Cloning of a novel scavenger receptor cysteine-rich type I transmembrane molecule (M160) expressed by human macrophages.

We report the cloning of a novel human type I cell surface Ag mainly expressed by macrophages. The primary structure was established by molecular cloning, which yielded a 4579-bp cDNA sequence encoding a polypeptide chain of 1453 amino acid residues with 16 potential N:-glycosylation sites. We designated this molecule M160. The domain organization features 12 scavenger receptor cysteine-rich domains followed by a transmembrane region and a cytoplasmic domain that occurs in two forms, a predominant form (M160-alpha) of 71 residues and an alternatively spliced form (M160-ss) of 39 residues. M160-alpha contains three possible phosphorylation sites, which are lost in the alternatively spliced form. RT-PCR analyses showed M160 to be expressed by alveolar macrophages and by the monocyte cell lines HL60, U937, and THP1, but not by Jurkat or Raji cells. Stimulation of U937 cells with phorbol ester resulted in an increased expression of M160 from day 5 onward. RT-PCR analysis of 19 different human tissues showed signals for M160-alpha of varying intensity in all tissues, whereas M160-ss was confined to the spleen. We conclude that M160 is a new member of the scavenger receptor cysteine-rich superfamily expressed by the monocyte/macrophage cell lineage.

Microfibril-associated protein 4 is present in lung washings and binds to the collagen region of lung surfactant protein D.

We have purified a glycoprotein from bovine lung washings using affinity chromatography on a maltose-affinity column. On SDS-polyacrylamide gel electrophoresis the protein showed a molecular mass of 36 kDa in the reduced state and 66 kDa in the unreduced state. On gel permeation chromatography the apparent molecular mass was 250 kDa. N-terminal sequencing showed homology to the human matrix protein microfibril-associated protein (hMFAP4), and the glycoprotein was designated bovine MFAP4 (bMFAP4). Lung surfactant protein D (SP-D) was also purified from lung washings, and calcium-dependent binding was demonstrated between bMFAP4 and SP-D. hMFAP4 was cloned, and recombinant hMFAP4 showed the same binding pattern to SP-D as bMFAP4. No binding was seen to recombinant SP-D composed of the neck region and carbohydrate recognition domain of SP-D, indicating that the interaction between MFAP4 and SP-D is mediated via the collagen region of SP-D. MFAP4 also showed calcium-dependent binding to mannan, which was partially inhibited by maltose. Our findings indicate that MFAP4 has two binding specificities, one for collagen and one for carbohydrate, and we suggest that MFAP4 may fix the collectins in the extracellular compartment during inflammation.

[Endosonography of the anal canal in traumatic incontinence]. / Endosonographie des Analkanals bei traumatischer Inkontinenz.

We performed transanal endosonography in 6 patients with severe faecal incontinence suspicious of traumatic origin. Traumatic lesions of the anal muscles could be localized precisely or excluded. Surgical procedures were chosen according to the sonographic picture.

[Rectal endosonography for detection of free fluid in the abdomen]. / Die rectale Endosonographie zum Nachweis freier Flüssigkeit im Abdomen.

In a study of 60 patients suspicious of free fluid we found a very high sensitivity of 95% and specificity of 100% with endorectal sonography. In 6 patients free fluid could be shown preoperatively by endorectal ultrasound, whereas transabdominal sonography proved to be negative. We conclude that endorectal sonography should be performed in all cases with a clinical suspicion of free fluid when transabdominal sonography is negative. Rectal endosonography is an easy and less stressful examination which clarifies conditions in the pelvis which are not clearly discernible from the transabdominal sonography.

[Rectal endosonography in differential diagnosis of surgical diseases of the pelvis]. / Die rektale Endosonographie in der Differentialdiagnostik chirurgischer Erkrankungen im kleinen Becken.

Rectal endosonography was performed in 35 patients in whom a pathologic process in the pelvis was suspected. Pathologic findings were shown in various cases: abscess, tumours, ascites. It was shown that rectal endosonography can provide information that is not revealed by such established examinations as abdominal sonography and computed tomography. We recommend that the indications for transrectal endosonography can be extended beyond the established use in rectal tumours and diseases of the pelvic floor. Further systematic examinations are required.

Indications for surgical treatment of acute pancreatitis.

