Comparative genomic hybridization detects genomic abnormalities in 80% of follicular lymphomas

Comparative genomic hybridization (CGH) was used to analyse 34 follicular lymphoma (FL) samples. 27 samples showed DNA sequence copy number changes of at least one genomic region (26 samples with at least one gain and nine with at least one loss). Some chromosomes or chromosomal regions were preferentially involved. The most frequently gained regions were chromosome 18q (29% of samples), chromosome X (21%), chromosome 7 (18%), chromosomes 2, 6p and 8q (12%). Two regions were preferentially lost: 6q (12%) and 17p (9%). All these gained and lost regions have been previously reported in cytogenetic studies, confirming the accuracy of CGH in detecting genetic abnormalities in FL. 21% of samples displayed normal profiles, probably reflecting the absence of unbalanced abnormality, which is also in agreement with the cytogenetic data. In conclusion, we showed that CGH is an accurate, reliable and rapid method and we propose the inclusion of CGH in the evaluation of FL at diagnosis.

Qualitative and quantitative analysis of HLA-DRB gene expression

Determination of the molecular mechanisms influencing HLA-DRB gene expression would allow better understanding of the regulation of the immune response in normal as well as in pathological conditions. We started an extensive sequencing analysis of the proximal promoter regions of the DRB genes and observed a nucleotide polymorphism involving the classical regulatory regions of the DRB promoters. These nucleotide substitutions were observed to induce variations of the promoter activities as assessed by chloramphenicol acetyl transferase assays and the quantification of DRB transcripts. Similar analysis performed in patients with rheumatoid arthritis strongly suggests dysregulation of HLA-DRB gene expression.

Experimental laparoscopic aortobifemoral bypass for occlusive aortoiliac disease

OBJECTIVE

To describe a totally laparoscopic technique for aortobifemoral bypass to treat aortoiliac atheromatous occlusive disease.

DESIGN

A feasibility study.

SETTING

A university teaching hospital.

SUBJECTS

Six piglets weighing between 70 and 80 kg were submitted to a totally laparoscopic retroperitoneal aortobifemoral bypass, performed through six trocar sites, with abdominal suspension and a gasless technique. No minilaparotomy was performed. After systemic heparinization, the infrarenal aorta was cross-clamped and the aortic bifurcation stapled. An end-to-end aorto-prosthetic anastomosis was performed. Retroperitoneal tunnels were created to allow each limb of the graft to join its corresponding femoral artery by a conventional anastomosis.

INTERVENTION

Totally laparoscopic aortobifemoral bypass.

MAIN OUTCOME MEASURES

Duration of the procedure, intraoperative blood loss and operative complications, bleeding in the immediate postoperative period. Evaluation of the aortic anastomosis at autopsy.

RESULTS

All aortobifemoral bypasses were completed in less than 4 hours. Intraoperative blood loss did not exceed 250 mL. No intraoperative complication was encountered except occasional bleeding at the aortic anastomosis upon releasing the arterial clamp. This was controlled with a collagen sponge (three cases) or extra stitches (two cases). The animals were observed for 15 minutes before sacrifice. Autopsy revealed a normal aortic anastomosis in all cases and a normal progression of the limbs of the graft under the ureters in the retroperitoneal tunnels.

CONCLUSIONS

This animal model demonstrates the feasibility of the aortobifemoral bypass through a laparoscopic approach. The retroperitoneal anatomy of the piglet is similar to that of man. Aortic surgery can be conducted as for the standard technique. We used a similar approach to perform the first human, totally laparoscopic aortobifemoral bypass with an end-to-end anastomosis.

[Histopathologic features of cytomegalovirus lymphadenitis in the "immunocompetent" patient. Report of 7 cases]

The authors report seven cases of cytomegalovirus lymphadenitis in apparently immunocompetent patients. One patient presented with an infectious mononucleosis-like illness. The main presentation of the others was isolated cervical lymphadenopathies. The lymph node pathology showed aspecific lymphoid hyperplasia, resembling the human immunodeficiency virus related lymphadenopathy, associated with diagnostic inclusion cells. Infected cells were confined to areas of monocytoid B cell hyperplasia in all cases whereas exceptionally observed in germinal centers. Because of their variable appearance, serial sectioning was frequently necessary to disclose their characteristic features. In all cases, immunohistochemistry using an anti-cytomegalovirus antibody was positive and revealed more infected cells than detected by morphology alone. Except for the endothelial cell, the nature of infected cells remained undetermined. An alteration of the antigenic expression as a consequence of cell infection might be responsible for immunohistochemistry failure in the cell characterization.

