Detection of novel skeletogenesis target genes by comprehensive analysis of a Runx2(-/-) mouse model

Runx2 is an essential factor for skeletogenesis and heterozygous loss causes cleidocranial dysplasia in humans and a corresponding phenotype in the mouse. Homozygous Runx2-deficient mice lack hypertrophic cartilage and bone. We compared the expression profiles of E14.5 wildtype and Runx2(-/-) murine embryonal humeri to identify new transcripts potentially involved in cartilage and bone development. Seventy-one differentially expressed genes were identified by two independent oligonucleotide-microarray hybridizations and quantitative RT-PCR experiments. Gene Ontology analysis demonstrated an enrichment of the differentially regulated genes in annotations to terms such as extracellular, skeletal development, and ossification. In situ hybridization on E15.5 limb sections was performed for all 71 differentially regulated genes. For 54 genes conclusive in situ hybridization results were obtained and all of them showed skeletal expression. Co-expression with Runx2 was demonstrated for 44 genes. While 41 of the 71 differentially expressed genes have a known role in bone and cartilage, we identified 21 known genes that have not yet been implicated in skeletal development and 9 entirely new transcripts. Expression in the developing skeleton was demonstrated for 21 of these genes.

[Stüve-Wiedemann syndrome in two siblings: focusing on a male patient with the longest actual survival rate]

BACKGROUND

We report on two siblings with Stüve-Wiedemann syndrome (SWS). The older patient, a 16-year-old boy, is -- as to our knowledge -- the longest-term survivor of this syndrome worldwide. The younger sister with the same clinical and radiographic findings died at the age of 10 months.

DEFINITION

Characteristic clinical symptoms are: muscular hypotonia, camptodactyly; respiratory insufficiency, swallowing difficulties; reduced sweating with heat intolerance, episodes of hyperthermia. Typical radiographic findings are: progressive bone bowing, unusual bone fractures, abnormal trabecular pattern, middle face hypoplasia.

GENETICS

The SWS is identical with the Schwartz-Jampel syndrome (SJS) type 2, which is gene-located on chromosome 1. So far further genetic details of the SWS can be expected in the near future. The genetic transmission is autosomal recessive. In inbred high risk populations the occurrence of the SWS is increased.

THERAPY

For the present only symptomatic therapy is available: extended intensive care during infancy, supportive pediatric orthopedics later on.

Application of mouse monoclonal antibodies for identification of antigen regions of human thyroid peroxidase in adolescents with Graves' disease and non-toxic multinodular goiter by flow cytometry

Thyroid peroxidase (TPO) is the major thyroid autoantigen recognized by serum autoantibodies from patients with Graves' disease (GD) or Hashimoto's thyroiditis directed to two immunodominant conformational regions termed A and B. The epitopes of human TPO have been defined using a panel of mouse monoclonal antibodies (mAbs). The aim of this study was to estimate the expression of chosen surface antigen regions of TPO (1, 18, 30, 64 epitopes) on thyroid cells in 15 patients with non-toxic multinodular goiter (NTMG) and 15 patients with GD. The thyrocytes were identified by indirect method: in the first stage we added mouse monoclonal autoantibodies specific for TPO regions and in the second stage we conjugated this complex with rabbit anti-mouse antibodies IgG (Fab')(2) with FITC. All investigations were performed by flow cytometry using Coulter EPICS XL apparatus. The percentages of thyrocytes with expression of epitopes 1, 18, 30, 64 TPO were measured in relation to the respective anti-TPO concentrations: 50-1600 microg/ml. The analysis of epitopes located in immunodominant regions (IDR) of TPO revealed higher percentages of thyrocytes in cases with GD in comparison to NTNG. The most predominant difference was observed for mAb 64 epitope (48 vs 7%, p < 0.019; 39 vs 5%, p < 0.017) at the concentration of 100-200 microg/ml mAbs. The expression of 18 epitope on thyrocytes was also statistically higher in Graves' patients than in the NTMG (14 vs 6%, p < 0.025) at concentration of 400 microg/ml mAbs. However, this expression was much less pronounced. In all the cases, the percentages of thyrocytes with epitopes 1 and 30 were in low detection (8-15% of positive cells). In conclusion, our findings suggest that the elevated expression of TPO epitopes 18 and 64 in young patients with thyroid autoimmune diseases increase stimulation and activation of thyroid cells during inflammatory reaction within the thyroid gland. In addition, predominant expression of 64 TPO epitope that recognizes B domain in GD patients could be a useful marker of the immune process in the thyroid gland.

Influence of esterification and modification of A-ring in a group of lupane acids on their cytotoxicity

The aim of this work was to find an optimal ester group for preparation of lupane derivatives connecting high cytotoxicity with good chemical and pharmacological properties. Activities of methyl-, pivaloyloxymethyl- (Pom-), and acetoxymethyl- (Acm-) esters were compared with the activity of free acids. Although the methyl- and Pom-esters were generally less active than free acids, some Acm-esters had cytotoxicity similar to or even better than the starting compounds. Cytotoxic activity was measured in five cancer cell lines.

Correlation of cytotoxic activity of betulinines and their hydroxy analogues

This research is based on intention to prepare and test 3beta-hydroxy and 3beta,28-dihydroxy analogues of new pro-apoptotic derivatives (betulinines) using selective hydrolysis procedure and strategic protective groups. The evaluation of cytotoxicity of prepared compounds on several tumor cell lines using an MTT test was our interest. It was found that hydrolysis of acetates in betulinines afforded compounds with higher cytotoxicity in case of 18-lupene-21-ones (e.g., ethyl 3beta-hydroxy-21-oxolup-18-en-28-oate), whereas hydrolysis of the 18-lupene-21,22-diones gave less active derivatives.

Efficacy of the fully human monoclonal antibody MOR102 (#5) against intercellular adhesion molecule 1 in the psoriasis-severe combined immunodeficient mouse model

BACKGROUND

Psoriasis is considered as a chronic immune-mediated disease characterized by inflammation and proliferation of the epidermis.

OBJECTIVES

Targeting intercellular adhesion molecule 1 (ICAM-1) is an attractive therapeutic option as this molecule is critically involved in leucocyte adhesion and extravasation as well as in lymphocyte activation.

