Prevalence of histological beta2-microglobulin amyloidosis in CAPD patients compared with hemodialysis patients

BACKGROUND

The prevalence of beta2-microglobulin amyloidosis (Abeta2m) in patients on continuous ambulatory peritoneal dialysis (CAPD) is unknown.

METHODS

We prospectively obtained a median of 2 (range 1 to 4) joint samples from 26 CAPD patients aged 44 to 93 (median 73) years at post-mortem evaluation after 4.5 to 126 (median 27) months solely on CAPD (N = 19) or primarily on CAPD (that is, < or = 10% and < or = 1 year of renal replacement therapy time on other modalities; N = 7). The diagnosis of Abeta2m rested on Congo red staining (typical birefringence) and positive immunostaining of amyloid deposits by a monoclonal anti-beta2m antibody.

RESULTS

Abeta2m was diagnosed in 8 of 26 patients (31%). Prevalence ranged from 20% (2 of 10 patients) within < or = 24 months CAPD to 30% (3 of 10 patients) after 24 to 48 months and 50% (3 of 6 patients) after 49 to 126 months (P = 0.11). The prevalence of Abeta2m was similar in patients without or with one or more peritonitis episodes. No significant difference in prevalence (P = 0.118) was found between CAPD patients (8+/26; 31%) and hemodialysis patients (13+/26; 50%) carefully matched for time on dialysis and age at the onset of dialysis.

CONCLUSIONS

The prevalence of histological Abeta2m reaches 31% after a median duration of 27 months of CAPD. This prevalence is not significantly different from that observed in a group of HD patients matched for age and dialysis duration.

Early irreversible osteonecrosis versus transient lesions of the femoral condyles: prognostic value of subchondral bone and marrow changes on MR imaging

OBJECTIVE

The purpose of this study was to determine the MR imaging features that enable differentiation between early irreversible osteonecrosis and transient lesions in nontraumatic lesions of the femoral condyle having the "bone marrow edema" pattern on MR imaging.

MATERIALS AND METHODS

We reviewed 23 nontraumatic painful lesions of the femoral condyle in 23 patients (12 men and 11 women; mean age, 62 years). All patients had undergone radiography of the knee with findings that were normal or inconclusive. Also, all patients underwent MR imaging that revealed the bone marrow edema pattern in a condyle. Lesions observed after trauma, surgery, or glucocorticoid medication, or with epiphyseal collapse or degenerative joint disease on initial plain radiographs, were excluded from this study. Of the 23 lesions, 14 showed complete resolution (and were designated as transient epiphyseal lesions). The remaining nine lesions were irreversible and, on follow-up radiographic and MR imaging studies, evolved to collapsed osteonecrosis (and were designated as early osteonecrosis). The presence and size of the subchondral features observed by two radiologists on initial MR studies were compared for both irreversible and transient epiphyseal lesions.

RESULTS

Initial MR imaging characteristics indicative of an early irreversible osteonecrosis included a subchondral area of low signal intensity on T2-weighted images with a thickness of more than 4 mm (sensitivity, 100% and 100%; specificity, 82% and 74% for the two observers) or a length of more than 14 mm (sensitivity, 89% and 88%; specificity, 93% and 87% for the two observers), focal epiphyseal contour depressions, and lines of low signal intensity located deep in the affected condyle. The extent of edema was similar for both transient epiphyseal lesions and early osteonecrosis.

CONCLUSION

Careful assessment of MR imaging changes occurring in the subchondral area can enable confident differentiation between transient epiphyseal lesions and early irreversible osteonecrosis of the femoral condyle.

Solitary fibrous tumor of the pleura: a report of five cases diagnosed by transthoracic cutting needle biopsy

Five patients had a solitary fibrous tumor of the pleura; a well-known but rare entity. In all cases, biopsy by a transthoracic cutting needle (Tru-Cut; Travenol; Deerfield, IL) yielded specimens adequate for histologic analysis and gave the clue to the diagnosis. In four patients, surgical resection confirmed the diagnosis. The opportunity for and interest in diagnosing these tumors by transthoracic cutting needle biopsy before surgery are discussed. An accurate diagnosis of solitary fibrous tumors of the pleura can be made by a minimally invasive procedure; this allows for a more informed allocation of surgical resources.

