[Chylous ascites following resection of abdominal aortic aneurysm]. / Puchlina mleczowa po zabiegu resekcji tetniaka aorty brzusznej.

Chylous ascites is an extremely rare complication of abdominal aortic surgery. We report on a case of chyloperitoneum following resection of aortic aneurysm. The diagnosis of lymphatic tear was confirmed by paracentesis which revealed milky fluid characterized by very high content of triglicerydes. Conservative management with a low-fat diet and diuretics resulted in a successful outcome.

[Angiomatosis of the liver]. / Naczyniakowatosc watroby.

Cavernous haemangioma of the liver is the most frequently observed benign hepatic tumour. Polyangiomatosis is a great rarity, and in view of the similarity to metastatic tumours, it is a serious diagnostic problem. In the paper three cases are described of polyangiomatosis of the liver diagnosed on the basis of abdominal ultrasonography. Final diagnosis was made analysing USG, CT, scintigraphy with labelled erythrocytes, and laparoscopy. In all described cases, despite significant enlargement of the liver containing multiple hemangiomas, no features indicating liver damage were found in the laboratory investigations. This seems to be an important diagnostic indicator in the diagnosis of this disease.

[Static and dynamic scintigraphy of the liver using labeled erythrocytes in the diagnosis of hepatic hemangioma]. / Statyczna i dynamiczna scyntygrafia watroby znakowanymi krwinkami czerwonymi w diagnostyce naczyniaków watroby.

In order to find hemodynamic differences between hemangioma (n = 10) and other tumours of the liver (n = 15) dynamic angioscintigraphy and late vascular scintigraphy of the liver were performed. Late vascular scintigraphy has revealed focal cumulation of the labelled erythrocytes in 7 hemangiomas of the diameter of 35 mm, 3 hemangiomas below this size have not been diagnosed with this technique. Beside hemangiomas, a focus of erythrocytes cumulation was found also in the hepatocellular adenoma. Arterial blood supply to hemangioma was significantly higher, than that in the malignant tumours of the liver (54.6% vs 31.7%). Other parameters of the early phase of angioscintigraphy have no diagnostic value in the differentiating the hepatic tumours. Vascular scintigraphy of the liver proved to be a valuable technique in the diagnosis of large hemangiomas only.

[Comparison of salicylazosulfapyridine bioavailability following oral and rectal administration in patients with ulcerative colitis]. / Porównanie biologicznej dostepnosci salicylazosulfapirydyny po podaniu doustnym i doodbytniczym u chorych na wrzodziejace zapalenie jelita grubego.

Salicylazosulfapyridine--a drug commonly used in the ulcerative colitis--is effective following both oral and rectal administration. Pharmacokinetics of the drug given per rectum (in the form of suppositories) has not been investigated so far. The present study aims at comparing bioavailability of salicylazosulfapyridine following oral and rectal administration to patients with the ulcerative colitis and healthy volunteers. It was found, that following rectal administration the drug is not so readily absorbed as in oral dosage form. No sulfapyridine and 5-aminosalicylic acid have been detected in blood serum, when the drug was given in the form of rectal suppositories. Clinical stage of the disease did not affect absorption of both unchanged drug and its metabolites. Due to the fact, that the drug is active locally, rectal suppositories seem a therapeutical alternative in patients only with lesions localized in the rectum.

Effect of nifedipine on interdigestive gallbladder volume and postprandial gallbladder emptying in man.

The effect of two oral doses (10 and 20 mg) of nifedipine versus placebo on the fasted gallbladder volume and on the meal-induced gallbladder emptying was assessed according to a double-blind study protocol in 12 healthy volunteers. Eight subjects underwent three studies (with placebo and with both nifedipine doses), whereas in two subjects the effect of a 10-mg nifedipine dose vs placebo and in two others the effect of a 20-mg nifedipine dose vs placebo was examined. The studies were performed on separate days, and the gallbladder volume was measured by means of real-time ultrasonography. Neither placebo nor 20 mg nifedipine per os elicited any significant change in the fasted gallbladder volume. With 10 mg nifedipine per os a significant increase in the interdigestive gallbladder volume was observed: 22.9 +/- 2.9 cm3 before and 26.2 +/- 3.2 cm3 after the drug receipt (P less than 0.005). A trend towards an inhibition of the postprandial gallbladder emptying was observed with 10 mg nifedipine per os without, however, reaching the level of statistical significance. Following 20 mg nifedipine per os, a marked delay in the meal-stimulated gallbladder emptying occurred, as reflected by a decrease in the gallbladder ejection fraction from 48.1 +/- 4.5% (placebo) to 26.4 +/- 5.0% (nifedipine) (P less than 0.02) at 30 min and from 54.0 +/- 3.6% (placebo) to 33.2 +/- 4.6% (nifedipine) (P less than 0.02) at 40 min after the test meal. We conclude that a therapeutic oral dosage of nifedipine has a significant relaxing effect on the human gallbladder.