METHODS

We have selected the fully human monoclonal antibody MOR102 (#5) against ICAM-1 from the Human Combinatorial Antibody Library (HuCAL). This antibody, as human IgG4 [corrected] was tested for its ability to interfere with lymphocyte activation and adhesion in vitro as well as for its antipsoriatic efficacy in vivo using the psoriasis-severe combined immunodeficient (SCID) mouse model.

RESULTS

The antibody demonstrated efficient inhibition of lymphocyte adhesion to ICAM-1 in vitro, with an IC(50) of approximately 0.4 microg mL(-1) (3 nmol L(-1)). In addition, MOR102 (#5) reduced lymphocyte proliferation in mixed lymphocyte cultures by approximately 50%. The in vivo efficacy of MOR102 (#5) was tested on grafts derived from lesional skin of patients with chronic plaque-stage psoriasis transplanted on to SCID mice. Intraperitoneal injection of 10 mg kg(-1) of MOR102 (#5) antibody every alternate day over a period of 4 weeks resulted in reconstitution of orthokeratotic differentiation and a significant (P < 0.05) reduction in epidermal thickness as well as marked reduction in the inflammatory infiltrate. Therapeutic activity may be related to the targeting of ICAM-1 on keratinocytes and thus preventing efficient activation of local T cells.

CONCLUSIONS

Based on the efficacy of the fully human monoclonal antibody MOR102 (#5) shown in vitro as well as in vivo in the psoriasis-SCID mouse model, initiation of clinical studies is indicated.

Intrinsic constraint of unlinked total elbow replacements--the ulnotrochlear joint

BACKGROUND

Many unlinked total elbow replacement designs with radically differing articular geometries exist, suggesting that there is no consensus regarding an optimal design. A feature inherent to the articular design is the intrinsic constraint afforded to the joint by the implant. Our aim was to compare the intrinsic constraints of unlinked implants with that of the normal ulnotrochlear joint.

METHODS

We tested twelve cadaveric ulnotrochlear joints with a custom-made multiple-axis materials testing machine. With compressive loads ranging from 10 to 100 N, the joints were moved in either valgus or varus directions at 90 degrees of flexion. The ulnotrochlear components from a single example of five medium-sized unlinked elbow replacements (Ewald, Kudo, Pritchard ERS, Sorbie-Questor, and Souter-Strathclyde) were also tested. The recorded measurements included the torques and forces, angular displacement, and axial displacement of the humerus relative to the ulna.

RESULTS

In general, the peak torque and the constraint ratio significantly increased with increasing compressive load for the implants as well as for the normal elbow. In valgus displacement, the Souter-Strathclyde implant had the highest and the Sorbie-Questor had the smallest peak torque and the Souter-Strathclyde had the highest and the Ewald had the smallest constraint ratio. In varus displacement, the Kudo had the highest and the Ewald had the smallest peak torque and constraint ratio.

CONCLUSIONS

The constraint ratio is a characteristic that is useful for describing elbow joint behavior and for comparing the behavior of implants with that of the human elbow. Of the unlinked implants tested, the Souter-Strathclyde and Kudo prostheses most closely approximated the behavior of the human elbow joint. Implants that resemble the human elbow in appearance do not replicate normal behavior consistently, whereas other implants that do not resemble the human elbow closely do not deviate markedly from human behavior. Thus, much basic information about elbow form and function is needed to improve the performance of total elbow prostheses.

Improving the safety of laparoscopic cholecystectomy: the routine use of preoperative magnetic resonance cholangiography

BACKGROUND

The aim of this study was to determine the value of routinely performed preoperative magnetic resonance cholangiography (MRC) in detecting common bile duct (CBD) stones in patients stated to undergo elective laparoscopic cholecystectomy. In addition, we used MRC to investigate possible variants of the cystic duct.

METHODS

Magnetic resonance cholangiography was performed preoperatively in 773 patients (311 male and 462 female; median age 55 years, range 16-91) who had no clinical signs of cholestasis prior to undergoing elective laparoscopic cholecystectomy. In cases where the MRC was positive for CBD stones, endoscopic retrograde cholangiopancreatiography (ERCP) was then performed. A total of 532 patients were available for continuous postoperatively follow-up (median 54 months, range 36-85). In 462 patients (247 female, and 215 male), MR images were also reviewed for variants of the cystic duct.

RESULTS

In 705 patients (91%), MRC was negative for CBD stones. In 64 patients (9%) MRC was positive. Of these patients, 47 (6%) had CBD stones on ERCP. In 12 patients (2%), MRC was false positive. In five cases (0.6%), ERCP had an inconclusive result postoperative follow-up (532 patients, or 69%) revealed evidence of CBD stones in three patients (10.4%) despite a preoperative negative MRC result. Anatomical variants in the course of the cystic duct and its confluence with the common bile duct were found in 27 of 462 patients (6%).

CONCLUSIONS

Magnetic resonance cholangiography proved to be a reliable screening technique in the preoperative evaluation of patients with silent CBD stones. Imaging of the course of the cystic duct is possible in a high percentage of cases. Therefore, MRC can be recommended as a screening technique before laparoscopic cholecystectomy.

Tobacco attributable deaths in South Africa

BACKGROUND

In mid 1998, a question "Was the deceased a smoker five years ago?" was introduced on the newly revised South African death notification form.

DESIGN

A total of 16,230 new death notification forms from 1998 have been coded, and comparison of the prevalence of smoking among those who died of different causes was used to estimate, by case-control comparisons, tobacco attributed mortality in South Africa. Cases comprised deaths from causes known (from other studies) to be causally associated with smoking, and controls comprised deaths from medical conditions expected to be unrelated to smoking. Those who died from external causes, and from diseases strongly related to alcohol consumption, were excluded.

SUBJECTS

Reports were available from 5340 deceased adults (age 25+), whose smoking status was given by a family member.

RESULTS

Significantly increased risks were found for deaths from tuberculosis (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.23 to 2.11), chronic obstructive pulmonary disease (COPD) (OR 2.5, 95% CI 1.9 to 3.4), lung cancer (OR 4.8, 95% CI 2.9 to 8.0), other upper aerodigestive cancer (OR 3.0, 95% CI 1.9 to 4.9) and ischaemic heart disease (OR 1.7, 95% CI 1.2 to 2.3).