Histological prevalence of beta 2-microglobulin amyloidosis in hemodialysis: a prospective post-mortem study

The histological prevalence of beta-2 microglobulin amyloidosis (A beta 2m) was evaluated in a prospective study of joint samples obtained at autopsy in 54 patients on hemodialysis (HD) for 2 to 163 (median 47) months, aged 20 to 80 (median 63) years at HD onset. Carpal tunnel syndrome surgery or radiological signs of A beta 2m were present in 2 and 4% of them, respectively. A control group of 34 patients without end-stage renal disease, autopsied during the same period was used as a reference. The 153 sampled joints (1 to 8, median 2 per patient) were sternoclavicular joints (N = 77), shoulders (N = 35), knees (N = 28), others (N = 13). A beta 2m was diagnosed (positive Congo red with typical birefringence and positive immunostaining of deposits for beta 2m) in 26 of 54 (48%) patients. Prevalence reached respectively 21%, 33%, 50%, 90% and 100% within two years, after 2 to 4 years, 4 to 7 years, 7 to 13 years and more than 13 years HD. The calculated sensitivity of the various joints for A beta 2m detection is significantly higher (P < 0.03) for sternoclavicular joints (97%) and knees (91%) than for shoulders (57%). Multivariate stepwise logistic regression with discriminant analysis identified both HD duration (P = 0.0008) and age at HD onset (P = 0.0093) but not diabetic nephropathy (P = 0.23) or gender (P = 0.25) as independent risk factors for A beta 2m. The probability of joint A beta 2m was quantitated as a function of age and HD duration. In conclusion, A beta 2m may be observed in the large joints early after HD onset. Overall prevalence reaches 48% of the patients on HD for a median of 47 months. It is much higher than that reported on the basis of clinical or radiological evidence. The sternoclavicular and knee joints are more frequently (P < 0.03) involved than the shoulder. The easily accessible sternoclavicular joint therefore appears to be the best site for the early detection of A beta 2m. Both HD duration and age at HD onset, but not diabetic nephropathy, are independent risk factors for A beta 2m.

[Osteosarcoma of the mandible]

We describe a case of osteosarcoma of the mandible presenting as a soft tissue mass associated with an enlargement of the mandibular canal at imaging work-up. Radiographic, isotopic, CT and MR features are reported.

Osteopenia, bone fragility and reflex sympathetic dystrophy syndrome in a man with ureterosigmoidostomy

A 68-year-old man is presented with a reflex sympathetic dystrophy syndrome (RSDS) of the right ankle diagnosed by radiography, magnetic resonance imaging and bone scintiscan. Investigations, including blood tests and bone biopsy, revealed a diagnosis of metabolic acidosis and osteomalacia. These appeared to result from a ureterosigmoidostomy performed 9 years previously for a transitional carcinoma of the bladder. Correction of the metabolic acidosis coincided with improvement in ankle pain. RSDS may be the initial presentation of osteomalacia, which in turn may be caused by the metabolic acidosis resulting from a ureterosigmoidostomy.

BCL3 rearrangement and t(14;19)(q32;q13) in lymphoproliferative disorders

Translocation t(14;19)(q32;q13) is a rare but recurrent abnormality in chronic lymphocytic leukemia and small cell lymphoma. It has been associated with rearrangements of the BCL3 gene, which is located at the breakpoint on chromosome 19 and is juxtaposed to the immunoglobulin heavy chain locus on chromosome 14 as a result of the translocation. This results in transcriptional up-regulation of the BCL3 gene, which encodes a transcription coactivator, an I-kappa B protein, probably contributing to disease progression. We found, among 4,487 cytogenetic analyses of lymphoproliferative disorders, six cases with a t(14;19)(q32;q13), five of which showed the classical t(14;19)(q32;q13) and one of which showed a three-way translocation t(7;19;14)(q21;q13;q32). The 14;19 translocation never occurred as a single abnormality; additional aberrations included trisomy 12 and several structural abnormalities. The cytogenetic examination was supplemented by molecular analysis using available probes for the BCL3 locus (p alpha 1.4P and p alpha 5B) in 1,150 of the 4,487 patients. Rearrangements of BCL3 could be detected in five cases, all of which had the classical t(14;19). In the case with t(7;19;14), the suspected BCL3 involvement could only be confirmed using long-range restriction mapping, indicating that, with the usually available BCL3 probes, rearrangements of this locus may be missed.