[Ontogenesis of lateralities. A review and attempted interpretation]

The present paper offers an updated review on lateralization development in normal children. Instead of just citing a voluminous litterature, we prefer to present an interpretation which perhaps is too synthetic but which tries to go beyond the frequent contradictions encountered within experimental studies as well as between the studies themselves. Results plead for a double movement in the human development, first towards a species-specific asymmetry, then towards a differentiated symmetry. We propose different advantages for the development of human competencies and for the underlying neuro-behavioural organization: asymmetry corresponds to phases in the intrahemispheric cerebral organization and symmetry to phases of interhemispheric synergy.

Atrial myxoma mimicking systemic disease. Profile modified by flurbiprofen administration

A patient had a left atrial myxoma which was modified by flurbiprofen administration. The diagnosis was made 42 months after the first symptoms appeared. Flurbiprofen may have reduced interleukin-6 secretion by the tumor, leading to a delayed diagnosis.

[Hemophagocytic syndromes. A series of 23 cases]

Inappropriate macrophage activation is responsible for clinical, biological and histological features characterized by diffuse non malignant histiocytic tissue infiltration called "reactive hemophagocytic syndrome" (RHS). We report here 23 new cases. Immunodepression (10 cases), hematologic malignancies (13 cases) and infection (10 cases) are the most favorable conditions associated with RHS. In many cases, several conditions were present at time of diagnosis of RHS and increased its severity. Mechanisms of RHS remains unclear, but cytokine may play a role. Outcome is variable, but death is the most common issue (17 deaths in our series related to RHS). Corticosteroids, etoposide can improve some situations. Further study is needed to establish the role of cyclosporine A or allogenic bone marrow transplantation.

[Abdominal lymphomas in children: place of surgery]

To determine the place of surgery in the management of abdominal Burkitt's lymphoma, we retrospectively reviewed the records of 17 children treated over a period of 10 years (1983-1992). Patients were 14 males. Seven patients presented with acute abdominal pain, 6 with an abdominal mass and 5 with intestinal obstruction. In 3 cases, the diagnosis was made without laparotomy (2 percutaneous tumoral puncture, 1 pleural puncture). In the 14 other cases, the diagnosis was made by laparotomy with 3 biopsies and 11 resection of the tumor (7 complete and 4 incomplete). These laparotomies were complicated by 1 evisceration and 2 intestinal obstruction. At the end of the initial chemotherapy, 1 children was reoperated for a residual mass with no histological viable tumor. Sixteen children were long term survivors (14 > 2 years); 1 died. Surgery was indicated in cases of intestinal intussusception. In cases of abdominal mass, surgery could have been avoided twice (positive ascitic fluid). A complete tumoral resection had no influence on survival which depend of extra-abdominal extension and more over of response to chemotherapy.

Occurrence of a T cell lymphoma in a patient with chronic myeloid leukemia treated with alpha interferon

A patient treated by recombinant human alpha interferon for chronic myeloid leukemia developed a T cell lymphoma. The T cell lymphoma cells were demonstrated to be genotypically different from the chronic myeloid leukemia cells. The possible role of interferon therapy in stimulating T cell proliferation is discussed.

Responses of ipsilateral retino-tectal (type I1) units of the frog (Rana esculenta) to moving configurational bars

In frogs, retinal information projecting to the ipsilateral optic tectum uses a complex, at least bi-synaptic, route. Ipsilateral visual units recorded at the tectal level correspond to isthmic axon terminals. For a better approach of their visual function, these units have been stimulated with moving (V = 7.6 degrees/sec) configurational stimuli proved earlier to be able to elicit classical behavioural sequences in amphibians. In the presence of W("worm-like")-stimuli of increasing length (2 degrees < L < 20 degrees), the discharge rate of type I1 units remains rather constant. In response to A("antiworm-like")-stimuli, the discharge rate first increases up to L = 5-6 degrees and then decreases continuously. The ability of these units to discriminate bars of equal dimension but of different configuration was defined using the "contrast-like" formula originally proposed by Ewert et al. (1978). The relationship between the discrimination factor D(W, A) and the length of the stimuli is similar in shape to that found in class R3 ganglion cells. Results suggest thus that the classical functional homology between type I1 ipsilateral units and class R2 retinal neurons is inadequate.

