Multisystem sarcoidosis and carcinoma of the uterine cervix: an unusual association

Sarcoidosis malignancy syndrome is a rare phenomenon which remains controversial. We report here the case of a 46-year-old woman presenting with multisystem sarcoidosis 12 months after the completion of combined treatment for stage III squamous cell carcinoma of the uterine cervix; at the time she was still in complete remission of the tumor. The outcome was rapidly favorable under oral corticosteroid therapy. The time interval between the two illnesses as well as patient's age strongly suggest a relationship. Possible pathophysiologic mechanisms and the literature regarding uterine tumors are briefly reviewed.

Angiosarcoma variant of Kasabach-Merritt syndrome

Kasabach-Merritt syndrome is characterized by the occurrence of disseminated intravascular coagulation (DIC) usually caused by benign angiomatous tumours. Here we report the case of a 70-year-old man in whom DIC revealed a locally advanced hepatic tumour. Although DIC resolved with heparin, antithrombin III, fresh frozen plasma and corticosteroids, the patient died from haemoperitoneum following a fall, 3 months after the initial observation. Histopathological examination by autopsy allowed the diagnosis of hepatic angiosarcoma. The physiopathogenic mechanisms and treatment options are discussed.

Hypermethylation of the calcitonin gene in acute lymphoblastic leukaemia is associated with unfavourable clinical outcome

We analysed calcitonin (CALC1) gene hypermethylation using semiquantitative differential polymerase chain reaction in 105 patients with adult (n = 49) and childhood (n = 56) acute lymphoblastic leukaemia (ALL), and studied the association of CALC1 hypermethylation with clinical presentation features and disease outcome. We also investigated the possible relationship between CALC1 methylation status and expression of the cell cycle inhibitor gene p57KIP2. We observed CALC1 hypermethylation in bone marrow cells from 43% (45 out of 105) of ALL patients. Clinical, molecular and laboratory features did not differ significantly between hypermethylated and hypomethylated patients, only T-cell lineage was associated with hypermethylation (14% vs. 47%, P = 0025). Complete remission rate was similar in both groups although hypermethylated patients had a higher relapse rate (68% vs. 19%, P < 0.00001) and mortality rate (55% vs. 36%, P = 0.06) than hypomethylated patients. Estimated disease-free survival (DFS) at 6 years was 66.1% for hypomethylated patients and 5.3% for hypermethylated patients (P < 0,00001). Multivariate analysis from potential prognostic factors demonstrated that CALC1 methylation status was an independent prognostic factor in predicting DFS (P = 0.0001). Separate analysis of adult and childhood ALL patients showed similar results to the whole series. In addition, hypermethylated patients showed downregulation of p57KIP2 expression. Our results suggest that CALC1 gene hypermethylation is associated with an enhanced risk of relapse independently of known poor-prognostic factors and we describe, for the first time, a possible implication of the p57KIP2 gene in the genesis and prognosis of ALL.

The Role of Copper Suppression as an Antiangiogenic Strategy in Head and Neck Squamous Cell Carcinoma

OBJECTIVE

To determine whether tetrathiomolybdate (TM), a powerful chelator of copper, is capable of lowering the body stores of copper and suppressing the growth of head and neck squamous cell carcinoma in an orthotopic murine model.

STUDY DESIGN

In vivo, murine model.

METHODS

Twelve 8-week-old male C3H/HeJ mice were assigned to either a TM treatment group (n = 7) or a control group (n = 5). Serum samples were obtained from a single mouse in each group to measure the level of ceruloplasmin as a surrogate marker of total body copper on days 0, 4, and 7. Mice in both groups received a floor-of-mouth injection of 1.5 x 105 SCC VII/SF cells. After 7 to 10 days of tumor growth the treatment group received fresh water daily, to which TM was added to achieve an oral intake of 50 mg per mouse. The control group received only fresh drinking water daily. Tumor volume measurements were obtained every other day. Microvessel density counts were assessed in the tumors by Factor VIII analysis.