CONCLUSION

If smokers had the same death rate as non-smokers, 58% of lung cancer deaths, 37% of COPD deaths, 20% of tuberculosis deaths, and 23% of vascular deaths would have been avoided. About 8% of all adult deaths in South Africa (more than 20 000 deaths a year) were caused by smoking.

The role of the therapeutic team in shaping eating habits and lifestyle in children with dietary calcium deficiency

PURPOSE

Assessment of the effect of low-calcium diet on bone mineral content in children and adolescents.

MATERIAL AND METHODS

The study involved 89 children (49 girls and 40 boys) aged 5-18 years, in whom diseases affecting bony metabolism had been excluded. Children with a history of dietary calcium content below 500 mg/day were recruited. The study group was divided according to age: group I, age 5-9 years (children before puberty); group II, age 9-15 years (early puberty); group III, 15-18 years (late puberty). Dual energy X-ray absorptiometry (DEXA) was used for densitometric measurements. Bone mineral density (BMD) was assessed in the whole skeleton (total BMD), in vertebrae L2-L4 (spine BMD) in g/cm2 and as Z-score. Concentrations of Ca, Ca2, P, activity of alkaline phosphatase (AP) and its bony isoenzyme were determined in the serum.

RESULTS

Total bone mass below 5th percentile (according to the norm for age and gender) was found in 56.98% of the children involved in the study. A significant reduction was noted in the spine mineral mass in boys (p < 0.01) as compared to girls (0.731 +/- 0.17 g/cm2 and 0.835 +/- 0.19 g/cm2, respectively). The lowest mean Z-score (-1.850) was observed in group III as compared to group I (-1.194) (p < 0.01) and group II (-1.201) (p < 0.05). There were statistically significantly positive correlations between total and spine BMD and BMI. The correlation coefficient was r = 0.56 and r = 0.41 (p < 0.001), respectively.

CONCLUSIONS

In the majority of the children (c. 60%), a reduction in bone mineral content was found. The lowest Z-score (-1.850) was revealed in the oldest children, which may disturb the process of reaching the optimum level of the peak bone mass.

[Infrared pupilometry measured by digital photography]

BACKGROUND

Pupil size is mainly controlled by the action of parasympathetic and sympathetic nerves. Measurement of pupil size and reaction to light are important in both experimental and clinical settings.

METHODS AND RESULTS

We have established infrared pupilometry using a commercially available digital camera and a calculation with standard computer software. Volunteers were habituated in a dark room for five minutes before pupil evaluation. Pupil measurement was repeated three times and the diameter was calculated according to the following formula: D(mm)=30/S(pix)*D(pix), where D(pix) and D(mm) represent the pupil size in pixels and millimetres, respectively, and S(pix) was the length in pixels of a 30 mm standard. Our method was validated by the measurement of the diameter of calibration circles printed on a white sheet of paper. Deviation from the actual size was less than 3%. We also compared the results of pupil size obtained by our method, with the results of the pupilometer Pupillscan II measurement. The relative difference between the two methods was always less than 5%. The applicability of the method was illustrated by measurement of the pharmacodynamic effect of the single dose of tramadol (100 mg p.o.) in seven volunteers, compared with control placebo-treated volunteers.

CONCLUSIONS

The proposed method is precise and sensitive enough to be used for pupil size determination.

Synthesis of A-seco derivatives of betulinic acid with cytotoxic activity

In this study, the relationships between the chemical structure and cytotoxic activity of betulinic acid (1) derivatives were investigated. Eight lupane derivatives (1-8), one of them new (6), five diosphenols (9-13), four of them new (10-13), two new norderivatives (14 and 15), five seco derivatives (16-20), four of them new (16, 17, 19, and 20), and three new seco-anhydrides (21-23) were synthesized from 1, and their activities were compared with the activities of known compounds. The effects of substitution on the A-ring and esterification of the carboxyl group in position 28 on cytotoxicity were of special interest. Significant cytotoxic activity against the T-lymphoblastic leukemia cell line CEM was found in diosphenols 9 and 13 (TCS(50) 4 and 5 micromol/L) and seco-anhydrides 22 and 23 (TCS(50) 7 and 6 micromol/L). All compounds were also tested on cancer cell lines HT 29, K562, K562 Tax, and PC-3, and these confirmed activity of diosphenols 9, 10, and 11 and anhydride 22. Diosphenols, as the most promising group of derivatives, were further tested on four more lines (A 549, DU 145, MCF 7, SK-Mel2).

Acceptability and utilisation of voluntary HIV testing and nevirapine to reduce mother-to-child transmission of HIV-1 integrated into routine clinical care

OBJECTIVES

Use of nevirapine for prevention of mother-to-child transmission (PMTCT) of HIV-1 has been routine clinical care at Coronation Women and Children's Hospital since April 2000. We assessed the effect of regular audit and targeted interventions on the utilisation of the PMTCT programme.

METHODS

Review of antenatal cards and hospital records of women discharged following delivery, in three time periods between October 2000 and February 2002. Following the initial audit an intervention was implemented to eliminate weaknesses in our PMTCT service. Following the second audit the hospital became a pilot site for the Gauteng PMTCT programme.

RESULTS

In the initial audit 53.2% of women (159/299) were tested for HIV and received their results, while 56% (14/25) of identified HIV-infected women, and 16% (4/25) of their infants, received nevirapine. By the third audit 74.3% of women (266/358) received their results, and 86% (43/50) of HIV-positive women and 74% (37/50) of newborns were documented to have received nevirapine. In all three audits over 90% of women initiating antenatal care at the hospital were tested for HIV, while women who initiated care at district community clinics were less likely to receive testing.

CONCLUSIONS

Ongoing audit has been important for targeting obstacles to detection of HIV-infected women and documented nevirapine uptake by women and infants. Rates of HIV testing and nevirapine use have increased significantly. Voluntary counselling and testing for HIV and use of nevirapine are acceptable to pregnant women in our setting. Roll-out of the pilot programme to district community clinics is essential for further improvement.