Stimulation, data acquisition, spikes detection and time/rate analysis with a graphical programming system: an application to vision studies

A Macintosh-based system performs stimulus control and data acquisition, and an off-line analysis, in experiments on visually driven neurons in frog. The stimulus is a target moved on a modified XY recorder. The computer is equipped with a multifunction input/output board to perform stimulus control and data acquisition. The graphical programming system LabVIEW 2 was used to develop the 'Vision 93' package made of 4 main 'virtual instruments' (VIs). By means of DOCS-Exp, the user controls the experiment via screen displays which look like front panels of electronic instruments. DOCS-Preproc performs a user-controlled spike detection and computes mean impulse rate values. DOCS-SAS displays the instantaneous frequency, mean impulse rate, spike counts or interspike time intervals as staircase histograms and/or spline smoothed curves. Finally, DOCS-x-Functions computes and graphs quantitative stimulus/response relationships in terms of velocity, diameter, orientation and configuration of the target. The functionalities of these main VIs are presented and original software components are detailed. System operation is illustrated by using the successive VIs to process a sample signal record.

Transplants of embryonic cortical tissue placed in the previously damaged frontal cortex of adult rats: local cerebral glucose utilization following execution of forelimb movements

Transplantation of fetal cortical tissue into the motor cortex of adult rats was used as an experimental model to examine the functional integration of homotopic fetal neocortical grafts into the motor pathways of adult host brain. We have employed the [14C]2-deoxy-D-glucose method to analyse the metabolic activity of the transplant and host sensorimotor cortex: (i) in animals solicited to perform specific lever-pressing movements with the limb contralateral to the transplant (experimental group); and (ii) in non-solicited animals or in animals using the limb ipsilateral to the transplant (control group). Grafts in the control group displayed homogeneous uptake of 2-deoxy-D-glucose throughout the rostrocaudal extent of the transplant. The local cerebral glucose utilization levels were low as compared to those of the surrounding cortex but were at least two-times higher than in the corpus callosum. Increase in 2-deoxy-D-glucose uptake by the transplant cells was found only in the experimental group. In this group, 2-deoxy-D-glucose uptake was higher in the caudal (AP: +3.0 to +1.7 mm, relative to Bregma) than in the rostral sectors of the transplants suggesting the existence of a topographic organization within the transplant. In addition, except in the rostral part, glucose utilization was higher in the transplant of the experimental group than in the sensorimotor areas of the non-activated cortex in the control group. Moreover, glucose utilization of the transplant cells was systematically higher in the experimental than in the control group. The transplants appear to display a certain level of metabolic integration with the host sensorimotor cortex since, in the experimental group, there was no significant differences in local cerebral glucose utilization values in the caudal sector of the transplant and in the surrounding sensorimotor cortical areas of the host. The 2-deoxy-D-glucose uptake was even higher in the caudal sector of the transplant than in some of the subfields of the contralateral sensorimotor cortex. The present findings indicate for the first time that motor activation of the contralateral forelimb produces an increase in metabolic activity in distinct transplant sectors, the topographic distribution of which matches the normal topographic organization of the forelimb somatomotor map. This suggests that transplants of embryonic frontal neocortex placed in the frontal cortex of adult hosts become functionally integrated with the host motor system.(ABSTRACT TRUNCATED AT 400 WORDS)

[The use of the teeth in genetic fingerprinting]

