- Email: [email protected]
The epidemiology of gallstones disease among Mexican-Americans, Cuban-Americans and Puerto Ricans
June 1987
ABSTRACTS
THE EPIDEIIIOLGGYOF GALLSMWESDISEASE AMMGI(EXICANA13ERICWS, CUBAN-AHBRICANS ANDPUERTO RICANS. KR. Flaurer, H.P. Roth, T.H. Shawker, R.S. Johannes, TM. Ezsati, D.L. Larson. W.C. Knowler. J.E. Everhart. National Center for Md., and DDN, Epidemiology Heal th 'Statietics, Hyattsville, h Data Systems Program of NIDDK, Bethesda, Hd. The 1982-84 Hispanic Health and Nutrition Examination Survey was the first large population based investigation of the epidemiology of Gallstone Disease (GSD) using Mexican-Americans (MA), Puerto Ricans ultrasonography. (PR) and Cuban Americans (CA) were randomly selected from a sample of households in Florida, Connecticut, New Jersey, New York and five Southwestern states. Guality control studies showed exoellent AgreexÌent (Kappas = 0.72-0.90) between the conclusions of the technicians conducting the examination and the radioloaists uho reviewed the imanes obtained during the ultraso;nd examinations. Among 971 men 53 cases of GSD were found. l’he prevalente of GSD increased with age to 135 among those 6074 years and differed little between RA, PR and CA. Among 636 MA men the prevalente of GSD was not signifioantly related to triceps, subscapular, iliac, and calf skinfolds, body mass index (BMI), education, and family inoome. Among 1328 women 253 oases of GSD were found. Age adjusted rates of GSD were at least 3.5 times greater among women than men. The age adjusted rate of GSD was high& among MA women than among CA and PR women (225, 16$, and 15% respectively). Data for MA women is reported belou. Anxxg 755 MA women the rates increased with age (20-39 vs. 60-74) from 13% to 43%. The relative risk (RR) of GSD for al1 skinfolds and Bl41 (upper vs. lower tertiles) ranged between 1.6-2.8 (PO.O5) after adjusting for age and BI1 in a multiple logistic regression analysis, suggesting that the effect of parity on GSD is not independent of age and obesity. Rates of GSD were higher among those with low education and familv income. In summary, among men GSD was signifioantly related only to inoreasing age and the prevalente of GSDdid not differ betueen MA, PR änd CA. Among women GSD wae related to iI'k?PeaSingage, obesity, low education, and low family inCOIW and was more connnon in MAthan in PR and CA. OBSTRUCTION-INDUCED COLONIC MUCOSAL ADAPTATION IS AFFECTED BY MICROFLORAL PRODUCED POLYAMINES. D.L. Osborne Seidel, E. Carolina U., Sch. of Med., GreenmNC
Colonic
mucosa
undergoes
an adaptational
and E.R.
27858
response following obstruction which is characterized by an increase The colon contains a in bNA, RNA, and protein content. large endogenous microfloral population which may serve as a source for many compounds needed by the mucosa. Experiments were designed to determine the contribution of luminally derived microfloral produced polyamines (PA) to the mucosal adaptation following colonic obstruction. Rats were treated orally for 7 days with either a 0.9% NaCl solution or an antibiotic solution containinq 60 mg bacitracin, 60 mq neoOn day 5 of mycin sulfate and 6 mg polymyxin B sulfate. a cotton umbilical tape ligature or a loose treatment, "sham" ligature was placed 7 cm distal to the caecum. Sixtysix hours of ligation produced an increase in the DNA, RNA, and protein content of the normal animal (Table 1). Antibiotic treatment alone has no effect, but combined with ligation there was an attenuation in the increase in total DNA, RNA and protein content. ~~~:"~"r~am
m*
igg!$T$*
yIm
NaCl-Ligated 6:00%:60 0:41To:o3 1:40+0:13 Antibiotic Control 8.8OzO.65 0.59+0.03 1.55TO.14 Antibiotic Ligpted P .05 as cömpared to Nam control Ornithlne decarboxylase (ODC) is the rate limiting enryme in PA biosyhthesis. Colonic mucosal ODC activity was unchanged In contrast, luminal, micr,ofloral by antibiotic treatment. ODC activity increased 3.5 fold in the normal, ligated In both antibiotic-treated groups the luminal ODC animal. activity was not significantly different from zero indicating that the antibiotic regimen successfully attenuated microfloral PA synthesis. These data stqgest that .when the microfloral population is intact, there is mucosal qrowth in However, in animals response to colonic obstruction. lacking a normal microfloral constitution, the adaptational Therefore, PA produced bythe GI response is attenuated. microflora are essential for the local adaptational response to colonic obstruction. Supported by NIH grant AM34110 and the AGA.
