[Immunoglobulin G4-associated cholangitis]

Autoimmune LgG4- associated cholangitis is a new entity among the liver and biliary tree disorders, classified among the so-called IgG4-related diseases. Even though prognosis of this disease is unclear, this type of sclerosing cholangitis is not being linked to a carcinoma. Clinical and laboratory data differ slightly from the findings associated with the usual primary sclerosing cholangitis and it is mainly the high IgG4 level and hyperbilirubinaemia that supports the diagnosis ofautoimmune disease. Unlike primary sclerosing cholangitis, this disease is not associated with a malignant prognosis and steroids represent an effective treatment. Combination of steroids with azathioprin is a possible alternative in case of a relapse. Patient's response to steroid therapy is a diagnosis-supporting criterion. This disease should always be considered as part of differential diagnosis of primary sclerosing cholangitis, especially when autoimmune aberrations or other autoimmune diseases are present. Long-term evaluations of these patients are so far lacking and thus studies on larger patient samples are required.

Simple Procedure for Automatic Detection of Unstable Alleles in the Myotonic Dystrophy and Huntington's Disease Loci

Human neurodegenerative and neuromuscular disorders are associated with a class of gene mutations represented by expansion of trinucleotide repeats. DNA testing is important for the diagnosis of these diseases because clinical discrimination is complicated by their late onset and frequently overlapping symptomatology. However, detection of pathologic alleles expanded up to several thousand trinucleotides poses a challenge for the introduction of rapid, fully automatic, and simple DNA diagnostic procedures. Here we propose a simple two-step polymerase chain reaction (PCR) protocol for rapid molecular diagnostics of myotonic dystrophy, Huntington's disease, and possibly also other triplet expansion diseases. Standard PCR amplification with target repeat flanking primers is used for the detection of alleles of up to 100 repeats; next, triplet-primed PCR is applied for detection of larger expansions. Automated capillary electrophoresis of amplicons allows rapid discrimination between normal, premutated and expanded (CTG/CAG)(n) alleles. Using the suggested protocol, the expanded allele was successfully detected in all test DNA samples with known genotypes. Our experience demonstrates that the suggested two-step PCR protocol provides high sensitivity, specificity, and reproducibility; is significantly less time-consuming; is easier to perform; and provides a better basis for automation than previous methods requiring Southern analysis. Therefore, it can be used for confirmation of uncertain clinical diagnoses, for prenatal testing in at-risk families, and, generally in research on these diseases.

Demonstration of MyoD1 expression in oncocytic cardiomyopathy: report of two cases and review of the literature

Oncocytic cardiomyopathy is a rare arrhythmogenic disorder usually associated with female sex, difficult-to-control arrhythmias, or sudden death of infants and children. Morphologically, it is characterized by the presence of oncocytic cells, which are diffusely distributed or form the nodular structures within the myocardium, occasionally involving the valves, with a large number of mitochondria in cytoplasms. We present two cases of oncocytic cardiomyopathy. The first case had a fatal clinical outcome, and the other case was surgically treated. The nuclear expression of skeletal muscle transcription factor MyoD1 was demonstrated in the first case, supporting the theory that oncocytic cardiomyopathy is a conduction system developmental disorder. To confirm this hypothesis, it is necessary to further investigate myogenic transcription factor program in human cardiac conduction system cells.

[A unique case of congenital muscular dystrophy]

The congenital muscular dystrophies (CMD, MDC) represent a heterogeneous group of autosomal recessive disorders manifesting in infancy by muscle weakness and hypotonia. Approximately 40% of patients with CMD have a primary deficiency of the laminin alpha 3. chain of merosin (laminin-2) due to mutations in LAMA2 gene. Laminin-2 bound to alpha-dystroglycan forms a link between actin--associated cytoskeletal proteins and the components of extracellular matrix. Disruption of this axis is responsible for several forms of muscular dystrophy. A unique case of congenital muscular dystrophy simulating a juvenile polymyositis in a muscle biopsy is presented. A profound reduction of alpha-dystroglycan and less pronounced secondary deficiency of alpha 2-laminin were found. All known forms of CMD were excluded, and the disorder was diagnosed as so far undescribed form of CMD. The mutation in a gene encoding the protein, that seems to play a role in a glycosylation of alpha-dystroglycan, is presumed.

