GABA transaminase deficiency. Case report and literature review

GABA transaminase deficiency should be considered in the differential diagnosis of early onset epileptic encephalopathies. This case was diagnosed post-mortem, but increased vigilance to this will allow for earlier diagnoses in other infants and families. This is a case study which involved diagnosis of a rare neurometabolic disorder in one of the babies in the family and eventual genetic counselling of the family. The family has been offered pre-implantation genetic diagnosis for future pregnancies. This case reporting has been approved by the hospital research and ethical committee.

Report of a case of Raine syndrome and literature review

We report on a case of Raine syndrome with a mutation in FAM20C and typical phenotypic features consisting of midface hypoplasia, hypoplastic nose, choanal atresia, wide fontanelle, exophthalmos, generalized osteosclerosis and intracranial calcification. New features in our patient are cerebellar hypoplasia and pachygyria. We review the literature and conclude that the triad of hypoplastic nose, exophthalmos and generalized osteosclerosis and/or intracranial calcification is consistent in all molecularly confirmed cases.

A novel syndrome of lethal familial hyperekplexia associated with brain malformation

Background

Hyperekplexia (HPX) is a rare non-epileptic disorder manifesting immediately after birth with exaggerated persistent startle reaction to unexpected auditory, somatosensory and visual stimuli, and non-habituating generalized flexor spasm in response to tapping of the nasal bridge (glabellar tap) which forms its clinical hallmark. The course of the disease is usually benign with spontaneous amelioration with age. The disorder results from aberrant glycinergic neurotransmission, and several mutations were reported in the genes encoding glycine receptor (GlyR) α1 and β subunits, glycine transporter GlyT2 as well as two other proteins involved in glycinergic neurotransmission gephyrin and collybistin.

Methods

The phenotype of six newborns, belonging to Saudi Arabian kindred with close consanguineous marriages, who presented with hyperekplexia associated with severe brain malformation, is described. DNA samples were available from two patients, and homozygosity scan to determine overlap with known hyperkplexia genes was performed.

Results

The kindred consisted of two brothers married to their cousin sisters, each with three affected children who presented antenatally with excessive fetal movements. Postnatally, they were found to have microcephaly, severe hyperekplexia and gross brain malformation characterized by severe simplified gyral pattern and cerebellar underdevelopment. The EEG was normal and they responded to clonazepam. All of the six patients died within six weeks. Laboratory investigations, including metabolic screen, were unremarkable. None of the known hyperkplexia genes were present within the overlapping regions of homozygosity between the two patients for whom DNA samples were available.

Conclusions

We present these cases as a novel syndrome of lethal familial autosomal recessive hyperekplexia associated with microcephaly and severe brain malformation.

Killer cell immunoglobulin-like receptor gene diversity in the Saudi population

Killer cell immunoglobulin-like receptors (KIRs) influence the outcome of haematopoetic stem cell transplantation by modulating the cytotoxic ability of natural killer (NK) cells and a subset of T cells. KIRs are also highly polymorphic and could therefore be good population genetic markers, much like their human leukocyte antigen (HLA) ligands. This study represents the first report on distribution of 16 KIR genes in 162 unrelated healthy Saudi individuals. All the 16 KIR genes were observed in the studied population and the four framework genes (KIR2DL4, 3DL2, 3DL3 and 3DP1) were present in all individuals. Forty- one distinct KIR profiles were expressed in our population, 11 of which had not been previously described in other populations including the Middle Eastern population. AA1, the most common genotypic profile was observed at a frequency of 26.5%. The group A haplotype was more frequent (53%) in the Saudi population compared to the group B haplotype (47%). The pattern of the inhibitory KIR/HLA ligands were also analyzed and 52.3% of the Saudi population was found to express two pairs of the inhibitory KIR/HLA-C. The KIR gene frequencies suggests that the Saudi population shares common general features with the Middle Eastern and other populations, but still has its own unique frequencies of several KIR loci.

Experts and performance in histopathology--a study in breast pathology

This study was undertaken to determine if it was possible to identify expertise within Histopathologists (trainees, district general pathologists and pathologists with a special interest in breast disease) using an objective measure of performance. The method of assessment of performance is based on the CWS (Cochran-Weiss-Shanteau) ratio formed by the individual's ability to discriminate between a spectrum of disease categories and their level of inconsistency when assessed at intervals. The slides circulated represented the spectrum of breast disease seen in routine practice. The results demonstrated the average CWS ratio to be lowest in trainees and highest in pathologists with a special interest in breast pathology although there was no statistical difference in the CWS scores obtained between the district general pathologists and pathologists with a special interest. Differences in inconsistency rather than discriminatory ability mainly accounted for the difference in the CWS ratio observed between the groups studied. The study shows that the CWS ratio is potentially a very useful tool in the assessment of pathologists with regard to assessing their progress through training.