P-glycoprotein positive, drug resistant invasive lymphoepithelial thymoma: treatment response to chemotherapy with cyclosporin and quinine

A case of invasive drug resistant thymoma, expressing P-glycoprotein, which showed noticeable clinical response to chemotherapy and the multidrug resistance modulating agents cyclosporin and quinine is reported. A 46 year old man presented with severe left shoulder pain and a diagnosis of invasive lymphoepithelial thymoma was made following chest x ray and a computed tomography scan. The patient underwent extensive chemotherapy without resolution of the tumour. More than 90% of the malignant epithelial cells were strongly positive for P-glycoprotein and based on this observation, cyclosporin and quinine were added to the chemotherapy regimen. The mediastinal mass completely resolved and the size of the pleural metastasis decreased substantially. The patient, however, died of an intercurrent infection. This case report highlights the feasibility and efficacy of using cyclosporin and quinine in combination with VAD chemotherapy in the treatment of invasive thymoma.

[Hepatic angiosarcoma developed 5 years following treatment for subacute glomerulonephritis]

A patient with hepatic angiosarcoma is described. This tumour, thought rare, still generates clinical interest, because of its characteristic association with occupational exposure to certain chemicals such as vinyl chloride and thorotrast. That association has led to extensive screening of high risk populations. An additional case of liver angiosarcoma which probably developed following long-term treatment with cyclophosphamide. The significant aspects of this tumour are delineated and the diagnostic modalities are discussed.

B lymphocyte and macrophage expression of carcinoembryonic antigen-related adhesion molecules that serve as receptors for murine coronavirus

The expression of carcinoembryonic antigen (CEA)-related glycoproteins that have been associated with intercellular adhesion and that serve as receptors for mouse hepatitis virus (MHV) was analyzed in cells from the immune system of BALB/c mice using immunolabeling and RNA polymerase chain reaction amplification of receptor transcripts. These glycoproteins, which are called biliary glycoproteins, were highly expressed in B lymphocytes, including cells of the B-1a (CD5+) lineage, and in macrophages, but were not detectable in resting T lymphocytes. Similarly, murine cell lines of B cell and macrophage origin expressed messenger RNA encoding CEA-related molecules, while the corresponding mRNA was only slightly detectable in a T cell line. These CEA-related cell adhesion glycoproteins were also expressed in endothelial cells. Therefore, their specific interaction with their so far unknown ligand may be of functional importance in cellular interactions in the immune response. Monoclonal antibody directed against these glycoproteins blocked MHV-A59 infection of the B cell-derived SP20 cell line. Thus, the functional receptors for MHV on B lymphocytes, like those on murine fibroblasts, are isoforms of CEA-related glycoproteins. Treatment of B cells with anti-receptor antibody also blocked B cell-mediated cytotoxicity against MHV-A59-infected fibroblasts, indicating that this phenomenon is mediated by interaction of viral attachment protein on the infected target cells with specific CEA-related receptor glycoproteins on the effector B cells.

Benign osteochondromas and exostotic chondrosarcomas: evaluation of cartilage cap thickness by ultrasound

Ultrasonography (US) enables accurate assessment of the cartilage cap of exostoses. The cartilage cap appears as a hypoechoic layer covering the hyperechoic surface of the calcified part. Measurements of cap thickness with US were compared with measurements performed on pathological specimens in 22 resected exostoses and 2 exostotic chondrosarcomas. The US measurements proved to be very accurate, with a mean measurement error of less than 2 mm for cartilage caps less than 2 cm thick. The detection rate and measurement accuracy of US were higher than with computed tomography (CT) and comparable to magnetic resonance imaging (MRI), which were available in 14 and 10 cases, respectively. US appears to be a good procedure for evaluating the cartilage cap, which is usually thin for a benign exostosis and thick for a malignancy. In addition, other complications--such as bursa formation--are easily recognizable. The sole limitation is that US cannot visualize the cartilage cap when it is inwardly orientated or deeply located in soft tissues, which are both, however, relatively uncommon situations.

