Postmenopausal intrauterine fluid collection: correlation between ultrasound and hysteroscopy

Postmenopausal intrauterine fluid is an alarming sign related to malignancy. Twenty postmenopausal women with intrauterine fluid were prospectively studied by means of sonographic evaluation, and hysteroscopic and histological examinations, to determine the correlation between ultrasound and hysteroscopy. All patients underwent endovaginal sonography, followed by hysteroscopy. Biopsies were performed on all patients with abnormal endometrium, and randomly on selected patients with normal or atrophic endometrium. In patients with abnormal endometrial structure and thickness (< 4 mm), two cases of endometrial cancer were histologically detected and one was revealed by cytology (Pup smear). Seventeen patients with thin endometrium (<or= 4 mm) had no pathology. Sonographic, hysteroscopic and histological findings correlated well in all cases.

Age-related differences in the effects of ethanol on performance and behaviour in healthy men

Four age groups of healthy men; 20-29, 30-39, 40-49, and 50-59 years (N = 12 per group), drank 0.68 g of ethanol/kg body weight as neat whisky in the morning after an overnight (10 hr) fast. The concentration of ethanol in fingertip blood, various signs and symptoms of intoxication, body-sway (open and closed eyes), hand-tremor, positional alcohol nystagmus (PAN) and roving ocular movements (ROM) were measured at 30-60 min intervals after drinking. Body-sway and hand-tremor increased with advancing age in tests made before the ingestion of alcohol (P < 0.05). After drinking alcohol, body-sway and hand-tremor increased in the four age groups (P < 0.05), being most pronounced at or near the time of reaching the peak blood alcohol concentration (BAC). The initial impairment subsided when the post-absorptive phase of ethanol kinetics commenced. At 60 min post-drinking, body-sway was most pronounced in men aged 40-49 years when their eyes were closed (P < 0.05). Otherwise, age-related differences in alcohol impairment in the other age groups were not statistically significant. Positional alcohol nystagmus (PAN) developed mainly during the acute phase of intoxication, decreasing in intensity as the time after drinking progressed. Roving ocular movements (ROM) were most apparent during the post-absorptive phase (120-420 min). We conclude that the acute effects of a moderate dose of ethanol on sensory and motor functions are not much different in men aged between 20 and 59 years.

Mechanism of expression and role in transcriptional control of the proto-oncogene NFKB-2/LYT-10

The NFKB-2 gene (previously LYT-10, NF-kappa Bp100 or NF-kappa Bp97) codes for a NF-kappa B/rel related protein which is highly homologous to NFKB-1 (previously NF-kappa Bp105) within its rel, poly-glycine and ankyrin domains. The NFKB-2 gene is a candidate proto-oncogene since it is involved in lymphoma-associated chromosomal aberrations. In order to gain insight into the physiological function and role in tumorigenesis of NFKB-2, we have analysed its mechanism of expression and role in transcriptional regulation. We report that, contrary to previous studies, a single 3.2 kb mRNA species and its 100 kD (p100) primary translation product is detectable in all cell types tested. A second NFKB-2 protein, p52, corresponding to the amino-terminal half (rel domain) of NFKB-2 p100, is detectable in the same cell types and derives from the post-translational processing of p100. While p100 is constitutively localized in the cytoplasm, NF-kappa B induction by TPA treatment of Hela cells is associated with cytoplasmic/nuclear translocation of NFKB-2 p52 and its appearance within DNA-binding NF-kappa B complexes. NFKB-2 p52 differs from NFKB-1p50 in its differential affinity for kappa B sequences: by itself it binds H2/HLA-kappa B sites more efficiently than HIV/IgK-kappa B sites, while it can bind both sites efficiently when complexed with Rel-A(p65). Transient co-transfection of expression and reporter plasmids in cells devoid of endogenous NF-kappa B activity showed that p52 has no intrinsic transcriptional activation capabilities: it can stimulate Rel-A(p65)-driven transcription by formation of p65/p52 heterodimers, whereas, overexpressed, it down-regulates p65-dependent transcription by formation of inactive p52/p52 homodimers. These results indicate that the NFKB-2 gene codes for an inducible NF-kappa B transcription factor with the capability of differentially regulating NF-kappa B transcription depending on its abundance in the nucleus.