The flow cytometric crossmatch in liver transplantation

The role of the cytotoxic crossmatch in liver transplantation is generally considered controversial. The development of the flow cytometric crossmatch has allowed the detection of lower levels of donor-directed IgG than is possible with the conventional crossmatch. This assay has been shown to be useful in renal transplantation. However, with the controversial role of the standard cytotoxic crossmatch, the flow cytometric crossmatch has not been used in liver transplantation. Twenty-seven human orthotopic liver allograft recipients were tested for donor-directed IgG using the flow cytometric crossmatch. Thirteen recipients were identified with either T or B lymphocyte-directed IgG. This group had a significantly increased incidence of clinical rejection (75%) as compared with the negative group (29%, P = 0.02, Fisher's exact test). The differences were greatest with B lymphocyte-directed IgG and the rejections were generally steroid sensitive. In this series, the flow cytometric crossmatch proved to be a better prognostic indicator of rejection than the conventional cytotoxic crossmatch. In addition, the association of a positive flow cytometric crossmatch with rejection indicates that the liver follows the same pattern seen in renal and cardiac grafts.

Leiomyosarcoma of the breast; cytological and histological features, with a review of the literature

This report describes the cytological and histological features of a leiomyosarcoma of the breast. The differential diagnosis of this rare tumour is discussed. Eleven well documented cases of leiomyosarcoma of the breast have been reported previously and details of these are included in this review.

Significance of borderline nuclear abnormality in cervical smears

Women with cervical smears showing borderline nuclear abnormality (BNA), or reactive changes in the form of squamous metaplasia (SM) or endocervical cell hyperplasia (ECH), were age-matched with healthy controls to determine the outcome of these conditions. No significant difference in the risk of dyskaryosis was observed in cases showing reactive changes and the controls. In contrast, there was a 23% excess of cases showing dyskaryosis in the repeat smears of cases of BNA over the controls. An odds ratio of 8.3 was obtained, showing dyskaryosis in subsequent smears after a diagnosis of BNA.

The cytological prediction of cervical intraepithelial neoplasia in colposcopically directed biopsies

The tissue sections and preceding cervical smears of 1262 women who had colposcopic cervical biopsies were reviewed and the reports correlated. Close correlation between the cytological and histological findings, to within one histological grade of cervical intraepithelial neoplasia (CIN), was noted in 86% of cases. However, the biopsy was negative, or contained evidence of wart virus infection only, in 24% of cases where dyskaryotic cells had been observed in the cervical smear. Of particular concern was the fact that negative histological findings were recorded in 13% of cases where the smear contained cells showing a moderate dyskaryosis and in 1.26% of cases where the smear showed severe dyskaryosis. This suggests that colposcopically directed biopsies do not always reflect the underlying pathological changes in the cervix. Management of these cases is discussed. In 45 women with a normal cervical smear prior to biopsy, histology revealed seven cases of CIN 3 and one case of invasive squamous carcinoma. This indicates that referral for colposcopy is advisable whenever there is clinical suspicion of cancer, even if the cervical smear report is normal.

Filamentous organisms in gastric brushings and gastric cancer diagnosis

An association between filamentous organisms and gastric carcinoma has been reported in gastric biopsies. Review of 45 Papanicolaou-stained gastric brushing specimens revealed filamentous organisms in two cases. In both cases, gastric carcinoma was confirmed on follow-up. Cytopathologists should be aware that the identification of filamentous organisms in gastric brushings is a specific, although insensitive marker of gastric cancer.

A microglandular adenosis-like lesion simulating tubular adenocarcinoma of the breast. A case report with cytological and histological appearances

Although rare, microglandular adenosis of the breast is well recognized as a benign lesion which mimics tubular adenocarcinoma. In this paper we present a case of a complex microglandular adenosis-like lesion which was thought to be suggestive of tubular adenocarcinoma by fine needle aspiration cytology. The problem of the cytological distinction of microglandular adenosis from tubular adenocarcinoma is discussed.

The determination of plasma intrinsic coagulant activity

The increase in absorbance was traced during the coagulation of citrated plasma, while in contact with a plastic cuvette surface. The tracings gave rise to coagulation curves, which provided four values. The coagulation curve values were found to change by time due to contact with the surface of the tube containing the plasma. The rate of change was used to determine the intrinsic coagulant activity, in response to a weak activating surface. The value of the determination as a means for detecting hypercoagulability is discussed. The method was also used to study the effect of different factors affecting intrinsic plasma coagulant activity as; the surface of different tubes, plasma concentration, temperature of the tube containing the plasma and platelet concentration.

