Intrafamilial variable phenotypic expression of a CIAS1 mutation: from Muckle-Wells to chronic infantile neurological cutaneous and articular syndrome

Among hereditary inflammatory disorders, Muckle-Wells syndrome, chronic infantile neurological cutaneous and articular syndrome (CINCA), and familial cold urticaria have recently been shown to be caused by dominantly inherited mutations in the CIAS1 gene. Reports suggest that these 3 diseases result from distinct missense mutations, with very few overlapping symptoms. We describe a French family presenting an intrafamilial overlapping clinical phenotype of CINCA and Muckle-Wells syndrome, caused by a mutation in CIAS1 gene. Clinical and genetic observations suggest that Muckle-Wells syndrome, CINCA, and familial cold urticaria are various phenotypic expressions of the same disease.

Exploration de la microcirculation pulpaire par écho-doppler digital chez des patients présentant une maladie de Raynaud ou une sclérodermie

BACKGROUND

Raynaud's phenomenon (RP) is a frequent vascular paroxysmal syndrome of the extremities. Generally benign, the condition is called Raynaud's disease (RD), which may reveal a connective tIssue disease, particularly systemic sclerosis (SS). We evaluated digital blood flow in patients with RD and SS using color Doppler ultrasound.

PATIENTS AND METHODS

Ultrasound examination was performed with a newly developed multi-D linear array transducer (VFX 13-5 Siemens), which allows better resolution. We first measured the diameters of the digital arteries (appendix 1) then epidermal, dermal, and hypodermal thickness for each patient (appendix 3) and performed a qualitative and quantitative analysis of pulpar microcirculation (appendix 4 & 5). All measures were made at 25 degrees C, 45 degrees C, 11 degrees C and after recovery. Thirty-three patients were included: 14 with primary RD and 19 with SS as assessed by American College of Rheumatology criteria.

RESULTS

The diameters of the digital arteries showed significant discrepancies allowed to distinguish primary RP from SS. At 11 degrees C, diameters were 0.6 +/- 0.2 mm for primary RP versus 0.2 +/- 0.3 mm for SS on lateral digital arteries (LDA) [p=0.005]; 0.7 +/- 0.2 mm for primary RP versus 0.4 +/- 0.3 mm for SS on medial digital arteries (MDA) [p=0.004]. After recovery, these diameters were respectively 1 +/- 0.2 mm versus 0.5 +/- 0.4 mm for LDA [p=0.000] and 1 +/- 0.2 mm versus 0.6 +/- 0.3 mm for MDA [p=0.000] (tables 1, 2, 3, 4). Similarly, pulpar vascularization was significantly higher in primary RP than in SS (tables 6, 7, 8). No difference was found in skin thickness nor in the epidermal aspect between the two groups (table 5).

CONCLUSION

Color Doppler ultrasound shows morphological and dynamic differences between RD and SS.

[Nonsurgical treatment of chronic subdural hematoma with steroids: two case reports]

INTRODUCTION

Hemorrhages beneath the dura define a subdural hematoma.

EXEGESIS

The course of chronic subdural hematoma may be asymptomatic for many months before diagnosis. Recovery is observed in 80% of patients after surgery. We report two cases of chronic subdural hematoma successfully treated with steroids.

CONCLUSION

Steroids can be an alternative treatment of subdural hematoma, specially in elderly or alcoholic patients.

[Horton's disease in elderly patients aged over 75: clinical course, complications of corticotherapy. Comparative study of 164 patients. Towards a reduced initial dose]

PURPOSE

Our study compares clinical and therapeutic courses (corticosteroid response, corticosteroid amount, complications) in people with giant cell arteritis before and over 75 years, during the first year of treatment.

METHODS

A series of 164 patients was retrospectively analysed (mean age: 73.3 years) among the two subgroups: before 75 and over 75 years. Patient received (monitoring of reduction in the corticosteroid dosage) a 240 mg intravenous bolus of methylprednisolone followed by 0.5 or 0.7 mg/kg/d of prednisone, or 0.7 mg/kg/d of prednisone without the bolus.