[Histopathology and differential diagnosis of celiac sprue]

Marsh' classification of celiac disease or malabsorption syndrome sensu stricto is based on increased number of intraepithelial lymphocytes, as the first and constant sign/feature of the disease. Thereafter follow structural alterations of the mucous membrane, particularly of villous architecture, crypt height and enterocytes. According to the Marsh' classification, type 0 corresponds to normal mucous membrane, and type 1, the infiltrative type, is characterised by an increase in intraepithelial lymphocytes (IEL), which amount to more than 40 lymphocytes/100 enterocytes. Type 2 has normal villous architecture, an increase in IEL numbers and crypt hyperplasia. Type 3, the destructive type, is characterised by villous atrophy and may be divided into three sub-groups depending on the degree of the atrophy-mild, marked, and total (flat mucosa). Combination of these histopathological findings, patient's history and clinical course may result in the definition of six "states" of celiac disease. Marsh' classification is helpful for an early diagnosis of the disease and should be applied in any case of the bioptical examination of the malabsorption syndrome. The disadvantage of this system, applied on formol-paraffin tissue sections, is impossibility of revealing disacharidases (particularly lactase) deficiency. From this point of view, histochemical detection of disacharidases should accompany the bioptical examination of jejunal mucosa.

Amplification and overexpression of HER-2/neu in invasive ductal carcinomas of the pancreas and pancreatic intraepithelial neoplasms and the relationship to the expression of p21(WAF1/CIP1)

Overexpression of HER-2/neu was described in pancreatic intraepithelial neoplasia (PanIN) and in invasive ductal adenocarcinoma of pancreas in a variable proportion of cases. The effects of HER-2/neu overexpression on mitogenic signalling and cell cycle progression were studied in breast luminal epithelial cells and mitogen activated protein kinase-dependent induction of p21(WAF1/CIP1) was found to be necessary for G1 phase progression. Overexpression of p21(WAF1/CIP1) was described as an early event in the development of PanIN by Biankin et al. (2001) and this finding was supported by our previous study that, moreover, did not confirm the possible role of activating K-ras mutations in the induction of p21(WAF1/CIP1) overexpression. Relationship between p21(WAF1/CIP1) expression and HER-2/neu status in PanIN lesions and ductal adenocarcinoma of the pancreas was investigated in our study. Expression levels of p21(WAF1/CIP1) and HER-2/neu were examined imunohistochemically and the amplification of HER-2/neu gene was evaluated by fluorescence in situ hybridisation in HER-2/neu overexpressing adenocarcinomas. Fourty nine pancreatic resection specimens from patients with invasive adenocarcinoma were included into the study. A large spectrum of PanIN lesions adjacent to the structures of infiltrating adenocarcinoma was also examined. The possible role of HER-2/neu in an induction of p21(WAF1/CIP1) overexpression was not confirmed and p21(WAF1/CIP1) overexpression seems to be HER-2/neu independent in pancreatic ductal adenocarcinoma according to our results. Increasing levels of HER-2/neu expression were demonstrated in pancreatic intraepithelial neoplasia and in 18.75% of pancreatic adenocarcinoma. The only 2 from 9 HER-2/neu overexpressing adenocarcinomas showed the amplification of HER-2/neu gene. Based on these results, the overexpression of HER-2/neu in pancreatic adenocarcinoma seems to be a result of increased transcription rather than gene amplification. Therefore HER-2/neu represents a good target for therapy of pancreatic adenocarcinoma only in isolated cases.

[Apoptosis and expression of bcl-2 protein in invasive ductal adenocarcinoma of the pancreas]

Apoptosis plays a central role in the development and/or progression of cancer. There are several methods for detection of apoptotic cells in tissue sections including light and electron microscopy, in situ nick end-labeling (ISEL), TdT-mediated dUTP nick-end labeling (TUNEL) and immunohistochemical detection of proteins associated with apoptosis. Apoptosis was assessed by the monoclonal antibody M30 CytoDEATH (M30), which is specific for neo-epitope in cytokeratin 18 that becomes available at an early caspase cleavage during apoptosis. Expression of bcl-2 protein was evaluated, because bcl-2 protein plays an important role in the regulation of apoptosis. Twenty-six invasive ductal adenocarcinomas of the pancreas were studied immunohistochemically with antibodies M30 and bcl-2. The mean apoptotic index (AI, the percentage of apoptotic cells of the total tumor cells number) was 2.75%. High AI (> 10%) was observed in 4 cases of the 26 pancreatic carcinomas (15%). Protein bcl-2 was expressed in 3 cases (11.5%). The AI did not correlate with the expression of protein bcl-2. In conclusion, the detection of neo-epitope in cytokeratin 18 by monoclonal antibody M30 can be used for quantification of apoptotic cells with immunohistochemical techniques in tissue sections. It is a new approach to evaluate apoptosis in pancreatic carcinomas. The low positivity of bcl-2 expression in pancreatic adenocarcinomas suggests that bcl-2 protein does not play a central role in pancreatic tumorigenesis and cancer progression.

