Manometrical evaluation in visceral neuropathies in children

Manometrical recordings were made at three levels of the digestive tract in 20 children with chronic intestinal pseudoobstruction (CIPO) defined clinically and histopathologically by deep biopsies showing a neuropathic process. Duodenal manometry showed severe abnormalities with hypomotility in all cases and absence of migrating motor complex in 13 of 20 cases. There was no relation between the histopathologic type and the motility pattern, but the most severe abnormalities were seen in the patients with extensive involvement of the digestive tract and the most severe clinical course. Esophageal manometry was abnormal in 18 of 19 patients, with altered peristalsis consisting of simultaneous, short-lasting, or low-amplitude waves. Rectoanal manometry showed the presence of the rectosphincteric inhibitory reflex in all patients. In conclusion, there is a high frequency of small bowel manometrical abnormalities in CIPO which seem to correlate with the extent of the pathological process and the prognosis of the disease. Esophageal manometry is useful for defining the extent of dysmotility and confirming the diagnosis of CIPO in some cases.

Duodenal and esophageal manometry in total colonic aganglionosis

Eleven children with total colonic aganglionosis were studied by esophageal and duodenal manometry. They were separated into two groups: group 1, with ileal involvement, and group 2, without ileal involvement. The results of the digestive motility studies were compared with the extent of ileal involvement of the aganglionosis and with the amount of artificial nutritional support required. All children showed abnormalities on both esophageal and duodenal manometry, suggesting complete digestive tract motility involvement. Recent advances in understanding Hirschsprung's disease and manometrial abnormalities suggest a primary motility disorder in children with total colonic aganglionosis.

[Contribution of genetic typing for the diagnosis of familial adenomatous polyposis in pediatrics]

BACKGROUND

The gene responsible for familial adenomatous polyposis, (APC), has been recently cloned and genetic map with several polymorphic markers has been established.

POPULATION AND METHODS

Blood samples (20 ml) were taken from 34 subjects belonging to four families at risk for familial adenomatous polyposis. Nineteen of these 34, less than 20 years old, had one parent having polyposis or dead because of it. Polyposis was diagnosed, in ten of these 19 by endoscopy. Genomic DNA was extracted from peripheral leukocytes and Southern blot analyses were performed in each family, using RFLPs on both sides of the APC locus.

RESULTS

DNA analysis identified normal and mutant haplotypes at the APC locus in each family. It was thus possible to follow the segregation of mutant alleles. These results were compared with the anamnestic and endoscopic data. Bearing in mind the risk of recombination when using extragenic markers, RFLPs allowed early diagnosis of APC in pre and/or asymptomatic patients.

CONCLUSIONS

Genetic analysis can be used to diagnose APC in affected families, provided the risk of recombination is taken into account. Intragenic microsatellites markers will soon be available. These will provide more information on the APC gene, and hence direct molecular diagnosis of APC.

Identification of alpha 1-adrenoceptor subtypes present in the human prostate

alpha 1-Adrenoceptors (ARs) play an important role in mediating human prostatic smooth muscle contraction. In the present study cDNA fragments covering different domains of 3 alpha 1-AR subtypes (alpha 1b, alpha 1c and alpha 1d) were generated from human prostate by reverse transcription coupled to the polymerase chain reaction (RT-PCR). The reconstituted partial sequence (349 amino acids) of the human prostatic alpha 1c-AR PCR products showed 94% identity at the amino acid level with that of the corresponding region of the cloned bovine brain alpha 1c-AR. Using human alpha 1-AR subtype selective cDNA probes in Northern blot analysis, the co-expression of mRNA transcripts corresponding to alpha 1b-, alpha 1c- and alpha 1d-AR subtypes was detected in 4 different regions (apex, base, periurethra and lateral lobe) of the human prostate. Competitive inhibition experiments of [3H]-prazosin binding to membrane preparations of human prostate revealed that the non-selective alpha 1-subtype antagonist, alfuzosin, produced a monophasic inhibition curve, whereas oxymetazoline produced a 2-component inhibition curve with pKi values of 8.54 and 5.46. The high-affinity alpha 1-AR component of the oxymetazoline inhibition curve was predominant (57%-66%) and showed an affinity for oxymetazoline comparable to that of the alpha 1c-AR subtype. As such our results illustrate the expression of different alpha 1-AR subtypes in human prostate and importantly that alpha 1c represents the predominant alpha 1-AR subtype present in this tissue.

