A prospective randomised clinical trial of the intra-operative use of 5-fluorouracil on the outcome of dupuytren's disease

5-Fluorouracil reduces proliferation rates of fibroblasts, myofibroblast differentiation and contractility of ocular fibroblasts in vitro. This double-blind randomized clinical trial assesses whether intra-operative topical treatment with 5-fluorouracil reduces the recurrence rate after limited excision of Dupuytren's tissue. Patients with two-digit disease were randomized to having 5-fluorouracil (25mg/ml) treatment for 5 minutes on one digit and placebo on the other. Fifteen patients were enrolled with 18 months follow-up. There were no peri-operative complications. Wound healing was not delayed and there was no deterioration in the flexion deformity of the 5-fluorouracil treated digits. Patients were subsequently assessed by joint angle measurement at 3, 6, 12 and 18 months. There was no significant difference between control and 5-fluorouracil treated digits.

[Study of terminally ill patients' needs in an university hospital]

Within the framework of a project to create a Mobile Palliative Care Unit, in May 2000 we conducted an evaluation of the needs of patients undergoing palliative care in a university hospital centre. Thanks to the use of a standardised questionnaire, a team of doctors and nurses for each service was able to describe the symptoms, treatments and social and family situations as well as assess the eventual outcome of the patients hospitalised in their service who were in an advanced or terminal phase. In total, the study included 52 cases (5.5% of available beds). 81% of patients reported suffering from physical discomfort and 70% from psychological distress. A specific treatment for the disease in question was maintained in 28% of the cases. In 24% of the cases, the patient had social problems. Among all of the patients, 31% were on the waiting list to be transferred to a different location.

Inhibition of cortisol secretion in dispersed head kidney cells of rainbow trout (Oncorhynchus mykiss) by endosulfan, an organochlorine pesticide

The effects of endosulfan, an organochlorine pesticide, on cortisol secretion in vitro were investigated in enzymatically dispersed head kidney cells of rainbow trout, Oncorhynchus mykiss. First, the conditions for maximal cortisol secretion were characterized by selecting the optimal concentrations of adrenocorticotropin (ACTH) (1 IU/ml) and N(6), 2'-o-dibutyryladenosine 3':5'-cyclic monophosphate (dbcAMP) (2 mM), incubation temperature (15 degrees ) and time period (60 min for ACTH, 120 min for dbcAMP), number of cells per incubation well (75 x 10(6)/ml), and osmolarity of the medium (270 mosmol/L). Exposure of head kidney cells to endosulfan decreased ACTH- or dbcAMP-stimulated cortisol secretion and cell viability in a concentration-dependent pattern and the doses required to disrupt cortisol secretion were significantly lower than doses lethal to the head kidney cells. The median effective concentration of endosulfan (EC(50), the dose that inhibits cortisol secretion by 50%) was 17.3 microM while the median lethal concentration (LC(50), the dose that kills 50% of the cells) was 308 microM. Our study identified endosulfan as an environmental endocrine disrupting chemical that interferes with the normal secretory function of teleost interrenal steroidogenic cells. Multiple sites may be affected within the steroidogenic cells since dbcAMP could not restore cortisol secretion in endosulfan exposed cells.

[Multicentric liposarcoma. Apropos of a case]

INTRODUCTION

Though rare, observations of multiple liposarcomas show that the development of secondary tumors occur in sites usually considered as primary locations. This would be more frequent for myxoid liposarcomas than for other subtypes of the disease. Their origin, either multicentric (i.e., coexistence of several primary tumors) or due to metastatic spreading, is still debated.

EXEGESIS

We report a case of myxoid-type multicentric (i.e., right popliteal fossa, retroperitoneum and soft tissue of the left arm) liposarcomas of different sizes, without pulmonary, hepatic or osseous involvement. These liposarcomas were simultaneously diagnosed in a patient who presented with pain in the right knee.

CONCLUSION

This support the hypothesis that multiple liposarcomas have a multicentric origin. Initial and follow-up staging of such tumors must investigate not only usual metastatic sites but also classical primary locations.