Analysis of p53 and ras gene mutations in endometriosis

No activating mutations in codons 12, 13 and 61 of ras genes nor inactivating mutations in exons 5-9 of the p53 tumor suppressor gene were detected by polymerase chain reaction and single-strand conformation polymorphism methods in either eutopic or ectopic endometrium from 10 women with severe endometriosis.

Frequency of RAS and p53 mutations in acute promyelocytic leukemias

The frequency of RAS and p53 mutations was investigated in 30 acute promyelocytic leukemias by single strand conformation polymorphism analysis and direct sequencing of genomic DNA. Only two cases bore N-RAS codon 12 mutations and none had p53 mutations responsible for aminoacid substitutions. It would, therefore, seem that neither RAS nor p53 are involved in acute promyelocytic leukemogenesis.

"Hook effect" in complete hydatidiform molar pregnancy: a falsely low level of beta-HCG

BACKGROUND

In some cases of gestational trophoblastic disease, a large amount of serum beta-hCG may lead to the high-dose "hook effect" with falsely low serum levels, creating misdiagnosis or delay in diagnosis and therapeutic hazards to the patient.

CASES

In two cases of the hook effect in complete hydatidiform mole, ultrasonographic scan showed intrauterine echogenic material, whereas diluted serum specimens gave very high levels of beta-hCG (1,600,000 and 2,225,000 mIU/mL).

CONCLUSION

The possibility of a method-dependent hook effect must be considered. Early recognition of falsely low values of beta-hCG can allow correction to the true values by various methods, such as serum dilution before the radioimmunometric method.

A modified transvaginal sonographic technique for better ovarian evaluation

Sonographic evaluation of the pelvis of postmenopausal women is not complete until both ovaries are scanned. Transvaginal sonographic examination combined with transabdominal screening is diagnostic in 85% of cases. Transvaginal examination performed with a partially full bladder significantly increased ovarian detection to 93.5% (p < 0.05).

Structural alterations of the NF-kappa B transcription factor lyt-10 in lymphoid malignancies

We have previously reported the identification of a novel putative proto-oncogene involved in the breakpoint of a t(10;14)(q24;q32) chromosomal translocation in a case of B-cell lymphoma. This gene, called lyt-10 (NFKB2/p52), is a member of the NF-kappa B family of transcription factors and displays a high degree of homology with the NFKB1/p50. Here we describe the genomic organization of the lyt-10 gene based on the restriction analysis of genomic phage clones and the sequence determination of exon-intron boundaries. The lyt-10 gene spans a genomic region of about 8 kb on 10q24, and contains 24 exons, ranging in size between 41 and 258 base pairs. To improve the understanding of the role of lyt-10 in lymphomagenesis, we performed Southern blot analysis to detect alterations of the lyt-10 gene in a large panel of cases representative of different types of lymphoid malignancies. We found rearrangements in 5 of 228 (approximately 2%) cases analysed: two cases of B-cell lymphoma, one case of multiple myeloma and two cases of T-cell lymphoma. The use of various probes specific for different regions of the lyt-10 locus revealed that rearrangements in positive cases lead to the partial or total deletion of the carboxy-terminal region containing the ankyrin domain. Taken together, our results indicate that lyt-10 gene rearrangements represent a recurrent lesion that may be involved in the pathogenesis of both B- and T-cell malignancies, and suggest that truncation of the ankyrin domain may be a common mechanism of lesion leading to abnormal lyt-10 activation in lymphoid neoplasia.

Vulvar leiomyoma

Since symptoms of benign and malignant conditions in the vulvar area are frequently similar, early diagnosis and treatment are mandatory. A rare case of a bizarre leiomyoma in the area of Bartholin's gland, which presented as a Bartholin's abscess, is described and discussed.

Evidence of clonal progression in a case of Richter syndrome

BACKGROUND

The debate continues as to whether Richter syndrome should be defined as non-Hodgkin lymphoma (NHL) because of a more malignant clone of neoplastic cells superimposed on preexisting chronic lymphocytic leukemia (CLL) or as the chance occurrence of two unrelated tumors. The cellular characteristics of the neoplastic clone involved in the CLL phase and the subsequent NHL were investigated in a patient in whom Richter syndrome developed.

METHODS

Cell analysis was performed with immunofluorescence, histologic analysis, DNA extraction, and Southern blot analysis.