Duodenal manometry in postobstructive enteropathy in infants with a transient enterostomy

Intestinal motility was studied in 11 children with a transient enterostomy secondary to a neonatal organic small intestine obstruction (5 total colon Hirschsprung's disease, 2 necrotizing enterocolitis, 1 intussusception, 3 ileal atresia). Eight children presented with a postobstructive enteropathy (severe grade I [5], moderate grade II [3]) and three were considered as controls (grade III). They were assigned to one of the three groups on the basis of the duration of parenteral nutrition and constant rate enteral nutrition needed and the oral feeding tolerance. Barium small intestine transit showed no persistent partial obstruction or peritoneal adhesions. The abnormal inert marker transit times were statistically correlated with the clinical groups as well as duodenal manometric abnormalities. Manometric recordings were characterised by the absence (grade I) or abnormal phase III (grade II) of the migrating motor complex and decreased motility index (grades I and II). This study confirms that this enteropathy is due to a chronic alteration in motility induced by prenatal or postnatal obstructions.

Use of helper cells with two host ranges to generate high-titer retroviral vectors

We have recently described Avian Leukosis Virus (ALV)-based packaging cell lines that can produce helper-free ALV-based retrovirus vectors with A, B, C, and E envelope host ranges. Here, we report that lacZ retroviral vectors of subgroup C or E can infect helper cells of subgroup A (Isolde) which are then able to produce high titers of lacZ recombinant viruses of subgroup A. Superinfection of helper cells by lacZ recombinant virus was performed by cocultivating packaging cells with two subgroup specificities (A and E), but this did not result in increased recombinant virus titers. This "ping-pong" process caused the emergence of replication-competent (RC) viruses which are shown to result from recombination between the viral sequences of the helper cell lines and the cis-acting sequences of the lacZ recombinant virus.

[Congenital myasthenia with esophageal involvement]

BACKGROUND

Mild disorders associated with persistent neonatal myasthenia gravis may not be recognized for several months. Esophageal dysfunction in this type of myasthenia has never been studied.

CASE REPORT

A gastroesophageal reflux was diagnosed during the first weeks of life in a girl; she was not treated. At 8 month-old, she was admitted for febrile convulsions; the pyrexia was due to urinary tract infection by Escherichia coli. 4 days later, the infant displayed weakness of the eyelids and extraocular muscles. The proximal muscles of the arms were also weak. Neostigmine, 0.3 mg subcutaneously, completely removed the symptoms in a few minutes. Neuromuscular transmission tests showed a progressive decrease in eyelid muscle response on repetitive stimulation of the nerve, with a pattern of post-synaptic defects that was corrected by edrophonium chloride injection. Neither the girl nor her mother had acetylcholine receptor antibodies. Overnight monitoring of the distal esophagus pH showed numerous episodes of acid reflux, essentially after the meal. Manometry disclosed abnormalities of both the striated and smooth muscles of the esophagus that were corrected with neostigmine. The girl was given neostigmine and was in good condition one year later.

CONCLUSION

Myasthenia could worsen and/or trigger a gastroesophageal reflux by decreasing esophageal clearance and lower esophageal sphincter pressure.

[Chronic intestinal pseudo-obstruction and delayed myenteric ganglion cell maturation]

BACKGROUND

Enteric nerve cells begin to mature during the last trimester of pregnancy and become mature only after birth. The degree of maturation seems to be related to bowel motility.

CASE REPORT

A girl was born from a pregnancy complicated by hydramnios, and did not pass meconium before the 64th hr of life. Barium enema on day 4 showed a left microcolon with no distension of the transverse colon. Tests for cystic fibrosis were negative. On day 12, the patient presented with septicemia due to Pseudomonas maltophylia. Parenteral alimentation by central catheter was instituted. Surgical rectal biopsy showed that the number of ganglion cells was normal but the cells were immature. Progressive feeding was possible for the 3rd month of life. A second rectal biopsy at 3 1/2 months showed some remaining immature ganglion cells.