Factor XIII subunits in relation to some other hemostatic parameters in ulcerative colitis.

The hemostatic parameters, particularly with respect to F.XIII subunits, were examined in 48 untreated UC patients (22 at active and 26 at quiescent stage). UC active patients showed a significant decrease of F.XIII subunit "a," compared with healthy subjects, as well as in UC patients in remission. In contrast, the level of F.XIII subunit "b" in each group was similar. Compared with normal subjects, UC active patients revealed a significant decrease in AT III concentration, prolonged ELT, and elevated fibrinogen level. In addition, the elevated titer of SDPS test for SFMC appeared in approximately 40% of those patients. However, no strict relationship was found between the presence of positive SDPS and diminution of AT III, as well as of F.XIIII subunit "a" in active UC state. In patients in remission, AT III level and ELT were similar to those as in the control group, but fibrinogen concentration was elevated. Such constellation of hemostatic parameters may indicate a tendency to blood hypercoagulability in UC active patients, whereas, in general, these changes are not associated with the stage of remission. The present data may also suggest that F.XIII behavior pattern should be taken into account in the clinical management of UC.

Neutrophil function in chemical plant workers employed in the production of dust pesticides.

In two divisions of a chemical plant producing dust pesticides, employees exposed to dust, containing 28%-65% SiO2, were examined. In the first division (group I, 38 males and 35 females), the average air dust concentration was 5.0 mg/m3, and the active substances were: chlorinated hydrocarbons, captan, carbamates and dodine. In the other division (group II, 26 males and 33 females), the air dust concentration was 4.8-5.2 mg/m3, and the active substances included: carbamates, triazine compounds, cupric oxychloride, captan, lindane, carboxine. Spirographic investigations showed signs of pulmonary emphysema (RV/TLC) in 65.8% males and 60% females of group I and 38.5% males and 40.6% females of group II. In leucocyte concentrate smears, the cytochemical reactions to beta-glucuronidase, acid phosphatase and myeloperoxidase, as well as the nitroblue tetrazolinum (NBT)-dye reduction of neutrophils were performed. The random migration and chemotaxis of isolated neutrophils, washed or incubated in 10% autologous serum, their phagocytic activity and tube adherence test were also investigated. Compared to the controls, the reaction to beta-glucuronidase as well as the NBT reduction were increased, whereas the acid phosphatase and myeloperoxidase reactions were lowered. Impairment of neutrophil chemotaxis stimulated with zymozan-activated serum was observed in all groups of workers; random migration was enhanced in workers of group I and lowered in male workers of group II. Higher phagocytosis of latex particles occurred in workers of group I and in males of group II, while tube adhesion was impaired in group I and enhanced in males of group II.

[Effect of pirenzepine on gallbladder volume during eating and gallbladder emptying after eating in humans]. / Ocena wplywu pirenzepiny na miedzyposilkowa objetosc pçherzyka zólciowego i jego opróznianie po bodzcu pokarmowym u ludzi.

The effect of pirenzepine (50 mg p.o.) vs placebo on the fasted gallbladder emptying after a test meal was examined in a double-blind study on 14 healthy male volunteers by means of an ultrasonographic method. Pirenzepine inhibited significantly the meal-induced gallbladder emptying, whereas no significant effect of this drug on the fasted gallbladder volume was observed.

The effect of levamisole on the maintenance of remission of ulcerative colitis. A 2-year double-blind study.

The results of our study of 50 patients show that levamisole is ineffective in the treatment of patients with ulcerative colitis. The data presented here support our hypothesis that the only effective drugs in ulcerative colitis act as suppressors of both acquired and natural immunity.

Function of phagocytes in experimentally induced colitis in rabbits. I. The Arthus phenomenon in the colon.

Adhesion, random and chemotactic migration, phagocytosis and nitroblue tetrazolium (NBT) dye reduction of peritoneal exudate polymorphonuclear leukocytes (PMN) and macrophages were examined in 110 rabbits with immune complex-mediated colitis and in controls. We may conclude that Arthus-like colitis in rabbits is accompanied by an impairment of adhesion and phagocytosis, and an increase in chemotactic and random migration of both PMN and macrophages. The examined phagocytes were obtained from the peritoneal cavity, and the changes in their function are related much more directly to the presence of circulating immune complexes than to the colitis. The mentioned impairment in their function may be responsible for prolonged persistence of immune complexes in the serum of rabbits with colitis; however, it does not prolong the time of healing of the ulcers.