RESULTS

Corticosteroid response was identical for the two groups, before and over 75 (patients with corticoresistance: 15% vs 11.4%; NS) and giant cell arteritis-related complications were equivalent (n = 2 vs n = 2; NS). Corticosteroid load was slightly lower in the elderly group (cumulative dose of corticosteroids during the first year of treatment 5.2 g vs 5.8 g; P = 0.03). Patients with rheumatic side effects (collapses of vertebral bodies, mainly) were more frequent in the elderly group (15.5% vs 4.3%; P = 0.01), in spite of a limited mean follow-up period (10.7 months).

CONCLUSION

Even if steroid response was identical in the therapeutic course of giant cell arteritis, rheumatic side effects appeared more frequent in the elderly group (over 75 years). In order to obtain a corticosteroid-sparing effect, new studies are necessary to evaluate a reduced initial dosage of corticosteroids.

[Erysipelas. A retrospective series of 92 patients in a department of internal medicine]

Erysipleas, also known as Saint Anthony's fire, is an acute infection of the skin caused, in most of cases, by group A streptococci. In the past, the most common site of involvement was the face and, in the pre-antibiotic era, mortality was high. In this retrospective study, we highlight the clinical and bacteriological features and report follow-up in 92 patients hospitalized in an internal medicine unit between 1st March 1992 and 31st December 1996 for 94 episodes of erysipelas. The involvement of the lower limbs predominated as involvement of the face is becoming very rare. Streptococci from others groups and Staphylococcus aureus have been implicated on occasions. Recovery is usual even if this infection may greatly weaken these often fragilized patients. In this paper, antibiotic treatment as well as the place of anticoagulants and Doppler ultrasound are discussed. Hospitalization is often necessary but it must not be systematic.

[Cryptococcal meningitis associated with chronic lymphocytic leukemia: a case report. Review of the literature]

INTRODUCTION

The authors report the occurrence of a cryptococcal meningitis in a patient treated by corticosteroids and polychemotherapy for a chronic lymphocytic leukemia.

EXEGESIS

A 63-year-old man with chronic lymphocytic leukemia was sent to hospital because of impaired condition with fever. Neurological disorders appeared. Cryptococcal meningitis was diagnosed. Under treatment, the outcome was favorable.

CONCLUSION

This paper highlights the feature of this infection most likely underestimated in HIV-seronegative patients and the need to a priori consider this diagnosis.

Inhibition of iron toxicity in human hepatocyte cultures by pyoverdins Pa A and Pf, the peptidic siderophores of Pseudomonas aeruginosa and fluorescens

The protective effect of pyoverdins Pa A and Pf, peptidic siderophores secreted respectively by Pseudomonas aeruginosa and fluorescens, was studied in primary cultures of human hepatocytes exposed to iron (50 or 100 microM of iron-citrate). AST, ALT and MDA releases were measured as indexes of cytotoxicity. In order to demonstrate that these chelators were able to decrease iron uptake or increase iron release from the hepatocytes, labelled cells were obtained by maintaining the cultures in the presence of 1 microM 55Fe ferric chloride plus 50 microM iron citrate. One day after iron treatment, an increase in AST, ALT and MDA release was observed with 50 or 100 microM of iron citrate; it appeared that the concentrations 50 and 100 microM of iron were highly toxic for human hepatocytes. In the presence of 50 or 100 microM of iron, the addition of 50 or 100 microM of Pa A or Pf was effective to inhibit the increase observed in the enzyme leakage and the MDA production resulting from iron exposure. In human hepatocytes cultured for 1 day in the presence of 1 microM 55Fe-50 microM iron citrate plus 50 or 100 microM Pa A or Pf, a net decrease of iron uptake by the cells was observed, as demonstrated by the low intracellular iron level. When the hepatocytes were cultured for 1 day in the presence of 1 microM 55Fe-50 microM iron citrate and then for a further day in the presence of 50 or 100 microM Pa A or Pf without additional iron, the chelators increased the extracellular iron level, indicating their iron release from the loaded cells; however, the effects of Pa A and Pf on iron release did not differ significantly. In conclusion, iron loading achieved by adding iron citrate to the culture medium is highly toxic for human hepatocytes. Pyoverdins Pa A and Pf are effective in protecting human hepatocytes against the toxic effect of iron by both decreasing the uptake of the metal and increasing its release from the loaded cells.