RESULTS

Measurable tumor growth was achieved in 100% of the mice by the tenth day. Total body copper was reduced by 28% from baseline levels in mice in the treatment group. The difference in mean tumor volume in the control group was 4.7 times greater than the TM-treated group at the completion of treatment (3004 mm3 and 633mm3, respectively). This accounted for an overall suppression rate of 79% (P =.008; two-tailed Student t test). In addition, microvessel density was reduced by 50% in the TM-treated group.

CONCLUSION

In this initial study, the first of its kind in head and neck squamous cell carcinoma, we have demonstrated the ability of TM to significantly suppress both the growth of squamous cell carcinoma and tumor vascularity in this orthotopic murine model, suggesting its potential for efficacy in the treatment of this disease in humans.

Detection of genetic diversity among bovine immunodeficiency virus population by single-strand conformation polymorphism analysis

Serial virus specimens rescued from rabbits, experimentally infected with bovine immunodeficiency (BIV) strain R29, were monitored for changes in quasispecies population, using the single-strand conformation polymorphism (SSCP) analysis. The generation of characteristic SSCP patterns enables the rapid differentiation of BIV variants derived from the conserved part on the env region of the BIV genome, reducing the need for expensive and time-consuming direct sequencing analyses. Our results showed genetic polymorphism among a number of sampled BIV population in experimentally infected rabbits. At least three SSCP patterns (BIV quasispecies) were detected. The SSCP analysis allows for an easy, sensitive, and rapid screening of genetic variants of the virus and the assessment of variation at a number of tissue target sites. These variations may relate to cell-type targets and/or disease progression, and could be significant to our understanding of lentiviral pathogenesis.

Correlation of atrophy measures on MRI with neuropsychological sequelae in children and adolescents with traumatic brain injury

To examine the relationship between neuropsychological sequelae and atrophy parameters from magnetic resonance imaging (MRI) following paediatric moderate-to-severe traumatic brain injury (TBI), 19 head injured children and adolescents were studied at least 6 years after injury. Three-dimensional MRI scans were obtained. A semi-automatic computerized method was used to estimate ventricular volumes and the corpus callosum area. Tests of intellectual, memory, visuospatial, frontal lobe, and motor speed functioning were administered to all patients and to 19 matched normal control subjects. Patients' performance significantly differed from controls in general intellectual function, visual memory, visuospatial and frontal lobe tests. The corpus callosum area correlated strongly with several measures involving processing speed and visuospatial function. Ventricular enlargement was less related to neuropsychological outcome. In conclusion, quantitative measurement of the corpus callosum on MRI reflects neuropsychological outcome better than ventricular dilation in paediatric patients.

Multisystem sarcoidosis and carcinoma of the uterine cervix: An unusual association

Abstract.

Alliot C, Barrios M, Desplechain C. Multisystem sarcoidosis and carcinoma of the uterine cervix: An unusual association.

Sarcoidosis malignancy syndrome is a rare phenomenon which remains controversial. We report here the case of a 46-year-old woman presenting with multisystem sarcoidosis 12 months after the completion of combined treatment for stage III squamous cell carcinoma of the uterine cervix; at the time she was still in complete remission of the tumor. The outcome was rapidly favorable under oral corticosteroid therapy. The time interval between the two illnesses as well as patient's age strongly suggest a relationship. Possible pathophysiologic mechanisms and the literature regarding uterine tumors are briefly reviewed.

Primary Hyperparathyroidism and Lymphoproliferative Diseases: Three Case Reports

Pathophysiologic mechanisms of malignancy-associated hypercalcemia are varied. The association of neoplasia and primary hyperparathyroidism (PHP) has been illustrated by clinical cases and by epidemiologic studies which have pointed to an increased risk of different malignancies during PHP. The authors report two cases of monoclonal gammapathy and one case of chronic lymphocytic leukemia (CLL) associated with PHP. A 58-year-old man presented with hypercalcemia due to PHP after remission for multiple plasmacytoma was obtained. A 70-year-old man was hospitalized for malaise, studies showed major hypercalcemia and benign monoclonal gammapathy. In the two cases, resolution of hypercalcemia was obtained by parathyroidectomy. The third patient was a 84-year-old woman with CLL who continued to deteriorate despite response to therapy, further studies confirmed hyperparathyroidism Physiopathogenic mechanisms of this association are discussed. The PHP-malignancy association should be considered ifthe symptoms or outcome of anyone of the two diseases are atypic.