Cytogenetic characterization of three cases of unusual B-cell non-Hodgkin's lymphoma

We report the cytogenetic results in three cases of B-cell non-Hodgkin's lymphomas with morphologic and immunophenotypic features compatible with a non-follicle center cell lymphoma. In all cases, a chromosome breakpoint at 14q32 and structural abnormalities of 1p were found. Increased copies of chromosome segment 12q and structural rearrangements of chromosome 6 were found in two cases. Translocation (14;18)(q32;q21) with rearrangement of bcl-2 was found in one case. These lymphomas have a perifollicular growth pattern and IgM+, IgD+, CD10-, and CD22+ immunophenotype features typical of non-follicle center cell lymphomas and probably belong to the follicle mantle lymphomas described recently. Little cytogenetic data about this group of lymphomas is available, possibly because in the Working Formulation for the Classification of Lymphomas they are not separated from follicle center cell lymphomas.

Autonomous growth and tumorigenicity induced by P40/interleukin 9 cDNA transfection of a mouse P40-dependent T cell line

To test the transforming potential of deregulated P40/Interleukin 9 expression, we transfected a mouse P40-dependent T cell line with P40 cDNA, and examined the tumorigenicity of the resulting transfectants. When the cells, which grew autonomously in vitro, were injected intraperitoneally or subcutaneously into syngeneic mice, a very high tumor incidence was observed with as few as 10(4) cells per inoculum. Animals died as a result of widespread dissemination of lymphomatous tissue to abdominal and thoracic organs. The same P40-dependent cell line transfected with a control construct did not form tumors even after injection of 10(7) cells. These results indicate that uncontrolled expression of P40 can support T cell proliferation in vivo, and may be a transforming event involved in the development of certain T cell tumors.

Lymphoplasmacytic/lymphoplasmacytoid immunocytoma with a high content of epithelioid cells. Histologic and immunohistochemical findings

Fifty-four lymph node biopsy specimens from 36 patients with lymphoplasmacytic/lymphoplasmacytoid immunocytoma with a high content of epithelioid cells (LPICep) were studied by light microscopy using conventional histologic and immunohistochemical techniques. Three other patients with extranodal involvement only were also included in the study. Of a total of 39 patients, 31 had the polymorphic subtype, six the lymphoplasmacytoid subtype, and two the lymphoplasmacytic subtype. Cellular composition and histologic structure are described in detail as a basis for discriminating LPICep from similar lymphomas with a high content of epithelioid cells, especially from lymphoepithelioid cell lymphoma (Lennert's lymphoma), angioimmunoblastic peripheral T-cell lymphoma with a high content of epithelioid cells, and Hodgkin's disease, mixed cellularity type with a high content of epithelioid cells. In 10 patients (26%) LPICep developed into a high-grade malignant lymphoma of B-immunoblastic type. Forty-seven biopsy specimens were studied with the peroxidase-antiperoxidase method to detect intracytoplasmic immunoglobulin. Plasma cells and plasma cell precursors revealed a monotypic immunoglobulin pattern in all specimens. In 25 biopsy specimens in which giant cells resembling Sternberg-Reed and Hodgkin's cells were found, these cells were CD15 negative. A comparison of the main clinical and laboratory data in these four lymphomas with a high content of epithelioid cells revealed both similarities and differences.

Cytohistologic and immunohistochemical findings in Hodgkin's disease, mixed cellularity type, with a high content of epithelioid cells