Short- and long-term reproducibility of autonomic measures in supine and standing positions

Autonomic nervous tests and heart rate variability (HRV) have been used to assess cardiac autonomic function and to evaluate long-term prognosis. The aim of this study was to evaluate the short- and long-term reproducibility of HRV parameters and autonomic nervous tests according to body position (supine or standing). The study group consisted of 26 healthy subjects. Autonomic nervous tests and HRV were performed twice during the day and the results were averaged. The protocol was then repeated 3 days after each examination and also after 6 and 24 months. Autonomic nervous tests included deep breathing, Valsalva manoeuvre and isometric muscle exercise (handgrip), as well as blood pressure and heart rate in response to standing. ECG recordings were taken for 10 min during spontaneous breathing for HRV analysis. We found that the reproducibility of some parameters of the autonomic nervous test were independent of body position [E/I ratio (heart rate response to deep breathing)], whereas other parameters were dependent on body position (Valsalva manoeuvre and blood pressure response to sustained handgrip). In addition, within-day measurements of those parameters varied from non-reproducible (Valsalva ratio, handgrip and blood pressure response to standing) to moderately reproducible [E/I ratio and 30/15 ratio (heart rate response to standing)]. Among the HRV parameters, we found that total power (TP), low (LF)- and high (HF)-frequency were reproducible not only for measurements made within the same day, but also during short- and long-term observations, and only the LF/HF ratio was dependent on body position. We conclude that only a few autonomic nervous tests are reproducible in the short- and long-term. Because HRV parameters obtained during spontaneous respiration showed high reproducibility for measurements made within the same day as well as in the short- and long-term, they should be used instead of autonomic nervous tests when long-term observations are carried out in a healthy population.

[Controversies in the diagnosis of growth hormone deficiency]

Evaluation of the GH secretion using pharmacological GH stimulation tests remains controversial in the diagnosis. The authors present diagnostic problems in recognizing growth hormone deficiency on the basis of literature.

[Polyglandular autoimmune syndrome in 14-year-old boy]

A case of polyglandular autoimmune syndrome (PGA) in a 14-year-old boy presented is. The case syndromes included hyperthyreosis with a high titre of antithyreoglobulin and antimicrosomal antibodies and hypofunction of adrenal glands confirmed by the test with ACTH. The boy was admitted to the clinic in an average general condition. Marked insufficiency of the body mass in comparison to the height, many pigmented moles on the skin and features of thyroid hyperfunction confirmed by laboratory examinations were observed. Thyreostatic and b-blocker were applied for treatment. The boy was discharged in the condition of clinical and biochemical euthyreosis. After two months of follow-up in the Endocrinologic Outpatient Department there was no weight gain, no appetite and general weakness. The anamnesis showed multiple faintings. The boy was hospitalized again. Suspecting adrenal hypofunction, a test with ACTH was carried out but it did not give any result. Substitutive treatment was applied resulting in a gradual improvement of the general condition and disappearance of complaints. The case is presented due to the rare incidence of the syndrome and due to the diagnostic difficulties.

[Precocious puberty: who should be treated?]

Authors, by a review in literature, show a therapeutical and diagnostic problems in diagnosis and treatment of the precocious puberty.

[The influence of upright position on heart rate variability parameters in adolescents with hypertension and type 1 diabetes]

BACKGROUND

The autonomic regulation of heart rate variability (HRV) is impaired not only in patients with type 1 diabetes but either in nondiabetic hypertensive patients.

AIM

The aim of the study was to evaluate the HRV parameters in adolescents with type 1 diabetes depending on appearance of hypertension.

MATERIAL AND METHODS

The study group included of 34 patients with diabetes and hypertension aged 15+/-2.2, and 38 patients with diabetes without hypertension aged 15+/-2.9. The control group consisted of 55 healthy persons aged 15+/-2.2. In every examined person were performed tests of autonomic nervous system in accordance to Ewing battery and frequency-domain analysis of HRV during supine and standing position.

RESULTS

The HRV parameters: total power (TP), low (LF) and high frequency (HF) were significantly decreased in patients with hypertension during supine and standing as compared to control group (p<0.001). There were differences between diabetics without hypertension and autonomic neuropathy and control group. The appearance of CAN in patients without hypertension caused the decrease all HRV indices during supine (p<0.001), however the standing position only decrease of TP and HF (p<0.01). TP value was depending on glycated haemoglobin concentration (p<0.001), but there was no correlation between HRV indices and left ventricular mass index.

CONCLUSIONS

The decrease of HRV parameters in adolescents with diabetes type 1 is connected not only with autonomic neuropathy but also with appearance of arterial hypertension.

[The prevalence of autoimmunological diseases in families of children with type I diabetes]

BACKGROUND

type I diabetes mellitus is considered as an autoimmune disease and is often associated with other diseases of that etiology. The genetic susceptibility to autoimmune disorders causes type I diabetes to occur more frequently in relatives of the diabetic patients.

OBJECTIVE

To evaluate the prevalence of type I diabetes and other autoimmune diseases in families of the children with type I diabetes.

MATERIAL AND METHODS

The prevalence of type I diabetes mellitus and other autoimmune endocrinopathies was evaluated in I, II and III degree relatives of 155 children with type I diabetes mellitus and 90 control children.

RESULTS

It was observed that: 1) diabetes mellitus occurred more often in relatives of diabetic children (in 22 families - 14.2%) in comparison with the control group (in 2 families - 2.2%); 2) other autoimmune diseases occurred frequently in families of diabetic children and they affected 2 or more members of one family more often than in the control group (18 families vs 4); 3) rheumatoid arthritis occurred more frequently in families of diabetic children.

CONCLUSIONS

The familial prevalence of type I diabetes mellitus and the tendency to more frequent prevalence of other autoimmune diseases in families of diabetic children was confirmed.

[Pseudohypoparathyroidism in a 14-year old girl]

The authors describe the case of a 14-year old girl with pseudohypoparathyroidism, who showed characteristic phenotypic features of Albright's hereditary osteodystrophy (short stature, round face, mild obesity, abnormal position of teeth, lack of canines, limb valgity) and biochemical disturbances--hypocalcemia, hyperphosphatemia. The nature of pseudohypoparathyroidism consists in a lack of response to the parathormone of effector organs, such as kidneys, bones, alimentary tract. The treatment of choice includes active metabolites of vitamin D3, calcium salts, phosphate-binding components. Pseudohypoparathyroidism is a rare disease. Worth noting is the fact that it can occur in a child with height deficiency.

[Usefulness of antioxidant vitamin supplementation in children and adolescents with newly diagnosed diabetes mellitus type I]

BACKGROUND

Diabetes type I is caused by immune-mediated destruction of the b-cells. During the immune response macrophages release free oxygen radicals and cytokines which damage DNA. Ascorbic acid, b-carotene, a-tocopherol and nicotinamide act as antioxidants (free radical scavengers).