The clinical spectrum of acute pancreatitis ranges from mild, self-limiting symptoms to fulminant illness that may rapidly lead to multiple organ failure and death. Differentiation between acute interstitial pancreatitis, necrotizing pancreatitis, pancreatic abscess and acute pseudocyst is mandatory for the choice of surgical treatment. If morphological evaluation by dynamic pancreatography reveals pancreatic or peripancreatic necrosis, bacteriological evaluation by CT-guided fine-needle aspiration is the mainstay of further decision-making, and should be performed if general signs of inflammation are not improved by conservative therapy. Basically, operative treatment may be directed against underlying pathology (e.g. cholelithiasis), or may aim to manage complications. Infected necrosis is the only clear indication for surgery. Whether the choice should be debridement and gravity drainage, continuous closed lavage of the lesser sac, staged relaparotomies, or open packing, depends on the extent of the process and the individual situation. Peripancreatic fluid collections and pancreatic pseudocysts without major ductal pathology rarely need operative treatment in the early stages, whereas abscesses resulting from infected necrosis should be dealt with by surgery rather than by percutaneous drainage.

[Endosonography of the anal canal in functional disorders of the pelvic flow. Initial experiences]. / Endosonographie des Analkanals bei Funktionsstörungen des Beckenbodens. Erste Erfahrungen.

Nine patients were examined by anal endosonography for pelvic floor disorder. Internal anal sphincter thickness was correlated with sphincter function. Six patients with idiopathic incontinence showed a reduction of internal anal sphincter thickness, one patient with outlet obstruction due to chronic anal fissure showed an increase of thickness. Traumatic lesions could be precisely localized because of defects in both internal and external anal sphincter. Anal endosonography can be recommended in the evaluation of pelvic floor disorders.

Value of endoscopic retrograde cholangiopancreatography in determining the cause but not course of acute pancreatitis.

We have recently shown that ERCP is the most useful technique for detecting a biliary origin of acute pancreatitis and can be done without side effects. We now report on a second series of 50 patients with acute pancreatitis in whom ERCP, computed tomography (CT), ultrasound (US), and clinical and laboratory assessment were performed within the first 24 to 48 hours of hospitalization. A score for ERCP, CT and US was used to assess the severity of the disease. Patients were followed up until discharge or death and their condition classified according to outcome as mild (less than or equal to 1 complication), severe (greater than 1 complication) or fatal. ERCP was superior in detecting choledochal stones (ERCP 100%, US 25%, CT 50%) and dilated intrahepatic ducts (ERCP 75%, US 75%, CT 37%) but not gallbladder stones (ERCP 70%, US 100%, CT 60%). When the ERCP severity score was calculated there was no relevant difference between patients thereafter having a mild course (0.66 +/- 0.91, range 0-3), a severe course (1.3 +/- 0.80, range 0-3), or a fatal outcome (1.0 +/- 1.1, range 0-3). In contrast, the CT score was different in all three groups (mild: 3.0 +/- 1.9; severe: 5.3 +/- 3.2; lethal: 6.3 +/- 3.1) as was the US score (mild: 1.5 +/- 1.3; severe: 3.2 +/- 2.3; lethal: 4.4 +/- 1.4). It is concluded from these results that ERCP is of value in defining the origin of acute pancreatitis. When a biliary origin is detected this can lead to immediate treatment using endoscopic sphincterotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Interleukin-8 and neutrophil activation in acute pancreatitis.

It has been suggested that leucocytes play an important role in the pathogenesis of complicated pancreatitis. Indeed, increased plasma concentrations of neutrophil elastase as a marker of neutrophil activation could be detected in patients with a severe course of the disease. Recently, interleukin-8 (IL-8) has been described as a novel neutrophil activating peptide. To determine the role of IL-8 in acute pancreatitis we measured its serum concentrations by a specific enzyme-linked immunosorbent assay in 10 patients with acute pancreatitis daily during the first week of hospitalization. IL-8 levels were compared with plasma concentrations of neutrophil elastase and the clinical course of the disease. Three of the patients had uncomplicated pancreatitis, while seven showed various extrapancreatic complications. Patients with complicated pancreatitis had statistically significant (P less than 0.05) higher mean values of IL-8 (121 +/- 41 pg/ml-1 vs. 13 +/- 6 pg ml-1, mean +/- SEM) and neutrophil elastase (547 +/- 35 ng ml-1 vs. 250 +/- 20 ng ml-1) than patients with uncomplicated disease. There was a positive correlation (r = 0.52, P less than 0.0001) between IL-8 and neutrophil elastase in the lower concentration range of IL-8 (less than 100 pg ml-1). At IL-8 levels greater than 100 pg ml-1 neutrophil elastase was always greatly elevated; however, under these conditions the relationship between IL-8 and elastase was no longer linear. No measurable IL-8 concentrations were found when plasma elastase was less than 200 ng ml-1. During follow-up, initially elevated IL-8 concentrations decreased in correlation with clinical improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Elevation of serum interleukin-6 concentration precedes acute-phase response and reflects severity in acute pancreatitis.

