Exploring p53 protein expression and its link to TP53 mutation in myelodysplasia-related malignancies-Interpretive challenges and potential field of applications

AIMS

TP53 alterations have a significant prognostic effect in myeloid neoplasms. Our objective was to investigate the TP53 gene mutation status, p53 protein expression and their relationship in dysplasia-related myeloid neoplasms with varying levels of myeloblast counts.

METHODS AND RESULTS

A total of 76 bone marrow biopsy samples with different blast counts were analysed. Total and strong (3+) p53 expression was determined. Dual immunohistochemical staining was performed to determine the cell population associated with p53 expression. NGS analysis was performed using the Accel-Amplicon Comprehensive TP53 panel. Both p53 expression and TP53 VAF showed a significant correlation with the myeloblast ratio (P < 0.0001); however, p53 expression was also present in other cell lineages. The VAF value exhibited a significant correlation with p53 expression. A high specificity (0.9800) was observed for TP53 mutation using the ≥ 10% strong (3+) p53 cut-off value, although the sensitivity (0.4231) was low.

CONCLUSIONS

Strong (3+) p53 expression using a ≥ 10% cut-off value accurately predicts TP53 mutation but does not reveal the allelic state. The p53 expression is significantly influenced by myeloblast count, and histological interpretation should consider the presence of intermixed non-neoplastic marrow cells with varying physiological p53 expression.

Case report: Complex evaluation of coagulation, fibrinolysis and inflammatory cytokines in a SARS-CoV-2 infected pregnant woman with fetal loss

Background

SARS-CoV-2 infection during pregnancy increases the risk of severe obstetrical complications. Detailed evaluation of COVID-19-associated coagulopathy in a pregnancy with stillbirth hasn't been described so far. Besides knowledge gaps in the pathomechanism leading to stillbirth in COVID-19 pregnancies, currently, no prognostic biomarker is available to identify pregnant patients who are at imminent risk of COVID-19-associated maternal and fetal complications, requiring immediate medical attention.

Case

Here we report the case of a 28-year-old SARS-CoV-2 infected pregnant patient, admitted to our hospital at 28 weeks of gestation with intrauterine fetal loss. The presence of SARS-CoV-2 placentitis was confirmed by immunohistological evaluation of the placenta. She had only mild upper respiratory symptoms and her vital signs were within reference throughout labor and postpartum. The stillborn infant was delivered per vias naturales. Fibrinogen concentrate was administered before and after labor due to markedly decreased fibrinogen levels (1.49 g/l) at admission and excessive bleeding during and after delivery. Although coagulation screening tests were not alarming at admission, the balance of hemostasis was strikingly distorted in the patient. As compared to healthy age- and gestational age-matched pregnant controls, increased D-dimer, low FVIII activity, low FXIII level, marked hypocoagulability as demonstrated by the thrombin generation assay, together with shortened clot lysis and decreased levels of fibrinolytic proteins were observed. These alterations most likely have contributed to the increased bleeding observed during labor and in the early postpartum period. Interestingly, at the same time, only moderately altered inflammatory cytokine levels were found at admission. Serum ACE2 activity did not differ in the patient from that of age- and gestational age-matched healthy controls, suggesting that despite previous speculations in the literature, ACE2 may not be used as a potential biomarker for the prediction of COVID-19 placentitis and threatening fetal loss in SARS-CoV-2-infected pregnancies.

Conclusions

Although based on this case report no prognostic biomarker could be identified for use in pregnant patients with imminent risk of fetal loss associated with COVID-19 placentitis, the above-described hemostasis alterations warrant awareness of postpartum hemorrhagic complications and could be helpful to identify patients requiring intensified medical attention.

Comparison of pre-mortem 2D-3D ultrasound examination to post-mortem micro-CT of carotid arteries - first experiences

Background and purpose

A prerequisite for the treatment of carotid atherosclerosis is the accurate measurement of the stenosis, that is most commonly evaluated by duplex ultrasonography. In this study, we aimed to verify the reliability of 2D and 3D ultrasonography, comparing the data to results of post-mortem micro-CT examination.