Argyrophil carcinoma of the breast: a cytologic, histochemical, and ultrastructural study of a case

Aspirate from an argyrophil carcinoma ("carcinoid") of the breast showed malignant dispersed epithelial cells. With Diff-Quik, the cytoplasm was seen to be abundant, with prominent eosinophilic granularity. The nuclei were fairly uniform, round or oval, and eccentric and had a finely stippled chromatin pattern. On histology, the tumor appeared typical for argyrophil carcinoma, and staining with Grimelius for argyrophilic granules was positive. Membrane-bound neurosecretory granules were seen on electron microscopy.

The increasing problem in Tayside of cervical cancer in younger women

The incidence of cervical carcinoma in younger women is increasing in Tayside despite a decrease in the overall incidence. However, stage for stage, we did not encounter a poorer survival in younger patients. A number of patients had been sterilised or had a pregnancy when cytological screening was available and not made use of. There were also some false negative smears which were reclassified for retrospective analysis. We would recommend cervical screening every three years and careful inspection of the cervix and a smear taken in cases of abnormal gynaecological symptoms such as post coital bleeding.

Glycosaminoglycans in human gallbladder basement membrane: nature and quantitative changes in chronic cholecystitis

Using cuprolinic blue as a stain along with enzymic digestion, heparan sulphate has been identified as the main glycosaminoglycan in the basement membrane of human gallbladder epithelium. The amount of glycosaminoglycans was quantified by counting the number of molecular profiles cm-2 in electron micrographs of mildly, moderately and severely inflamed gallbladders. There is a significant increase (P = 0.009) in the amount of glycosaminoglycans in the basement membranes of severely inflamed gallbladders compared with cases of mild chronic cholecystitis. Differences, although present, are less significant when mild and moderate or moderate and severe cholecystitis are compared. The findings suggest that there is a continuous accumulation of heparan sulphate in the basement membrane in chronic cholecystitis which increases in amount with the severity of inflammation.

A spectrophotometric method for the standardization of thromboplastin clot-promoting activity

A simple spectrophotometric method for the quantitating of the clot promoting activity of thromboplastin in commercial preparations was developed. Thromboplastin activities were proportional to the maximum rate of clot formation. This was calculated from curves of absorption change during the coagulation of plasma coagulation control. The clot-promoting effects of thromboplastin in commercial preparations varied widely when assayed by this method.

A simple spectrophotometric method for the determination of thrombin activity

The activity of thrombin in commercial preparations was measured by an easy, precise spectrophotometric method that allows determination of thrombin activity in dilute solutions more accurately than other methods hitherto used. The method can also be used to compare fibrinogen content in plasma samples.

A simple method for the determination of plasma extrinsic coagulant activity

A spectrophotometric study of plasma coagulation is presented with a method for the determination of plasma coagulant activity, via the extrinsic pathway. Dilute citrated plasma was coagulated by recalcification after the addition of a very small amount of thromboplastin. The maximum increase in absorbance per min during coagulation was used as a measure of coagulant activity. The method was applied to normal platelet-rich plasma samples, and the effect of changing the concentration of plasma, thromboplastin, fibrinogen, and heparin was studied.

The uptake of lead by small intestine, colon and gallbladder of the guinea pig in vivo

The binding and uptake of lead by the jejunal, colonic and gallbladder epithelium of guinea pig has been investigated by electron microscopy. Binding occurred rapidly, the most marked by the microvilli was by the jejunum, followed by colon and gallbladder. The tracer was subsequently internalised in small membrane bound vesicles and smooth endoplasmic reticulum. By 30 min, it appeared in multivesicular bodies at all three sites.

DPN- and TPN-17beta-hydroxy-C19-steroid dehydrogenases; intracellular localization in dog prostate

Both the DPN- and TPN-linked 17β-hydroxy-C19-steroid dehydrogenase activities of the dog prostate were localized in the microsomal fraction. The usual procedure of tissue fractionation resulted in a loss of DNA from the nuclei and an unsatisfactory separation of the subcellular components. Initial homogenization in 2.2 m sucrose, however, not only yielded clean nuclei but also permitted an effective separation of the mitochondrial, microsomal, and soluble fractions. The completeness of the separations was characterized by the determination of protein, DNA, RNA, succinic dehydrogenase and esterase activities of each fraction. The microsomal preparation retained its dehydrogenase activity on storage at –20° C. It did not metabolize the 3α-hydroxy- or the Δ5-3β-hydroxy groups. The pH of maximum activity was slightly different in the presence of DPN (10.6) than in TPN (10.2). The two coenzymes competed for the active site on the dehydrogenase. The Km value for the substrate (testosterone) was the same in the presence of each coenzyme, but the maximum activity was approximately three times greater with DPN than TPN.