[Surgical treatment for ureteropelvic junction syndrome in infants and children (report of 73 cases)]

between 1982 and 1990, 73 children were operated for pyeloureteric junction syndrome (76 pyeloplasties). The authors distinguish between a group of 45 infants operated before the age of 2 years and a group of 35 children operated after the age of 2 years. 40% of these cases had been detected antenatally, which modified the management and treatment of these infants, operated at about the age of 6 months (mean: 6.6 months). Treatment was conservative (one nephrectomy out of the 41 infants operated: 2.4%). Pyeloplasty was performed according to the Anderson-Hynes-Küss resection-anastomosis technique under an operating magnifying glass. Early surgery offers the best chance of recovery. Urinary tract drainage was not systematic in these infants (50% of cases) and did not affect the long term results. Early complications and surgical revisions (3.9%) were not more frequent in the infants operated earlier. The definitive results were good in 88.5% of cases, while 7.2% of cases required further surveillance. Renal parenchymal lesions (4.3%) were related more to pyelonephritis than to failure of surgery. Overall, a conservative surgical approach is recommended, except in minor syndromes which require rigorous surveillance.

Antiovary antibodies, repeated attempts, and outcome of in vitro fertilization

OBJECTIVE

To determine whether the microtrauma induced by repeated puncture of ovarian follicles could result in the production of autoantibodies in women submitted to in vitro fertilization (IVF).

DESIGN

Antiovarian antibodies were assayed in serum samples obtained from women engaged in IVF and in serum samples from healthy controls.

SETTING

Blood samples were obtained after oocyte collection in the local hospital's IVF unit.

PATIENTS

One hundred ten women undergoing IVF entered the study. Oocyte division, numbers of embryos, and pregnancy were recorded for each woman. Control samples were from 40 individuals with no sign of autoimmune disorder.

INTERVENTIONS

Antiovarian antibodies were assayed in indirect immunofluorescence and enzyme-linked immunosorbent assay (ELISA) using human ovary as antigen. Specific immunoglobulin (Ig)G, IgA, and IgM were tested separately in an ELISA.

MAIN OUTCOME MEASURE

Antiovarian antibody levels were compared between patients and controls and correlated with the subsequent results of IVF.

RESULTS

Significantly higher levels of IgG, IgA, and IgM antiovarian antibodies were observed in the group of IVF women (P less than 0.001). IgM antiovarian antibodies correlated with a lower number of embryos (P less than 0.001) and IVF failure (P less than 0.05).

CONCLUSIONS

These data suggest that ovarian trauma may lead to the production of autoantibodies.

[Helicobacter pylori gastritis: a new infectious disease. Reflections from personal experience]

To determine the relationship of microscopic chronic antral gastritis to Helicobacter pylori, 69 consecutive patients were studied. In a prospective longitudinal study, at least 2 successive gastroscopies with antral biopsies were performed (177 investigations on the whole). Sixty six of the 69 patients were treated with various therapeutic regimens i.e. antiulcer drugs and/or antibiotics. The type and intensity of inflammation (as based on whole inflammatory infiltrate density, polymorphonuclear cells presence or absence and IgA and IgM plasma cells counts) were correlated with H. pylori status (Giemsa staining and/or biopsy culture). The presence of the organism (Hp) and the gastritis were significantly correlated (high grade of whole inflammatory infiltrate Hp + ve: 98/109 90 p. cent, Hp-ve: 9/61 15 p. cent, p less than 0.001--presence of neutrophil PMNC Hp + ve: 80/109 73 p. cent, Hp-ve: 1/61 2 p. cent; p less than 0.001--IgA and IgM plasma cells respectively Hp + ve: 7.6 +/- 6.6, 10.6 +/- 7.1, Hp-ve 1.9 +/- 2.9, 4.2 +/- 4.5; p less than 0.005). Clearance and/or eradication of H. pylori after antibiotic treatment were associated with the disappearance of chronic gastritis activity and a statistically significant decrease of whole inflammatory infiltrate density (p less than 0.001) and IgA (p less than 0.005) and IgM (p less than 0.01) plasma cells counts. Mucosal inflammation was unchanged in case of H. pylori persistence and inflammation worsening occurred in case of infection relapse. H. pylori gastric mucosa colonization seemed to be responsible for the antral chronic inflammation associated with its presence. This study documents that antral chronic gastritis is a microbial disease associated with infection by H. pylori, against which there is an inflammatory response characterized by a significant mucosal infiltration with granulocytes and IgA and IgM secreting plasma cells.