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Methods

Neurological patients with any life-threatening, presumably fatal neurological disease were enrolled. Ultrasound examinations were performed with a Philips Epiq 5G machine, using a VL13-5 broadband linear volume array transducer. Plaque length, diameter and vessel area reduction (stenosis) were calculated using the 2D images. Finally, the stenosis was reassessed using automatized, 3D application as well. After the death of the patient, autopsy was performed, during which the previously examined carotid artery was removed. The samples were examined with micro-CT. Similar to the ultrasound examination, plaque length, diameter and vessel area reduction (stenosis) were determined.

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Results

Ten vessels of seven patients were eligible for complex comparison. Plaque diameter and length measured by CT did not correlate with the ultrasound data. CT-measured axial plaque and vessel areas showed no correlation with ultrasound results either. While determining the strength of correlation between stenoses measured by the different modalities, significant correlation was found between the results measured by ultrasound (2D) and CT (Pearson r: 0.902, P<0.001).

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Conclusion

Three-dimensional ultrasound analysis is a spectacular method for examining carotid plaques, as it can assist in a more detailed evaluation of the plaque morphology and composition, thereby identifying plaques with a particularly high risk of stroke. Micro-CT is an excellent tool for the exact determination of calcified plaque areas, but ultrasound images are not suitable yet for such a precise examination due to acoustic shadowing and artifacts.

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Loss of Uncoupling Protein 1 Expression in the Subcutaneous Adipose Tissue Predicts Childhood Obesity

Stimulation of thermogenesis by inducing uncoupling protein 1 (UCP1) expression in adipocytes is thought to promote weight loss by increasing energy expenditure, and it is postulated that the human newborn has thermogenic subcutaneous fat depots. However, it remains unclear whether a relevant number of UCP1-expressing (UCP1+) adipocytes exist in the early postnatal life. Here we studied the distribution of UCP1 and the expression of thermogenic genes in the subcutaneous adipose tissues of the human fetus, infant and child. We show that the deep layer of human fetal and neonatal subcutaneous fat, particularly the abdominal wall, is rich in UCP1+ adipocytes. These adipocytes develop in the late third trimester and persist throughout childhood, expressing a panel of genes linked to mitochondrial biogenesis and thermogenesis. During the early childhood adiposity rebound-a critical phase that determines obesity risk later in life-the absence of adipose tissue UCP1 expression in children with normal body mass index (BMI) correlates with an obesity-associated gene expression signature. Finally, UCP1 expression is negatively correlated with BMI z-score and adipocyte size in infants and children. Overall, our results show that the absence of UCP1 expression in adipose tissue is an early indicator of adipose tissue expansion in children.

Grade Group accuracy is improved by extensive prostate biopsy sampling, but unrelated to prostatectomy specimen sampling or use of immunohistochemistry

Assessing the accurate Grade Group of a prostate needle biopsy specimen is essential for choosing the adequate therapeutic modality for prostate cancer patients. However, it is well-known that biopsy Grade Group tends to up- or downgrade significantly at radical prostatectomy. We aimed to investigate the correlation between accuracy and biopsy core number, performed immunohistochemical staining (IHC) or prostatectomy specimen sampling, with the latest also being correlated with higher detection rates of adverse pathological features, e.g., positive surgical margins, higher pathological stage or presence of perineural invasion (PnI status). The study cohort consisted of 315 consecutive patients diagnosed with prostate adenocarcinoma via transrectal ultrasound-guided needle biopsy who later underwent radical prostatectomy. We grouped and compared patients based on Grade Group accuracy, presence of IHC on biopsy, margin status, pathological stage, and PnI status. Inter-observer reproducibility was also calculated. Statistical analyzes included ANOVA, Tukey's multiple comparisons post hoc test, Chi-squared test, and Fleiss kappa statistics. Undergraded cases harboured a significantly lower number of biopsy cores (p < 0.05), than accurately graded cases. Using IHC did not affect grading accuracy significantly, nor did the number of slides from prostatectomy specimens. The mean number of slides was virtually identical when margin status, pathological stage and PnI status of prostatectomy specimens were compared. Inter-observer reproducibility at our institute was calculated as fair (overall kappa = 0.29). Grade Group accuracy is significantly improved by obtaining more cores at biopsy but is unrelated to performed IHC. The extent of sampling prostatectomy specimens, however, did not affect accuracy and failed to significantly improve detection of adverse pathological features.

