Midtrimester diagnosis and anomalies in the dup(22q) syndrome: correlation of aneuploidy with low maternal serum alpha-fetoprotein and oligohydramnios

We present the first reported case of prenatally diagnosed dup(22q) syndrome in a 20-year-old woman referred for genetic counseling because of a low maternal serum alpha-fetoprotein value. An ultrasound study at 22 weeks demonstrated oligohydramnios, intrauterine growth retardation, multiple facial malformations, and a cardiac defect. Fetal karyotype was 46, XYdup(22)(pter----q13:: q12----qter) by amniocentesis. Necropsy following pregnancy termination confirmed all prenatally delineated anomalies. Comparison is made with the complete and partial proximal dup(22q) syndromes. We emphasize the correlation between aneuploidy and the presence of low maternal serum alpha-fetoprotein, oligohydramnios, and midgestational intrauterine growth retardation.

Metastatic metaplastic carcinoma of the breast: diagnosis by bronchial brush cytology

Metaplastic carcinoma of the female breast is an uncommon lesion that may metastasize to body sites. To our knowledge, this is the first reported case of pulmonary metastasis diagnosed on bronchial brush cytology. The patient presented with pulmonary symptomatology 1 yr and 3 mo after a left modified radical mastectomy for breast carcinoma. Bronchoscopic examination revealed an endobronchial lesion partially obstructing the bronchus intermedius. Bronchial brush cytology showed the presence of nonkeratinizing squamous tumor cells admixed with a few scattered clusters of tumor cells with glandular features. Histologic review of the original breast lesion showed a metaplastic carcinoma of the breast with a predominant squamous-cell component. Accurate knowledge of a patient's clinical history is necessary to differentiate a second primary lesion from a metastatic one, particularly when the original lesion is so uncommon.

Antigenic relationships between the surface-exposed, secreted and somatic materials of the nematode parasites Ascaris lumbricoides, Ascaris suum, and Toxocara canis

The cosmopolitan nematode parasites Ascaris lumbricoides, Ascaris suum, and Toxocara canis are closely related phylogenetically, and are all pathogenic to man. In the case of the latter, the antigens released by the tissue-invasive parasitic larvae in vitro ('excretory/secretory' or 'ES' antigens) are routinely used for serodiagnostic purposes. Here we have found, using radioimmunoprecipitation with defined rabbit antiserum, and SDS-PAGE, that there is a significant antigenic similarity between the secreted and somatic antigens of the three nematodes, and have characterized cross-reactive components. Among these is a 14 kD internal protein which has a homologue in all three parasites. This molecule is the subject of an IgG antibody response in Ascaris infection, but there is no measurable response to it in toxocariasis. Lastly, using quantitative immunofluorescence, the antigens exposed on the surface of intact, living, larvae were found to be cross-reactive or specific depending on the developmental stage of the parasites. This means that the surface of tissue-invasive Ascaris larvae bears stage-specific epitopes.

Malnutrition of children under 5--findings from Mahmoodabad survey

To assess the nutritional status of children under 5, a survey was conducted in the under-privileged community of Mahmoodabad. Of over 1,000 children, three-fourth had varying grades of protein calorie malnutrition. The prevalence of grade III malnutrition was higher in children in their 2nd year and among those belonging to families of more than four persons. On the average, a child was reported to suffer from two spells each of diarrhoea and respiratory illness. Both the diseases seemed to be associated with age and nutritional status of the children. An association was found between history of roundworm infestation and the nutritional status. On the basis of these findings, we emphasize on education of the mothers on various aspects of child health, regular growth monitoring, and on measures to improve general health status in the underprivileged communities.

Symmetrical intrauterine growth retardation is not symmetrical: organ-specific gravimetric deficits in midtrimester and neonatal trisomy 18

Models to predict normal fetal growth have been of limited accuracy. Abnormal growth is even more problematic. We have developed a mathematical modeling system based on observed body and brain weights to study fetal growth patterns in midgestational trisomy 18 fetuses. Third-degree polynomial-based analysis using observed fetal body and brain weights to generate predicted weights for various organ systems allows for the comparative study of growth patterns at various fetal weights and gestational ages. Our data suggest that what has been previously called symmetrical intrauterine growth retardation associated with aneuploid fetuses is really an asymmetrical pattern that is dynamic in nature and may change through the course of pregnancy.

