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A 65 year old woman with a history of occupational talc inhalation presented with hypoxaemia, cough, and dyspnoea with a normal chest radiograph. Bronchoalveolar lavage showed considerable lymphocytosis, with a predominance of T8+ T lymphocytes, and open lung biopsy showed peribronchiolar granulomas containing talc crystals. Corticosteroid treatment resulted in dramatic improvement. Bronchoalveolar lavage may aid in the diagnosis of talc related lung injury. [ABSTRACT FROM AUTHOR]

Presents a case study that described a patient with a mediastinal germ cell tumor associated with the hemophagocytic syndrome. Background on the case studies; Its results.

The sirtuin family consists of seven NAD+-dependent enzymes affecting a broad array of regulatory protein networks by primarily catalyzing the deacetylation of key lysine residues in regulatory proteins. The enzymatic activity of SIRT1 can be enhanced by small molecule activators known as SIRT1 activator compounds (STACs). We tested the therapeutic potential of the STAC SRT3025 in two preclinical models of severe infection, the murine cecal ligation and puncture (CLP) model to induce peritonitis and intratracheal installation of Streptococcus pneumoniae to induce severe bacterial pneumonia. SRT3025 provided significant survival benefits over vehicle control in both the peritonitis and pneumococcal pneumonia models when administered with appropriate antimicrobial agents. The survival benefit of SRT3025 in the CLP model was absent in SIRT1 knockout showing the SIRT1 dependency of SRT3025's effects. SRT3025 administration promoted bacterial clearance and significantly reduced inflammatory cytokines from the lungs of animals challenged with S. pneumoniae. SRT3025 treatment was also accompanied by striking changes in the transcription profiles in multiple inflammatory and metabolic pathways in liver, spleen, small bowel, and lung tissue. Remarkably, these organ-specific changes in the transcriptome analyses were similar following CLP or pneumococcal challenge despite different sets of pathogens at disparate sites of infection. Pharmacologic activation of SIRT1 modulates the innate host response and could represent a novel treatment strategy for severe infection.

The RAGE (receptor for advanced glycation end products) is believed to play a role in sepsis by perpetuating inflammation. The interaction of RAGE with a variety of host-derived ligands that accumulate during stress and inflammation further induces the expression of RAGE. It was previously shown that a rat anti-RAGE monoclonal antibody protected mice from lethality in a cecal ligation and puncture model. We studied the effects of a humanized anti-RAGE monoclonal antibody in the murine pneumococcal pneumonia model of sepsis. Moreover, a gene expression analysis was performed in lung tissue of animals that underwent cecal ligation and puncture and treated with the rat anti-RAGE monoclonal antibody, compared with controls. Administration of humanized anti-RAGE mAb 6 h after intratracheal infection with Streptococcus pneumoniae improved mortality in BALB/c mice whether a 7.5 mg/kg (P < 0.01) or a 15 mg/kg dose (P < 0.01) was administered in combination with antibiotics. Gene expression analysis showed that many of the genes modulated by treatment with the anti-RAGE antibody were those that play an important role in regulating inflammation. Anti-RAGE monoclonal antibody offered a survival advantage to septic mice. This protective role in treated animals is supported by the observed gene expression profile changes of genes involved in sepsis and inflammation.

Human inter-α inhibitor proteins are endogenous human plasma proteins that function as serine protease inhibitors. Inter-α inhibitor proteins can block the systemic release of proteases in sepsis and block furin-mediated assembly of protective antigen, an essential stop in the intracellular delivery of the anthrax exotoxins, lethal toxin and edema toxin. Inter-α inhibitor proteins administered on hour or up to 24 h after spore challenge with Bacillus anthracis Sterne strain protected mice from lethality if administered with antimicrobial therapy (P < 0.001). These human plasma proteins possess combined actions against anthrax as general inhibitors of excess serine proteases in sepsis and specific inhibitors of anthrax toxin assembly. Inter-α inhibitor proteins could represent a novel adjuvant therapy for the treatment of established anthrax infection.

Introduction: The receptor for advanced glycation end products (RAGE), a multi-ligand member of the immunoglobulin superfamily, contributes to acute and chronic disease processes, including sepsis., Methods: We studied the possible therapeutic role of RAGE inhibition in the cecal ligation and puncture (CLP) model of polymicrobial sepsis and a model of systemic listeriosis using mice genetically deficient in RAGE expression or mice injected with a rat anti-murine RAGE monoclonal antibody., Results: The 7-day survival rates after CLP were 80% for RAGE-/- mice (n = 15) (P < 0.01 versus wild-type), 69% for RAGE+/- mice (n = 23), and 37% for wild-type mice (n = 27). Survival benefits were evident in BALB/c mice given anti-RAGE antibody (n = 15 per group) over serum-treated control animals (P < 0.05). Moreover, delayed treatment with anti-RAGE antibody up to 24 hours after CLP resulted in a significant survival benefit compared with control mice. There was no significant increase in tissue colony counts from enteric Gram-negative or Gram-positive bacteria in animals treated with anti-RAGE antibody. RAGE-/-, RAGE+/-, and anti-RAGE antibody-treated animals were resistant to lethality from Listeria monocytogenes by almost two orders of magnitude compared with wild-type mice., Conclusion: Further studies are warranted to determine the clinical utility of anti-RAGE antibody as a novel treatment for sepsis.