We studied 123 lymph node biopsies from 99 patients with Hodgkin's disease, mixed cellularity type, with a high content of epithelioid cells (HDMCep), by light microscopy using conventional histologic and immunohistochemical techniques. The cellular composition and histologic structure, which are described in detail, serve as a basis for discriminating HDMCep from similar lymphomas with a high content of epithelioid cells, especially from lymphoepithelioid cell lymphoma (Lennert's lymphoma, LeL) and angioimmunoblastic (LgX) type of peripheral T-cell lymphoma with a high content of epithelioid cells (AILD-PTCLep). In all lymph nodes from patients with HDMCep, the nodal architecture was effaced. In 11% it was partially replaced by a massive infiltration of epithelioid cells and small to medium-sized lymphoid cells occurring in varying proportions with some immunoblasts. In all biopsy specimens, some typical Sternberg-Reed (SR) and Hodgkin (H) cells were found. Plasma cells and plasma cell precursors were present in all biopsy specimens; in most cases, they were sparse to moderate in number. Eosinophils were always present; half of the biopsy specimens had rather large numbers of them. Formation of granulomas like those seen in sarcoidosis was noted in 7% of the specimens. Increased vascularity and an increased number of fibers were found in 53% and 63% of the biopsy specimens, respectively. Necrosis was seen in 20% of the specimens. Immunohistochemically in 30 of 67 (45%) biopsy specimens, giant cells stained positively for the granulocyte-specific monoclonal antibody 3C4 (approximately CD15). Plasma cells and plasma cell precursors in all 70 specimens exhibited a polyclonal Ig pattern. A comparison of the main clinical and laboratory data in these three entities reveals both similarities and differences. HDMCep--defined as a special variant of Hodgkin's disease, mixed cellularity type (HDMC)--marks apparently the border between Hodgkin's disease and non-Hodgkin's lymphomas.

Prediction of recurrence in the treatment of Dupuytren's disease: evaluation of a histologic classification

Histologic staging of Dupuytren's lesions into three types is proposed: a proliferative type with high cellularity and mitosis, a fibrocellular type characterized by the presence of a reticulin network, and a fibrous type with few cells. Sixty-three patients (77 hands) who had selective fasciectomy as a primary procedure and whose histologic specimen was available were clinically reviewed for disease recurrence and extension. Twenty-two hands (29%) were free of disease; twenty-five (32%) were free from recurrence but showed an extension, and thirty (39%) had a recurrence. This histologic classification seems to have a prognostic value because the recurrence rate is higher in type I (70%) and lower in type III (18%). The risk of extension did not correlate with the histologic type.

Angioimmunoblastic lymphadenopathy--type of T-cell lymphoma with a high content of epithelioid cells. Histopathology and comparison with lymphoepithelioid cell lymphoma

A peripheral T-cell lymphoma with a high content of epithelioid cells--an entity that reveals morphologic and clinical characteristics resembling those seen in angioimmunoblastic lymphadenopathy (AILD)--was separated from lymphoepithelioid cell lymphoma (Lennert's lymphoma, or LeL); it was considered a variant of the AILD type of peripheral T-cell lymphoma (AILD-PTCLep). A histologic evaluation of 135 lymph node biopsies from 98 patients with AILD-PTCLep showed that AILD-PTCLep and LeL share certain features, but there are also differences between the two. A finding common to both lymphomas was the mixture of neoplastic T-lymphocytes and a large number of epithelioid cells, which accumulated mostly in small, poorly defined clusters. Additionally, typical Sternberg-Reed and Hodgkin cells as well as giant cells resembling them were observed only rarely in either of these lymphomas. In contrast to LeL, AILD-PTCLep showed a great increase in follicular dendritic cells, which were sometimes identifiable in routine slides as so-called burned-out germinal centers. In AILD-PTCLep, the number of small vessels (predominantly epithelioid venules) and fibers is also usually greatly increased, whereas in LeL this is not the case, or the increase is only slight. Hypocellular and lymphocyte-depleted areas and PAS-positive intercellular material were seen in AILD-PTCLep (18% and 34%, respectively), but not in LeL. Large numbers of eosinophils, plasma cells and plasma cell precursors, and diffuse neoplastic infiltration of the capsule and extranodal tissue were observed much more commonly in AILD-PTCLep. Corresponding to these differences in the histologic pictures are differences in the clinical pictures. Hyperimmune phenomena (pruritus, skin rash, hemolytic anemia, allergy to antibiotics) and hypergammaglobulinemia were much more common in AILD-PTCLep than in LeL. Allergy to chemotherapeutic agents was observed only in AILD-PTCLep patients. Carcinomas were observed as a second neoplasm in 11% of the patients with AILD-PTCLep, but not at all in LeL. The similarities between the two lymphomas include the age and sex distribution (peak in the seventh decade and slight predominance of the male sex) and a similar median survival time. Another similarity is the possibility that the disease will develop into a large-cell malignant lymphoma. This was observed in 13% of the cases of AILD-PTCLep and 8% of the cases of LeL.