"Placental polyp": light microscopic and immunohistochemical observations

A case of the chronic type of placental polyp, occurring in a 37-year-old woman approximately 9 years after abortion of her last known pregnancy, is reported. The placental polyp was predominantly composed of necrotic and hyalinized chorionic villi without identifiable lining trophoblast; however, some villi showed a thin rim of apparently viable syncytiotrophoblast that exhibited focal strong positivity for human chorionic gonadotropin by immunohistochemical studies. Intermediate trophoblast, especially abundant within the intervillous fibrin, appeared most viable and showed strong positivity for human placental lactogen (hPL); syncytiotrophoblast also showed focal positivity for hPL. The basal aspect of the polyp was composed of abundant decidua that contained dilated and ectatic blood vessels. This study demonstrates the presence of cytoplasmic markers for pregnancy in a chronic type of placental polyp, apparently of 9 years' duration, and draws attention to an entity that may be encountered more frequently due to the current prevalence of induced abortions.

Ultrasonographic prenatal diagnosis and fetal pathology of Langer mesomelic dwarfism

In a family at risk for Langer mesomelic dwarfism, we document the onset of disproportionate growth in the second trimester by sonographic biometry. Midtrimester pathologic correlation of this condition demonstrates primary changes in the growthplate in the regions of proliferating cartilage and hypertrophic and degenerative chondrocytes.

Identification of human herpesvirus 6-specific DNA sequences in two patients with non-Hodgkin's lymphoma

Human herpesvirus 6 (HHV-6) is a recently discovered virus which has not been causally linked to any particular disease. In order to investigate the possible role of this virus in the pathogenesis of lymphoid malignancies, we examined tissue samples from 117 patients for the presence of HHV-6-specific DNA sequences. Two cases of non-Hodgkin's lymphoma were found to be positive. One patient had a T cell lymphoma and a preceding history of angioimmunoblastic lymphadenopathy; the other had a B cell lymphoma occurring in the context of Sjögren's syndrome. HHV-6 has been isolated previously from a patient with angioimmunoblastic lymphadenopathy, and viral sequences have been identified in another patient with Sjögren's syndrome and B cell lymphoma. The relationship between HHV-6 and these conditions therefore warrants further investigation.

Species-specific and common epitopes on the secreted and surface antigens of Toxocara cati and Toxocara canis infective larvae

It is widely accepted that the major cause of visceral larva migrans (VLM) in man is Toxocara canis infection. This has been largely based on the detection of antibodies to this species. We have compared the antigens of T. canis and Toxocara cati in order to establish whether assay for the former might be compromised by infection with the latter. Comparisons were made by radioiodination of the surface and excretory/secretory (ES) glycoproteins of the infective larvae of both species, immunoprecipitation with poly- and monoclonal reagents, and SDS-PAGE. The SDS-PAGE profiles of surface antigens of the two species showed few similarities, whereas that of the ES material indicated considerable homology. Serum from infected animals and a human VLM patient exhibited complete cross reactivity, although there was evidence in the mouse of a specific response to one of the components of T. cati ES. Testing of ES against a panel of monoclonal antibodies (MoAbs) confirmed the similarity; all but one of the MoAbs recognized several of the components of both sources of ES. The only exception was MoAb Tcn-2, which did not react with T. cati surface, somatic or ES antigens. This antibody is known to recognize a carbohydrate determinant which is widespread on T. canis glycoproteins. This species-specific determinant, therefore, represents a reversal of the consensus that peptide determinants tend to be the more specific. Finally, the MoAbs were used to examine the exposure of shared epitopes on the surface of intact larvae of T. cati. Again, fine differences in binding by anti-carbohydrate monoclonals were observed when the two species of Toxocara were compared, reflecting a distinction in exposure or orientation of surface molecules on these nematodes. Moreover, these epitopes were absent or variably present on the surface of freshly hatched larvae, and full exposure did not occur until about 24 h post-hatching. This delay in the presentation of epitopes might have implications for the process of infection in sensitized hosts. In conclusion, it is probable that the serological response in man to T. canis is, by current serological methods, indistinguishable in specificity from that induced by T. cati infection, and that the MoAb which we describe could be used to permit discrimination.