The clinical laboratory is a vital component of modern podiatric medical practice. In order to interpret laboratory data correctly, the practitioner must understand the essentials of diagnostic testing. These essentials include precision, accuracy, sensitivity, specificity, and prevalence-based values of a given test. In addition, the podiatric physician should be aware of the limitations, variations, and interferences that can spuriously alter test results.

A case of primary carcinoid tumor of the liver with striking morphologic and electron microscopic features is reported. Conventional histologic examination showed a prominent paranuclear clear zone in numerous tumor cells. By electron microscopic examination, this clear zone corresponded to a paranuclear mass of intermediate filaments admixed with neurosecretory granules and other cytoplasmic organelles.

Platelet pseudopodia were compared to platelet cell bodies with respect to their lipid composition, fatty acid distribution and protein composition. The methodology for producing pseudopodial preparations of platelets stimulated with thrombin, ADP or calcium ionophore was established. The separation of pseudopodia and cell bodies was verified by electron microscopic examination of the respective platelet components. Lipid analyses demonstrated a preponderance of lysophospholipids and sphingomyelin in pseudopodial preparations and a large increase in mono-, di- and tri-ene fatty acids as compared to cell bodies. Changes were also evident in the protein composition evaluated by one- and two-dimensional SDS-polyacrylamide gel electrophoresis and by [32P]ATP labeling of exofacial membrane proteins. A protein of approximately 68 kDa which reacted strongly with antibody to PlA1, was prominantly displayed in platelet pseudopodia. Thus, our studies demonstrate a heterogeneous distribution of lipids and proteins in a mammalian membrane system which may have important implications for the functional behavior of the cell.

Considerable controversy exists about the value of histologic classifications of gastric adenocarcinoma in the prediction of patient survival. Histologic sections of 75 consecutive gastrectomies were used to compare Lauren and Ming classifications with emphasis on clinical stage, size, location of tumor, desmoplasia, inflammatory reaction, and 5-year survival. Both classifications generally correlated and, when combined, proved helpful in defining certain cases. At surgery, about one third of the total cases of intestinal (INT, Lauren) and expanding (ET, Ming) were in early stages, whereas almost all the diffuse (DT, Lauren) and infiltrative (INF, Ming) types were in late stages. When the Lauren classification was applied to preoperative endoscopic biopsies, a 72% diagnostic correlation with the surgical specimens was found. Followup revealed no survivors of the DT and INF and 12 and 11 survivors of INT and ET, respectively, regardless of stage. Inflammatory response was associated with good prognosis. Desmoplasia and size had no prognostic significance. Tumors of the cardia had worse prognoses than those in the body or antrum. Both Lauren and Ming classifications, and especially the degree of inflammation, were significant in predicting survival. Lauren INT and Ming ET should be declared only when they are the sole or predominant features.

Histological and histochemical evaluation of 33 biopsies and 8 distal esophagectomy specimens revealed specialized columnar epithelium with intestinal features [intestinal metaplasia (IM)] to be the most common type (91%) of metaplasia in Barrett's esophagus (BE). Junctional epithelium was found in only 3 of the 33 biopsies. The type III subvariety of IM (TIII-M), characterized by the presence of sulfomucins in the non-goblet columnar cells, was found in 58% of all our biopsies and 62% of operative specimens. Six of the 7 cases of epithelial dysplasia were associated with TIII-M; one of them subsequently developed an adenocarcinoma. The transitional epithelium adjacent to adenocarcinomas in the operative specimens also showed TIII-M in five of six cases. Our findings indicate that TIII-M is almost as common in Barrett's-associated carcinoma as in nonneoplastic cases of BE, thereby limiting the usefulness of this histological marker as an indicator of neoplastic change (P = 0.5). On the other hand, TIII-M seems to be significantly associated with mild dysplasia in BE. The value of TIII-M as a prognostic indicator regarding the subsequent development of esophageal carcinoma remains in doubt and could be more precisely assessed by a prospective study.

The biochemical, ultrastructural and functional aspects of digitonin-permeabilized platelets were investigated. Human platelets were permeabilized by exposure to the steroid glycoside digitonin. A 60 microM concentration of this permeabilizer produced a very substantial release of cytosolic enzymes from the platelets. Release from subcellular granules was relatively low and did not inhibit the response of platelets to a series of agonists. Although digitonin-permeabilized platelets required higher threshold concentrations of the usual stimulants, both primary and secondary aggregation as well as the release of nucleotides and enzymes from their respective granules remained intact. Transmission electron micrographs revealed discontinuities in the plasma membrane of digitonin-treated platelets, but scanning electron microscopy showed no difference between control and permeabilized platelets. No substantial loss of structural or membrane proteins could be detected by one- and two-dimensional gel electrophoresis. The pore size produced by digitonin treatment was sufficient to allow entry of 125I-labeled IgG into the platelet cytosolic space.

Patients with the acquired immune deficiency syndrome (AIDS) frequently develop interstitial lung disease. This is due most commonly to opportunistic infections, but malignancy and lymphocytic interstitial pneumonitis have also been associated with the syndrome. In contrast, there has been little reported about airways disease in patients with HIV infection. We describe a patient with AIDS-related complex who presented with symptoms and radiographic evidence of micronodular interstitial lung disease. Transbronchial biopsy revealed a lymphocytic bronchiolitis but no evidence of interstitial lung disease and a marked T-suppressor lymphocytosis was found on analysis of the bronchoalveolar lavage (BAL) specimen. Routine fungal, viral and bacterial cultures did not yield an etiologic agent. This case raises the possibility that lymphocytic bronchiolitis may represent another pulmonary manifestation of HIV infection.