Histological and immunohistological findings in lymphoepithelioid cell lymphoma (Lennert's lymphoma)

Four hundred and two cases considered or suspected to be lymphoepithelioid cell lymphoma (Lennert's lymphoma) were analyzed morphologically, immunohistochemically, and clinically. One hundred and eight of these cases, investigated in 180 biopsies, fulfilled the morphological and immunohistochemical criteria for lymphoepithelioid cell lymphoma and are herein reported. Cellular composition and histological structure are described in detail as a basis for discriminating Lennert's lymphoma from similar lymphomas with a high content of epithelioid cells (Hodgkin's disease, AILD type of T-cell lymphoma, lymphoplasmacytic lymphoma) and from inflammatory epithelioid cell reactions. Single typical Hodgkin cells were found in only 3.8% of biopsy specimens examined, and single typical Sternberg-Reed cells were found in only 2.2% of the biopsy specimens examined. Because these single Hodgkin and Sternberg-Reed cells were situated in a relatively monotonous lymphoid cellular pattern and because both these cells types also may occur in peripheral T-cell lymphomas, we include cases with such cells in the category of Lennert's lymphoma. Eight percent of the patients with lymphoepithelioid cell lymphoma showed transformation into a large-cell T-cell lymphoma without the prominent focal epithelioid cell component previously observed. Immunohistochemically, seven of the 69 biopsy specimens with detectable giant cells stained positively for the granulocyte-specific monoclonal antibody 3C4 (approximately CD15). Plasma cells were rare and always showed a polytypic immunoglobulin pattern. Lymphoepithelioid cell lymphoma, defined as a lymphoma of CD4+ T lymphocytes, marks the border between Hodgkin's disease and the non-Hodgkin's lymphomas. Today, absolute criteria for distinguishing between these two classes of lymphoma are lacking.

Differential effects of phosphatidylcholine and cardiolipin on carnitine palmitoyltransferase activity

Rates of carnitine palmitoyltransferase-catalyzed conversion of palmitoylcarnitine to palmitoyl-CoA are markedly decreased with the progress of this reaction presumably owing to the build up of inhibitory palmitoyl-CoA in the enzyme vicinity. High, above micellar, concentrations of palmitoylcarnitine, phosphatidylcholine liposomes and high KCl concentrations increased the activity, apparently by facilitating the removal of palmitoyl-CoA from the enzyme surface. The presence of cardiolipin was found to be inhibitory. The enzyme activity followed in the direction of palmitoylcarnitine formation with low palmitoyl-CoA concentration as substrate, was inhibited by phosphatidylcholine, but stimulated by cardiolipin. Both of these lipids markedly stimulated the enzyme activity followed by the isotope exchange procedure which requires progression of both the forward and the backward reactions. The results indicate that one of the effects of phospholipids on carnitine palmitoyltransferase activity is exerted from the ability of these substances to bind the amphipathic reactants of this enzyme, particularly long-chain acyl-CoA. The possibility that the activity of the membrane-bound carnitine palmitoyltransferase may at times be affected by changes in the concentrations and composition of the various phospholipids in the enzyme's vicinity is raised by these findings.

Intra-articular calcification in progressive systemic sclerosis

Subcutaneous and periarticular dystrophic calcifications are well known to be associated with progressive systemic sclerosis (PSS). On the other hand, calcifications inside the joints are very rarely reported. We report a new case of this unusual complication of PSS. The observation of the complete radiological follow-up led us to propose a mechanical rather than a purely inflammatory pathogenetic mechanism of this complication.

An essential requirement of cardiolipin for mitochondrial carnitine acylcarnitine translocase activity. Lipid requirement of carnitine acylcarnitine translocase

The phospholipid requirement for the optimal solubilization of carnitine acylcarnitine translocase from the inner membrane vesicles of rat liver mitochondria and for its reconstitution in liposomes was investigated. At the octylglucoside-solubilization step, the presence of cardiolipin proved superior to the other lipids tested. For reconstitution, a mixture having phosphatidylcholine, phosphatidylethanolamine and cardiolipin was found to be particularly effective. The requirement of cardiolipin at this step was met less effectively by other anionic phospholipids. Moreover, in intact mitochondria of rat liver and heart, the translocase activity was markedly inhibited by micromolar concentrations of doxorubicin, a specific cardiolipin-binding agent.