Evidence for postnatal neurogenesis in the human amygdala

The human amygdala is involved in processing of memory, decision-making, and emotional responses. Previous studies suggested that the amygdala may represent a neurogenic niche in mammals. By combining two distinct methodological approaches, lipofuscin quantification and ¹⁴C-based retrospective birth dating of neurons, along with mathematical modelling, we here explored whether postnatal neurogenesis exists in the human amygdala. We investigated post-mortem samples of twelve neurologically healthy subjects. The average rate of lipofuscin-negative neurons was 3.4%, representing a substantial proportion of cells substantially younger than the individual. Mass spectrometry analysis of genomic ¹⁴C-concentrations in amygdala neurons compared with atmospheric ¹⁴C-levels provided evidence for postnatal neuronal exchange. Mathematical modelling identified a best-fitting scenario comprising of a quiescent and a renewing neuronal population with an overall renewal rate of >2.7% per year. In conclusion, we provide evidence for postnatal neurogenesis in the human amygdala with cell turnover rates comparable to the hippocampus.

Lipofuscin labeling and ¹⁴ C retrospective birth-dating of neurons, along with mathematical modelling, here suggest continued postnatal neurogenesis in the human amygdala, rather than protracted maturation of developmentally generated neurons.

Discrepancies between clinical and autopsy findings in patients who had an acute stroke

Objectives

According to international observations, the incidence of clinical autopsies is declining worldwide, plummeting below 5% in the USA and many European countries. It is an unfavourable trend as, in 7%–12% of cases, recent clinicopathological studies found discrepancies that might have changed the therapy or the outcome if known premortem. As previous large-scale observations have examined varied patient populations, we aimed to focus on the differences between the clinical and pathological diagnostic findings in only patients who had a stroke.

Material and methods

We assessed the postmortem non-neuropathological and neuropathological findings of 534 consecutive patients who had a stroke who passed away. Systemic neoplasms, pneumonias, thromboembolisms and haemorrhagic transformations revealed only by autopsy were considered severe abnormalities; in addition, benign abnormalities important from an educational or scientific point of view were also recorded.

Results

In 26 of the 534 cases (4.9%), the presence of systemic neoplasms had already been confirmed in the clinical stage; however, 8 (1.5%) malignant tumours were only detected during autopsy. Also, 80 (15%) thromboembolic events, 73 (13.6%) pneumonias and 66 (18%) haemorrhagic transformations were only diagnosed at autopsy. Longer hospital stay (from admission to death) resulted in fewer discrepancies between clinical and autopsy diagnosis of thromboembolic events and pneumonias (p<0.01). In 169 cases, benign findings were detected.

Conclusions

While the type of acute stroke is reliably diagnosed with imaging techniques, postmortem autopsies are also important in patients who had a stroke as autopsies may reveal clinically silent diseases (eg, tumour), and contribute to knowing the actual incidence of stroke-related thromboembolic and pneumonia complications.

Haemangioma a méhnyakban: 4 eset ismertetése és irodalmi áttekintés

Összefoglaló. A haemangioma a női nemi szervekben viszonylag ritkán, a méhnyakban pedig még ritkábban fordul elő. Kis mérete és szegényes megjelenése miatt elkerülheti a figyelmet, előfordul azonban, hogy műtéti ellátást igénylő vérzést okoz. Az évek során 4 esetben (ebből 2 esetben terhesség alatt) diagnosztizáltunk méhnyak-haemangiomát (2 esetben cervicalis intraepithelialis carcinomával társulva), melyeknek ismertetjük változatos tüneteit, kolposzkópos megjelenését és a diagnózist biztosító szövettani (immunhisztokémiai) illusztrációit, valamint a képlet terhesség alatti fejlődésének kolposzkópos monitorizálását. 2 esetben capillaris (cavernosus) haemangiomát, 2 esetben arteriovenosus malformatiót igazoltunk. Az általunk hozzáférhető szakirodalomban nem találtunk magyar szerző(k)től beszámolót erről a cervicalis lokalizációjú, ritka, jóindulatú, de gyakran veszélyes vascularis daganatról. Orv Hetil. 2022; 163(5): 187–194.