Experimental studies have shown that interleukin-6 induces all major acute-phase proteins in the liver, including C-reactive protein. In 50 patients with acute pancreatitis, the serum concentrations of interleukin-6 and C-reactive protein were determined daily during the first week of hospitalization. Patients were divided into three groups according to clinical criteria: mild pancreatitis (less than or equal to 1 complication; n = 25), severe pancreatitis (greater than or equal to 2 complications; n = 15), and lethal outcome (n = 10). Patients with mild disease showed initially slightly elevated levels of interleukin-6 (22.0 +/- 9.8 U/mL) that decreased to low levels within 4 days (5.0 +/- 1.0 U/mL). In patients with severe pancreatitis, serum concentrations of interleukin-6 were initially clearly elevated (35.0 +/- 7.5 U/mL) and remained slightly elevated until day 7 (13.0 +/- 2.0 U/mL). Patients with lethal outcome had markedly elevated initial interleukin-6 concentrations (61.0 +/- 15.0 U/mL) that decreased but were still elevated at day 7 (26.0 +/- 2.5 U/mL). In all three groups, C-reactive protein concentrations followed the course of interleukin-6 concentrations by 1 day. There was a positive correlation between maximal interleukin 6 concentrations and maximal increases in the serum concentrations of C-reactive protein (r = 0.66). At days 1 and 2, increased (greater than 15 U/mL) interleukin-6 concentrations (positive predictive value, 91%; negative predictive value, 82%) predicted a severe or lethal course of the disease more accurately than elevated [greater than 0.10 g/L (greater than 10 mg/dL)] C-reactive protein concentrations (positive predictive value, 67%; negative predictive value, 79%). In conclusion, elevated serum concentrations of interleukin-6 followed by increased levels of C-reactive protein reflect the severity of acute pancreatitis.

[Sonographic acute and follow-up diagnosis after blunt abdominal trauma]. / Sonographische Akut- und Verlaufsdiagnostik nach stumpfem Bauchtrauma.

Experience with ultrasonographic acute and follow-up diagnostic as noninvasive imaging procedure for blunt abdominal trauma was analysed in a retrospective study. Between 1986 and 1989 166 organ lesions were noticed in 440 patients with clinically regarded diagnosis of a blunt abdominal trauma. 107 patients were laparotomised. Retrospectively, the sensitivity concerning free fluid in the abdominal cavity caused by lesion of an intrabdominal organ was 0.96 and the specifity 0.98. The predictive value of a positive test was 0.91 and the predictive value of a negative test was 0.99. The rate of negative laparotomy was 1.3%. Thus the sole use of ultrasonographic diagnostic and the non-use of peritoneal lavage seems justified in case of blunt abdominal trauma. Some figures illustrate typical cases and our own results.

[Surgical indications in ulcerative colitis and Crohn disease]. / Operationsindikation bei Colitis ulcerosa und Morbus Crohn.

Despite the progress made in recent years, treatment of chronic inflammatory bowel disease remains problematic. The highly individual spontaneous course of such conditions always makes an interdisciplinary management strategy mandatory. In view of the fact that continence-preserving procedures are possible in ulcerative colitis as well as bowel-preserving procedures in Crohn's disease, elective interventions in patients who fail to respond to what is accepted as suitable medication may be considered supplementary to the therapeutic spectrum. A consideration of all the factors involved suggests that too many reservations vis-a-vis surgery are no longer justified.

Scintigraphic assessment of leukocyte infiltration in acute pancreatitis using technetium-99m-hexamethyl propylene amine oxine as leukocyte label.