CONCLUSION

Immature ganglion cells can account for neonatal functional intestinal obstruction, as has been established for the small left colon syndrome. The progressive loss of symptoms seems to be correlated with histological maturation of the neurological apparatus of the large bowel. Severe complications, such as occlusion, sepsis, nutritional disorders can occur during this long period of functional intestinal obstruction.

Nasal mask ventilation in acute respiratory failure. Experience in elderly patients

Nasal mask ventilation (NMV) has been used successfully in chronic restrictive respiratory failure and more recently in acute exacerbations of chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the possible role of NMV in acute respiratory failure (ARF) episodes when mechanical ventilation with endotracheal intubation is questionable. Thirty patients (age, 76 +/- 8.1 years) were treated by NMV during ARF episodes (COPD, 20; other chronic respiratory failure [CRF], 5; chronic heart failure [CHF], 4). All patients were hypoxemic (PaO2, 5.85 +/- 1.62 kPa) and hypercapnic (PaCO2, 8.63 +/- 1.89 kPa) with respiratory acidosis (pH, 7.29 +/- 0.08). In all cases, clinical or physiologic parameters indicated the need for mechanical ventilation, but endotracheal intubation was either not applied because of the age and the physiologic condition of the patients (17 cases) or was postponed (13 cases). NMV was performed using a volume-cycled ventilator and a customized nasal mask. Ventilation was continuous during the first 12 hours and the following nights and was then intermittent during the day. Twenty-one patients improved clinically, within a few hours. Progressive correction of arterial blood gases was observed: PaO2 increased during the first hour, but PaCO2 decreased more slowly. Eighteen patients were able to be successfully weaned from NMV. Twelve patients failed to improve despite NMV: eight of them died and four required endotracheal intubation. There was no difference in the success rate between patients in whom endotracheal ventilation was contraindicated or postponed. Clinical tolerance was satisfactory in 23 patients and poor in seven patients. A return to the respiratory condition was observed in the surviving patients with subsequent discharge from hospital. NMV therefore successfully treated respiratory distress initially in 60 percent of the 30 patients. These results suggest that NMV could be a possible alternative in the treatment of ARF, even in very ill patients, when endotracheal ventilation is controversial or not immediately required.

Improvement of avian leukosis virus (ALV)-based retrovirus vectors by using different cis-acting sequences from ALVs

Production and expression of double-expression vectors which transduce both Neo(r) and lacZ genes and are based on the structure of avian leukosis virus were enhanced by using cis-acting sequences (long terminal repeats and noncoding sequences) from Rous-associated virus-1 and Rous-associated virus-2 rather than those of avian erythroblastosis virus previously used in our constructs. Polyclonal producer cells obtained after transfection of these vectors into the Isolde packaging cell line gave rise to titers as high as 3 x 10(5) lacZ CFU/ml, whereas it was possible to isolate clones of producer cells giving rise to titers of more than 10(6) resistance focus-forming units per ml.

Consequences of prenatal diagnosis of cystic fibrosis on the reproductive attitudes of parents of affected children

Three hundred and twenty-six French families with a cystic fibrosis-affected child who were referred for prenatal diagnosis were analysed by sibship size: 74.2 per cent of the couples had no further pregnancies to term after the affected child, who was deceased in 34.6 per cent of cases. These couples were followed prospectively after prenatal diagnosis and 77 had two or more consecutive pregnancies with prenatal diagnosis. The aim of these couples was to succeed in constituting a family with two normal children.