Parovirus B19 infection in an HIV-infected patient with febrile pancytopenia and acute hepatitis

The case of a 34-year-old male patient with HIV infection referred for severe febrile pancytopenia is reported. Clinical and laboratory evaluations revealed acute hepatitis B infection and concomitant parvovirus B19 infection. The patient died just before treatment with immune globulin was to be administered. Parvovirus B19 has been found to cause a wide variety of hematologic disorders such as neutropenia, thrombocytopenia, pancytopenia, and hemophagocytic syndrome. The role of parvovirus B19 in the pathogenesis of bone marrow or liver involvement is briefly discussed.

Hemophagocytic Syndrome Induced by HIV

Hemophagocytic syndrome is an unusual illness due to the proliferation of activated macrophages phagocyting the hematopoietic cells. This syndrome has been reported in association with infectious agents, lymphoproliferative diseases, immunosuppressive conditions or auto-immune illnesses. Cytokines secreted by activated or neoplastic lympho-cytes activate the macrophages. Autocrine and paracrine mechanisms take over and could explain resistance to therapy. Some viruses, including EBV, could upregulate cytokine genes. This report describes an adult with HIV-infection presenting with severe hemophagocytic syndrome in whom an extensive evaluation did not reveal opportunistic disease and suggests that the cause was the HIV. The outcome was fatal and highlights the poor prognosis of hemophagocytic syndrome in this context.

Bovine immunodeficiency virus in experimentally infected rabbit: tropism for lymphoid and nonlymphoid tissues

The bovine immunodeficiency virus (BIV)/New Zealand (Oryctolagus cuniculus) rabbit model was used to study events that underlie the early and chronic stages of viral replication, routes and time course of viral dissemination and the distribution of the virus in the lymphoid. nonlymphoid and mucosa associated tissues. The results indicated that BIV, a lentivirus with genetic relatedness to the HIV, induced changes of clinical (anorexia, weight loss, muscular wasting, diarrhea, hypoalgesia, torticollis), immunological (recurrent T- and B-cell dysfunctions) and histopathological (lymphadenopathy, splenomegaly) nature that closely parallels those described for cat (Fly), monkey (SIV) and human (HIV) lentiviral diseases. These findings showing that BIV induces both splenomegaly and lymphadenopathy syndromes with associated fatal immune dysfunctions and the ability of the virus to replicate productively at the mucosal surfaces in rabbits, emphasize the importance of the BIV/rabbit system as a good small-animal model for the study of retrovirus-induced AIDS and offers the opportunity to evaluate prophylactic and therapeutic anti-retroviral agents of relevance to HIV-1 as well as the opportunity to study mechanisms of drug resistance phenomena.

Autoimmune cytopenias associated with malignancies and successfully treated with intravenous immune globulins: about two cases

The authors report on the cases of two adult male patients presenting with autoimmune cytopenias associated with malignancies: a case of autoimmune haemolytic anemia occurring after remission of Hodgkin's disease and a case of autoimmune neutropenia in the setting of renal carcinoma. High-dose intravenous immune globulins (IIG) administered after failure of corticosteroid therapy produced a rapid and long-lasting response. These cases illustrate that intravenous immunoglobulins may be helpful in refractory cases of autoimmune cytopenias. The association of IIG and corticosteroid could be synergistic and effective independently of the outcome of the underlying disease. The pathophysiogenic mechanisms and literature are discussed briefly.

[Neutralization of the hemorrhagic effect induced by Bothrops asper (Serpentes: Viperidae) venom with tropical plant extracts]

Organic extracts representing 48 species included in 30 families of Costa Rican tropical plants were evaluated for their ability to neutralize hemorrhagic activity induced by the venom of the snake Bothrops asper. A bioassay in mice was used, based on intradermal injection of either venom or venom-extract mixtures followed by the measurement of hemorrhagic areas. Total inhibition of hemorrhage was observed with the ethanolic, ethyl acetate and aqueous extracts of Bursera simaruba, Clusia torresii, C. palmana, Croton draco, Persea americana, Phoebe brenesii, Pimenta dioica, Sapindus saponaria, Smilax cuculmeca and Virola koschnyi. Chemical analysis of these extracts identified catequines, flavones, anthocyanines and condensated tannins, which may be responsible for the inhibitory effect observed, probably owing to the chelation of the zinc required for the catalytic activity of venom's hemorrhagic metalloproteinases.