The infiltration of leukocytes has been linked to the pathophysiology of complicated or severe pancreatitis. We have tested the ability of leukocyte scintigraphy using technetium-99m-hexamethyl propylene amine oxine (HM-PAO) as label to demonstrate the localization of leukocytes in the pancreas during acute pancreatitis. Twenty-eight patients with acute pancreatitis (eight with biliary, 13 with alcoholic, and seven with unknown origin) were studied with leukocyte scintigraphy using planar imaging and single photon emission computed tomography (SPECT). Fourteen patients had a mild (group I), II a severe (group II), and three a lethal outcome (group III) of pancreatitis. All patients of group III, six of group II, and two of group I had a positive leukocyte scan. Thus, the sensitivity of leukocyte scintigraphy for the detection of a lethal course of acute pancreatitis was 100%, of a severe course 54%, and of a severe or lethal course 64%. The specificity of a negative scan for a mild pancreatitis was 86%. Comparison of the results of leukocyte scintigraphy with those of contrast enhanced CT showed that six of eight patients with pancreatic necrosis in CT had a positive leukocyte scan, but only five of 20 patients without detectable pancreatic necrosis in CT. In summary, leukocyte infiltration into the pancreas during pancreatitis can be demonstrated by noninvasive leukocyte scintigraphy using technetium-99m-HM-PAO as label. A correlation between the severity of the disease and leukocyte infiltration exists.

[Diagnosis and treatment of intra-abdominal abscesses]. / Diagnostic et traitement des abcès intra-abdominaux.

Intraabdominal abscesses are life threatening complications of inflammatory processes or major surgery. Ultrasonography, computed tomography and scintigraphy are the diagnostic methods of choice. Diagnostic percutaneous puncture can be followed by therapeutic percutaneous drainage (PD). The diagnosis "intraabdominal abscess", however, is not sufficient for a rational therapeutic strategy. Therapy of intraabdominal abscesses (IAA) depends upon etiology and localization of the process and the individual situation of the patient.

[Is advanced age by itself a risk factor in large abdominal surgical interventions]. / Ist das höhere Lebensalter an sich ein Risikofaktor bei grossen abdominalchirurgischen Eingriffen.

A logistic regression analysis was performed retrospectively in 237 patients over 70 years of age (group 1) who underwent surgery for diseases of the biliary tract, stomach, and colon and rectum. The data were compared with those of 273 patients with identical operations under the age of 60 years (group 2). The results of our analysis differed according to the cohort of patients. Age was shown to be a significant risk factor for perioperative mortality according to the analysis of young and old patients (group 1 and 2). Analysis of group 1 showed that the urgency of the operation and the sum of coexisting morbidities were significant. The combination of age and urgency is a significant risk factor following colorectal but not gastric and biliary surgery.

Granulocyte elastase in assessment of severity of acute pancreatitis. Comparison with acute-phase proteins C-reactive protein, alpha 1-antitrypsin, and protease inhibitor alpha 2-macroglobulin.

Complexes of granulocyte elastase and alpha 1-antitrypsin are markers for granulocyte activation. In 75 patients with acute pancreatitis these complexes were immunologically determined daily in plasma during the first week of hospitalization. Patients were classified into three groups: mild pancreatitis (I, less than or equal to 1 complication, N = 34), severe pancreatitis (II, greater than or equal to 2 complications, N = 29), lethal outcome (III, N = 12). Initially, granulocyte elastase (mean +/- SEM) was lower in group I (348 +/- 39 micrograms/liter) as compared to groups II (897 +/- 183 micrograms/l) and III (799 +/- 244 micrograms/liter), P less than 0.001 for I vs II + III. Initial elastase concentrations greater than 400 micrograms/liter were consistent with a severe or fatal course of the disease but did not distinguish between severe and lethal pancreatitis. In patients with mild or severe disease, mean elastase concentrations decreased continuously during the following days (197 +/- 15 micrograms/liter in mild cases, 325 +/- 30 micrograms/liter in severe cases at day 7). In patients with lethal disease, however, mean elastase concentrations even increased at day 2 and remained higher than 700 micrograms/liter during the observation period. At days 1 and 2 the predictive value for severe or lethal disease of raised (greater than 400 micrograms/liter) elastase concentrations [positive predictive value (PPV) 82%, negative predictive value (NPV) 81%] was better than that of elevated (greater than 100 mg/liter) C-reactive protein (PPV 73%, NPV 73%), elevated (greater than 4.0 g/liter) alpha 1-antitrypsin (PPV 59%, NPV 50%), or decreased (less than 1.5 g/liter) alpha 2-macroglobulin (PPV 82%, NPV 67%).(ABSTRACT TRUNCATED AT 250 WORDS)