to the neurosurgical community and provides updated guidelines in the diagnosis and management of patients with this complex disease process. RESULTS: Turcot's Syndrome is related to two distinct genetic errors. The first involves a germ-line mutation in the adenomatous polyposis coli (APC) gene, which is postulated to act as a tumor suppressor gene. The second is a germ-line defect in one of a group of genes responsible for DNA nucleotide mismatch repair. CONCLUSION: The elucidation of the gene defects responsible for the hereditary forms of colon cancer has provided a clearer understanding of the molecular basis of Turcot's Syndrome. Patients with hereditary forms of colon cancer and neurologic symptoms require immediate and thorough investigation because of their significantly increased risk of developing CNS tumors. Previously healthy patients diagnosed with a CNS tumor with a family history of adenomatous polyposis coli should undergo screening and surveillance colonoscopy as the CNS lesion may precede colonic symptoms. CNS screening guidelines for asymptomatic patients with adenomatous polyposis coli requires further risk analysis studies. All patients diagnosed with Turcot's Syndrome should be tested for the gene defect, including the CNS tumor tissue to provide further data on the genetic relationship between Turcot's Syndrome and the hereditary forms of colon cancer.

Primary solitary amyloidosis of the spine: a case report and review of the literature.

BACKGROUND: Amyloidosis is a term that encompasses a group of disorders that have as their common feature the intercellular deposition of the amyloid protein by several different pathogenetic mechanisms. Primary solitary amyloidosis, or amyloidoma, is a rare subset of amyloidosis in which the amyloid deposition is focal and not secondary to a systemic process or plasma cell dyscrasia. We present the second reported case of a cervical spine amyloidoma and discuss its presentation and management. METHODS: This 58-year-old man presented with a 1-year history of intermittent chest pain that would radiate into both legs precipitated by valsalva maneuvers. A magnetic resonance imaging (MRI) of the cervical spine revealed a homogenously enhancing lesion focally involving the C-7 vertebral level with significant spinal cord compression. He underwent combined anterior and posterior decompressive procedures with instrumentation for spinal stabilization. Histopathology revealed amyloid deposits and a systemic work-up was negative for amyloidosis. RESULTS: The patients is free of any tumor recurrence at 24 months and has a stable spine construct. CONCLUSIONS: Primary solitary amyloidosis is a rare subtype of amyloidosis which, unlike other forms of amyloidosis, has an excellent prognosis with local resection. Diagnosis requires special stains and therefore a degree of suspicion for the disease. Management of vertebral amyloidoma involves aggressive local resection of the tumor when feasible and stabilization of the spine as mandated by the degree of tumor involvement. Complete evaluation for the diagnosis of systemic amyloidosis is essential for the management and prognostication of each case.

Regeneration and transformation of Eucalyptus camaldulensis.

Reliable regeneration protocols for Eucalyptus camaldulensis using leaf explants from in vitro-grown plants have been developed. Out of the 24 clones tested 13 were regenerated and of these, 6 showed regeneration from more than 60% of the explants. Identical protocols were also successful in the regeneration of some clones of E. microtheca, E. ochrophloia, E. grandis and E. marginata, but at lower frequencies. Co-cultivation of E. camaldulensis leaf explants with Agrobacterium tumefaciens strains carrying a kanamycin resistance gene and the reporter gene ß-glucuronidase (GUS), followed by selection on kanamycin at 9 mg l-1, allowed the selection of transformed shoots that could be rooted on selective media. Transformation of the plants was verified by staining for the GUS enzyme in various plant tissues, NptII assays and by Southern blotting on isolated DNA using specific probes for both the GUS and selectable marker genes. Transformed tissue was obtained with 5 clones of E. camaldulensis tested and a number of A. tumefaciens strains. However, only 1 clone regenerated transformed whole plants reliably.

Study of the functional anatomy of bovine cervical mucosa with special reference to mucus secretion and sperm transport.