Summary. Hemangioma is relatively rare in the female genital organs and even less common in the uterine cervix. Its small size and poor appearance often result in a missed diagnosis, but it may cause bleeding that requires surgery. Over the years, we have confirmed the diagnosis of cervical hemangioma in 4 cases including two in pregnancy. 2 cases were associated with cervical intraepithelial neoplasia. This case report describes the symptoms, colposcopic appearance, and histological characteristics including immunohistochemical findings, and the colposcopic monitoring of development of the condition during pregnancy. In 2 cases, a capillary (cavernous) hemangioma, in 2 cases an arteriovenous malformation was diagnosed. We did not find any report from Hungarian author(s) about this rare, benign, but often dangerous vascular tumor with cervical localization. Orv Hetil. 2022; 163(5): 187–194.

Vesicovaginal fistula repair after a failed Lehoczky's island flap procedure

Vesicovaginal fistula (VVF) is the most common genitourinary fistula associated with significant, detrimental impact on the quality of life. Surgical repair of VVF may be complex requiring tissue interposition techniques to bring fresh blood supply, minimize recurrence, and improve functional outcomes. The international literature is scarce regarding complications related to interposition tissue. However, caution is particularly recommended in selecting the tissue interposition technique to avoid unexpected and frustrating problems. We present a 57-year-old woman following multiple failed transvaginal and transabdominal VVF repairs involving a labium majus skin island flap (Lehoczky flap) after radical hysterectomy for cervical cancer.

The use of hysteroscopy in endometrial cancer: old questions and novel challenges

Endometrial cancer is the most common gynecological malignancy with a relatively good overall prognosis. It traditionally has two subtypes: type 1 (endometrioid carcinoma) and type 2 (non-endometrioid carcinoma). The prognosis is excellent for stage I endometrioid cancer, with a 5-year survival rate of 96%. However, the prognosis is much worse for women with high-risk endometrial cancer. Effective preoperative staging is important in order to tailor treatment and achieve optimal long-term survival. The majority of asymptomatic polyps detected by ultrasound are treated surgically. Conventionally, dilatation and curettage was performed to obtain a histological diagnosis, but nowadays hysteroscopy with biopsy is starting to be considered as the gold standard. Hysteroscopic resection seems to reduce the risk of underdiagnosed (atypical endometrial hyperplasia) endometrial cancer. To avoid the spread of malignant cells, hysteroscopy should be performed with concern to keep intrauterine pressure low. In comparison with cervical injection, the hysteroscopic method has a better detection rate in the para-aortic area during sentinel lymph node mapping. In the assessment of cervical involvement, the accuracy of magnetic resonance imaging is significantly higher than the accuracy of hysteroscopy. In fertility-sparing cases, hysteroscopic endometrium resection with progesterone therapy is an acceptable option.

Effectiveness of different methods for polypectomy in the menopause: a retrospective study