Resistance of nematode secretory products to cleavage by mast cell proteinases

Mast cell proteinases are known to be released in response to helminth infection, and are, in particular, characteristic of the immune rejection of intestinal nematode parasites. In intestinal mucosal tissue the relevant enzyme is rat mast cell proteinase II (RMCP II) and that of other tissues, including the lung, is rat mast cell proteinase I (RMCP I). The function of these enzymes is unknown, and we have examined the possibility that they directly attack the parasites. This was done by examining the cleavage patterns produced by both proteinases on 125I-labelled excretory/secretory (ES) products of two intestinal nematodes (the infective larva of Ascaris suum, and adult Nippostrongylus brasiliensis) and one which has a pulmonary migration route (the third/fourth stage larva of A. suum). It was first established that all the labelled molecules were proteinaceous, by their susceptibility to broad spectrum proteinases, and that none were host components carried over into culture, by their antigenicity to infected hosts. All the nematode ES products were found to be remarkably resistant to RMCP I and II, only one major component of the infective larva of A. suum being cleaved by both enzymes. This was not found to reflect a resistance to serine proteinases in general, since selected ES components were cleaved by chymotrypsin and trypsin. This would, therefore, argue that, if the enzymes play any direct role in the immune expulsion of nematodes, it is unlikely to be successfully directed at their secretions.

Homology and heterology between the secreted antigens of the parasitic larval stages of Ascaris lumbricoides and Ascaris suum

The materials released in vitro by the tissue-parasitic larval stages of the large roundworm of man, Ascaris lumbricoides, were analysed by radio-iodination, immunoprecipitation, and SDS-PAGE. The antigens were found to be heterogeneous, ranging in molecular weight from 14 to 410 kD, and were found to alter radically during the parasites' migration to the lungs. The antigens secreted by the infective and lung-stage larvae of the pig homologue, Ascaris suum, were compared with those of the human worms. This revealed a remarkable degree of homology between the products of the two, at both the molecular and immunological levels. The two species could be discriminated, however, on the basis of the SDS-PAGE profiles of the antigens secreted by both developmental stages of the parasites examined. Finally, antiserum to the canine ascarid infective to man, Toxocara canis, was found to precipitate a significant proportion of Ascaris-secreted molecules. These studies, therefore, confirm the potent antigenicity of excretory/secretory materials, and their potential for use in immunodiagnosis, but predict serious difficulties for seroepidemiology and the specific detection of ascariasis in man.

Stage-specific secreted antigens of the parasitic larval stages of the nematode Ascaris

The excretory/secretory (ES) antigens of the infective (L2) and lung-stage (L3/4) larvae of Ascaris have been characterized by radio-iodination, immunoprecipitation, and SDS-PAGE. These antigens were found to be heterogeneous, ranging in apparent molecular weights from 14,000 to 410,000, were stage-specific and were the targets of considerable antibody responses mounted in infected hosts. A major contaminant of the ES of L3/4 recovered from the lungs of host animals was found to be serum albumin, which appeared to have been processed in some way by the worm or its secretions. A comparison between the humoral responses of three species of experimental animals showed that rabbits recognized all ES components, while mice and rats responded to distinct subsets of these. The mouse was distinguished by non-recognition of a major 14,000 MW antigen that was common to both L2 and L3/4 ES. The body fluid of adult Ascaris worms (ABF) was similarly characterized, and the antibody response to this was inferior to that of ES materials in discriminating between infected and non-infected animals. The major constituent of ABF was a 14,000 MW molecule homologous to that of larval ES products. The variability in host responsiveness to Ascaris antigens, revealed by the disparate responsiveness of three species of experimental animal, and the potential of ES for serodiagnosis, might prove of significance to immunological studies of ascariasis in man. Moreover, the heterogeneity of ES components questions the assertion of previous workers that the allergenic, IgE-potentiating, and protective activities of larval ES can be ascribed to one molecular species.

Vasectomy

Vasectomy has become a popular method of family planning in recent years in Australia. The relatively simple procedure is effective, has few complications and usually does not require hospitalisation.

Necropsy of a cadaver containing 50 mCi of sodium131 iodide

A patient who received an oral dose of iodine-131 for the treatment of metastatic thyroid carcinoma unexpectedly died with a large total-body retention of the radioiodine. An autopsy was required and the family requested the body to be transported out of state to their home town. Since the radiation intensity near the surface of the cadaver was above 200 mR/hr, advanced planning and special precautions were necessary in order for the autopsy to proceed safely. This required the immediate cooperation of the pathologists, nuclear medicine physicians, health physicists, an endocrine oncologist, and other hospital staff. As a result of team efforts, personnel radiation exposures were kept as low as reasonably achievable, contamination of the autopsy room was minimal, and the radiation level of the cadaver was adequately reduced for safe transport and burial.

The acute breast abscess. Practical procedures

The female breast is a delicate organ which is prone to infection during lactation. Although the treatment plan outlined by the author appears simple we do not recommend routine treatment by the occasional operator. The breast should be treated with the utmost care and respect because irreversible distortion can result from the chronic inflammation and persistent discharge associated with delayed or inadequate drainage of the abscess.