The bovine cervical mucosa was investigated with respect to structure, mucus secretory pattern, and sperm transport. Structural investigation included stereomicroscopic examination of surface-stained tissue blocks and graphic reconstruction of serial sections by using both computer-generated and Plexiglas models. Histochemistry of the mucosa was evaluated in follicular- and luteal-phase animals. Alcian blue, periodic acid Schiff, and high-iron diamine were utilized to distinguish sialomucins, sulfomucins, and neutral mucins. Location and orientation of cervical sperm in follicular phase animals were evaluated 12 h postmating by using light and electron microscopy. Cervical mucosa was characterized by longitudinal primary folds, most of which maintained continuity throughout the cervix. Superimposed on these were secondary folds which varied in length and depth. Abundant, shallow, uniformly spaced, and parallel longitudinal "grooves" covered all surfaces. Grooves had greater continuity in regions distal, as opposed to proximal, to the cervical canal. Blind-ending glands or crypts were not apparent. Follicular-stage cervices exhibited a pronounced sialomucin production in basal areas within grooves while neutral and sulfomucins were predominant in apical areas. In luteal-phase animals, basal sialomucin production was markedly decreased while sulfated and neutral mucins remained abundant. Numerous cranially oriented spermatozoa were observed within the shallow grooves of cervical folds (sialomucin-rich areas) in mated animals and were unidirectionally opposed to ciliary beat. It appeared that privileged paths for transport of viable spermatozoa may originate in the fornix vagina, extend through longitudinal primary folds at the external os, and progress to the uterus within continuous sialomucin-rich channels which are associated with basal areas of the shallow grooves, distal to the cervical canal.

Endocrine therapy testing of human breast cancers in the soft agar clonogenic assay.

The human tumor soft agar cloning assay has been used to assess the biological effects of cytotoxic drugs and other agents on human cancers. In this study we have examined the effects of two hormonal agents, tamoxifen (Tam) and medroxyprogesterone acetate (MPA), on colony growth of the MCF-7 human breast cancer cell line as well as fresh human breast cancer specimens. Using standard criteria for a colony (greater than 50 cells or greater than 60 microns in diameter) Tam (1.0 microM) reduced MCF-7 colony formation by only 30% to 50%, and MAP (1.0 microM) had no effect. However, both agents dramatically reduced the formation of larger colonies; less than 10% of colonies larger than 124 microns survived Tam exposure, and less than 25% survived with MPA. In vitro sensitivity (less than 30% colony survival) of fresh human breast cancer specimens was observed infrequently with either Tam (1/39 evaluable assays) or MPA (3/36 evaluable assays). Colony growth of human breast cancer was unaltered when cells were plated in charcoal-stripped serum to reduce the endogenous estrogen concentration. In vitro sensitivity to Tam or MPA was not increased under these conditions. No correlation was found between estrogen receptor (ER) concentration and inhibition of colony survival with Tam or MPA. None of 16 assays from ER-positive specimens treated with Tam and 2 of 18 ER-positive specimens treated with MPA were sensitive in vitro. In contrast, 2 of 12 ER-negative specimens tested with Tam and 3 of 7 ER-negative specimens tested with MPA were sensitive in vitro.(ABSTRACT TRUNCATED AT 250 WORDS)

Zinc toxicity in ruminants.

Four natural occurrences of zinc toxicity in sheep and one in calves were studied. To assist in the confirmation of a diagnosis of zinc toxicity, 2 experiments were conducted in which sheep were given toxic amounts of zinc. The clinical findings, clinical pathology, and gross and microscopic pathology are given. Clinical manifestations included inappetance, loss of condition, diarrhoea with dehydration or subcutaneous oedema, profound weakness and jaundice. Significant rises in the concentration of zinc were usually found in the liver, kidney and pancreas, but occasionally in only 1 or 2 of these organs. Many affected sheep were anaemic. Pathological changes were found in the pancreas, kidney, liver, rumen, abomasum, small intestine and adrenal gland. Lesions in the kidney and abomasum apparently made the most significant contribution to the deterioration in health of affected animals, but the pancreas was the only organ consistently affected. The degenerative changes in the pancreas were mainly restricted to the exocrine portion of the organ, and regeneration of the damaged tissue was observed although exposure to toxic amounts of zinc continued. Attention is drawn to the importance of the pancreas in the diagnosis of zinc toxicity and in estimating the period of exposure.