Germline NPM1 mutations lead to altered rRNA 2'-O-methylation and cause dyskeratosis congenita

RNA modifications are emerging as key determinants of gene expression. However, compelling genetic demonstrations of their relevance to human disease are lacking. Here, we link ribosomal RNA 2'-O-methylation (2'-O-Me) to the etiology of dyskeratosis congenita. We identify nucleophosmin (NPM1) as an essential regulator of 2'-O-Me on rRNA by directly binding C/D box small nucleolar RNAs, thereby modulating translation. We demonstrate the importance of 2'-O-Me-regulated translation for cellular growth, differentiation and hematopoietic stem cell maintenance, and show that Npm1 inactivation in adult hematopoietic stem cells results in bone marrow failure. We identify NPM1 germline mutations in patients with dyskeratosis congenita presenting with bone marrow failure and demonstrate that they are deficient in small nucleolar RNA binding. Mice harboring a dyskeratosis congenita germline Npm1 mutation recapitulate both hematological and nonhematological features of dyskeratosis congenita. Thus, our findings indicate that impaired 2'-O-Me can be etiological to human disease.

[Double pylorus (review of the literature and cases contribution)]

The Authors describe two cases of "double pylorus" came to their observation. Such name mean the presence of a peri-pyloric gastro-duodenal fistula carrying out a second duct which lead in communication the gastric antrum with the upper part of duodenal bulb. Because of rarity of this pathology (58 cases are described in the literature) its frequency are usually undervalved, as well since the clinic no presents a special features in comparison with other diseases of the upper gastrointestinal tract.

[Diagnostic usefulness of Doppler sonography in the study of cerebrovascular pathology]

The Authors point out the doppler usefulness for the study of obstructive cerebrovascular pathology specially of the carotids with personal short casuistry.

[Usefulness of Doppler echography in the diagnosis of upper thoracic outlet syndrome]

The Authors emphasize the importance of the Doppler-sonography for the diagnosis of the outlet thoracic syndrome with our personal casuistry.

[Phytobezoar of the gastric stump]

The Authors present a case who occurred to their observation concerning a patient undergoing subtotal gastrectomy for cancer four years ago which have developed a phytobezoar in the gastric stump, treated with enzymatic dissolution with acetylcysteine associated with metoclopramide . According to the Literature, the Authors point out the etiology, pathogenesis and therapy of this non rate consequence of the gastric surgery.

[Measurement of venous pressure by Doppler sonography: usefulness and limitations in saphenectomy]

After a short mention on the many last methods for venous pressure measurement, the Authors presents a relatively new method of this measurement with the Doppler ultrasonography. They point out its utility with regard to safenectomy by a study on 42 patients whose, at the present, only 10 preliminary results are available. This results allow to verify the opportunity of to value preoperatory and precisely the pressure drop obtainable with the safenectomy.

[Comparison of mannitol and traditional methods in the preparation of the large intestine for barium enema]

The authors point-out the importance of a good bowel preparation for radiological researches. After an evaluation of the results of so-called "traditional methods" and an oral Mannitol method, the Authors conclude that a mannitol preparation is easily accepted by the patient for his effectiveness and tolerance and should be widely used.

[Uterine multiple node fibromyomatosis associated with an asymptomatic leiomyoma of the small intestine]

Benign small bowel tumours are rare, often asymptomatic and are founded incidentally at surgery or post mortem examination. In about 70% patients with benign small bowel tumour were reported to have associated benign or malignant tumours of other districts. The Authors report a case of leiomyoma of the small intestine associated with multinodular leiofibromyomatosis of the uterus.

[Preoperative biliary culture and short-term antibiotic therapy]

The author have considered 92 patients operated for cronic calcolous cholecystitis (cholecystectomy). All patients have undergoing an intraoperative bile drawing and liver biopsy with hystological examination of the gallbladder wall. The results show a low incidence of positive bile cultures that become nigligible in patients who have undergoing the short term antibiotic therapy. This make think that infectious moment in cronic pathology of the biliary tract have very little value.

[A case of ample intestinal resection for massive mesenteric infarct]

The authors describe a case of a patient with massive ileal infarction was treated by large intestinal resection. It is remarkable that significant diarrhea and chronic malabsorption secondary to this intervention did not appear.

[A case of bilateral primary gynecomastia in 2 brothers]

After a short introduction on the ethiopathogenesis and therapy of the gynecomastia, the authors present a case which recently occurred to their observation of two brothers affected by bilateral primary gynecomastia.

[Surgical treatment of the ingrown nail using the Dubois technic]

After a short mention on the ethiopathogenesis and therapy of the ingrown nail, the Author point out the importance of the Dubois method for the surgical treatment of this affection. A good cosmetic result and radicality are achieved thanks to the preservation of the nail.

[Acute abdomen caused by phlegmonous appendicitis and leukemic infiltration of the cecum in a patient with acute lymphatic leukosis in relapse: clinico-therapeutic aspects]

We report a case of eleven years old child with an acute lymphoblastic leukemia who developed an acute abdomen while in haematological relapse. He had an acute appendicitis with leukemic infiltration of the coecum. The early surgical intervention and the coecum irradiation were successful: the following chemiotherapy achieved remission. A more aggressive surgical approach to the acute abdomen, combined with careful supportive measures, might improve the usually grim prognosis in patient whose leukemia offers a chance for remission.

[Gastric resection using Billroth I method: review of the literature]

The author point out the importance of the maintenance of duodenal passing after gastric resection for gastro-duodenal ulcer, and also examine the traditional operation by the Billroth's 2 method from a physiopathological point of view. With a critic study of the literature, the advantages and the disadvantages of two methods there is presented.

[Nakajama's gastroduodenostomy. Case contribution]

In general, after subtotal gastrectomy for gastroduodenal ulcus and antral carcinoma, the digestive tract usually is reconstructed by the Billroth II method. The author paint out the disadvantages of this method due to the exclusion of the duodenal transit; also emphasize the importance of the gastro-duodenostomy according to Nakajama's modifications.

[Hyperhistaminemia in neoplasms of the breast]

The authors analyse the course of the total haematic hystamine rate in 13 women with breast cancer. They find that neoplasm take a significant increase of the histamine rate in comparison with the controls, while the mastectomy quickly is followed by the normalization of these values. They conclude that, as already suggested for others kinds of neoplasms of the lung and gastroenteric tract, also in the neoplastic pathology of the breast, the haematic hystamine dosage is a useful parameter for the monitoring the course of the illness.

[Zollinger-Ellison syndrome]

After an exposition of the modern trends on the definition, ethiopathogenesis, symptomatology and therapy of the Zollinger-Ellison Syndrome, the authors presents a case of Z.-E. Syndrome, which occurred to their observation.