Prenatal ultrasonographic diagnosis of a recurrent case of Johanson-Blizzard syndrome

We report on ultrasonographic prenatal diagnosis of a recurrent case of Johanson-Blizzard syndrome. The pregnancy was terminated at 21 weeks'. This observation highlights the great variability of the expression of this syndrome, including in the same family, and the necessity of collaborating with an experienced geneticist in all antenatal diagnosis of any complex of abnormalities.

Effect of enteral supplementation with glutamine on mesenteric blood flow in premature neonates

BACKGROUND AND AIMS

This study investigated the effects of enterally supplied glutamine on mesenteric blood flow in premature neonate.

METHODS

Twenty-five neonates, aged at least 14 days and free of acute illness participated in a prospective, randomised, double-blind study. All were fed with total enteral nutrition enriched with glutamine (0.7 g kg(-1)day(-1), group 1) or isonitrogenous control (group 2). Blood flow velocities in the superior mesenteric artery were analysed by pulsed Doppler US before and after 21 days of supplemented feeding. Peak systolic velocity (PSV), end-diastolic velocity (EDV) and time-averaged mean velocity (TAV) were measured and resistance index (RI) and flow (Q) were calculated.

RESULTS

Both groups were well matched clinically at inclusion. At inclusion, the velocimetry parameters were (mean +/- SD) : PSV:114.9 +/- -38 cms(-1), EDV:17.5 +/- 7.5 cm x s(-1), TAV:44.8 +/- 18.2 cms(-1), RI : 0.8 +/- 0.1, Q : 2.4 +/- 1.2 mls(-1). Mesenteric blood flow parameters remained stable between day 0 and day 21 with same values in both groups.

CONCLUSIONS

Superior mesenteric blood flow remained stable in neonates after 14 days of life and did not appear to be influenced by enteral glutamine at that stage.

Johanson-Blizzard syndrome. a new case with autopsy findings

Here we present a new case of Johanson-Blizzard Syndrome. Clinical features consistent with the diagnosis of Johanson-Blizzard Syndrome in a term neonate are described: intra-uterine growth retardation, aplasia of the nasal alae, midline scalp defect, total situs inversus, imperforate anus, malrotation of the small intestine, pancreatic insufficiency, deafness, and lethal congenital heart defects with dextrocardia. These features were confirmed by findings at autopsy. Parents were consanguineous. We compare these clinical features and findings at autopsy with previous cases reported in the literature.

Immunohistochemical analysis of the role of angiogenic status in the vasculature of peritoneal endometriosis

OBJECTIVE

To investigate the angiogenic status of the vasculature in peritoneal endometriosis based on macroscopic appearance.

DESIGN

Prospective study.

SETTING

University hospital.

PATIENT(S)

Patients with peritoneal endometriosis.

INTERVENTION(S)

During laparoscopy, 25 samples of predominantly red peritoneal lesions and 27 samples of predominantly black peritoneal lesions were collected from a total of 31 patients with endometriosis. Eutopic endometrium from 25 patients with endometriosis was collected by curettage during laparoscopy or just after surgery.

MAIN OUTCOME MEASURE(S)

A proliferating endothelial cell index (PCI) was determined by calculating the percentage of microvessels that contained proliferating endothelial cells. A vessel maturation index (VMI) was determined by calculating the percentage of microvessels showing colocalization of CD34- and alpha-SMA-positive staining.

RESULT(S)

Peritoneal endometriotic tissues had extremely low or null PCI. The VMI of red peritoneal lesions was significantly lower than that of black ones. Vessel maturation index of red lesions was higher that that of proliferative eutopic endometrium and similar to that of secretory eutopic endometrium.

CONCLUSION(S)

Compared with the case of black peritoneal lesions, red lesions had a much higher fraction of immature vessels.

Increase in cyclooxygenase-2 and nitric oxide-synthase-2 mRNAs in pouchitis without modification of inducible isoenzyme heme-oxygenase-1

OBJECTIVES

The pathophysiology of pouchitis occurring after ileal pouch-anal anastomosis remains controversial. Prostaglandins and nitric oxide synthesized in excess by cyclooxygenase-2 and nitric oxide synthase-2 are thought to be involved in the inflammatory process. Because heme oxygenase-1, by its antioxidant properties, could modulate inflammatory reaction, we analyzed mRNAs of the three enzymes (cyclooxygenase-2, nitric oxide synthase-2, and heme oxygenase-1) in patients with ileal pouch-anal anastomosis.