Multiplicity of acidic subunit isoforms of crotoxin, the phospholipase A2 neurotoxin from Crotalus durissus terrificus venom, results from posttranslational modifications

Crotoxin, the major toxin of the venom of the South American rattlesnake, Crotalus durissus terrificus, is made of two subunits: component B, a basic and weakly toxic phospholipase A2, and component A, an acidic and nontoxic protein that enhances the lethal potency of component B. Crotoxin is a mixture of isoforms that results from the association of several isoforms of its two subunits. In the present investigation, we have purified four component A isoforms that, when associated with the same purified component B isoform, produced different crotoxin isoforms, all having the same specific enzymatic activity and the same lethal potency. We further determined by Edman degradation the polypeptide sequences of these four component A isoforms. They are made of three disulfide-linked polypeptide chains (alpha, beta, and gamma) that correspond to three different regions of a phospholipase A2 precursor. We observed that the polypeptide sequences of the various component A isoforms all agree with the sequence of an unique precursor. The differences between the isoforms result first by differences in the length of the various chains alpha and beta, indicating that component A isoforms are generated from the proteolytic cleavage of the component A precursor at very close sites, possibly by the combined actions of endopeptidases and exopeptidases, and second by the possible cyclization of the alpha-NH2 of the N-terminal glutamine residue of chains beta and gamma. These observations indicate that the component A isoforms are the consequence of different posttranslational events occurring on an unique precursor, rather than the expression of different genes.

[Helicobacter pylori gastritis: a new infectious disease. Reflections from a personal experience]

To determine the relationship of microscopic chronic antral gastritis to Helicobacter pylori, 69 consecutive patients were studied. In a prospective longitudinal study, at least 2 successive gastroscopies with antral biopsies were performed (177 investigations on the whole). Sixty six of the 69 patients were treated with various therapeutic regimens i.e. antiulcer drugs and/or antibiotics. The type and intensity of inflammation (as based on whole inflammatory infiltrate density, polymorphonuclear cells presence or absence and IgA and IgM plasma cells counts) were correlated with H. pylori status (Giemsa staining and/or biopsy culture). The presence of the organism (Hp) and the gastritis were significantly correlated (high grade of whole inflammatory infiltrate Hp + ve: 98/109 90%, Hp-ve: 9/61 15%, p less than 0.001--presence of neutrophil PMNC Hp + ve: 80/109 73%, Hp-ve: 1/61 2%; p less than 0.001--IgA and IgM plasma cells respectively Hp + ve: 7.6 +/- 6.6, 10.6 +/- 7.1, Hp-ve 1.9 +/- 2.9, 4.2 +/- 4.5; p less than 0.005). Clearance and/or eradication of H. pylori after antibiotic treatment were associated with the disappearance of chronic gastritis activity and a statistically significant decrease of whole inflammatory infiltrate density (p less than 0.001) and IgA (p less than 0.005) and IgM (p less than 0.01) plasma cells counts. Mucosal inflammation was unchanged in case of H. pylori persistence and inflammation worsening occurred in case of infection relapse. H. pylori gastric mucosa colonization seemed to be responsible for the antral chronic inflammation associated with its presence.(ABSTRACT TRUNCATED AT 250 WORDS)

Dynamic changes in soluble interleukin-2 receptor levels during treatment of Graves' disease. Correlation with disease activity

The activation of T lymphocyte is accompanied by the release of soluble interleukin-2 receptors (sIL-2R) which can be assessed in biological fluids. A prospective study of the dynamic changes in sIL-2R levels was performed in the serum of 10 patients undergoing a medical treatment for Graves' disease. All patients received carbimazole during the study and, when necessary, L-thyroxine to compensate hypothyroidism. sIL-2R levels were measured before (M0) and after the 1st (M1), 3rd (M3) and 6th month (M6) of treatment. The levels of sIL-2R were high at M0 and M1, and decreased significantly between M1 and M3 (p = 0.03). At M0, the levels of sIL-2R were highly correlated with triiodothyronine (T3) levels (p = 0.0003), early [131I] uptake (p = 0.007) and, to a lesser degree, with anti-thyrotropin receptor antibody levels (p = 0.02). At M6, no correlation was found anymore. We conclude that sIL-2R levels are increased in patients with untreated Graves' disease. They are highly correlated with the markers of Graves' disease activity and decrease during medical treatment.