RESULTS

The separated CLL and NHL B-cells from blood and bone marrow, as well as the neoplastic cells in autopsy specimens of the organs affected by NHL, particularly the brain, were found to express the same light chain of surface immunoglobulin (SIg). The change MD-->M in the SIg heavy-chain expression and the appearance of cytoplasmic IgMk suggested isotype switching simulating that observed on the final phases of primary B-cell differentiation. This hypothesis was confirmed by Southern blot analysis of DNA from blood cells in the CLL phase and in Richter transformation, which showed that the two cell populations had identical Ig gene rearrangement.

CONCLUSIONS

The NHL in the patient in this study represented a malignant progression of CLL, not a second lymphoid malignancy.

[Ischemic colitis localized in the right colon. A clinical case report]

Ischemic colitis shock-associated still is a not well-defined clinical entity. The authors describe symptoms, clinical course and treatment in a case recently observed. They outline the difficulties of preoperative diagnosis and the need of a not postponable surgical treatment due to shock and peritonitis.

p53 gene mutations in multiple myeloma are associated with advanced forms of malignancy

The frequency and type of p53 gene mutations was investigated in a series of 52 cases of multiple myeloma (MM) representative of the different clinical phases and forms of the disease (indolent, 12 cases; chronic, 24 cases; acute/leukemic, 16 cases). DNAs were analyzed for p53 gene mutations in exons 5 to 9 by polymerase chain reaction (PCR), single-strand conformation polymorphism (SSCP), and direct sequencing of PCR-amplified fragments. Point mutations were detected in 7 of 52 patients (13%) (5 at exon 8; 1 at exon 6; 1 at exon 7), and were specifically associated with the more advanced and clinically aggressive acute/leukemic forms of MM (7 of 16 [43%].) Three of the mutated cases had been evaluated at clinical presentation in earlier phases of the disease (indolent or chronic) and were found to be negative for p53 mutation. Moreover, three patients with p53 mutation had not received chemotherapy at the time of investigation. These results support the notion that the development of MM is a multistep process and suggest that alterations in the p53 gene may represent an important late event in MM tumor progression.

Bacterial vaginosis in pregnancy treated with yoghurt

As various drugs might have an effect on the fetus during pregnancy, the use of drugs should be minimized in the pregnant woman. Since bacterial vaginosis (BV) can be associated with prematurity and postpartum complications, we searched for alternative therapy for its cure during pregnancy. Commercial yoghurt incorporates both factors necessary for maintaining the protective mechanism of the vagina, vaginal pH and lactobacillus. A total of 32 women with BV in the first trimester of pregnancy were treated with intravaginal application of yoghurt. The result was favorable indicating that the continuous correction of vaginal pH and lactobacillus flora is crucial for normal vaginal ecology. During pregnancy, a local treatment restoring the normal acidity and vaginal flora, without systemic effect, may be preferable to any other treatment.

[Vascular access for hemodialysis. Clinical experience]

Seventy-nine arteriovenous fistulas for periodic hemodialysis were created in 62 uremic patients: 64 primary vascular accesses and 15 salvage operations for malfunctioning fistulas. Sixty-three distal and 1 proximal arteriovenous fistulas between the radial artery and the cephalic vein, were created as primary vascular access. The utilization time of the primary arteriovenous fistulas was longer than 5 years in 34%, 3-4 years in 25% and 0-2 years in 41% of cases. Eleven fistulas evidenced thrombosis: a salvage operation (resection-anastomosis) was possible for 9 (89%). A salvage operation was possible for 100% of poor flow fistulas. The utilization's time of the salvage fistulas is longer than 5 years in 15%, 3-4 years in 15% and 0-2 years in 70% of cases.

Open reduction of acetabular fracture in pregnancy. A case report

A 24-year-old woman in her 20th week of pregnancy sustained a severely displaced acetabular fracture. Skeletal traction failed to achieve reduction. Open reduction and internal fixation were performed through an extended iliofemoral approach without affecting the pregnancy. At full term, she had a normal delivery. Four years after the injury, the patient had a pain-free hip with full range of motion and a healthy child. The potential benefit or danger of surgery to the patient and her pregnancy was thoroughly considered.