Blood, hairs and sperm are tissues currently used in forensic science to carry out DNA fingerprints in the field of individual identification. Our study aims at showing that dental pulp can also be an exploitable DNA source. A quantitative and qualitative DNA investigation on a yield gel with sizing extracted from this tissue shows that the molecule appears to be in a great quantity and of a high molecular weight. The last characteristic allows the use of the restriction fragments length polymorphic technique to make DNA fingerprints, based on the individual variations of the restriction sites disposition, within the DNA molecule, for a given enzyme. Thus, for an enzyme, the length of the restriction fragments obtained and revealed by a probe, is visualized by autoradiograph. According to this technique, we compared the DNA fingerprints obtained on 8 persons with the probe MS43A, from both pulpal and nucleated blood cells. During the extraction of the third molar of each sample, a small quantity of blood was taken in the tooth socket. In the same time DNA was recovered. For a same person, the autoradiograph showed the same pattern for both blood and tooth sample. The DNA profile similitude confirms the possibility of using the tooth for genetic analysis. The interest in using dental tissues as a DNA source of individual identification falls within the particular character of resistance of this organ towards physical or chemical exterior aggressions. The tooth which until now was used in Anthropology and Forensic Science for its morphological aspects could be used this way for genetic study.

Testicular tumor and the acquired immunodeficiency syndrome

Immunocompromised patients, particularly those suffering from the acquired immunodeficiency syndrome (AIDS), present an increased risk of tumoral pathology. From the observation of a testicular lymphoma associated with Epstein-Barr virus in a HIV + patient, we review 19 cases of testicular tumor in HIV + patients previously published in the literature. These tumors are either lymphomas (4 cases) or germ cell tumors (15 cases). Their diagnosis was not difficult, although in the first stages enlarged and painful testicles are often wrongly identified as orchiepididymitis and treated as such. Therapy management proves to be delicate as a result of the significant tumor spread seen in these patients with dysfunctional immune systems. Regarding lymphomas, a low-dose multiagent chemotherapy with intrathecal chemotherapy was recommended by Levine. Concerning germ cell tumors, Wilson prefers an instant aggressive treatment with retroperitoneal lymphadenectomy (whether or not combined with chemotherapy) to avoid the risk of recurrence. In fact, tumor relapses will be difficult to control in the progressive stages of immunodeficiency syndrome.

[The role of adrenal gland x-ray computed tomography and scintigraphy using radiolabelled norcholesterol in the etiological diagnosis of primary hyperaldosteronism]

The major etiologies of primary aldosteronism are aldosterone-producing adrenal adenoma, requiring a surgical treatment, and bilateral hyperplasia, usually managed with medical therapy. We only report a retrospective study on 22 patients with primary aldosteronism diagnosed by clinical and usual biochemical tests. All the patients were explored by computed tomography scan (CT) and iodomethyl-norcholesterol scintigraphy. The purpose of this study was to compare the capacity of the two methods to differentiate adrenal adenoma and hyperplasia. The CT scan was more sensitive (sensitivity: 88%) compare to scintigraphy (sensitivity: 64%) for the diagnosis of adrenal adenoma. However, the scintigraphy was a useful tool to detect asymmetric macronodular adrenal hyperplasia. Therefore, the catheterisation of adrenal venous would be only necessary for a few cases. We conclude from this study and the literature review that CT scan and iodomethyl-norcholesterol scintigraphy are complementary and both useful to increase diagnostic reliability of primary aldosteronism.

[Extramedullary hematopoiesis. An unusual cause of Pagetic spinal cord compression]

An original case is reported: spinal cord compression due to extramedullary hematopoiesis of the epidural space, related to Paget's disease of bone, successfully treated by surgery. Extramedullary hematopoiesis, usually occurring in cases of hematological disease, can also complicate Paget's disease, probably by bone effraction mechanism. A review of literature has found 5 other cases of extramedullary hematopoiesis occurring in Paget's disease, without hematological disease. Medullar scintigraphy (Indium111, Technetium99 Sulfur colloid) can confirm the diagnosis after X-ray findings, without the need for biopsy. Awareness knowledge of this complication can sometimes avoid invasive investigation. Low dose radiotherapy is useful in the case of hematological disorders. In Paget's disease, there is a risk of sarcomatous degeneration. In our patient, surgery cured cord compression, but it relapsed because of extensive fibrosis, in complicating surgical hemorrhage.