OBJECTIVES

Comparative analysis of diabetes mellitus clinical course in the first year after diagnosis with and without antioxidative vitamin supplementation.

MATERIAL AND METHODS

40 children and adolescents with newly-diagnosed diabetes type I treated with: group A (n=13) n insulin + diet, group B (n=14) n additional vitamins A+E, C, group C (n=13) n additional vitamins A+E, C, PP.

RESULTS

The remission was observed in n=13 (92.8%) children in group B, in n=6 (46.1%) in group C and only in 2 (15.4%) in group A after 3-4 months. After 6-7 months the remission was obtained in 10 patients (71.5%) in group B, in 6 (46.1%) - in group C and in 4 (30.8%) - in group A. After one year observation 6 (42.5%) patients in group B had remission, 4 (30.7%) in group C and 2 (15.4%) - in group A. Daily insulin demand was similar after diagnosis, after 3-4 months it was more reduced in group B (x - 0.28 u./kg/d, SD n 0.23) vs. x - 0.40 u./kg/d SD n 0.24 (group C) and vs., x - 0.5 u./kg/d - (group A). The insulin demand was augmented in the following months but all the time it was lower in the group supplemented by vitamins A, E, C. The glycaemic control and the values of lipids, thiobarbituric and reactive substances, group-SH of glutathione and vitamin C were similar in analysed groups in simultaneous periods.

CONCLUSIONS

Supplementation with antioxidant vitamins in newly diagnosed diabetes mellitus type I leads to more frequent remissions and reduced insulin demand, particularly in the first months of diabetes duration.

[Application of the rough set theory in the prognostication of the diabetic nephropathy prevalence. Preliminary communication]

The following aspects were evaluated by rough set methods in 107 patients aged 5-22 and suffering from insulin dependent diabetes for 2-13 years: sex, age at which the disease was diagnosed, time of disease, family anamnesis, criteria of the metabolic balance, type of the applied insulin therapy and presence or absence of microalbuminuria. Mathematical analysis showed that the most significant aspects were: age at which the disease began, HbA1c and time of the disease lasting. The above aspects influence incidence of microalbuminuria in children suffering from diabetes type I.

[The epidemiology of type 1 diabetes in children and adolescents in north-east Poland in the period 1988-1999]

AIM

The studies performed in many European countries show the increasing tendency of the incidence of type 1 diabetes in different regions of our continent. The aim of study was the evaluation of incidence of type 1 diabetes in children and adolescents in north-east Poland in the period 1988-1999 and its analysis according to sex, age, place of residence and season of diabetes diagnosis.

MATERIAL AND METHODS

Diabetic outpatient clinic and II Department of Pediatrics at Medical Academy in Białystok take medical care of children and adolescents in north-east macroregion of Poland (administrative border from 1975) with 4% population of Poland. Retrospective study was performed in the period 1.01.1988-31.12.1999. All new cases of diabetes in 0-18 years old children and adolescents were registered. Incidence index of IDDM was expressed by ratio of new diabetes cases to 100 000 age-selected population. The number of population was taken from Demographic Yearbooks 1988-1999 of Central Statistical Office.

RESULTS

During twelve-year observation of developmental age population living in north-east Poland diagnosis of diabetes type 1 was established in 421 persons: 221 boys (52.5%) and 200 girls (47.5%). Incidence index for the whole region was 7.33 (4.6-10.1). The analysis of the patient age at the diagnosis revealed rarer occurrence of diabetes in children under 5 years - 53 persons (12.5%). The type 1 diabetes was more often recognized in pubertal period - 188 persons (44.65%). The highest increase in incidence of diabetes was noted in 5-14 years old persons and it reached 17/100,000 in 1999. The analysis of the place of residence showed the increase of diabetes incidence of only in country regions. It was the same in towns. The diabetes manifested itself more often in autumn and winter than in summer period.

CONCLUSION

1) The incidence of type 1 diabetes mellitus in north-east Poland rised significantly from 4.6 in 1988 to 10.1 in 1999. The identification of the etiological factors and prevention of disease may be necessary. 2) The seasonal incidence of type 1 diabetes confirms the real participation of environmental factors in etiopathogenesis of the disease.

[Cytokins and adhesion molecules in Graves's disease]

The course of thyroid autoimmune diseases is associated with the inflow of lymphocytes to the thyroid gland and with the expression of anti-TSH receptor, anti-thyroglobulin and antithyroid peroxidase antibodies. Vascular endothelium of the thyroid, which is not only the source of cytokines but also a location for adhesion molecules, plays a key role in the immune process. These microscopic glycoproteins participate in cell adhesion and transmission of intercellular information, which eventually leads to their activation or proliferation. Strongly expressed molecules within thyroid endothelium are involved in lymphocyte homing in the autoimmune process. A special role is assigned to ICAM and VCAM, which interact with lymphocytes or rather with integrins LFA-1 and VLA-4 present on their surface and responsible for adhesion and inflow of these cells to the sites of inflammation. The increased expression of adhesion molecules on endothelium is caused by the activation of locally produced cytokines (TNF-alpha, INF-gamma, IL-1, IL-6, sIL-6R), which are released during the inflammatory process. Such induction promotes migration of cells through endothelium during inflammation and contributes to the phasic inflow of various populations of leucocytes.

[Effectiveness of pre- and postprandial Humalog in adolescents with type 1 diabetes]

The aim of the study was to evaluate the glycaemic response to pre- and postprandial Humalog.

MATERIAL

The study involved 47 type 1 diabetic adolescents between the ages 12 and 18 (mean 15.5) and the duration of diabetes from 1 to 13 years (mean 5.16).

METHODS

All patients received Humalog in intensive therapy during 3-month period: 29 persons just before the meal and 18 immediately after the meal. All patients were injected with basal insulin twice a day (Humulin N). HbA1c values were determined at the beginning and the end of study. Patients' blood glucose levels were measured preprandially and 1 and 2 hours after eating their first bite of breakfast (noted in 1, 6 and 12 week of observation). At the end of observation (after 3 months) the analysis of the blood glucose levels after pre- and postprandial administration of Humalog insulin was performed. Blood samples were obtained at -40, -20, 0, 15, 60, 90, 120, 150 and 180 minute relative to the start of the meal.