[Triclonal gammopathy and malignant immunoproliferative syndrome]

Three distinct monoclonal gammopathies were identified in the serum of a 79 year-old man. In 1972 he presented with Waldenström's macroglobulinemia IgM Kappa. Twenty years later multiple myeloma was diagnoses. Serum protein electrophoresis performed at this time showed three monoclonal bands. Immunofixation identified these bands as monoclonal IgM kappa, IgG kappa and IgA kappa. Twenty-six cases of triclonal gammopathies were previously reported. Sixteen cases were associated with malignant immuno-proliferative diseases (non-hodgkin lymphoma, Waldenström's macroglobulinemia, multiple myeloma); five cases with non-hematologic diseases; three cases were of undetermined significance. The origin of three distinct monoclonal proteins may derive from three unrelated clones or alternatively from a single clone in which an isotype switch has occurred.

Do gonadotrophin-releasing hormone neurons express estrogen receptors in the rainbow trout? A double immunohistochemical study

A double immunocytochemical procedure, with two different chromogens, was used to compare the respective distributions of estrogen receptor-immunoreactive cells and gonadotrophin-releasing hormone-immunoreactive neurons on the same sections of the brains of adult male and female rainbow trout (Oncorhynchus mykiss). Estrogen receptor-immunoreactive cells were observed in the ventral and lateral telencephalon, the preoptic region, the mediobasal hypothalamus, and the ventromedial thalamic nucleus. Gonadotrophin-releasing hormone-immunoreactive perikarya were detected in the olfactory bulbs, the ventral telencephalon, the preoptic area, and the mediobasal hypothalamus. Double-staining studies showed that, although some estrogen receptor-positive cells were in close proximity to gonadotrophin-releasing hormone-immunoreactive perikarya, careful examination of 550 gonadotrophin-releasing hormone-positive cells from five adult females and two adult males failed to demonstrate any evidence that gonadotrophin-releasing hormone neurons coexpress estrogen receptor in the brain of the rainbow trout. The present study provides, for the first time in teleosts, morphological evidence that gonadotrophin-releasing hormone neurons do not represent major direct targets for estradiol, suggesting that the positive feedback effects of estradiol onto the gonadotrophin-releasing hormone system are likely to be conveyed via other cell populations.

Interactive effects of dietary levels of tryptophan and protein on voluntary feed intake and growth performance in pigs, in relation to plasma free amino acids and hypothalamic serotonin

The effects of dietary level of tryptophan (TRP) and CP content and composition on voluntary feed intake, growth performance, and carcass characteristics in finishing pigs were studied in two experiments, with an equal number of females and castrated males. In Exp. 1, involving 120 Large White pigs from 44 to 99 kg BW with ad libitum access to feed, six treatments were compared according to a 2 x 3 factorial arrangement: 1) two levels of TRP (.09 and .13%), suboptimal and optimal for growth, respectively, 2) three types of CP supply (a 12.5% CP diet based on corn-soybean meal, and adequately balanced for essential amino acids [EAA] other than TRP; 15.7% CP diet with additional protein from corn gluten meal; 16.2% CP diet with additional nonessential amino acids [NEAA, in the form of L-glutamic acid.HCl and glycine], and the same levels of EAA as in the 12.5% CP diet. In Exp. 2, including four of the six previous factorial combinations (.09 and .13% TRP, 12.3 and 15.8% CP with additional protein), 32 pigs of 50-kg initial BW were used during 21 d, and further observations on meat quality characteristics, plasma free amino acid levels, and serotonin concentrations in the posterior hypothalamus were made. The major observed effects were interactions of different magnitude according to sex between TRP level and the amount and the composition of additional CP. At the suboptimal level of .09% TRP, the increase in protein content severely decreased daily feed intake and growth compared with the .13% level, especially in females. Conversely, the addition of NEAA at both TRP levels had little effect on daily feed intake and growth. Deficiency of TRP exerted a significant increase of pH in adductor femoris and semimembranosus muscles measured 45 min and 24 h postmortem, but only in females. Voluntary feed intake, as affected by dietary TRP and CP levels, was linearly related with concomitant changes in TRP to large neutral amino acids (TRP:LNAA) ratio both in feed and in plasma, which in turn was directly associated to hypothalamic serotonin concentration. It was concluded that an overly low concentration of serotonin in the hypothalamus, especially in females, as a result of TRP:LNAA imbalance, could be involved in the reduction of voluntary feed intake.