Introduction: Most endometrial polyps represent focal hyperplasia of the endometrium. Endometrial polyps can be diagnosed by ultrasound, hysterocontrast sonography, hysterosalpingography, endometrial biopsy, and uterine curettage, but diagnostic hysteroscopy is considered the gold-standard method, with the greatest sensitivity and specificity and also with the opportunity for treatment at the same time.Study design: A retrospective study was conducted on 424 patients between 2006 and 2018. The polyps were verified during diagnostic hysteroscopy and were removed by resectoscopy or curettage. All samples underwent histological examination. The effectivity of the type of resection and the recurrence rate were evaluated.Results: The average age of the patients was 60.2 ± 9.3 years. Polyps were excised in 62.97% by resectoscopic polypectomy and in 37.03% by curettage. Malignancy was confirmed in 4.24% of cases. Histological verification of polyps was 79.4% in the resectoscopy group and 69.04% in the curettage group; the difference was significant (p < 0.01). The recurrence rate was 20.47% after resectoscopy and 27.12% following curettage.Conclusion: Hysteroscopy remains the best option and the gold-standard method among diagnostic procedures of endometrial pathology. In this study, there was a significant difference in matching hysteroscopic and histological findings in the two methods of polypectomy. The recurrence rate is also lower following resectoscopy.

Dissemination of NDM-1 carbapenemase-producer Providencia stuartii strains in Romanian hospitals: a multicentre study

Several Romanian hospitals have noted increasing isolation of Providencia stuartii strains in recent years, with an alarming rate of carbapenem resistance. In order to provide molecular epidemiological data regarding their dissemination, 77 P. stuartii strains collected from five hospitals located in different regions of Romania were analysed. All strains harboured IncA/C plasmid, and 67 carried the blaNDM-1 gene. Six clonal clusters were differentiated by pulsed-field gel electrophoresis. The predominant subtype was found in all five hospitals. Our study highlights the need for efficient infection-control measures, the optimization of antibiotic use and the targeted surveillance for carbapenemase-producing P. stuartii.

Thyroid Carcinoma Coexisting with Hashimoto's Thyreoiditis: Clinicopathological and Molecular Characteristics Clue up Pathogenesis

Thyroid cancer (TC) coexisting with Hashimoto’s thyroiditis (HT) presents with several characteristic features including multifocality and lower clinical stages compared to de novo carcinomas but its exact biology is still not understood. We reexamined clinico-pathological and molecular correlations between Hashimoto’s thyroditis and papillary thyroid cancer. A total of 262 patients with TC was evaluated who underwent thyroidectomy at the Surgical Department of the University of Debrecen. Clinical data, histology and molecular data were evaluated. Our cohort included 43 patients (16.4%) with (5 male, 38 female) and 219 (83.6%) patients without coexisting HT (48 male, 171 female). Hashimoto’s thyroiditis related thyroid cancer presented predominantly (93.0% of the cases) with the papillary histological type. Multifocality was observed more frequently with coexisting HT (16/40; 40.0%) compared to cases uninvolved (45/190; 23.7%)(p = 0.034). In contrast, lymphatic metastasis (pN1) with a significantly reduced frequency in patients with HT (4/11; 36.4%) then without HT (34/41 pN1; 82.9%)(p = 0.002). BRAF V600E mutation could be demonstrated at significantly lower rates in cases of PTC + HT (32.1 vs 60.7%, p < 0.005). High incidence, multifocality and papillary morphology strongly support a causal relation between TC and preexisting Hashimoto’s thyroiditis, the latter to be considered as a preneoplastic condition promoting thyroid carcinogenesis.

A Case of Therapy-related Acute Myeloid Leukemia Following Treatment with 5-Fluorouracil

Therapy-related acute myeloid leukemia (t-AML) is most frequently observed after the use of alkylating agents and topoisomerase II inhibitors and is associated with the frequent occurrence of high-risk karyotypes, poor prognosis, and distinct clinical behavior. Therefore, identifying therapy-related causation among patients with newly diagnosed acute leukemia is of great interest. We report the case of a patient who developed therapy-related acute myeloid leukemia after exposure to antimetabolite chemotherapy and emphasize the importance of identifying genetic alterations when the possibility of a therapy-related origin arises.

[Clinico-pathological features of papillary thyroid cancer coexistent with Hashimoto's thyroiditis]

INTRODUCTION AND AIM

Former studies suggest the frequent coexistence of Hashimoto's thyreoditis with papillary thyroid cancer, frequently featured by multifocal carcinogenesis but lower clinical stages compared to thyroid cancers lacking thyroiditis. We examined the clinico-pathological correlations between Hashimoto's thyroditis and papillary thyroid cancer in our region in the North-Eastern part of Hungary.