[Disorders of laminins in diseases of myocardial and skeletal muscles]

The Emery-Dreifuss muscular dystrophy is caused by muscular lesions and disorders of cardial rhythm and/or by cardiomyopathy. An autosomal dominant form is related to mutations of genes, which are coding for lamins A/C.

GROUP AND METHODS

In the group A the authors examined 37 patients with the diagnosis of dilatation cardiomyopathy (DKMP) and the mean ejection fraction 28.4; 8.8%. In the group B of 13 patients a cardiac stimulator was implanted for a rhythm disorder. Both groups were subjected to cardiological, neurological, clinical and electromyographic (EMG) examinations. A muscle biopsy from m. vastus lateralis was made and the sample was evaluated by histology, histochemistry and immunohistochemistry. The coding sequences of genes for lamins were amplified by polymerase chain reaction and the products were analyzed by the DHPLC method (denaturing higher performance liquid chromatography).

RESULTS

In the group A there was a clinically myopathic picture in three patients, while EMG examination revealed a myogenic finding in 12 patients and a marginally myogenic one in five patients. The histological finding in 12 patients was evaluated as myogenic and marginally myogenic in six. In one patient the mutation analysis revealed mutation in the gene for lamin A/C. A myogenic finding in this patient was determined by EMG as well as by histological examination and the autosomal dominant form of the Emery-Dreifuss muscular dystrophy was therefore diagnosed. In the group B one patient displayed a myopathic neurological finding and a myogenic finding during EMG. A subsequent mutation analysis revealed a mutation in the gene for lamin A/C. The case was therefore the autosomal dominant form of the Emery-Dreifuss muscular dystrophy. In the other patients the clinically marginal myopathic finding was observed once, a marginally myogenic finding during EMG was seen five times, histology and immunochemistry revealed a myogenic finding once and a marginally myogenic finding also once. The other findings were within normal range.

CONCLUSIONS

A careful neurological examination including EMG determined symptoms of skeletal muscle myopathies in a surprisingly high percentage of our cardiological patients. This observation draws attention to the need of neurological examination in patients with DKMP in order to discovered disorder in this area in time. In two patients mutations in genes coding lamins A/C were detected. It would be useful to analyze also genes coding for other cytoskeletal proteins in the future.

[Molecular diagnosis in pancreatic carcinoma]

Present diagnostic possibilities virtually do not make it possible to diagnose early stages of pancreatic cancer. Likewise, it is very difficult to differentiate between pancreatic cancer and chronic pancreatitis. The methods of visualization are insufficiently sensitive and the determination of certain genes could enrich our diagnostic opportunities. Considerable attention in this direction has been devoted to the determination and evaluation of the presence of oncogene K-ras. Our initial experience with the determination of K-ras in preparations from patients with pancreatic cancer or with chronic pancreatitis confirmed that K-ras in an oncomarker associated with adenocarcinoma of pancreas, whereas in patients with chronic pancreatitis it occurs in about 10% of the examined samples.

Relationship between K-ras mutation and the expression of p21WAF1/CIP1 and p53 in chronic pancreatitis and pancreatic adenocarcinoma

Overexpression of p21WAF1/CIP1 was recently described as an early event in the development of pancreatic intraepithelial neoplasia. Since activating K-ras mutations are described in more than 80% of pancreatic cancers and are known to increase intracellular levels of p21WAF1/CIP1 in experimental models, the possible role of activating K-ras mutations in an induction of the p21WAF1/CIP1 expression was investigated in our study. We examined 71 surgical specimens, 29 of chronic pancreatitis and 42 of invasive ductal adenocarcinoma both having a large spectrum of PanIN (pancreatic intraepithelial neoplasia) lesions. Expression of p53 and p21WAF1/CIP1 was examined immunohistochemically and codon 12 K-ras mutational analysis was performed using the very sensitive mutant-enriched PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) analysis. Our study demonstrated the overexpression of p21WAF1/CIP1 as an early event in the development of pancreatic intraepithelial neoplasia in the group of chronic pancreatitis and invasive adenocarcinoma as well. Overexpression of p21WAF1/CIP1 increased progressively from normal ducts through the spectrum of PanIN lesions to invasive carcinomas. The p53 overexpression increased again progressively according to the severity of the lesion and seems to be a later event in the development of pancreatic intraepithelial neoplasia if compared to p21WAF1/CIP1 expression. Our results confirmed also the possible p53 independent p21WAF1/CIP1 expression in some PanIN2, PanIN3 lesions and invasive carcinomas. K-ras mutations were not revealed in samples with only low grade PanIN lesions (PanIN1a and PanIN1b). K-ras mutations were detected in 69,4% adenocarcinomas and in only one case of chronic pancreatitis. Two codon 12 K-ras positive pancreatic carcinomas showed K-ras mutations in the surrounding normal pancreatic tissue. In adenocarcinomas, no statistically significant correlation was found between K-ras mutational status and p21WAF1/CIP1 and p53 expression, respectively. The possible role of activating K-ras mutations in an induction of p21WAF1/CIP1 expression was not confirmed in this study.