RESULTS

The mean HbA1c value decreased from 8.01 to 7.63%. The patients' preprandial glucose levels 1 and 2 hours after meal were similar in two groups in each measurement (1, 6, 12 week). The pre- and postprandial glucodynamics were similar in the two groups. The number of mild hypoglycaemic episodes was slightly higher in the group receiving Humalog before meal (0.32 vs. 0.19 episodes/person/day - p<0.05).

CONCLUSION

Postprandial Humalog insulin may provide good postprandial glucodynamic control because it is safe, insulin dose can be matched to the actual food intake and it is not associated with an increase in the frequency of hypoglycaemic events. The possibility of the pre- and postprandial Humalog insulin administration improves the quality of life of patients with diabetes.

[Serum levels of interleukin 6 (IL-6) and soluble IL-6 receptor (sIL-6R) in children and adolescents with Graves-Basedow disease]

The concentration of interleukin 6 (IL-6), soluble IL-6 receptor (sIL-6R) and intercellular adhesion molecule-1 (sICAM-1) was assayed in 24 children with Graves' disease, aged 6.5-17 years, before treatment with methimazole, during clinical and biochemical remission (8 weeks), and following the eighteen-month therapy with the thyrostatic. ELISA method was used to determine the concentration of interleukin 6, sIL-6R and sICAM-1. An increase was observed in serum concentration of IL-6 and its receptor sIL-6R and soluble intercellular adhesion molecule-1 in the course of Graves' disease. A significant reduction in sIL-6R (8 weeks) and IL-6 (18 months) was noted after therapy with methimazole. A positive correlation was found between microsomal antibodies and the concentration of sICAM-1 and sIL-6R, and between antithyroglobulin antibodies and concentration of sIL-6R in children with fresh hyperthyroidism. No correlation was revealed between the level of thyroid hormones and the concentration of cytokines and adhesion molecules.

[Fluorescence cystoscopy using 5-aminolevulinic acid]

BACKGROUND

Fluorescence diagnosis has an increasing importance in different medical fields. In the presented paper, comparison of cystoscopy in white light with fluorescence cystoscopy after intravesical administration of 1 g of 5-aminolevulinic acid is presented.

METHODS AND RESULTS

From the group of 63 persons examined, no difference between findings in white and blue light was found in 39 cases. In 21 patients more pathological spots were found in blue light (10 cases) or, in agreement with histology, pathology was detected in the blue light only (11 cases).

CONCLUSIONS

The intravesical administration of 5-aminolevulinic acid had no side effects. Our study has definitely proved the advantages of fluorescence cystoscopy.

[Lumbar meningeal enhancement after surgery in the posterior cranial fossa: a normal finding in children?]

PURPOSE

Spinal meningeal Gd-DTPA enhancement after cranial surgery is a known observation of a not well understood underlying mechanism. This paper demonstrates that this MRI finding is a normal meningeal reaction to subarachnoid hemorrhage, which should not be mistaken for metastatic spread.

MATERIAL AND METHODS

Three pediatric patients were examined by MRI for metastatic spread of malignant infratentorial tumors along the spinal canal two to nine days after the removal of the primary cerebral lesion. The findings were compared with a control group that underwent cranial surgery (cyst resection or fenestration of the posterior cranial fossa) without major bleeding into the subarachnoid space. Unenhanced and enhanced sequences were obtained to prove that the high signal within the CSF is caused by an abnormal Gd-DTPA uptake and not by methemoglobin.

RESULTS

Meningeal enhancement was observed in all patients with intraoperative bleeding resembling subarachnoid masses on enhanced T 1 -weighted images. This was not present in any patient of the control group. This finding lasts for approximately two weeks.

CONCLUSION

The meningeal enhancement renders immediate postoperative studies inconclusive for the detection of metastatic spread. Consequently, the obligatory tumor staging along the spinal canal should ideally be done prior to the resection of a cerebral tumor.

Late potentials: are they related to cardiovascular complications in children with type 1 diabetes?

INTRODUCTION

The aim of our study was to assess the influence of cardiovascular complications on the occurrence of late ventricular potentials (LP) in children with diabetes mellitus type 1.

MATERIALS AND METHODS

72 children (36 boys and 36 girls), with average course of diabetes type 1 of 6.5+/-2.8 years, were included into the study. Standard physical examination, blood pressure measurements, signal-averaged electrocardiogram (SAECG), autonomic test, 24-h Holter monitoring, and Doppler echo investigations were performed. The control group consisted of 55 sex- and age-matched healthy children. We utilised nonlinear logistic regression analysis to assess the effect of disease duration, albuminuria, insulin demand, cardiac autonomic neuropathy (CAN), heart rate variability (HRV) indices, diabetes complication score, metabolic control, systolic and diastolic blood pressure, left ventricular parameters, and ventricular arrhythmias on LP occurrence.

RESULTS

LP was discovered in 12 patients with diabetes and in 1 from the control group (P<.014). Diabetic children with LPs had thicker left ventricular posterior wall (LVPW) and longer diabetes duration time than children without LP (P<.045 and.031, respectively). Nonlinear regression model shows that duration of diabetes, CAN, and LVPW were the strongest independent parameters of LP occurrence (P<.001,.01 and.005, respectively).

CONCLUSIONS

Diabetes type 1 is associated not only with increased occurrence of abnormal SAECG but also with LP presence. The disease duration, posterior wall thickness, and CAN are independent predictors of LP appearance in diabetes type 1 children. The presence of cardiovascular complication has no influence on LP occurrence in diabetic children.

Gap junction-mediated bidirectional signaling between human fetal hippocampal neurons and astrocytes

Gap junctions are clusters of intercellular channels that connect the interiors of coupled cells. In the brain, gap junctions function as electrotonic synapses between neurons and as pathways for the exchange of metabolites and second-messenger molecules between glial cells. Astrocytes, the most abundant glial cell type coupled by gap junctions, are intimately involved in the active control of neuronal activity including synaptic transmission and plasticity. Previous studies have suggested that astrocytic-neuronal signaling may involve gap junction-mediated intercellular connections; this issue remains unresolved. In this study, we demonstrate that second-trimester human fetal hippocampal neurons and astrocytes in culture are coupled by gap junctions bidirectionally; we show that human fetal neurons and astrocytes express both the same and different connexin subtypes. The formation of functional homotypic and heterotypic gap junction channels between neurons and astrocytes may add versatility to the signaling between these cell types during human hippocampal ontogeny; disruption of such signaling may contribute to CNS dysfunction during pregnancy.