OF PAPERS
2063
CYTOMEGALOVIRUS (CMV) INFECTION AND IMMUNOSUPPRESTRANSPLANTATION. PEDIATRIC LIVER THERAPY IN E. Pehlivanoglu, J. Spolidoro, C. Leach, M. Ament, J. Vargas, R. Busuttil, W. Berquist. University of California at Los Angeles. Department of Pediatrics. Intense postoperative immunosuppressive treatment is reauired to orevent reiection in orthotopic liver transplant (OLT) pts b;ut increa& their risk for opportunistic fungal and viral infectibns. Oifferentiation of rejection from CMV hepatitis is a major problem since their cïinical and lab-
SERIDUS
SIVE
oratory presentation may be similar while management of these problems is different. We reviewed uur experience in 22 OLT pts from March 1984 to May 1986 at UCLA Medical Center to investigate the clinical, laboratory and histopathologica1 differences between rejection and CMV infection.
Mean age at the time of transplantation was 5y 2m (range 7m to 16~). Nine of 22 (41%, Group A and 6) developed positive CMV IgM and CF antibody titers and cultures for CMV from /l or more sites (blood, throat, urine or bronchipl lavage) following surgery, and 3 (Group A) develpped interstitial pneumonitis. CMV specific'inclusion bodies were found in 'luns. liver and oastric bioosies. GroÜb #
CMV Biopsy Reje&.ion Steroid 0KT3 Culture + No. (SD)* Pulse * A 3 + t 6.3(0.6) 5.7 0:: 1 B 6t 3.7(3.0) 4.5 C 13 3.4t2.0) 3.3 0.3 I ’ ’ ~’ ” * mean'#/pt Two pts in Group A were treated successfully
I
Imuran Hosp * Days* 1.0 105 0.2 57 0.2 33
I
with DHPG and -by decreasing immunosuppressive treatment. The third pt died due to sepsis, GI bleeding, intestinal perforation and liver dysfunction. Clinical presentation (fever, fatigue, hepatomegaly) of rejection episodes were s,imilar in al1 groups. Percutaneous liver biopsy with routine stains helped in detecting CMV when inclusion bodies were seen. We conclude that culture proven CMV infection is common post OLT. Serious CMV infection occurred more frequently in these post OLT pts who received qreater immunosuppressive therapy for possible graft rejectiön. Monitoring Cki infection following OLT is absolutely necessary. Decreasing the immunosuppressives and using antiviral agënts is important in the management of CMV infection after OLT.
THE RBLATIOUSHIPOF PARTICLE SIZB ABD BILIARY PRESSURg TO CHOLANGIO-VWOUSREFLUX. SG Gian, BBJ Stimpson, _ Pellegrini, LWUay. Surgical Service, VABC and Department of California, San Francisco. Ca. of Surgery, University To learn more about wbat detennines the passage of bacteria and toxins from bile to blood we investigated the influence of particle size and biliary pressure on cholangiovenous reflux of fluid in the isolated rat liver. Expetiments were carried out in 9 groups of 5 rats each. The liver was removed and continuously perfused via the portal vein with oxygenated FHB buffer. The bile duet was perfused with a solution of 3-5 PCi I%l inulin (5000 mol wt), r31iI dextran (70,000 mol wtl, or 131iI E Coli in saline for 60 min at three different pressures (sec tablel. The hepatic venous effluent was collected in 30 sec aliquots. particle concentration was detenained from the radioactivity of the effluent and expressed as a fraction of the radioactivity infused into the duet for each 2 min period CR/11 and for the total study. The results were as follows: Total Reflux Proportion CR/11 Pressure(cm H20)_ Imilin K.COli Daxtrti 0.38fl.10 0.37s.09 0.13+0.06* 12-20 20-30 0.91&o.O3# 0.9_.03# [email protected]*’ 35-45 O.BI+o.O7# O.B7~.01# 0.15s.04* *< inulin OP dextrm; 4 > preosure of 12-20 cm H20; CP<.051 For dexttan and inulin B/I increased rapidl and plateaued 5-10 min after the onset of the infus ! on. This study shows that: 1) at la biliaky pressures particles of up to 70,WO mol ut. msy pass from bila to
blood; 2) increaties in biliary prsssure. siiilar to tbose found in the obstructad bile duet produce free cholangiovenous reflux of dextran (which is si~Uar in size te most endotoxins); 3) smal1 particlu (5000-70000 mol wt) appear to travel through direct pathuSys (since their transit was fa&); 4) regardle&s of biliery pressure, the propörtiön of bacterie that refluxes is
low, at least wben the bile no bile duet obstructionl.
duet barrier
is
intact
(ie.