Enhanced urinary albumin excretion after 35 weeks of gestation and during labour in normal pregnancy

This study reports on the urinary albumin to creatinine ratio during normal pregnancy, with special emphasis on the pre-delivery and labour periods. Albumin was determined in single voided urine specimens obtained from healthy non-pregnant women (n = 16) and healthy pregnant women (n = 203; Groups A and B, 133 females examined during clinic visits and presentation at obstetric department; Group C, 70 females examined during labour) by radioimmunoassay (RIA). The mean ratio (+/- SD) for albumin/creatinine (A/Cr) in non-pregnant women was 1.46 +/- 0.32 mg mmol-1 Cr. Thus, 2.10 mg mmol-1 Cr (mean+2 SD) was considered to be the upper limit of normo-albuminuria. During pregnancy, 73% of the women (97 out of 133, Groups A and B) excreted less than or equal to 2.10 mg mmol-1 Cr. During the first 35 weeks of gestation, 30 of 34 pregnant women (88%) excreted less than or equal to 2.10 mg mmol-1 Cr, the mean being 0.93 +/- 0.64 mg mmol-1 Cr (median 1.0 mg mmol-1). During 36-42 weeks of gestation, the median A/Cr was 1.93 mg mmol-1 Cr (range 0.43-12.16) and 32 of 99 (32%) had values greater than 2.10 mg mmol-1 Cr, an increase of more than two-fold (p less than 0.031) compared with the first 35 weeks. During labour, 61% of non-haematuric urines (33 of 54, Group C) were greater than 2.10 mg mmol-1 Cr, being 125% greater (p less than 0.006) than that observed during pregnancy. Thus in normal pregnancy, A/Cr is increased during the late period of pregnancy and during labour.

[Pheochromocytoma and homolateral stenosis of the renal artery. A rare association?]

A case of association between pheochromocytoma and homolateral stenosis of renal artery is discussed. Until now, this is the first notification of such an association. The authors examine the possibility of a link between the two pathologies on the basis of congenital or physical factors. This association could have been so rarely just only due to the difficulty to prove it.

Combined anomalies of the müllerian and wolffian systems

Combined congenital anomalies of the Müllerian and Wolffian duct systems are a rare phenomenon. We report a case of bicornuate uterus and infected right Gartner duct cyst, associated with agenesis of the left kidney and a left ovarian cyst. The case is discussed in view of its unknown occurrence.

B cell lymphoma-associated chromosomal translocation involves candidate oncogene lyt-10, homologous to NF-kappa B p50

A B cell lymphoma-associated chromosomal translocation, t(10;14)(q24;q32), juxtaposes the immunoglobulin C alpha 1 locus to a novel gene, lyt-10. The normal lyt-10 cDNA codes for a 98 kd protein which displays amino-terminal homology with the rel (DNA-binding) domain of the NF-kappa B-rel family of transcription factors and carboxy-terminal homology with the NF-kappa B p50 precursor protein, including the putative proteolytic cleavage domain (poly-G) and the ankyrin-like repeat domains. The lyt-10 protein can bind to kappa B sequences in vitro, although with different specificity from NF-kappa B p50, and in vitro DNA-binding is activated by removal of the ankyrin domain. Chromosomal translocation generates an lyt-10-C alpha 1 fusion gene coding for a protein that retains the rel effector domain, lacks the ankyrin regulatory domain, and binds kappa B sequences in vitro, suggesting its constitutive activation in vivo. Analogous rearrangements of the lyt-10 gene have been found in an additional three cases of lymphoid neoplasia. The lyt-10 gene defines a new subfamily (rel/poly-G/ankyrin) of NF-kappa B-rel transcription factors with potential for oncogenic activation in human cancer.

Familial dilated cardiomyopathy: a transverse and longitudinal clinical and echocardiographic study

The familial occurrence of hypertrophic cardiomyopathy is well known; familial dilated cardiomyopathy has so far received less attention. Ten families with two or more members affected by dilated cardiomyopathy were studied by echocardiography. In 3 out of 10 families, a transverse study extended to even apparently healthy subjects was carried out, which included a total of 45 subjects. In 19 out of the 45, dilated cardiomyopathy (either symptomatic or asymptomatic) was diagnosed at echocardiography. Three more relatives, already dead of the disease, were identified through hospital records. A clinical and echocardiographic longitudinal study, lasting up to 11 years, was carried out in 5 of the 10 families. During the follow-up, 8 out of 19 patients who, at first examination were affected by dilated cardiomyopathy, died, one improved, 3 remained in stable condition and 7 were lost at follow-up. One of two patients who presented echocardiographic findings suggestive of border-line dilated cardiomyopathy returned to normality and the other developed dilated cardiomyopathy. The clinical and echocardiographic findings in our patients, and in their relatives, suggest the possibility that idiopathic dilated cardiomyopathy may be a multifactorial disease in which genetic factors might play a variable role.