[Detection of carriers of Duchenne and Becker muscular dystrophy using the fluorescence in situ hybridization method]

Duchenne and Becker muscular dystrophies (DMD/BMD) are X-linked recessive disorders caused by mutations in the dystrophin gene. A large intragenic deletion has been described in about 65% of DMD/BMD patients. Mothers of affected males are DMD/BMD carriers in two thirds of the cases. Routine deletions detection in DMD/BMD males is performed using multiplex polymerase chain reaction (mPCR), RT-PCR with a protein truncation test (PTT) or using Southern blotting. In females the deletions detection is complicated by the presence of a normal gene copy on the second X-chromosome. We are presenting the diagnostic strategy using FISH for the deletions detection in the dystrophin gene of female DMD/BMD carriers. We have used a set of six cosmid probes for the detection of the most frequently deleted areas of the dystrophin gene from the Department of Human Genetics, Leiden University Medical Center. We have examined 14 mothers of DMD/BMD males with a deletion in the dystrophin gene identified using mPCR. Four mothers of affected males have been diagnosed as carriers of a deletion in the dystrophin gene. We have revealed no deletion mutations in the exons examined in a control group of four healthy females. No discrepancy has been found between the FISH analysis results and the results of mPCR. Our results indicate that FISH is an effective and direct method for the identification of DMD/BMD carriers and we suggest this method as a method of a first choice in the identification of DMD/BMD carriers.

[Muscular dystrophies detected by immunophenotyping and genotype analysis (mRNA and DNA)]

Complex diagnosis of muscular dystrophies including clinical, bioptical and molecular genetic approaches has been provided in a limited extent in this country. Our group of neurologists, pathologists and geneticists has examined approximately 240 patients suspected of having muscular dystrophies, mostly coming from Southern and Northern Moravia. The patients were sent to the examination most often from departments of neurology and clinical genetics, and less frequently from departments of internal medicine. According to the final diagnosis, the patients were divided into groups: with dystrophinopathies and carriers of dystrophinopathies (DMD/BMD), merosin deficient form of congenital muscular dystrophy, and Emery-Dreifuss muscular dystrophy including the carriers of this disease. Some relatives of patients with dystrophinopathies were also examined using the methods of segregation analysis. High proportion of the DMD/BMD patients can be detected by the methods of molecular genetics. Analysis of mRNA using RT PCR and PTT enables the detection of deletions, duplications, and point mutations in dystrophin gene and encompasses a larger diagnostic scope in comparison with examinations of DNA level by the multiplex PCR method from the peripheral blood which enables only deletion detections. Immunophenotyping of the dystrophin protein plays an important role especially using antibodies against carboxyterminal (DYS2) and rod domain (DYS1) of dystrophin. Deficient sarcolemmal expression of DYS2 and DYS1 reveals unambiguously a pathological dystrophin. On the other hand, less pronounced deficiencies in dystrophin expression in BMD patients and DMD/BMD carriers may not always be detected in muscle biopsies. In this case, it is necessary to supplement the examination by Western blotting and genotype analysis. The examination of patients with clinically diagnosed muscular dystrophy should start with a muscle biopsy which enables the estimation of presence and degree of structural changes. Application of antibodies against the components of DGC and emerin may reveal a deficiency in expression of these proteins. Immunohistochemical examination completed by Western blotting leads to the subsequent molecular genetic analysis of DNA or mRNA. Secondary deficiencies in expression of other DGC proteins are often revealed in muscle biopsies of dystrophinopathies and this fact must be taken into account in the evaluation of immunohistochemical findings. There is a possibility of replacement of invasive muscle biopsy by skin biopsy or buccal mucosal smears in cases of merosin and emerin deficiencies. Commercially available antibodies against merosin, emerin, calpain and sarcoglycans enable extensive identification and detailed classification of muscular dystrophies. Screening of the patients based on the application of methods described and discussed in this report is the task of the forthcoming period.

[Congenital myopathy with type 2 fiber hypoplasia]

An atypical case of congenital myopathy characterised by a low frequency of hypoplastic type 2A fibres, type 2B fibre deficiency and type 1 fibre predominance is reported. Our patients are siblings, a 10 year old girl and a 7 year old boy. Both children suffered from ophthalmoplegia and muscle weakness, and the boy also showed signs of psychomotoric retardation. A muscle biopsy from musculus trapezius has shown type 1 fibre predominance and hypoplastic type 2 fibres.