Enhanced expression of interleukin-6 in bone and serum of metastatic renal cell carcinoma

Interleukin-6 (IL-6) is produced by renal cell carcinoma (RCC) cell lines and primary tumors. Using immunohistochemical staining in two RCC patients with hypercalcemia and high serum levels of free and total IL-6, we showed expression of IL-6 in metastatic bone tissue. The role of IL-6 in hypercalcemia and bone resorption would suggest that bisphosphonates or dexamethasone could be useful as adjuvant therapy for IL-6 dependent bone metastases which fail to respond to interferon alpha (IFN) alpha 2a and all trans retinoic acid (ATRA).

Systemic juvenile rheumatoid arthritis and associated Isaacs' syndrome

We describe a patient with systemic onset juvenile chronic arthritis who developed clinical and electromyographic features of acquired Isaacs' syndrome. This association has not been reported before and possible links between the 2 diseases are discussed.

SAPHO syndrome and pyoderma gangrenosum: is it fortuitous?

Pyoderma gangrenosum is well known as an associated feature of inflammatory bowel disease (IBD). Recently, higher than normal prevalence of IBD in patients with the SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome has been reported. However, the association of pyoderma gangrenosum with SAPHO syndrome without definitely excluded IBD has not been reported. We describe a case that suggests a possible connection between these 2 entities.

[Tuberculous tenosynovitis of the wrist: ultrasonographic diagnosis and contribution of MRI]

Chronic tenosynovitis of the hand due to Mycobacterium tuberculosis has become rare. In the two cases presented here, the final diagnosis was obtained by isolation of the organism in the intercarpal fluid (1 case), or by a synovial biopsy (1 case). Ultrasonography showed a hypoechoic thickening of one or several tendon sheaths. MR enabled better differentiation between the thickening of the synovium itself and a fluid effusion. The criteria permitting to differentiate tuberculous from non-infectious tenosynovitis are: young age, male sex, specific epidemiological factors, elevated erythrocyte sedimentation rate, marked local swelling, association with other foci of tuberculosis, unusual exudation and synovial thickening, and association with osteitis.

Changes in the rat lung after exposure to radon and its progeny: effects on incorporation of bromodeoxyuridine in epithelial cells and on the incidence of nuclear aberrations in alveolar macrophages

The aim of this study was to investigate some responses of cells in the rat respiratory tract as a function of time after inhalation exposure to various levels of radon and its progeny. Rats were exposed to a constant concentration of radon and its progeny to give cumulative exposure levels of 120, 225, 440 and 990 working level months (WLM). An additional unexposed group of rats served as controls. The end points selected for investigation were (a) the incorporation of bromodeoxyuridine (BrdU) in epithelial cells of the conducting airways and of the alveolar region of the respiratory tract and (b) the incidence of alveolar macrophages with nuclear aberrations. After exposure, the incidence of epithelial cells incorporating BrdU--the labeling index--increased in all regions of the respiratory tract examined, but the increase occurred later in alveolar than in airway epithelial cells. The highest labeling index was found in bronchial epithelial cells, which probably received the highest radiation dose. After an initial induction period, the incidence of alveolar macrophages with nuclear aberrations also increased. The possibility of using the labeling index of alveolar and airway epithelial cells, and/or the incidence of nuclear aberrations in alveolar macrophages, to estimate the radiation dose to various regions of the respiratory tract after exposure of rats to radon and its progeny is discussed.

Detection of human T lymphotropic virus type I tax gene in salivary gland epithelium from two patients with Sjögren's syndrome

OBJECTIVE

To investigate whether human T lymphotropic virus type I (HTLV-I) could be involved in the pathogenesis of Sjögren's syndrome (SS).

