T lymphocytic and immature macrophage alveolitis in active pulmonary tuberculosis.

The phenotype of bronchoalveolar cells from 11 healthy subjects and from affected and unaffected lungs of 15 patients with pulmonary tuberculosis (PTB) was determined. An immature macrophage alveolitis was found in the affected lung and the unaffected lung versus controls as determined by morphology and peroxidase activity. T lymphocytic alveolitis also was found in the affected but not the unaffected tuberculous lung compared with healthy controls. The majority of alveolar lymphocytes in unaffected and affected PTB lungs were T cells expressing the alpha beta T cell receptor. Alveolar T cells from both unaffected and affected lungs were activated, as determined by increased expression of CD69 and HLA-DR. Interleukin-2 receptor (IL-2R alpha) expression was, however, unchanged on alveolar lymphocytes from affected lung and was decreased in the unaffected lung. Thus, activated T lymphocytes and immature macrophages in the tuberculous lung are basic to the local immunopathogenesis of PTB.

Lactose enemas plus placebo tablets vs. neomycin tablets plus starch enemas in acute portal systemic encephalopathy. A double-blind randomized controlled study.

A randomized, double-blind comparison of lactose enemas plus placebo tablets vs. starch enemas plus neomycin tablets was performed on 18 patients with acute portal systemic encephalopathy. Ten patients received starch enemas (10%; 1000 ml t.i.d.) plus neomycin tablets and 8 patients received lactose enemas (20%; 1000 ml t.i.d.) plus placebo tablets. A significant mental state improvement was demonstrated in the group of patients treated with starch enemas-neomycin tablets (p less than 0.05) and in the group of patients treated with lactose enemas-placebo tablets (p less than 0.025). Both treatments significantly improved the frequency of asterixis, ammonia blood levels, and electroencephalograms. In addition, patients treated with lactose enemas showed significant improvement in number-connection test times (p less than 0.02), and their stools showed a more acid pH (p less than 0.05). No side effects were evident with either treatment. Lactose enemas are a safe and effective treatment for acute portal systemic encephalopathy.

Decreased bioavailability of prednisone due to antacids in patients with chronic active liver disease and in healthy volunteers.

To investigate the potential action of antacids on prednisone absorption and on prednisolone serum levels, we studied 5 healthy volunteers and 12 patients with chronic active liver disease. Six patients responded to treatment and 6 did not. After administering two 5-mg tablets of prednisone with 60 ml of water, 60 ml of Melox (AlOH 3.75 g/100 ml + MgOH 4.0 g/100 ml), or 60 ml of Aldrox (AlOH 8.0 g/100 ml + MgOH 1.95 g/100 ml), we measured prednisolone by radioimmunoassay. Both peak heights and areas under the serum-concentration curves were significantly reduced when prednisone was administered with antacids. The relative bioavailability of prednisone after prednisone-antacid treatments compared to that after prednisone-water treatment was 74% +/- 13% (p less than 0.05) with Melox and 57% +/- 15% (p less than 0.01) with Aldrox in healthy volunteers. In patients with chronic active liver disease responding to treatment, prednisone bioavailability was 65% +/- 120% (p less than 0.01) and 87% +/- 20%, respectively. Among patients with chronic active liver disease not responding to treatment, this parameter was 76% +/- 12% (p less than 0.05) and 80% +/- 21% (p less than 0.05), respectively. To insure adequate prednisolone levels in patients with chronic active liver disease, prednisone should not be given simultaneously with antacids.

[Furosemide-amiloride combination in the treatment of ascitic-edema in patients with hepatic cirrhosis]. / Uso de la combinación furosemida-amilorida en el tratamiento de la ascitis-edema en pacientes con cirrosis hepática.

The combination of furosemide-amiloride was used in the management of fluid retention in 16 cirrhotic patients. The study lasted 60 days. In 15 out of the 16 patients a clinical response was observed, namely increased urinary volumen and reduction of abdominal girth. The body weight was reduced by a mean of 7.7 Kg. Serum potassium rose, within normal limits, in 14 patients and a reduction of urinary potassium elimination was observed. Mild hepatic encephalopathy was noticeable in 3 cases, rapidly responding to treatment reduction or withdrawal. The combination of furosemide-amiloride seems to be of value in the management of fluid retention in liver cirrhosis and is uncommonly associated to side effects.