Novel dystrophin mutations revealed by analysis of dystrophin mRNA: alternative splicing suppresses the phenotypic effect of a nonsense mutation

The complete dystrophin mRNA sequence has been analyzed in 20 Duchenne muscular dystrophy and Becker muscular dystrophy patients. In 13 cases, deletions in mRNA were detected using reverse transcription-polymerase chain reaction and in another seven cases, point mutations were found using the protein truncation test. Sixteen patients diagnosed with Duchenne muscular dystrophy showed the presence of deletions or of nonsense point mutations. From four patients with the Becker muscular dystrophy phenotype, three cases were associated with deletions conserving the translational frame and one was associated with a nonsense mutation E1110X. In the case of the E1110X mutation, an alternative splicing of dystrophin mRNA (3485-3640del) was detected in this patient which included the E1110X mutation site (nucleotide 3536) and did not change the translation reading frame. Individual nonsense point mutations were characterized by sequence analysis, which showed five novel mutations with respect to those reported in the Cardiff Human Gene Mutation Database http://uwcm.web.cf.ac.uk/uwcm/mg/hgmd0.html and the Leiden muscular dystrophy pages http://www.dmd.nl/.

[Physical training in patients with chronic heart failure: functional fitness and the role of the periphery]

In recent years evidence is increasing on the usefulness of physical loads and controlled physical training in patients with chronic heart failure (CHSS). In the presented work the authors assessed changes of the functional capacity and muscular strength after training on a bicycle ergometer. The group comprised 38 patients with CHSS due to IHD or dilatation cardiomyopathy NYHA II-III, EF lower than 40%, with a peak oxygen consumption (pVO2) lower than 20 ml/kg/min. The group was subdivided in a random fashion to subjects participating in training (T) and the control group (K). The patients were subjected to clinical examination, examination by common laboratory methods, spiroergometry, dynamometry. By the puncture technique a specimen of the m. vastus lateralis was taken for histological and histochemical examination of the muscle. The patients trained on the bicycle ergometer three times per week for a period of eight weeks, one exercise session lasted 30 minutes and was at the level of the anaerobic threshold. After completion of the training period the examinations were repeated.

RESULTS

Before the onset of training the groups did not differ in any indicators. After termination of training they increased in group T: pVO2 from 18.9 +/- 4.8 to 22.13 +/- 15.72 ml/kg/min. (p < 0.0004), the oxygen consumption at the level of the anaerobic threshold (VO2AT) from 13.4 +/- 3.4 to 15.96 < or = 3.75 ml/kg/min. (p < 0.0006), the respiratory quotient (RQ) from 0.93 +/- v0.09 to 0.97 +/- 0.006 (p < 0.05), the maximal tolerated load from 0.72 +/- 0.72 to 1.08 +/- 0.33 W/kg (p <0.002), the maximal voluntary contraction of the femoral quadriceps muscle (MVC START) from 291.2 +/- 70.1 to 328.1 +/- 66.0 N (p<0.01), the maximal voluntary contraction of this muscle after 20 mins. of repeated contractions (MVC END) from 157.6 +/- 109 to 290.1 +/- 64.9 N (p < 0.01), the decrease of the maximal contraction after 20 minutes of repeated contractions was from 52.8 +/- 32.1 to 12.4 +/- 5.0% (p < 0.01). After training there were statistically significant differences between groups in VO2AT (p < 0.01), in pVO2 (p < 0.03) and in the decrement of the maximal muscular contraction (p < 0.01). The authors found a trend towards normalization of the diameter of muscle fibres I and II and of their ratio. The ventilation equivalent for carbon dioxide VE/VCO2 during the maximal tolerated load correlated significantly with the systemic and pulmonary vascular resistance, with RQ, VO2AT, pVO2, with the maximal tolerated load and with the blood level of prostaglandin F.

CONCLUSION

Controlled physical training in patients with CHSS was safe, led to a significant improvement of spiroergometric indicators, load tolerance and muscular strength. After training there was a trend towards normalization of pathological changes in skeletal muscle. Based on the authors' experience and findings of other authors it is advisable to recommend training as part of treatment of patients with CHSS.