[Osteosynthesis of forearm fractures using a P.C.D. "Small fragments" plate from A.O instruments. Apropos of 283 screwed plates]

The authors report the results of using 283 P.C.D. "petits fragments" plates by A.O. instruments, inserted between 1980 and 1989 for internal fixation of 207 forearm fractures. These included 97 double forearm fractures, 34 isolated ulnar fractures, 30 isolated radial fractures, 24 Monteggia fractures, 13 Galeazzi fractures and 9 pseudoarthroses of the radius or ulna. The mean delay to consolidation was 3.3 months with a range of 2 to 15 months. Complications included 1 hypertrophic callus of the ulna; 3 pseudoarthroses, 7 cases of sepsis (6 ulnar, 1 radius i.e. 2.5%); no plate ruptures occurred in this series. 125 plates were removed after consolidation (after 18 months); the fracture recurred in only one case where the plate was removed after 8 months. Results are based on 203 operated patients (4 lost to follow up). Before treatment of the complication, results showed 150 very good results (73.2%), 44 good results (21.5%) 1 moderate (0.5%) and 10 poor results (4.8%). After treatment of the complications there were 156 very good results (77%), 46 good results (22.5%) and 1 moderate result. In summary, forearm fractures are no longer a problem in traumatology. The P.C.D. "petits fragments" plate of A.O. instruments would appear to be particularly adapted and a bulkier implant (4.5 screw) is not required.

[A.L.J. external fixation. Indications and results in 59 cases]

The authors report their results in 59 cases of external fixation with A.L.J. type devices inserted from November, 1984, to November, 1988, in 57 patients (2 cases of bilateral injuries). These included 49 cases of "recent" traumatology, 4 cases of "second-hand" traumatology, and 6 orthopaedic cases (tibiotarsal arthrodesis for degenerative lesions). Among the recent traumatic injuries, 38 were fractures, most often compound fractures (stages II and III), and 11 serious soft tissue lesions, for which the external fixation was used temporarily for stabilization until the wound was healed. The older traumatological lesions were 4 infected pseudarthroses. The results based on 52 cases (6 were lost to follow-up and 1 is a peculiar case) include 45 healed injuries (ie. 86.5%) and 7 failures. The soft-tissue lesions have all healed within 2 to 4 months. Among the bony lesions, some knit primarily without an additional graft (20 of 37 cases, ie 54 percent), the others after 1, 2 or 3 grafts (10 of 37 cases, ie. 27 percent). The union also occurred without any problem for all 6 tibiotarsal arthrodeses. The 7 failures occurred in cases where no additional bone graft had been performed. The discussion evidences the advantages and drawbacks of the A.L.J.

[Value of Illizarov's method in the treatment of long bone pseudarthrosis. Apropos of a A.S.A.M.I.F series of 87 cases]

This study is the outcome of multicenter endeavour compiling 87 cases of pseudoarthrosis managed according to principles set forth by G.A. Ilizarov. All clinical forms are described: simple pseudoarthrosis (non-infected and without loss of substance); septic pseudoarthrosis; pseudoarthrosis with loss of bone substance, both septic and aseptic. This method is used in the majority of cases. This method is used in the majority of cases after several consecutive unavailing attempts with conventional therapeutical procedures. Considering all situations, the lesions heal in over 90% of cases and the infection subsides with an equal rate of success. Such results are achieved within a period of 5 months. Sequelae or complications imputable to the method are few. Indications are specified, which depend upon the clinical form of the treated pseudoarthrosis, as well as upon the surgeon's personal skill.

Vasoactive intestinal peptide and its receptors in fetuses with cystic fibrosis

Fetuses were investigated to establish whether vasoactive intestinal peptide (VIP) and its receptors are involved in the basic biochemical defect causing cystic fibrosis (CF). The intestine was used as a target for the disease and the liver as control. The immunoreactive and biologically active VIP contents of the colon and lower part of the small intestine were 1.5-2.5 times higher in CF fetuses than in controls. In control and CF intestinal mucosa, there was no change in the Scatchard parameters of the 125I-labeled VIP binding sites (Kd = 4.7-6.1 X 10(-11) M; Bmax = 268-280 fmol/mg protein for the high-affinity sites), in the two molecular components constituting the cross-linked 125I-VIP binding (Mr = 66,000 and 30,000), or in the pharmacological properties and functional characteristics of the VIP receptors activating the G proteins-adenylate cyclase system (Ka = 0.7 X 10(-9) M VIP). Similar results were obtained in liver. These findings suggest that neither VIP nor its receptors are involved in CF intestine. The possible involvement of other effectors related to the VIP pathway in CF intestine, including the release of VIP and adenosine 3',5'-cyclic monophosphate signal-transduction cascade, are presented.