The enigma of the old poet: did the child Wienke in Theodor Storm's novella "Der Schimmelreiter" (1888) have phenylketonuria?

We report a probable case of phenylketonuria in a figure from "Der Schimmelreiter", a novella by German author Theodor Storm (1817-1888), published in 1888. The child Wienke, daughter of the story's protagonist, Hauke Haien, displays symptoms of phenylketonuria. Storm's description of this child, its physiognomy, and increasing mental retardation, lead us to believe that Storm in fact described a case of phenylketonuria, a condition not reported until Følling's description in 1934.

Elevated concentrations of homocysteine in children and adolescents with arterial hypertension accompanying Type 1 diabetes

BACKGROUND

Ischemic heart disease is the primary cause of morbidity and mortality among diabetics, especially those who became ill at a young age. In evaluating the risk of the development of atherosclerotic changes, especially when occurring prematurely, increasing attention is being paid to new, unconventional risk factors. One of many such new factors, and one whose role in the development of atherosclerotic changes currently seems to be beyond dispute, is homocysteine. The purpose of this article is to evaluate the concentration of homocysteine in children and youth with Type 1 diabetes, and to attempt to determine the dependence between homocysteine and the degree of metabolic control, the duration of the illness, the age at onset, the insulin dose, the appearance of complications, and a family history of ischemic heart disease.

MATERIAL AND METHODS

Our research involved 103 children and youth (average age 13.3 years) with Type 1 diabetes, with an average duration of illness of 5.3 years. The control group consisted of 44 healthy, non-obese children. The concentration of homocysteine was measured using the AXIS homocystein EIA immunoenzymatic method with a set of reagents from the Bio Rad company.

RESULTS

The average homocysteine concentration in the experimental group was 5.6 micromol/L, which did not constitute a significant difference from the control group's 6.1 micromol/l. No statistically significant differences were discovered in the concentration of homocysteine depending on the degree of metabolic control, age at onset, method of insulinotherapy, or family history. A significant increase in the concentration of homocysteine was found in children who had been ill for a long time (more than 10 years): 6.1 micromol/L, as against 5.1 micromol/l in children who had been ill for a shorter period of time, and a significantly higher concentration of Hcy in children with diabetic complications (6.1 vs 5.3 micromol/L) and in children with arterial hypertension.

CONCLUSIONS

The significant increase in the concentration of homocysteine in children with Type 1 diabetes and arterial hypertension indicates that this group is particularly exposed to early atherosclerotic changes, independently of metabolic control and the parameters of lipid metabolism, and requires the implementation of treatment aimed at reducing the blood concentration of homocysteine.

The large increase in incidence of Type I diabetes mellitus in Poland

AIMS/HYPOTHESIS

A rising incidence of Type I (insulin-dependent) diabetes mellitus in different countries in Europe during the last decade has been recently reported. However, in the early 1990s, Poland was reported to have a stable low incidence of this disease. This study aimed to estimate the annual incidence of Type I diabetes in a north-eastern region of Poland (Białystok region) and investigate if it is associated with age, sex, urban rural differences and the season of disease onset.

METHODS

A register of patients with Type I diabetes using two independent sets of data sources was established in 1994 as part of the EURODIAB TIGER programme. The primary data sources were paediatric and internal medicine divisions of the hospitals in the Białystok province and the secondary were outpatient diabetic clinics in the region. The degree of ascertainment was 98.5 % for the combinated data sources.

RESULTS

We found a significant rising trend in the incidence of Type I diabetes in children under 15 years of age (in 1998 the incidence was approximately twice as high as in 1994). Increasing incidence rates were observed in the rural areas but not in urban populations. Seasonal variation in the incidence was also found, with a peak in winter and nadir in summer.

CONCLUSIONS/INTERPRETATION

These results show that the north-eastern region of Poland is an area with a moderate rather than a low risk of Type I diabetes. Our observations confirm the important role of environmental and socio-economic factors or both in the pathogenesis of Type I diabetes.

Growth-suppressive function of human connexin32 in a conditional immortalized mouse hepatocyte cell line

Mouse hepatocytes immortalized with a temperature-sensitive allele of the SV40 large T-antigen (CHST8 cells) were found to lack the high expression of the gap junction proteins Cx26 and Cx32 that characterizes normal mouse hepatocytes, expressing instead Cx43 and Cx45 at minimal levels. In order to examine the growth suppressive function of Cx32 on hepatocytes, we transfected these CHST8 cells with human Cx32 complementary deoxyribonucleic acid and measured the growth rates at 33, 37, and 39 degrees C. Expression of human Cx32 and its messenger ribonucleic acid in the stable cell lines was confirmed by immunocytochemistry and by Western and Northern blots analyses. Dye transfer following lucifer yellow injection into the transfectants was extensive; Cx32 channels displayed unitary conductances of about 70 pS and were moderately voltage sensitive. When cultured at 33 and 39 degrees C, growth rates of both parental cells and transfectants were of the same level. When examined at 37 degrees C, growth rate of the transfectant, which highly expressed Cx32 at the membranes, was significantly decreased compared to the parental cells. However, no changes in the expression of Cx32 protein in the transfectants were observed between 33 and 37 degrees C. These results suggest that Cx32 expression could inhibit hepatocyte growth in vitro using the conditional immortalized cells. Cx32 transfectants using a conditional immortalized mouse hepatocyte may be useful for examining the mechanisms of growth and differentiation in hepatocytes by gap junction expression.