Detection of cytoskeletal proteins in small cell lung carcinoma

Small cell lung carcinoma (SCLC) is the most aggressive of lung tumors, metastasize widely and are virtually incurable by surgical means. Therefore, the classification of lung cancer into SCLC and non-small cell lung carcinoma is essential for disease prognosis and treatment. For this purpose we have compared the immunohistochemical distribution of different cytoskeletal proteins as tumor markers. Analysis was performed by using of monoclonal antibodies directed against cytokeratins, neurofilaments, betaIII-tubulin, epithelial membrane antigen and neuron-specific enolase. Our results indicate that keratin and epithelial membrane antigen are reliable epithelial markers for SCLC. In addition, the positive staining with monoclonal antibodies TU-20 against betaIII-tubulin and neuron-specific enolase was found in some cases of SCLC. We suggest, that these antibodies could be a useful tool for complex immunohistochemical diagnosis of SCLC.

The up-regulation of utrophin is not limited to muscular dystrophies

Immunohistochemical reactivity for utrophin has been recorded in 45 biopsies from patients with various neuromuscular diseases. The upregulation of utrophin on the extrajunctional sarcolemma has been found in dystrophinopathies, other muscular dystrophies, congenital myopathies, inflammatory myopathies, neurogenic muscle disorders (diabetic neuropathy, amyotrophic lateral sclerosis and spinal muscular atrophies), minimal change myopathies as well as in some normal biopsies.

[Whipple's disease, early diagnosis, early therapy]

The authors describe a case of Whipple's disease diagnosed early during gastroduodenofibroscopy from a bioptioc specimen of the prepyloric gastric mucosa, and treated in time. The disease was complicated by superinfection with Salmonella enteritidis. In the clinical picture digestive symptoms predominated, loose stools, malabsorption, loss of body weight, anaemia, skin pigmentation. After antibiotic and later chemotherapeutic treatment clinical symptoms receded and the histological finding in bioptic specimens from the stomach was normal.

Expression of class III beta-tubulin in normal and neoplastic human tissues

The class III beta-tubulin isotype is widely used as a neuronal marker in normal and neoplastic tissues. This isotype was, however, also immunodetected in certain tumours of non-neuronal origin such as squamous cell carcinoma. Using a newly described monoclonal antibody we compared the distribution of class III beta-tubulin in normal and neoplastic tissues. The TU-20 mouse monoclonal antibody was prepared against a conserved synthetic peptide from the C-terminus of the human class III beta-tubulin isotype, and its specificity was confirmed by immunoblotting, by competitive enzyme-linked immunosorbent assay and by immunofluorescence microscopy on cultured cells. In different cell lines of various origins the antibody reacted only with neuroblastoma Neuro-2a cells and with embryonal carcinoma P19 cells stimulated to neuronal differentiation by retinoic acid. Immunohistochemistry on formaldehyde-fixed paraffin-embedded normal human tissues revealed the presence of the class III beta-tubulin isotype in cell bodies and processes of neuronal cells in the peripheral and central nervous systems. In other tissues, this beta-tubulin isotype was not immunodetected. Class III beta-tubulin was found in all cases of ganglioneuroblastoma, ganglioneuroma, medulloblastoma, neuroblastoma, sympathoblastoma and in one case of teratoma. In contrast, no reactivity was detected in tumours of non-neuronal origin, including 32 cases of squamous cell carcinoma. The results indicate a specific TU-20 epitope expression exclusively in neuronal tissues. The antibody could thus be a useful tool for the probing of class III beta-tubulin functions in neurons as well as for immunohistochemical characterisation of tumours of neuronal origin.

[Monoclonal antibodies to dystrophin in biopsy diagnosis of Duchenne and Becker progressive muscular dystrophies]

Immunohistochemical method detecting dystrophin in muscle biopsies was introduced and applied in 121 cases with a large scale of neuromuscular diseases. A monoclonal antibody NCL-DYS 2 (Novocastra) was used for the detection of C-terminal domain of dystrophin. Normal, i.e. sarcolemmal, localization of dystrophin was found in controls, in inactivity atrophy, neurogenic lesions and congenital myopathies. A similar situation except regenerating fibres was found in myositis and progressive muscular dystrophies different from Duchenne (DMD) and Becker (BMD) types, DMD cases showed a complete or nearly complete loss of sarcolemmal reaction product, whereas a partial loss of dystrophin in membrane was found in BMD cases as well as in transmitter females. Fibres splitting during neurogenic and myogenic lesions had dystrophin in newly produced sarcolemmal parts. Sarcolemmal immunoreactivity starting as early as in the 10th-12th week of gestation was found in human fetuses.