Primary Epstein-Barr virus infection with clonal T-cell lymphoproliferation

A case of fatal Epstein-Barr virus infection in a previously healthy girl who was first found to have severe infectious mononucleosis with spontaneous recovery is reported. Because an abnormal immune response to the virus persisted, the disease relapsed, manifesting in cutaneous and pulmonary lesions associated with hemophagocytic syndrome responsible for death. Pathologic findings were characterized by polymorphous atypical lymphoid infiltrate, prominent necrosis, and histiocytic hyperplasia. Lymphoid cells displayed CD8 phenotype and clonal T-cell receptor gene rearrangement. Viral genome was detected in lesions by Southern blot and located in nuclei of lymphoid cells by in situ hybridization. Pathologic findings suggested fatal infectious mononucleosis; however, phenotype and genotype favored a malignant diagnosis. Clonality was demonstrated to have arisen during primary infection. Virologic examination indicated that Epstein-Barr virus was a causative agent. Such a process belongs to the recently recognized spectrum of Epstein-Barr virus-related T-cell lymphoproliferative disorders that might overlap fatal infectious mononucleosis in patients who are especially vulnerable to the virus.

Immunohistochemical detection of cells positive for colony-stimulating factor 1 in lymph nodes from reactive lymphadenitis, and Hodgkin's disease

Colony-stimulating factor 1 (CSF-1) is a cytokine involved in hematopoiesis and perhaps more importantly in the early stages of immunological defense mechanisms. Although numerous studies of in vitro CSF-1-producing cells have been published, in vivo data is totally lacking. According, we performed immunohistochemical detection of CSF-1-positive cells on frozen sections of reactive lymphadenitis (three cases) and Hodgkin's disease (13 cases) lymph node biopsies, using as antibody a highly specific polyclonal rabbit antiserum prepared in our laboratory. Endothelial cells from high endothelial venules and most fibroblasts were positive in all cases (reactive lymphadenitis and Hodgkin's samples), and most lymphocytes in interfollicular T cell areas showed faint granular positivity in reactive lymphadenitis lymph nodes. Hodgkin and Reed-Sternberg cells were positive in all cases tested, although staining intensity was highly variable and the percentage of positive cells differed from case to case. These data from in vivo biopsies confirm previous results for in vitro CSF-1 production by endothelial cells, fibroblasts, T lymphocytes, and Hodgkin cell lines. They are consistent with the role of this cytokine in immune response and raise the question of its significance in Hodgkin's disease.

[Vertebral compressions revealing Cushing's syndrome. 3 cases]

The authors report three cases of osteoporotic vertebral fractures in the Cushing Syndrome. This osteoporosis is partially reversible after treatment of the cause. Laboratory findings must comport a cortisonuric and a 17 hydroxycorticosterone cycle.

[Values and limitations of the notion of chronic hallucinatory psychosis. Study of 17 cases]

From a study of 17 cases of Chronic Hallucinatory Psychosis (PHC) hospitalized between 1982 and 1990 at Tours in the public university department of psychiatry, and from recent results about the female specificities of schizophrenia, the article puts forward the hypothesis that PHC primarily describes a late and singular modality of schizophrenia in women.

Acquired aphasia, dementia, and behavior disorder with epilepsy and continuous spike and waves during sleep in a child

Severe persistent neuropsychological disorders sometimes develop in the course of a focal epilepsy of unknown origin in previously normal children. Very frequent bilateral focal or generalized discharges are often noted on the sleep EEG records of these patients with no evidence of clinical seizures. The relation between these paroxysms and the observed deterioration remains unclear. We report a child with a partial complex epilepsy and severe disturbances of language, cognition, and behavior acquired in the early years of development who was followed for 15 years. A correlation between the evolution of the striking EEG abnormalities during sleep and the neuropsychological disorders could be established retrospectively. The observed sequence of onset and recovery of the aphasia, the dementia, and the "psychotic" behavior makes a direct causal relation between the deficits quite unlikely. Rather it suggests an association of independent symptoms with a specific language disorder becoming manifest in the course of the evolution. This child shows many of the main characteristics of the syndromes of "acquired aphasia with convulsive disorder" (Landau-Kleffner syndrome) and "epilepsy with continuous spike waves during sleep." Both syndromes describe probably different facets of a similar underlying, still unexplained cerebral dysfunction.