Comparison of outcome, clinical, laboratory, and immunological features in 164 children and adults with T-ALL. The Groupe d'Etude Immunologique des Leucémies

T cell acute lymphoblastic leukemia (T-ALL) is a disease of poor prognosis, usually studied separately in adults or children. Controversial clinical or biological prognostic factors have been reported, and little information is available regarding the frequency and prognostic value of membrane markers identified on blast cells. We report an extensive investigation of the incidence and prognostic value of immunophenotypic, clinical, and laboratory data in T-ALL, performed as a multicenter study in 164 patients. CD7, CD5, and CD2 were the most frequently expressed T cell antigens, and CD2 and CD4 were more frequently observed in children than in adults. MHC class II, CD9, and CD10 were observed in 16, 22, and 21% of the patients, respectively. The male prevalence of T-ALL, and the more frequent presence of a tumoral syndrome in children were confirmed, but mediastinal enlargement and high leukocyte counts were observed in less than half the patients. A poor prognosis was associated with the expression of MHC class II in adults. The presence of a mediastinal mass appeared to be of good prognosis in adults, as well as a leukocyte count lower than 100 x 10(9)/l whatever the age of the patient.

CD4-like molecules in human sperm

The expression of a molecule recognized by CD4 monoclonal antibodies was investigated on human sperm using immunolabelling, biochemical and immunochemical methods. Flow cytometry detected a significant fluorescence signal. SDS-PAGE analysis and Western blotting identified a molecule of 60 kDa, consistent with a CD4-like structure as confirmed after selective immunoseparation. Additional bands reacting with anti-CD4 were found in sperm extracts (73 kDa) and seminal fluid (90 kDa). These data indicate that sperm express a molecule similar to the receptor for HIV described on mononuclear cells.

A multicenter, double-blind, placebo-controlled trial of the efficacy of prazosin in the treatment of dysuria associated with benign prostatic hypertrophy

An 8-center, double-blind, placebo-controlled trial of 39 patients with benign prostatic hypertrophy was conducted to assess the effects of prazosin HCl treatment on functional urologic variables after a treatment period of 4 weeks. The randomized groups were comparable for demographic variables and symptoms, except for the mean residual urinary volume, which was significantly higher in the prazosin HCl group. Prazosin HCl elicited statistically significant improvements in the mean prostatic urethral pressure and prostate area (Mann-Whitney U test: p = 0.001 for both variables as compared with the placebo group). Functional bladder capacity also improved significantly in the group receiving the test drug (Mann-Whitney U test: p = 0.05, as compared with the placebo group). Clinical improvements were also observed in the mean maximum urinary flow, decreased nocturia frequency, and residual urinary volume. Patient preference significantly favored the prazosin HCl treatment (Mann-Whitney U test: p = 0.001). Seven patients on prazosin HCl and 5 receiving placebo reported one or more side effects during the trial phase; these were mild to moderate and disappeared or were tolerated. No statistically significant effects on blood pressure or heart rate were observed.

Isotype evolution in the follow-up study of patients with Campylobacter pylori associated gastritis

Four sequential immuno-assays were performed from May to November 1988 to follow the levels of IgG, IgA and IgM to Campylobacter pylori in 16 infected patients with histologically proven gastritis, among which 12 received appropriate therapy. Histopathological examination of antral biopsies, bacteriological cultures and urease tests were performed on each occasion when serum was tested for antibodies to C. pylori. The detection and quantitative assessment of the various isotypes to this bacterium proved valuable to appreciate the response to therapy with, in case of success, a steady decrease of antibodies levels concomitant with clinical improvement.