Expression of phosphorylated high molecular weight neurofilament protein (NF-H) and vimentin in human developing dorsal root ganglia and spinal cord

The expression of vimentin and the phosphorylated variant of high molecular weight neurofilament protein (NF-H) was studied in developing human fetal dorsal root ganglia and spinal cord. The technique used for examination of cryosections was double-label fluorescence with monoclonal antibodies. Both proteins were present in the nerve fibres inside the ganglia of 6- and 8-week-old embryos. During further development the expression of vimentin continued to increase in the satellite cells, but was found to be decreasing in the ganglion cells. Phosphorylated NF-H was found in the processes of ganglion cells, as well as in the perikarya at all developmental stages. In the spinal cord of 6- and 8-week-old embryos, phosphorylated NF-H protein was found in the longitudinal fibres of the marginal layer and in processes of the mantle zone; some of the fibres also contained vimentin. Later the co-expression of the two proteins ceased and vimentin was found only in glial and mesenchymal derivatives. Phosphorylated NF-H was located, at all developmental stages, in the axons of both white and grey matter, but not in the neuronal perikarya. The results indicate that phosphorylation of the NF-H in human dorsal root ganglia starts in the perikarya of the ganglion cells while in the ganglion cells of the spinal cord it takes place in the axons.

[Differential diagnosis in early muscular hypotonia: spinal atrophy]

Changes in type, size and structure of muscle fibres were analyzed in 68 biopsies with clinical and morphological signs of spinal atrophy. Reliability of clinical prebioptic diagnosis was evaluated in comparison with bioptic finding and final diagnosis. Muscle biopsy is often to be performed in spite of apparently unambiguous clinical and electromyographical finding. Contribution of biopsy to the diagnosis of spinal atrophy with characteristical grouping of atrophic fibres is undisputable in most cases. However, unproper sampling in excessively atrophic areas and structural "myogenic" changes can made the bioptic diagnosis difficult or impossible. Size analysis of muscle fibres proved participation of both the basic fibre types in atrophy with increase in number of immature type 2c fibres, and prevalence of type 1 fibres in hypertrophic areas (compensatory hypertrophy or re-innervation respectively) where also hybrid fibres can often be found during transformation of their type. Angular atrophic fibres occurring in hypertrophic fibre groups gave evidence of continuous or secondary denervation in benign forms of spinal atrophy. The author found regressive structural changes in benign form and in malignant Werdnig-Hoffman atrophy either--though less extensive.

[Computer tomography in the diagnosis of neuromuscular diseases in children]

Recently in the literature occasional reports were published on the use of computed tomography (CT) in the diagnosis of neuromuscular diseases. The authors compared in a group of 23 children aged 3 to 15 years the results of clinical, laboratory, electromyographic, bioptic and CT findings on muscles. Only in four children the result of CT did not correlate with the clinical finding because of the incipient stage of the disease with structural changes which were yet only slightly expressed. Consistent with data in the literature it was possible from the CT to differentiate primary myopathies from neurogenic ones. The objective of the work was to prove the assets of the new method in the diagnosis of neuromuscular diseases, in particular in young children who do not cooperate during routine EMG examinations. There CT is an important guide for selective EMG and in particular for aimed bioptic studies which still hold priority in the specification of the disease. In already diagnosed and treated patients it is possible to investigate by means of CT the course of the disease by a non-invasive approach.

[Monoclonal antibodies against intermediate cytoskeletal filaments. Their importance in the study of tissue differentiation and biopsy diagnosis]

The expression of intermediate filaments during tissue differentiation, in mature tissues and in their neoplastic derivatives (lungs, thyroid gland, kidney, uterus, CNS) was investigated by means of monoclonal antibodies prepared in our departments (Institute of Molecular Genetics, Czechoslovak Academy of Sciences, Prague and in the Department of Immunology and Molecular Biology, Brno). The conclusions of these investigations provide evidence of the restricted specificity of detection of intermediate filaments in relation to germ layers and mesenchymal vs. epithelial set-up of tissues and the need of knowledge of the differential programme of a given tissue for the interpretation of the presence of intermediate filaments in tumours which develop from it.

Expression of vimentin and glial fibrillary acidic protein in human developing spinal cord

Expression of intermediate filament proteins was studied in human developing spinal cord using immunoperoxidase and double-label immunofluorescence methods with monoclonal antibodies to vimentin and glial fibrillary acidic protein (GFAP). Vimentin was found in the processes of radial glial cells in 6-week embryos, while GFAP appeared in vimentin-positive astroglial cells at 8-10 weeks. GFAP and vimentin were present in approximately equal amounts in differentiating astrocytes in 23-week spinal cord. In 30-week fetuses, astrocytes reacted strongly for GFAP, while both the reaction intensity and the number of vimentin-positive cells fluctuated predominantly in the grey matter. No clear-cut transition from vimentin to GFAP was noticed during the development of astrocytes. The majority of ependymal cells in 23-week fetuses contained vimentin but only a few of them reacted for GFAP. The expression of vimentin continued during the whole development of the ependymal layer, in contrast to the reactivity for GFAP which disappeared between the 30th week and term.