[Femur-fibula-ulna (FFU) complex in the 33rd week of gestation: ultrasonography, radiology, pathology and differential diagnosis. Case report]

We present a case of a 27 year old I. gravida, I. para. Despite of regular ultrasonographic examination the diagnosis of skeletal malformation at the fetus was not before 33. weeks of gestation. It was the rare type of a bothside femur-fibula-ulna (FFU) complex. The FFU-complex is a no lethal malformation with typical unilateral combination from defects of femur and fibula, with contralateral defect of ulna. Dependent to involvement of malformated limbs the FFU-complex is classifiable in four groups. Only in 10 % all limbs are affected. Our case (type IV) showed a peromelia of both upper limbs with stumps of humeri, bothside aplasia of fibula and missing from 4. and 5. toes. There fetus were without nonlimb congenital abnormalities. The etiology of FFU-complex is unknown, the occurrence sporadic. There are never found genetic abnormalities. Familial recurrence is not described. There is no maternal or paternal age effect on FFU-complex. The differential diagnosis must include malformations with reduction anomalies of extremities, like thalidomide syndrome, splenogonadal fusion with limb malformations, Roberts syndrome, oroacral complex or acheiropodia. Mark off are amniotic band too.

Prostate-specific antigen: current status

PSA is the most important of all tumor markers because it has significant applications in all aspects of the management of men with prostatic disease. Certainly, the most important utilization of PSA is for early detection of this most ubiquitous of all human neoplasms. In this article the authors describe the molecular forms of PSA and their characteristics, the factors influencing values of serum concentration of PSA, the problems of screening, and particularly the possibility to use PSA for detection of prostate carcinoma. A big problem in prostate carcinoma detection is the low specificity of PSA at the concentrations between 4-10 ng/ml, the so-called diagnostic gray zone, where the incidence of prostate carcinoma is only 25%. The authors evaluate the methods which make it possible to increase the sensitivity and/or specificity of PSA detection, such as PSA density, PSA density of the transition zone, PSA velocity, PSA doubling time, age-specific PSA, free PSA and, prospectively, the use of the RT-PCR technique.

Treatment of benign ureterointestinal anastomotic strictures with permanent ureteral Wallstent after Camey and Wallace urinary diversion: long-term follow-up

BACKGROUND AND PURPOSE

Ureterointestinal anastomotic stricture follows urinary diversion in 4% to 8% of patients and may lead to a progressive deterioration of renal function. There are problems with all current management techniques: surgical revision, endourologic incision, nephrostomy drainage, external ureteral stents, and dilation with a high-pressure angioplasty balloon. The authors present their long-term results with permanent ureteral Wallstents for the treatment of benign ureterointestinal stricture.

PATIENTS AND METHODS

Eight patients with 10 strictures were treated by placement of self-expanding permanent indwelling stents via percutaneous nephrostomy between September 1993 and January 1998. The mean age of the group was 59.2 years. Development of strictures occurred a mean of 20.9 months after urinary diversion. There were seven complete and three partial strictures. Of 49 patients treated by the Camey procedure, 7 patients (14%) developed 9 (18%) strictures. Of 28 patients having the Wallace procedure, 1 patient (3.5%) developed one stricture. After recanalization of the distal ureter by a Terumo guidewire and dilation with a high-pressure angioplasty balloon, a Wallstent was placed across the stricture via a percutaneous approach.

RESULTS

The endourologic placement of the Wallstent was well tolerated by all patients. The hospital stay averaged 2 days. Seven patients with nine strictures after the Camey procedure are doing well with a follow-up of 7 to 68 months (mean 22.4 months). One major complication was observed in one patient necessitating an additional procedure (lithotripsy) because of stone formation at the lower part of the stent extending into the neobladder in order to maintain patency after 68 months. The other patient, who had a Wallace procedure, is doing well 1 year 8 months afterward.

CONCLUSION

An endourologic ureteral Wallstent approach to ureterointestinal stricture is a successful alternative, providing satisfactory management of the problem in most patients. No complication such as stent migration, hematuria, pain, or recurrent stricture was observed.

[Magnetic resonance imaging and magnetic resonance arthrography of the acetabular labrum: comparison with surgical findings]

AIM OF THE STUDY

To evaluate the accuracy of magnetic resonance imaging (MRI) and magnetic resonance (MR) arthrography in detecting acetabular labral lesions in correlation to surgical findings.

PATIENTS AND METHODS

Forty patients (40 hips) with chronic hip pain and a strong clinical suspicion of labral lesions were examined with MRI in the coronal and axial plane by obtaining T1 weighted and proton density-weighted spin echo sequences. Additionally, MR arthrography of the hip joint in the coronal oblique and sagittal oblique plane was performed by obtaining T1-weighted three-dimensional gradientecho sequences after the intraarticular injection of gadopentate dimeglumine. The labra were prospectively evaluated on the basis of morphology, signal intensity, the presence or absence of a tear, and their attachment to the acetabulum. All patients underwent surgery, and the MRI findings and MR arthrography findings were compared with the surgical results.

RESULTS

Surgically, 34 labral lesions, and 6 normal labra were detected. MRI correctly depicted labral lesions in 24 patients and two normal labra, and MR arthrography correctly depicted labral lesions in 30 patients and 5 normal labra compared with the surgical results. The sensitivity of MRI was 80%, the accuracy of MRI was 65%, the sensitivity of MR arthrography was 95%, and the accuracy of MR arthrography was 88%.

CONCLUSIONS

MR arthrography enables considerably more accurate detection of acetabular labral lesions than MRI. MR arthrography should be the method of choice for the diagnosis of the presence or absence of acetabular labral lesions in patients with chronic hip pain and a strong clinical suspicion of labral lesions.

Ultrasonographic and clinical appearance of a 22-week-old fetus with Brachmann-de Lange syndrome

The diagnosis Brachmann-de Lange or Cornelia-de Lange syndrome is based on the characteristic facial appearance and other malformations. Prenatal ultrasonographic diagnosis has been made occasionally usually confirmed by clinical photographs of third trimester fetuses with distinctly recognizable hair anomalies (synophrys, low anterior and posterior hairlines, and hypertrichosis). However, at 22 weeks of gestation, these highly characteristic signs fail to support the clinical diagnosis. We report on pre- and post-natal findings in a 22-week-old female fetus with Brachmann-de Lange syndrome. The facial Gestalt was already characteristic and the associated upper limb malformations (bilateral monodactyly and ulnar agenesis) supported the diagnosis. The prenatal ultrasound images demonstrated a grossly abnormal facial profile (a protruding and overhanging upper lip and severe retrognathia) highly suggestive of Brachmann-de Lange syndrome. The recurrence risk is estimated &#1%. The recognition of Brachmann-de Lange syndrome in second trimester fetuses is essential for genetic counselling and reassurance of parents contemplating future reproduction.