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Polyarteritis nodosa and microscopic polyangiitis involve small and medium-sized blood vessels. The majority of patients with microscopic polyangiitis have perinuclear antineutrophil cytoplasmic antibodies, usually antimyeloperoxidase (anti-MPO) antibodies. This report describes the first case of perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) associated vasculitis presenting as, and manifesting predominantly with, cholecystitis. We review the spectrum of disease in small and medium-sized vessel arteritis of the gallbladder from localized arteritis that may not require treatment other than careful observation for the development of systemic disease to multiorgan involvement requiring aggressive immunosuppressive therapy.

The isolated perfused lung (IPL) preparation is a well-established model for the study of alveolar epithelial sodium transport. We noted that preparations of normal fluid-filled rat lungs with recirculated perfusate reproducibly lost weight, whereas preparations in which the perfusate was discarded after a single pass through the lungs had a variable and lesser weight change. To confirm this, we performed IPL experiments by using male Sprague-Dawley specific-pathogen-free rats (175-225 g). In 10 IPLs, perfusate initially was discarded after passing through the lungs and then was recirculated continuously. During the single-pass period, the rate of weight change was +0.7 +/- 2.0 mg/min compared with -9.0 +/- 1.3 mg/min for the recirculating period. Adenosine 3',5'-cyclic monophosphate (cAMP) accumulated during recirculation. The weight loss induced by recirculation was reproduced by perfusion with 8-bromoadenosine 3',5'-cyclic monophosphate or terbutaline in single-pass fashion and blocked when the kinase inhibitor H-8 or phosphodiesterase was present in the recirculating perfusate. In summary, perfusate recirculation in the IPL stimulates fluid resorption at least partially via cAMP. This should be factored into the design and interpretation of IPL experiments.

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