Differential expression of keratin 19 in normal human epithelial tissues revealed by monospecific monoclonal antibodies

Three monospecific monoclonal antibodies (BA16, BA17 and A53-B/A2) recognizing different epitopes of the human keratin 19 were used to determine tissue distribution of this 40 kDa keratin polypeptide. Immunohistochemical methods revealed four different staining patterns among normal human epithelial tissues: firstly, complete negativity of the epidermis, sebaceous glands, hepatocytes and other tissues; secondly, homogeneous positivity as seen for example in the gall bladder and urinary bladder epithelium, endometrium and many other epithelia; thirdly, a mosaic of positive and negative cells among mammary gland luminal cells, prostate epithelia and some other epithelia and fourthly, a more complex heterogeneous pattern found in non-keratinizing squamous epithelia and hair follicles with generally the basal layer being the most strongly or sometimes exclusively stained. The pattern seen in non-keratinizing squamous epithelia varied considerably according to the fixation method and the antibody used as well as among different donors and in different areas of the same organ. The other three staining patterns were on the other hand nearly identical with all three antibodies on both frozen sections and sections of methacarn-fixed paraffin-embedded tissues. Our results provide evidence for differential expression of the human keratin 19 at the single cell level, an observation which could be exploited in the study of epithelial differentiation and pathology.

[Rhabdomyoma of the vagina]

Three cases of benign vaginal rhabdomyoma were examined by light and electron microscopy. Frequency, localization, genesis, nomenclature, and differential diagnosis of the rare tumour were discussed.

[Histochemical diagnosis of Hirschsprung's disease]

Examination of 65 rectal biopsies and 10 resections by the histochemical detection of cholinesterase leads to the following conclusions: 1. Density of the nerve fibers in lamina propria is irregular and the examination of the cholinesterase activity may lead to falsely negative results in aganglionosis. 2. Constant is, in aganglionosis, the finding of markedly increased reaction in the nerve fibers of the muscularis mucosae and submucosa. 3. Biopsy must, therefore, include even muscularis mucosae and the choice of the instrument for biopsy removal must meet this requirement.

[Primary amyloidosis of the brain in 34-year-old man]

In a male aged 34 dying suddenly with symptoms of cerebral haemoarrhage, amyloid deposits were found in the vicinity of arterioles, venules, small arteries and veins. In the vicinity of lateral ventricles, particularly around the frontal horns, the amyloid formed compact masses macroscopically presenting as grayfish areas showing a distinctly firmer consistency. The perivascular aggregates strongly resembled those occurring in Alzheimer's disease.

Improved localization of thiamine pyrophosphatase activity in mounted cryostat sections using gel fixation and gel incubation media

The presence of 1% agar in the fixation and substrate solutions for the histochemical demonstration of thiamine pyrophosphatase (4.4 mM TPP; 3.6 mM Pb2+; 0.025 Tris-maleate buffer, pH 7.2) clearly facilitates the localization of the enzyme in Golgi apparatus in cold microtome sections prepared from unfixed specimens.

[Neurogenic muscular lesion presenting a picture of "central core disease"]

A neurogenic lesion has been described in mother and son. In the son there was a prevalence of denervation changes whereas reinervation ones prevailed in the mother. In both, "central cores" were present in aggregations of type-1 fibres. In the authors' opinion the findings represent a neurogenic lesion (also verified clinically and electromyographically), less advanced in the son and more advanced in the mother, ultimately stabilizing to yield a pattern resembling that of the "central core disease".

[Histochemical and quantitative methods in the biopsy examination of skeletal muscles]

A complex bioptic examination of skeletal muscles as carried out in 280 excised samples has been subjected to a critical analysis. The examination suggested consists of histological and histochemical processing of native cryostat sections. Besides conventional staining methods the techniques recommended include the reaction for detection of myosin ATP-ase with and without acid preincubation, and reactions for NADH tertazolium reductase, acid phosphatase, nonspecific esterase, glycogen and lipids. Sections stained for ATP-ase are suitable for quantitative examinations such as assessing the diameters of muscle fibres.

The possibilities and limitations of membrane methods for the histochemical demonstration of cholinesterases

The thiocholine method for the histochemical detection of cholinesterases according to Karnovsky-Roots was adapted for unfixed cryostat sections by addition of the agar solution to the incubation mixture and by using the semipermeable membrane interposed between the section and the incubation medium. The procedure prevents the leakage of the enzyme activity of the section and is suitable for tissues where the cholinesterase activity is low.