METHODS

Endoscopic biopsies were obtained in eight patients with normal ileal pouch-anal anastomosis, in eight patients with pouchitis, and in normal ileum of six healthy subjects. A relative quantitative RT-PCR was performed to determine the levels of cyclooxygenase-2, nitric oxide synthase-2, and heme oxygenase-1 mRNAs.

RESULTS

Cyclooxygenase-2 and nitric oxide synthase-2 mRNAs were increased both in normal ileal pouch-anal anastomosis and in pouchitis, compared with healthy subjects. Pouchitis disease activity index was correlated with mRNA levels of cyclooxygenase-2 (r = 0.71; p < 0.01) and nitric oxide synthase-2 (r = 0.51; p < 0.05). Heme oxygenase-1 mRNA levels were not significantly different in patients versus healthy subjects.

CONCLUSIONS

The increase in cyclooxygenase-2 and nitric oxide synthase-2 mRNA levels both in pouchitis and normal ileal pouch-anal anastomosis demonstrates that a latent inflammatory process occurs in the ileal pouch mucosa. This inflammatory process was not found to be associated with an induction of heme oxygenase mRNA, a possible regulator of the inflammatory response.

Expression of the cyclin-dependent kinase inhibitor p27Kip1 in eutopic endometrium and peritoneal endometriosis

OBJECTIVE

This study was undertaken to evaluate the immunohistochemical expression of the cell cycle inhibitor p27Kip1 and proliferation marker Ki67 in peritoneal endometriosis and eutopic endometrium.

DESIGN

Prospective study.

SETTING

University hospital.

PATIENT(S)

Thirty-one patients with peritoneal endometriosis.

INTERVENTION(S)

During laparoscopy, 25 samples of predominantly red peritoneal lesions and 27 samples of predominantly black peritoneal lesions were collected from 31 patients with endometriosis. Eutopic endometrium from 25 patients with endometriosis was collected by curettage during laparoscopy or just after surgery.

MAIN OUTCOME MEASURE(S)

The percentage of glandular and stromal cells exhibiting positive staining for p27Kip1 and Ki67 (labeling index, LI) was determined.

RESULT(S)

The LI of stromal cells in red peritoneal lesions for both p27Kip1 and Ki67 was similar to that of proliferative eutopic endometrium. Although the LI of glandular epithelial cells for Ki67 in red lesions was comparable to that of proliferative eutopic endometrium, the LI for p27Kip1 was significantly higher. Furthermore, we detected a significantly higher LI of glandular epithelial and stromal cells for p27Kip1 in black lesions compared with red lesions.

CONCLUSION(S)

Our results suggest that expression of the cyclin kinase inhibitor p27Kip1 is involved in the natural history and progression of peritoneal endometriosis.

Renal tubular dysgenesis-like lesions and hypocalvaria. Report of two cases involving indomethacin

We describe a case of twins with twin-to-twin transfusion syndrome (TTS) who were found to have renal tubular dysgenesis (TRD)-like lesions and hypocalvaria attributed to indomethacin treatment of the mother for acute polyhydramnios. History of pregnancy, postnatal clinical course, pathological findings of the kidneys, and the skulls are presented and discussed. These findings include incompletely differentiated proximal tubules in the kidneys and hypoplastic calvaria in both twins. The renal tubular lesions were more marked in the donor than in the transfused twin, probably due to the greater degree of ischemia in that twin. This seems to be in favor of a vascular etiology of the renal defects. However, the fact that similar renal lesions and hypocalvaria were also present in the transfused twin seems to indicate that indomethacin played a role in their onset. This so-called kidney-skull connection has never been reported in conjunction with indomethacin therapy.

Fibrogenesis in peritoneal endometriosis. A semi-quantitative analysis of type-I collagen

OBJECTIVE

To evaluate the degree of fibrosis in the stroma of peritoneal endometriosis, according to the macroscopic appearance.

METHODS

Red and black lesions of peritoneal endometriosis were collected and type-I collagen was immunohistochemically identified. The percentage of the stained area in the stroma was measured using a computerized image analysis system.