METHODS

Labial salivary gland (LSG) biopsy specimens from 9 patients with SS (4 with primary SS and 5 with SS secondary to rheumatoid arthritis) and 9 controls were studied for the presence of the tax gene of HTLV-I using in situ hybridization, and for the presence of tax, gag, pol, and env genes of HTLV-I using the polymerase chain reaction (PCR). Testing for antibodies to HTLV-I and examination of lymphocytes on blood smears were performed to determine whether systemic viral infection was present.

RESULTS

Using in situ hybridization and PCR, we detected the tax gene, but not the gag, pol, or env genes, of HTLV-I in LSG sections from 2 of 9 patients with SS and from none of the control subjects. Tax DNA was present mostly in nuclei of epithelial cells, but also in some lymphoid cells. Serum of the 2 affected patients did not contain antibodies to HTLV-I. In 1 patient, examination of blood smears revealed rare convoluted lymphocytes, sometimes with the appearance of "flower cells," as observed in the blood of HTLV-I-infected patients.

CONCLUSION

None of the known endogenous retroviral sequences is homologous to the tax gene. Thus, we suggest that HTLV-I (or another related retrovirus) can infect salivary epithelium. Transactivation properties of the tax protein could be implicated in the pathogenesis of SS. Alternatively, viral infection could cause de novo expression of HLA-DR antigens and favor the presentation of antigens by epithelial cells, leading, in some genetically predetermined subjects, to lymphoid infiltration of the gland.

Detection of Epstein-Barr virus DNA by in situ hybridization and polymerase chain reaction in salivary gland biopsy specimens from patients with Sjögren's syndrome

PURPOSE

To determine whether Epstein-Barr virus (EBV) could be involved in the pathogenesis of Sjögren's syndrome (SS).

PATIENTS AND METHODS

In situ hybridization using the BamH1-W fragment of EBV DNA was performed using labial salivary gland biopsy specimens from 14 patients with SS (eight with primary SS and six with secondary SS) and 39 control subjects. Furthermore, labial salivary gland biopsy specimens from 12 patients with SS (seven with primary SS and five with secondary SS) and 24 control subjects were submitted to the polymerase chain reaction to detect EBV DNA.

RESULTS

In situ hybridization detected EBV DNA in epithelial cells of labial salivary gland biopsy specimens from four of eight (50%) patients with primary SS, zero of six patients with secondary SS, and three of 39 (8%) control subjects. The difference between patients with primary SS and control subjects was statistically significant (p less than 0.02). The polymerase chain reaction detected EBV DNA in six of seven (86%) patients with primary SS, three of five (60%) patients with secondary SS, and seven of 24 (29%) control subjects. The difference between patients with primary SS and control subjects was statistically significant (p less than 0.01).

CONCLUSION

Both newly developed techniques showed that the presence of EBV DNA was significantly increased in patients with primary SS in comparison with control subjects. In all the positive SS patients who underwent in situ hybridization, epithelial cells of the labial salivary gland were the target of EBV infection. Our results suggest that this virus may play a role in the pathogenesis of SS. We cannot yet determine whether EBV is directly responsible for the destruction of the gland, or if its presence is a secondary event following gland injury.

Cytomegalovirus pneumonia in a patient with rheumatoid arthritis treated with low dose methotrexate and prednisone

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[Anti-radical enzymes, oxygenated free radicals and lipoperoxydation in rheumatoid polyarthritis. Effects of treatment with D-penicillamine]

Three aspects of the action of oxygenated free radicals were studied in 10 controls and 20 patients with rheumatoid arthritis, 11 not treated and 9 treated with D-penicillamine. Free radical production was evaluated in whole blood, malondialdehyde was measured in plasma, the concentration of antiradicular enzymes (copper and manganese superoxide dismutase, catalase and glutathion peroxydase) in hemolysate, platelets and plasma and copper superoxide dismutase activity in a chloroform erythrocyte extract. Only patients treated with D-penicillamine showed a significant decrease in the concentration of platelet anti-radicular enzymes and plasma manganese superoxide dismutase. The involvement of oxygenated free radicals in the pathophysiology of rheumatoid arthritis and in the mechanism of action of D-penicillamine in this pathology is discussed.