[Loss of digital tissues and carpal canal syndrome. Apropos of 3 cases]

We have observed three cases of carpal tunnel syndrome (CTS) complicated by cutaneous ulcerations and acroosteolysis. Although our first patient had a mild case of CTS, he had a concomitant amphetamine addition. This led to a mania for gnawing away at the digits in the territory of the median nerve. Our other two patients had severe cases of CTS. One suffered from diabetes and the other from primary amyloidosis. Surgical decompression of the median nerve was carried out in these two cases and led to rapid healing of the cutaneous lesions. The latter patients suffered from the entity known in the french literature as carpal tunnel "ulcero-mutilating" (ulcero-osteolytic CTS). This paper discusses possible mechanisms for its pathogenesis. In one of our cases, for example, we were struck by the role played by the patient's behavioral habits whether it be conscious or subconscious in the self-perpetration of the cutaneous and osseous lesions.

Sjögren's syndrome in a child

Sjögren's syndrome is a relatively uncommon condition in the paediatric age group. The youngest child reported thus far was a 5-year-old girl. This article reports the case of a 2-year-old girl admitted for recurrent infections of the respiratory tract with diffuse pulmonary interstitial infiltrations and a progressive swelling of the parotid glands. The clinical features and the results of laboratory investigations, including parotid and hepatic biopsies, chest X-rays and sialography helped to establish the diagnosis of Sjögren's syndrome. Clinical, immunological and genetic characteristics of Sjögren's syndrome are reviewed.

Solubilization and reconstitution of rat liver mitochondrial carnitine acylcarnitine translocase

Carnitine acylcarnitine translocase has been solubilized from inverted inner membrane vesicles of rat liver mitochondria with octyl glucoside and reconstituted into asolectin liposomes. For both processes, optimization of the detergent to phospholipid ratio was found crucial for obtaining reconstitutively active liposomes. Reassembly of the solubilized carrier into asolectin liposomes was achieved either by the octyl glucoside dilution method or by Extracti-Gel D column chromatography. The reconstituted system catalyzed exchange diffusion of carnitine, exhibited the expected inhibitor and temperature sensitivity, and discriminated between stereoisomers of octanoylcarnitine. The activity of unidirectional import of carnitine was low compared to exchange diffusion. It showed high-temperature sensitivity and a loss of activity on prolonged sonication that was regained by an appropriate freeze-thaw step subsequently.

gamma-butyrobetaine in tissues and serum of fed and starved rats determined by an enzymic radioisotopic procedure

A method for the determination of picomole quantities of gamma-butyrobetaine and its application for the determination of gamma-butyrobetaine distribution in tissues are described. The method is based on the quantitative conversion of gamma-butyrobetaine into carnitine by using a 50-60%-satd.-(NH4)2SO4 fraction of rat liver supernatant as the source of gamma-butyrobetaine hydroxylase [4-trimethylaminobutyrate,2-oxoglutarate:oxygen oxidoreductase (3-hydroxylating), EC 1.14.11.1]; the carnitine formed is then measured enzymically. The mean gamma-butyrobetaine content, as nmol/g wet wt. of tissue, ranged from a low of 4.6 in livers to a high of 12.3 in hearts of normal fed male adult rats. Starvation for 48 h did not affect the gamma-butyrobetaine concentration in serum, liver and brain, but that in skeletal muscles, kidney and heart was increased. These data are in line with the present views that most tissues are able to produce gamma-butyrobetaine, and show that starvation enhances the synthesis and/or the retention of this compound in many tissues. The observed high affinity of gamma-butyrobetaine hydroxylase for gamma-butyrobetaine (Km 7 microM), the high activity of this enzyme and the low concentration of gamma-butyrobetaine in liver indicate that gamma-butyrobetaine availability is one of the factors that normally limit carnitine synthesis.