Similar high levels of expression were seen in luminal epithelial cells and crypt epithelial cells in 22 (56%) of the 39 HCNA specimens (Figure 2).
Appendix mucosal epithelial cells showed strong iNOS expression in all AIA specimens and in 20 (51%) of the 39 HCNA specimens (Figure 3).
In contrast, there was strong MHC class II expression in the mucosal epithelial cells of all AIA specimens and in 20 (51%) of the 39 HCNA specimens.
COX-2 is believed to be responsible for the production of PGs associated with inflammation. Prostaglandin [E.sub.2], which is the principal proinflammatory prostanoid synthesized from arachidonic acid by COX-2, is well recognized as a mediator of hyperalgesia.[43,44] In the present study, [PGE.sub.2] was strongly expressed in the mucosal epithelial cells of all AIA specimens and in 56% of HCNA specimens.
We also demonstrated increased expression of iNOS activity in the mucosal epithelial cells in all AIA specimens and 51% of HCNA specimens, whereas iNOS activity was not detectable in control specimens.
The strong expression of MHC class II antigens in mucosal epithelial cells of AIA specimens and approximately 50% of HCNA specimens adds further proof to an active inflammatory process even though the appendix appeared normal at operation and by histologic examination.
Some recent studies have suggested that there is an inflammatory basis to the presenting symptoms in some of these patients.[10-16] Wang et al provided new insights into the immunopathologic events in histologically classified normal appendices (HCNAs) in patients with a clinical diagnosis of acute appendicitis.
Velvet Miller also is doing work through HCNA. She has had an extraordinary career working in public health.
He helped co-found two conflict resolution organizations: The Center for Health Care Negotiation (CHCN), a non-profit mediation service for resolving consumer complaints, and Health Care Negotiation Associates (HCNA), a consulting firm that works to resolve organizational (hospital mergers) and professional conflict, mostly among physicians.