Reduced design fluency in subclinical obsessive-compulsive subjects

This study examined the verbal and design fluency abilities of 25 subclinical obsessive-compulsive (OC) subjects and 27 noncompulsive control subjects. As hypothesized, the OC group showed reduced design fluency, and design fluency was also negatively correlated with obsessionality. These results provide further evidence for the involvement of the right corticostriatal systems in the mediation of OC behaviors, extending the findings to individuals with subclinical symptoms.

Emotional state of patients with relapsing-remitting MS treated with interferon beta-1b

BACKGROUND

Depression has been cited as a possible side effect of interferon beta-1b (IFNbeta-1b) therapy in patients with MS. This association remains unproven because of a lack of longitudinal studies.

OBJECTIVE

To determine the changes in emotional state in relapsing-remitting (RR) MS patients during the first 2 years of treatment with IFNbeta-1b.

METHODS

Emotional state was evaluated in a sample of 90 patients at the onset of IFNbeta-1b treatment during an inclusion period of 2.5 years. Seventy-five patients were evaluated at their 12th month of treatment and 56 patients at their 24th month. We assessed their emotional state with the following psychological tests: Hamilton Depression Rating Scale, Beck Depression Inventory, and State-Trait Anxiety Inventory.

RESULTS

We found significant improvement in emotional state after the first and second years of treatment.

CONCLUSIONS

Our findings show that IFNbeta-1b does not increase depression or anxiety in RR MS patients during the first and second years of IFNbeta-1b treatment. In fact, slight but significant improvement in depression and anxiety symptoms was observed during this period.

Modulatory effect of nitric oxide on acetylcholine-induced activation of cat petrosal ganglion neurons in vitro

The inhibitory effect of nitric oxide (NO) on carotid chemosensory responses to hypoxia has been attributed in part to an antidromic inhibition of chemoreceptor cells activity. However, NO may also modulate the activity of the primary sensory neurons because NO is produced in the soma of these neurons located in the petrosal ganglion. Since a population of petrosal neurons is selectively activated by acetylcholine (ACh), we studied the effects of NO-donor, sodium nitroprusside (SNP), and the NO-synthase inhibitor, Nomega-nitro-l-arginine methyl ester (l-NAME), on the responses evoked in the carotid sinus nerve (CSN) by ACh applied to the petrosal ganglion in vitro. ACh (1 microgram-1 mg) increased the frequency of action potentials recorded from the CSN in a dose-dependent manner. SNP (10-50 microM) reduced the sensibility and amplitude of the CSN response to ACh, although the maximal response appears less affected. The withdrawal of SNP from the superfusion medium increased the sensibility of the responses to ACh. l-NAME (1-2 mM) slightly increased the sensibility of the ACh-induced responses, effect that persisted after l-NAME withdrawal. These results suggest that NO may play a role as modulator in this autonomic primary sensory ganglion.

Neuropsychological functioning in a subclinical obsessive-compulsive sample

BACKGROUND

Previous neuropsychological research has suggested that the study of psychometrically defined subclinical samples might be a valid approach to understand the underlying pathophysiology of obsessive-compulsive disorder (OCD). This approach has the potential benefit of overcoming some of the methodological problems linked to the use of clinical samples.

METHODS

A group of subclinical obsessive-compulsive (OC) subjects (n = 35), selected on the basis of their scores on the Padua Inventory, and a control group were assessed on executive functioning tasks and other neuropsychological tests which have been demonstrated to be impaired in clinical OCD patients and/or in those with several basal ganglia disorders.

RESULTS

Subclinical OC subjects needed significantly more moves than controls to reach the solution criteria on the Tower of Hanoi puzzle, and performance on this test was positively correlated with total score and the Checking factor of the Padua Inventory. There were no between-group differences on the other frontal lobe tests.