[Medical treatment of sustained ventricular tachycardia. Retrospective study of 85 patients]

In this retrospective study the antiarrhythmic of 85 patients suffering from sustained and recurrent attacks of ventricular tachycardia is analysed. Among these patients, 48 had ischaemic heart disease, 18 had right ventricular arrhythmogenic dysplasia, 9 had dilated cardiomyopathy and 2 had complex heart disease; in 8 patients the tachycardia was idiopathic. Two hundred and seventy-two antiarrhythmic treatments administered orally alone or in combination were studied. Their effectiveness was evaluated on the clinical course of the disease, on the résults of Holter recordings and, in some cases, on electrophysiological exploration. The mean follow-up period was 50 months. Each patient received 3.2 antiarrhythmic treatments on average. The effectiveness and side-effects of these treatments are analysed retrospectively, but the relative effectiveness of a treatment compared to another cannot be extrapolated to a new patient. Prescription in this field is purely empirical. The recent amiodarone-flecainide combination has been the most frequently used antiarrhythmic treatment in recent years. It was given to 33 patients in this series and proved effective in 21 patients followed up for 22 months.

Anatomical intra-laryngeal anterior branch study of the recurrent (inferior) laryngeal nerve

The studies are based upon 60 dissections of the recurrent laryngeal n. (inferior laryngeal n.). The authors describe in detail the branches destined for the intrinsic musculature of the larynx. This study is a working approach for interventions of selective laryngeal reinnervation in man. The conclusion is that, it is necessary to resect the inferior cornu of the thyroid cartilage, to reach the abductor and adductor branches of the vocal cord.

Structural analysis of the 5' flanking region of the beta-globin gene in African sickle cell anemia patients: further evidence for three origins of the sickle cell mutation in Africa

Haplotype analysis of the beta-globin gene cluster shows two regions of DNA characterized by nonrandom association of restriction site polymorphisms. These regions are separated by a variable segment containing the repeated sequences (ATTTT)n and (AT)xTy, which might be involved in recombinational events. Studies of haplotypes linked to the sickle cell gene in Africa provide strong argument for three origins of the mutation: Benin, Senegal, and the Central African Republic. Nevertheless, the haplotype determination does not give any information about the variable segment and does not totally exclude the possibility of recombination leading to different haplotypes linked to the mutation. The structure of the variable segment in the three African populations was studied by S1 nuclease mapping of genomic DNA, which allows a comparison of several samples. A 1080-base-pair DNA segment was sequenced for one sample from each population. S1 nuclease mapping confirmed the homogeneity of each population with regard to both (ATTTT)n and (AT)xTy repeats. We found three additional structures for (AT)xTy correlating with the geographic origin of the patients. Ten other nucleotide positions, 5' and 3' to the (AT)xTy copies, were found to be variable when compared to homologous sequences from human and monkey DNAs. These results allow us to propose an evolutionary scheme for the polymorphisms in the 5' flanking region of the beta-globin gene. The results strongly support the hypothesis of three origins for the sickle mutation in Africa.

The anatomical basis for transfixion of the thigh

Serial cross-sections of the thigh have been used to indicate where osseous transfixion is possible without damaging neuro-vascular structures or major tendons or penetrating a joint. Safe areas for transfixion using fine wires and their corresponding cutaneous zones are indicated. Two cutaneous zones each representing a quarter of the circumference of the thigh form safe zones for transfixion. The first begins on the ventral surface of the hip and ends on the medial aspect of the knee, while the second begins on the posterior aspect of the buttock and ends on the lateral aspect of the knee.

Recent insertion of an Alu sequence in the beta-globin gene cluster of the gorilla

We present the nucleotide sequence of a new Alu family member that lies between the delta- and beta-globin genes in gorilla DNA. The sequence exhibits 91% similarity with a consensus sequence of the Alu family. It is flanked by a perfect repetition of a 16-nucleotide target sequence and terminates with 24 adenylic residues. As this sequence is absent at this locus in other primate DNAs, its insertion occurred less than 8 million years ago, thus supporting the idea that Alu sequences are still mobile elements in the hominoid genome.