RESULTS

There was a significant difference in the mean percentage of the total stained area between red and black lesions.

CONCLUSION

The amount of type-I collagen is significantly higher in the stroma of black peritoneal lesions than in red peritoneal lesions.

Effects of enteral glutamine on gut mucosal protein synthesis in healthy humans receiving glucocorticoids

In hypercatabolic patients, the beneficial effects of glutamine on gut mucosa could be partly due to a stimulation of protein synthesis. The fractional synthesis rate (FSR) of gut mucosal protein was measured in four groups of healthy volunteers treated with glucocorticoids for 2 days. Two groups were studied in the postabsorptive state while receiving glutamine or a nitrogen equivalent (control) and two groups in the fed state with or without glutamine, using a 5-h intravenous infusion of [(13)C]leucine, [(2)H(5)]phenylalanine, and cortisone. After nutrient and tracer infusion, duodenal biopsies were taken. In the postabsorptive state, FSR of gut mucosal protein were 87 and 76%/day in the control group and 130% (P = 0.058 vs. control) and 104% (P = 0.17 vs. control)/day in the glutamine group, with leucine and phenylalanine as tracers, respectively. During feeding, FSR did not increase and no significant difference was observed between glutamine and control groups. Overall, FSR of the four groups were two- to threefold higher than those obtained previously in healthy humans, suggesting that glucocorticoids may increase gut mucosal protein synthesis. However, in this situation, a moderate enteral glutamine supply failed to demonstrate a significant effect on gut mucosal protein synthesis in the postabsorptive state and during feeding.

Transformation of mycosis fungoides: clinicopathological and prognostic features of 45 cases. French Study Group of Cutaneious Lymphomas

The course of mycosis fungoides (MF) is indolent except when transformation to a large T-cell lymphoma occurs. The diagnosis of transformed MF (T-MF) relies on the presence of more than 25% of large cells on biopsy of an MF lesion. We analyzed 45 patients with T-MF recorded by the French Study Group on Cutaneous Lymphomas to better determine clinicopathological features of MF transformation and to analyze their impact on prognosis. Median time from diagnosis of MF to transformation was 6.5 years. Extracutaneous progression was present in 20 patients. Mean survival from transformation to death was 22 months. In univariate analysis, only an extracutaneous progression was associated with a worse prognosis (5-year actuarial survival: 7.8% versus 32%). Neither sex, age, clinical and skin disease stage at transformation, transformation speed, nor percentage of large cells or CD30 expression (14 of 45) had a prognostic value. When performing multivariate analysis, age (at least 60 years), and extracutaneous spreading were found to be associated with a poor prognosis. There was no difference between survival curves of patients with T-MF and with pleomorphic large T-cell CD30- lymphomas. The main diagnostic pitfall was "histiocytic-rich" MF, requiring CD68 staining for the diagnosis of T-MF. Out of 45 patients, 6 presented an histologic transformation before clinical progression, suggesting that an early histopathological diagnosis may be performed by histological follow-up. The prognostic value of such early histopathological diagnosis must be confirmed by prospective studies.

The Spectrum of Cutaneous Lymphomas in HIV infection: a study of 21 cases

We studied 21 HIV-associated lymphomas with cutaneous presentation to determine whether they showed features of primary cutaneous lymphoma arising fortuitously or whether they represented the cutaneous involvement of AIDS systemic lymphoma. Besides rare mycosis fungoides (n = 3), which shared typical clinicopathologic lesions, nonepidermotropic large-cell lymphomas (n = 18) were predominant. They frequently presented as a solitary nodule or tumor. Seven of the eight large T-cell lymphomas had a CD30-positive (CD30+) phenotype but did not express ALK protein. Overexpression of p53 protein was observed in six cases. Although EBV-EBER transcripts were detected in two of them, LMP1 protein was absent. Except for their original prevalence, the features of these T-cell CD30+ cutaneous lymphomas were the same as in immunocompetent patients. The 10 B-cell cutaneous lymphoma were immunoblastic or centroblastic lymphomas, with a differential expression of BCL-6 and Syndecan. Four of them expressed CD30, EBER-EBV transcripts, and LMP1 and p53 proteins. This B-cell CD30+ EBV+ phenotype contrasts with cutaneous lymphoma in immunocompetent patients. Human herpesvirus 8 was not involved in lymphomagenesis since its sequences were detected in a single patient with Kaposi's sarcoma and Castleman's disease. These lymphomas occurred in severely immunocompromised patients with a low CD4 count. Death was due to immunodepression rather than to lymphoma spread, suggesting avoiding aggressive immunosuppressive treatment in such patients.