CONCLUSIONS

The results suggest that deficits in manipulating spatial information might be basic in OCD, and are congruent with the involvement of the frontostriatal circuits in the disorder.

Infection of rabbits with R29 strain of bovine immunodeficiency virus: virulence, immunosuppression, and progressive mesenteric lymphadenopathy

To assess the value of bovine immunodeficiency virus (BIV) infection as a model for human immunodeficiency virus (HIV) infection in man, we studied the impairment of certain immunologic functions in New Zealand white rabbits experimentally infected with an uncloned virulent isolate of the virus, BIV R29. Serum samples were tested by Western blot for the presence and persistence of antibody production. The T- and B-lymphocyte function was studied by evaluation of the blastogenic responsiveness to concanavalin A (Con A) and to dextran sulfate (DxS). All infected rabbits seroconverted to BIV antigens within 2 to 4 weeks postinfection (p.i.) The BIV was isolated from the peripheral blood lymphocytes (PBLs) of 13 of 17 rabbits (77%) early in the infection and also from 5 of 17 hyperplastic mesenteric lymph nodes (29%) and 10 of 17 spleens (59%) during the chronic stage of infection. Seven of 17 BIV-infected rabbits (41%) developed marked immunodepression 2 to 5 months p.i., and later, 5 exhibited a rapidly progressive disease with anorexia, weight loss, neurologic impairment, splenomegaly, and mesenteric lymphadenopathy. These data underline the value of the BIV model for studying HIV pathogenesis in vivo and the development of interventional strategies for AIDS.

[Memory in multiple sclerosis: review of performance and relationship with clinical variables and neuroimaging]

INTRODUCTION

Neuropsychological studies in multiple sclerosis (MS) mainly have centred on the study of memory disorder.

DEVELOPMENT

The prevalence of memory deficits in MS population is around 40-60%. These deficits could be sum up in an impaired immediate memory, a learning capacity lower than normal controls subjects and a worse long term memory. The results of the reviewed studies about the relationship between performance in memory tasks and clinical variables, show that physical disability and depressive symptoms do not influence this performance. Whilst, years of evolution and, mainly, disease course are related to a worse performance in memory tasks. In structural neuroimaging studies (CT and MRI) it is considered that ventricular dilatation and the total lesion load are predictor variables of MS patients performance in different memory tasks.

CONCLUSION

This paper reviews several studies relative to amnesic function in subjects suffering from MS, emphasizing the most relevant contributions of the present neuropsychological literature.

An in vivo model to study the anti-malaric capacity of plant extracts

An in vivo model to study the antimalaric effect of plant extracts is described. White mice (25-30 g body weight) are treated subcutaneously with 0.6 ml of the diluted extract starting seven days before P. berghei infection; treatment continues until death or for 30 days. Simultaneously 0.2 ml of the extract are applied per os starting three days before infection. In a test of the model, treated and non-treated animals differed in body weight, survival time, haematocrite, parasitemia development, and spleen or liver weight of recent dead or killed mice.

In vitro suppression of HIV-1 replication by ajoene [(e)-(z)-4,5,9-trithiadodeca-1,6,11-triene-9 oxide]

Studies were performed to establish whether synthetic ajoene exhibited differential inhibitory activity against human immunodeficiency virus (HIV)-1 (IIIB) and to clarify the mechanism of its antiviral effects. Our results demonstrate that ajoene protected acutely infected Molt-4 cells against HIV-1 and blocked further destruction of CD4 T-cells in vitro. Ajoene showed dose-dependent inhibition, with 50% cytotoxic concentration (CTC50%) and 50% effective inhibitory concentration (EIC50%) values of 1.88 microM and about 0.35 microM, respectively, when the test compound was added before or after HIV-1 infection and incubation carried out at 37 degrees C for 4 days. Ajoene proved relatively more active than dextran sulfate in blocking HIV-1 virus-cell attachment. The mode of anti-HIV action of ajoene can be ascribed to the inhibition of early events of viral replication, particularly virus adsorption.