ABSTRACTS
THE EPIDEIIIOLGGYOF GALLSMWESDISEASE AMMGI(EXICANA13ERICWS, CUBAN-AHBRICANS ANDPUERTO RICANS. KR. Flaurer, H.P. Roth, T.H. Shawker, R.S. Johannes, TM. Ezsati, D.L. Larson. W.C. Knowler. J.E. Everhart. National Center for Md., and DDN, Epidemiology Heal th 'Statietics, Hyattsville, h Data Systems Program of NIDDK, Bethesda, Hd. The 1982-84 Hispanic Health and Nutrition Examination Survey was the first large population based investigation of the epidemiology of Gallstone Disease (GSD) using Mexican-Americans (MA), Puerto Ricans ultrasonography. (PR) and Cuban Americans (CA) were randomly selected from a sample of households in Florida, Connecticut, New Jersey, New York and five Southwestern states. Guality control studies showed exoellent AgreexÌent (Kappas = 0.72-0.90) between the conclusions of the technicians conducting the examination and the radioloaists uho reviewed the imanes obtained during the ultraso;nd examinations. Among 971 men 53 cases of GSD were found. l’he prevalente of GSD increased with age to 135 among those 6074 years and differed little between RA, PR and CA. Among 636 MA men the prevalente of GSD was not signifioantly related to triceps, subscapular, iliac, and calf skinfolds, body mass index (BMI), education, and family inoome. Among 1328 women 253 oases of GSD were found. Age adjusted rates of GSD were at least 3.5 times greater among women than men. The age adjusted rate of GSD was high& among MA women than among CA and PR women (225, 16$, and 15% respectively). Data for MA women is reported belou. Anxxg 755 MA women the rates increased with age (20-39 vs. 60-74) from 13% to 43%. The relative risk (RR) of GSD for al1 skinfolds and Bl41 (upper vs. lower tertiles) ranged between 1.6-2.8 (P
Colonic
mucosa
undergoes
an adaptational
and E.R.
27858
response following obstruction which is characterized by an increase The colon contains a in bNA, RNA, and protein content. large endogenous microfloral population which may serve as a source for many compounds needed by the mucosa. Experiments were designed to determine the contribution of luminally derived microfloral produced polyamines (PA) to the mucosal adaptation following colonic obstruction. Rats were treated orally for 7 days with either a 0.9% NaCl solution or an antibiotic solution containinq 60 mg bacitracin, 60 mq neoOn day 5 of mycin sulfate and 6 mg polymyxin B sulfate. a cotton umbilical tape ligature or a loose treatment, "sham" ligature was placed 7 cm distal to the caecum. Sixtysix hours of ligation produced an increase in the DNA, RNA, and protein content of the normal animal (Table 1). Antibiotic treatment alone has no effect, but combined with ligation there was an attenuation in the increase in total DNA, RNA and protein content. ~~~:"~"r~am
m*
igg!$T$*
yIm
NaCl-Ligated 6:00%:60 0:41To:o3 1:40+0:13 Antibiotic Control 8.8OzO.65 0.59+0.03 1.55TO.14 Antibiotic Ligpted P .05 as cömpared to Nam control Ornithlne decarboxylase (ODC) is the rate limiting enryme in PA biosyhthesis. Colonic mucosal ODC activity was unchanged In contrast, luminal, micr,ofloral by antibiotic treatment. ODC activity increased 3.5 fold in the normal, ligated In both antibiotic-treated groups the luminal ODC animal. activity was not significantly different from zero indicating that the antibiotic regimen successfully attenuated microfloral PA synthesis. These data stqgest that .when the microfloral population is intact, there is mucosal qrowth in However, in animals response to colonic obstruction. lacking a normal microfloral constitution, the adaptational Therefore, PA produced bythe GI response is attenuated. microflora are essential for the local adaptational response to colonic obstruction. Supported by NIH grant AM34110 and the AGA.