Function of phagocytes in experimentally induced colitis in rabbits. II. The Shwartzman phenomenon in the colon.

Adhesion, phagocytosis, chemotactic and random migration, nitroblue tetrazolium dye reduction of peritoneal exudate neutrophils and macrophages, fibrinogen level, gelation of soluble fibrin and serial dilution protamine sulfate test were investigated in 115 New Zealand white rabbits with experimentally induced Shwartzman phenomenon in the colon, and in control animals. The results presented in this report demonstrated impairment of chemotactic migration of phagocytes in the presence of endotoxin. The depression was dose-dependent and less marked when neutrophils were stimulated with monocyte-derived chemotactic factor or with casein, than with complement-derived chemotactic factor. The prolonged depression of chemotactic migration of neutrophils and macrophages in rabbits with colitis, however, did not affect the healing time of the ulcers in the colon.

Effect of long-term therapy with sulphasalazine, levamisole, corticosteroids and ascorbic acid and of disease activity on polymorphonuclear leukocyte function in patients with ulcerative colitis.

Adhesion, random migration and chemotactic migration, phagocytosis, and spontaneous nitroblue tetrazolium-dye reduction (NBT) capacity of polymorphonuclear leukocytes (PMNs) were analysed in 38 patients with ulcerative colitis before and during therapy with sulphasalazine (12 months), corticosteroids (6 months), levamisole (12 months), ascorbic acid (6 months) and sulphasalazine plus levamisole (12 months). Remission was achieved by levamisole in as many patients as by sulphasalazine and by sulphasalazine and levamisole used together. Nevertheless, the only function of PMNs affected by levamisole therapy was a depression of chemotaxis, whereas other functions as well as chemotaxis were altered by sulphasalazine, whether used alone or in combination with levamisole. Of patients treated with corticosteroids, all were in remission at 6 months and the most marked decrease in chemotaxis was seen. No clinical benefits were observed after 6 months of treatment with ascorbic acid and PMNs function was unaltered. The depression of chemotaxis occurred whether or not remission was achieved, suggesting a direct drug-induced effect. The apparent discrepancies of the "in vivo" drug effects in comparison with previously reported findings may reflect abnormal reactivity of PMNs in UC.

Humoral immune system and ulcerative colitis activity. I. Serum immunoglobulins and C-reactive protein levels.

Serum immunoglobulins and C-reactive protein (CRP) levels were examined in 85 ulcerative colitis (UC) patients and were correlated with activity, extension and duration of the disease, as well as with extraintestinal manifestations and therapeutic effects. An increase of IgG, IgA, IgM, IgE, CRP and decrease of IgD levels was found in UC, but the activity of the disease was correlated only with CRP level. Patients with extraintestinal manifestations showed elevation of IgG, IgA and IgM level, however, only in inactive colitis. After 12 months of therapy with sulphasalazine the immunoglobulins and CRP returned to the level found in the inactive colitis. An elevation of IgE level was also observed in patients with accompanying allergic disorders. The examined parameters did not reveal any relationship with the duration or extension of the disease. It seems that abnormality in immunoglobulin and CRP levels is an accompanying phenomenon in UC. Increase of IgE level suggests the share of allergic mechanism in pathogenesis of the disease.

Humoral immune system and ulcerative colitis activity. II. Complement level.

C4, C3 and C5 levels and the complement hemolytic activity were analysed in 84 ulcerative colitis patients and correlated with activity, extension and duration of the disease, with the presence of extraintestinal manifestation, and with therapeutic effects. The elevation of C3 was observed in both mild active and in severe colitis. Only C3 correlated with disease activity and with C-reactive protein level. On the other hand, C4 and C5 levels were significantly decreased in the active disease extended to the left side or to total great bowel. The importance of these findings is discussed. No significant connection of the examined complement components with duration, therapy and extraintestinal manifestation was observed. A trend to increase the complement hemolytic activity in severe colitis was noted. Our study of complement and its components activity suggests the secondary role of analysed parameters in pathogenesis of UC and clinical usefulness of C3 level as an indicator of the disease activity.

Humoral immune system and ulcerative colitis activity. III. Immune complexes.

Serum immune complexes (IMC) were examined by means of 4.166% polyethylene glycol precipitation. IMC were found in 33.3% of all examined patients (12.8% of inactive and 51.1% of active colitis). Polyethylene glycol serum precipitation was correlated with the activity of the disease, and was found to be increased in patients with extensive morbid process and with duration of the disease. In the patients with extraintestinal manifestations IMC increased particularly in those with skin lesions. Our study confirmed suggestion of other authors on the possible role of the pathogenesis of UC and in extraintestinal complications. Their secondary role however, cannot be excluded.