Developmental changes in the inhibitory actions of ethanol on glutamate-induced translocation of protein kinase C in cerebellar granule neurons

The effects of increasing concentrations of ethanol (25-200 mM) on the enhancement of [3H]phorbol-12,13-dibutyrate ([3H]PDBu) binding produced by different glutamate receptor agonists, indicative of a translocation of the intracellular enzyme protein kinase C (PKC), were studied in rat cerebellar granule cells at 2, 4, 8, and 12 days in vitro (DIV). Glutamate-produced stimulation of [3H]PDBu binding was inhibited by 50 mM ethanol at 2 DIV, whereas higher ethanol concentrations (> 100 mM) were needed to reduce the increase of [3H]PDBu binding in cells grown for 4, 8, and 12 DIV. Ethanol significantly inhibited NMDA-stimulated [3H]PDBu binding in a concentration-dependent fashion in cells maintained in culture for 4 and 8 days, respectively, with a slightly less pronounced inhibition by ethanol (50 mM) seen in cells kept for 2 and 12 DIV. Application of higher ethanol concentrations (> 100 mM), inhibited the NMDA-induced stimulation in all cell preparations. Following kainic acid-induced enhancement of [3H]PDBu binding, ethanol (100 mM) reduced the binding only in cells maintained for 2 DIV. Even higher ethanol concentrations (200 mM) inhibited the effects of kainic acid only in cells maintained for 2 and 4 DIV, respectively. Our data suggest that various subclasses of glutamate receptors display a developmentally determined differential sensitivity to ethanol at least in cerebellar granule cells in vitro.

Hemispheric functional imbalance in a sub-clinical obsessive-compulsive sample assessed by the Continuous Performance Test, Identical Pairs version

Obsessive-compulsive disorder (OCD) sufferers have long been observed to give excessive consideration to normally ignored exogenous and endogenous stimuli. This over-focused attention concerning their symptoms has led researchers to experimentally investigate the attentional mechanisms involved in this disorder and its psychobiological basis. Previous psychometric and neuropsychological research has demonstrated the validity of the sub-clinical analogue in the study of the mechanisms underlying OCD. In this study, 71 introductory university students were recruited from an original pool of 450 people on the basis of their scores on the Spanish version of the Padua Inventory. A high obsessive group (n = 35) was compared with a control group (n = 36) on a standard sustained attention task: the Continuous Performance Test, Identical Pairs version (CPT-IP). The results showed a significant interaction effect between CPT-IP subscales (verbal and spatial) and group membership. This effect was more evident among men. The results were unrelated to general intelligence, depression, anxiety, personality or motivational factors. These findings support the hypothesis that neuropsychological deficits in OCD may be related to a hemispheric functional imbalance rather than to a lateralised dysfunction of a particular hemisphere.

Involvement of calcium in the cardiac depressant actions of a garlic dialysate

In order to elucidate a possible role for calcium on the negative cardiotropic effects of a garlic (Allium sativum L., Liliaceae) dialysate in rat atria we studied: (a) the effects of our extract 15 min after preincubation with high and low concentrations of extracellular calcium ([Ca2+]o) on left and right activity of rat atria. The negative inotropism of garlic dialysate increased with calcium 0.75 mM; in contrast, high level of calcium (4.5 mM) induced a significant reduction of this depressant effect. None of these treatments modified the negative chronotropism of garlic; (b) nifedipine (10(-9) to 10(-7) M, verapamil (10(-9) to 10(-7) M) and diltiazem (10(-9) to 10(-7) M) induced a concentration-dependent synergism of the log concentration-effect of garlic dialysate on left atria. Verapamil and diltiazem (10(-7)M), but not nifedipine increased the inhibitory chronotropism of garlic in right atria; (c) negative inotropic and chronotropic effects demonstrated by nifedipine (1 x 10(-10) to 1.1 x 10(-6) M) were antagonized as expected by preincubation with Bay K-8644. Depressant actions of garlic were not modified with this pretreatment. These results suggest that the negative inotropic effect of our garlic dialysate is related to [Ca2+]o availability. It is possible that a restriction of intracellular calcium contributes to this effect. However, the negative chronotropic effect of garlic is scarcely affected by these modifications.