OF PAPERS
2063
CYTOMEGALOVIRUS (CMV) INFECTION AND IMMUNOSUPPRESTRANSPLANTATION. PEDIATRIC LIVER THERAPY IN E. Pehlivanoglu, J. Spolidoro, C. Leach, M. Ament, J. Vargas, R. Busuttil, W. Berquist. University of California at Los Angeles. Department of Pediatrics. Intense postoperative immunosuppressive treatment is reauired to orevent reiection in orthotopic liver transplant (OLT) pts b;ut increa& their risk for opportunistic fungal and viral infectibns. Oifferentiation of rejection from CMV hepatitis is a major problem since their cïinical and lab-
SERIDUS
SIVE
oratory presentation may be similar while management of these problems is different. We reviewed uur experience in 22 OLT pts from March 1984 to May 1986 at UCLA Medical Center to investigate the clinical, laboratory and histopathologica1 differences between rejection and CMV infection.
Mean age at the time of transplantation was 5y 2m (range 7m to 16~). Nine of 22 (41%, Group A and 6) developed positive CMV IgM and CF antibody titers and cultures for CMV from /l or more sites (blood, throat, urine or bronchipl lavage) following surgery, and 3 (Group A) develpped interstitial pneumonitis. CMV specific'inclusion bodies were found in 'luns. liver and oastric bioosies. GroÜb #
CMV Biopsy Reje&.ion Steroid 0KT3 Culture + No. (SD)* Pulse * A 3 + t 6.3(0.6) 5.7 0:: 1 B 6t 3.7(3.0) 4.5 C 13 3.4t2.0) 3.3 0.3 I ’ ’ ~’ ” * mean'#/pt Two pts in Group A were treated successfully
I
Imuran Hosp * Days* 1.0 105 0.2 57 0.2 33
I
with DHPG and -by decreasing immunosuppressive treatment. The third pt died due to sepsis, GI bleeding, intestinal perforation and liver dysfunction. Clinical presentation (fever, fatigue, hepatomegaly) of rejection episodes were s,imilar in al1 groups. Percutaneous liver biopsy with routine stains helped in detecting CMV when inclusion bodies were seen. We conclude that culture proven CMV infection is common post OLT. Serious CMV infection occurred more frequently in these post OLT pts who received qreater immunosuppressive therapy for possible graft rejectiön. Monitoring Cki infection following OLT is absolutely necessary. Decreasing the immunosuppressives and using antiviral agënts is important in the management of CMV infection after OLT.
THE RBLATIOUSHIPOF PARTICLE SIZB ABD BILIARY PRESSURg TO CHOLANGIO-VWOUSREFLUX. SG Gian, BBJ Stimpson, _ Pellegrini, LWUay. Surgical Service, VABC and Department of California, San Francisco. Ca. of Surgery, University To learn more about wbat detennines the passage of bacteria and toxins from bile to blood we investigated the influence of particle size and biliary pressure on cholangiovenous reflux of fluid in the isolated rat liver. Expetiments were carried out in 9 groups of 5 rats each. The liver was removed and continuously perfused via the portal vein with oxygenated FHB buffer. The bile duet was perfused with a solution of 3-5 PCi I%l inulin (5000 mol wt), r31iI dextran (70,000 mol wtl, or 131iI E Coli in saline for 60 min at three different pressures (sec tablel. The hepatic venous effluent was collected in 30 sec aliquots. particle concentration was detenained from the radioactivity of the effluent and expressed as a fraction of the radioactivity infused into the duet for each 2 min period CR/11 and for the total study. The results were as follows: Total Reflux Proportion CR/11 Pressure(cm H20)_ Imilin K.COli Daxtrti 0.38fl.10 0.37s.09 0.13+0.06* 12-20 20-30 0.91&o.O3# 0.9_.03# [email protected]*’ 35-45 O.BI+o.O7# O.B7~.01# 0.15s.04* *< inulin OP dextrm; 4 > preosure of 12-20 cm H20; CP<.051 For dexttan and inulin B/I increased rapidl and plateaued 5-10 min after the onset of the infus ! on. This study shows that: 1) at la biliaky pressures particles of up to 70,WO mol ut. msy pass from bila to
blood; 2) increaties in biliary prsssure. siiilar to tbose found in the obstructad bile duet produce free cholangiovenous reflux of dextran (which is si~Uar in size te most endotoxins); 3) smal1 particlu (5000-70000 mol wt) appear to travel through direct pathuSys (since their transit was fa&); 4) regardle&s of biliery pressure, the propörtiön of bacterie that refluxes is
low, at least wben the bile no bile duet obstructionl.
duet barrier
is
intact
(ie.