Quantitative stimulus-response studies on sustained ganglion cells in the frog retina

"Sustained" visual units, i.e. nonerasable (R1) and erasable (R2) units as commonly described, were recorded in the superficial layers of the rostral optic tectum of Rana esculenta and their neuronal activity (expressed as the mean firing frequency R) was quantitatively analyzed. The mean value of the exponent alpha of the velocity function of the erasable R1 units was found to be 0.46 and the constant k to be about 24.7. The optimal stimulus diameter was equal to 2.6 deg. For the whole population of the erasable units, the exponent alpha was found to be between 0.36-0.75 (mean value approximately 0.56, i.e. largely different from the values currently reported for such units) and was independent of the stimulus diameter (D = 0.6-6 deg). However, the constant k of the velocity function (range: 8.2-37.7) varied with D. Most of the erasable units (called "mixed R1-R2" units) therefore showed an R1-type velocity function with an exponent alpha approximately 0.5 and a constant k approximately 25 but reacted to other parameters as did "typical" R2 units: (i) their neuronal response was related to the stimulus diameter by a logarithmic function with a maximum obtained for D = 2.4 deg; and (ii) a variation of about 4-17% on either side of the average value of R was observed, independent either of the stimulus velocity or of the diameter of the stimulus. Results are compared to known quantitative data, and the use of stimulus-response relationships as a tool for classification is discussed.

Handedness and reading disability: a developmental study

124 normal children were followed from age 5 to 9. Manual laterality status continues to consolidate between these ages and reveals itself unrelated to reading level.

Quantitative studies on ipsilateral type 2 retinotectotectal (IRTT) units in frogs: homologies with R3 ganglion cells

Contralateral and ipsilateral responses from deep layers of the rostral neuropil of the optic tectum of Rana esculenta were recorded extracellularly and quantitatively analyzed. Effects of the velocity and diameter of the stimulus on the neuronal response (measured as the mean firing frequency, R) were mainly tested in this work. 1. Among the population of changing contrast or event ganglion cells, R3-like units (with a weak response to background off-on stimulation) were defined in addition to typical R3 ganglion cells. 2. A power function relating R and the stimulus velocity (v) was established in all units (R = k v alpha), with alpha = 0.80-1.07 and k = 2.1-9.5 for R3 units, alpha = 0.55-0.77 and k = 5.8-15.2 for R3-like units, and alpha = 0.80-1.16 and k = 1.3-5.1 for ipsilateral I2 units. 3. The area function was expressed by a logarithmic function. In all classes the maximal response was obtained with 4.4 degrees-7.5 degrees targets, independent of the test velocity. 4. Both the velocity and the diameter of the stimulus influenced the value of the dynamic receptive field diameter. 5. Finally, results show that qualitative and quantitative properties of I2 units are similar to those of R3 ganglion cells.

[Giant fibrovascular polyp of the esophagus. Apropos of a case. Review of the literature]

Two operations were necessary to establish the diagnosis, in a patient with giant fibrovascular polyp of esophagus, imaging data suggesting an erroneous perioperative diagnosis of idiopathic mega-esophagus. This intraluminal tumor is benign and pedunculated, the symptoms arising from the esophageal obstruction. During vomiting, blockage at the laryngeal level by the fibrovascular polyp can provoke an acute asphyxia. Treatment is a function of polyp size, small tumors being removed endoscopically with the ever present risk of hemorrhage. Large tumors require surgery, the approach depending on the pedicle site.

[Algodystrophy in children and young adults with low isotope retention in the bones. Apropos of 5 cases]

The authors report 5 observations of young adults, 3 teen-agers and 2 children suffering from algodystrophy, and in whom isotopic exploration of the skeleton disclosed a clear bony hypofixation during the entire evolution. These observations confirm their 1981 work concerning a young adult suffering from algodystrophy with isotopic bony hypofixation. Recent Canadian and American studies emphasize also the frequency of isotopic hypofixation in children algodystrophy. It seems, therefore, that isotopic bony hypofixation (linked perhaps to a decreased blood flow), is rather specific of algodystrophy in young subjects.