Decreased lymphocyte function-associated antigen-1 molecule expression on peripheral blood lymphocytes from patients with Graves' disease

Humoral and cellular abnormalities have been described in autoimmune thyroid diseases, but a deficient cooperation between humoral and cellular systems has been poorly investigated in such diseases. Lymphocyte function-associated antigen-1 (LFA-1), a glycoprotein expressed on T- and B-lymphocytes, plays an important role in cell-cell interaction mechanisms and is involved in the homing phenomenon. The expression of this molecule was investigated on peripheral blood lymphocytes from patients suffering from various thyroid disorders. Decreased numbers of LFA-1-positive cells were observed in 30 patients with Graves' disease, while normal values were present in 8 patients with Hashimoto's thyroiditis and 37 subjects with nonautoimmune thyroid disorders. Treatment-induced improvement of Graves' disease was associated with an increase in LFA-1-positive cell number.

Cowden disease in a young girl: gynecologic and immunologic overview in a case and in the literature

There is an increased risk of cancer (mainly breast cancer) in patients with Cowden disease. Little is known of the etiopathogenic mechanisms of this condition, but immunologic abnormalities may be evoked. A young patient with Cowden disease was submitted for gynecologic examination and immunologic investigations. Although no neoplastic disorder had appeared, laboratory investigations disclosed abnormalities of the humoral and cellular immune compartments in the peripheral blood. This rare observation of gynecologic involvement in a very young girl with family antecedents of Cowden disease prompted a review of the gynecologic features and etiopathogenic bases of Cowden disease. The possible role of neoplasia such as breast cancer in this syndrome makes early diagnosis a criterion for good prognosis.

[Current pathogenetic data on mesangial glomerulonephritis with immunoglobulin A deposits]

The pathogenesis of mesangial immunoglobulin A nephropathies was elucidated through the analysis of their clinical features and investigation of their biological characteristics. An alteration of the mucosal immune system is currently considered chiefly responsible for these diseases. A dysregulation of other compartments of the immune system is likely to enhance this abnormality and/or contribute to the persistence of immune complexes. Little is known, however, about the etiology of these renal diseases, and their treatment remains palliative or preventive.

Crotoxin, a phospholipase A2 neurotoxin from the South American rattlesnake Crotalus durissus terrificus: purification of several isoforms and comparison of their molecular structure and of their biological activities

Crotoxin, the major toxin of the venom of the South American rattlesnake Crotalus durissus terrificus is a mixture of several isoforms that differ slightly in their molecular structure. The toxin consists of two nonidentical subunits: a basic and weakly toxic phospholipase A2, component B, and an acidic and nontoxic subunit, component A. In the present investigation, we have used fast-performance liquid chromatography (FPLC) on anionic and cationic exchange columns to purify isoforms of both crotoxin subunits. Two component A isoforms and four component B isoforms were obtained in a homogeneous state, and their purity was verified by isoelectric focusing in polyacrylamide gels. The amino acid composition of the purified component A and component B isoforms was in good agreement with the protein sequences determined previously with mixtures of isoforms. The amino acid compositions indicated that for both crotoxin components the isoforms differed only by the replacement of few amino acid residues. Eight crotoxin complexes have been prepared in a homogeneous state by reassociation of pure component A and component B isoforms. The quantitative comparison of enzymatic and pharmacological properties of the reconstituted crotoxins indicated that the two component A isoforms had identical properties, whereas the four component B isoforms fell in two classes: crotoxin complexes formed with component B isoforms of the first class were enzymatically less active and pharmacologically more potent than those obtained with component B isoforms of the second class.

Immunoglobulin-producing cells in human prostate

Immunohistological techniques were used to investigate the presence of immunoglobulin-producing cells in human prostate. Surgical samples from 14 patients with prostate hyperplasia were analyzed. Lymphoid infiltration was rarely seen and was in no way comparable with the classical structure of mucosae-associated lymphoid tissue (MALT). Plasma cells were observed in nine cases. They produced predominantly IgA and lambda chains, but noticeable numbers of IgM-secreting cells were also seen. These cells were most numerous in patients with antecedents of infection or prostatitis. These data suggest that the local immune system of the prostate is in relation with the MALT, and can be colonized by MALT-derived cells in response to bacterial stimuli.