Ischemic necrosis of bile ducts complicating Schönlein-Henoch purpura

Gastrointestinal complications of Schönlein-Henoch purpura are frequent and sometimes severe. However, there seem to be no reports of liver involvement. A child is described in whom Schönlein-Henoch purpura was complicated by bile duct lesions, resulting in biliary cirrhosis and requiring liver transplantation. At surgical removal, the liver had lesions of bile ducts and of adjacent small blood vessels in the hilum, very similar to those complicating hepatic artery thrombosis after liver transplantation. These findings suggest that Schönlein-Henoch purpura can be complicated by vasculitis of the peribiliary vessels resulting in ischemic necrosis of the bile ducts. Schönlein-Henoch purpura can be added to the list of causes of ischemic cholangiopathies.

Toxoplasma gondii infection in rats by the RH strain: inoculum and age effects

Toxoplasma gondii strains are classified according to their virulence in mice. Rats are considered to be resistant to the infection, depending on the age. Newborn rats are fully susceptible but weaned rats are resistant. However the effect of inoculum has not been examined. Using RH strain inocula of 10(2), 10(4), 5 x 10(7) and 10(8) tachyzoites intraperitoneally inoculated into Wistar and Fischer rats of 7, 11, 21, 24 and 46 days old, the authors show that inoculum and not the age of the host had a statistically significant effect (p < 0.01) on the survival curve.

Angiogenesis in endometriosis

We evaluated angiogenesis in eutopic endometrium and ectopic endometrium from patients with endometriosis. Microvessels were identified by immunohistochemistry using anti-von-Willebrand factor antibody and vascular parameters were measured using a computerized image analysis system. No relationship was observed between vascular density and type of endometriotic lesion. Heterogeneity in vascular density was observed in different lesions within the same patient. Between red and black peritoneal lesions a significant difference was observed in the frequency distribution of luminal diameter. In black lesions the variability of luminal diameter was decreased and most microvessels were less than 20 mm in diameter. We suggest that the frequency distribution of microvessel luminal diameter of red and black peritoneal lesions may be different and should be important when studying the regulation of angiogenesis in endometriotic implants.

The relationship between MIB-1 proliferation index and outcome in pancreatic neuroendocrine tumors

The expression of the cell-cycle-associated Ki-67 antigen by MIB-1 monoclonal antibody was retrospectively assessed in 35 surgically resected neuroendocrine tumor specimens of the pancreas embedded in paraffin. The MIB-1 proliferation index was correlated with the classification of the neuroendocrine tumors of the pancreas proposed by Klöppel et al. Four prognostic factors showed a significant correlation with MIB-1: local invasion, metastases, tumor differentiation, and production of insulin. However, analysis by the Cox Proportional Hazards Regression Model showed that only local invasion was an independent predictor of outcome. Finally, our study showed a statistically significant increase in the number of deaths and a statistically significant decrease in survival time when the MIB-1 proliferation index was higher than 4%. We conclude that MIB-1 proliferation index is a simple and reliable tool to predict the clinical outcome of the neuroendocrine tumors of the pancreas. The index might be useful for determining the prognosis for an individual because of the significant decrease in survival when the index is higher than 4%.

Evaluation of the 5' spliced form of human cathepsin B mRNA in colorectal mucosa and tumors

To evaluate the 5' spliced form of human cathepsin B mRNA in colorectal mucosa and tumors, we have determined the ratio of the spliced form for the exon 2/the complete form of cathepsin B mRNAs obtained by RT-PCR. Such ratio is significantly higher in colorectal tumors than in colorectal mucosa (p < 0.05, Kruskal-Wallis test) or in skeletal muscle (p < 0.05). Moreover, 2-fold more complete form than the spliced mRNA was found in the tumors than in the colorectal mucosa. Our data indicate that the alternative splicing of human cathepsin B mRNA in the 5'UTR may be considered as an indicator of the cellular transformation, in colorectal cancer.