PATIENTS AND METHOD

We included a total of 230 patients with papillary thyroid cancer who underwent thyroid surgery at the Surgical Department of the University of Debrecen. Patients' sex, age, multifocality of thyroid cancer and clinical stage were evaluated.

RESULTS

Cases included 40 patients (17.4%) with (4 male, 36 female) and 190 (82.6%) patients without HT (44 male, 146 female). Hashimoto's thyroiditis related thyroid cancer was almost exclusively associated with the papillary histological type. Multifocality of papillary cancer was significantly more frequent with coexisting Hashimoto's thyroiditis (16/40; 40.0%) compared to cases uninvolved (45/190; 23.7%; p = 0.034). In contrast, lymph node metastasis was significantly less frequent among patients with Hashimoto's thyroiditis (4 pN1 [36.4%]; 7 pN0 [63.6%]) then without it (34 pN1 [82.9%]; 7 pN0 [17.1%]; p = 0.002).

CONCLUSION

Higher frequency and multifocality of papillary thyroid cancer might be the consequence of preexisting Hashimoto's thyroiditis to be considered as a preneoplastic stimulus supporting carcinogenesis, though the exact pathomechanism of this correlation is not clear yet. Orv. Hetil., 2017, 158(5), 178-182.

The nature of discrete second-order self-similarity

A new treatment of second-order self-similarity and asymptotic self-similarity for stationary discrete time series is given, based on the fixed points of a renormalisation operator with normalisation factors which are not assumed to be power laws. A complete classification of fixed points is provided, consisting of the fractional noise and one other class. A convenient variance time function approach to process characterisation is used to exhibit large explicit families of processes asymptotic to particular fixed points. A natural, general definition of discrete long-range dependence is provided and contrasted with common alternatives. The closely related discrete form of regular variation is defined, its main properties given, and its connection to discrete self-similarity explained. Folkloric results on long-range dependence are proved or disproved rigorously.

Monitoring environmental change in an ecosystem

The monitoring and analysis of the processes taking place in an ecosystem is a key issue for a sustainable human activity. A system of populations, as the biotic component of a complex ecosystem is usually affected by the variation of its abiotic environment. Even in nearly natural ecosystems an abiotic effect like climatic implications of global warming may cause important changes in the dynamics of the population system. In ecosystems involving field cultivation or any industrial activity; the abiotic parameter in question may be the concentration of a substance, changing, e.g. as a result of pollution, application of a pesticide, or a fertilizer, etc. In many cases the observation of the densities of each population may be technically complicated or expensive, therefore the question arises whether from the observation of the densities of certain (indicator) populations, the whole state process of the population system can be uniquely recovered. The paper is aimed at a methodological development of the state monitoring, under the conditions of a changing environment. It is shown, how the technique of mathematical systems theory can be applied not only for the approximate calculation of the state process on the basis of the observed data, even under the effect of an exogene abiotic change with known dynamics; but in certain cases, also for the estimation of the unknown biological effect of the change of an abiotic parameter. The proposed methodology is applied to simple illustrative examples concerning a three-species predator-prey system.

Effect of different types of feeding on fatty acid composition of erythrocyte membrane lipids in full-term infants

Significantly higher levels of arachidonic acid (AA) and docosahexaenoic acid (DHA) in plasma lipids have previously been reported in 2 to 8-wk-old as well as in 6 to 12-mo-old full-term infants fed exclusively human milk than in infants exclusively receiving formula without AA and DHA. However, in real life many infants receive both human milk and breast milk substitute formula. Healthy, full-term infants aged 2 to 12 mo and fed exclusively human milk (n = 29, age: 29.2 [14.6] wk, mean [SD], no human milk substitute formula), exclusively formula without AA and DHA (n = 30, age: 26.6 [15.2] wk, no human milk after the age of 1 mo) or combined diet (n = 38, age: 30.3 [12.8] wk, human milk for > 1 mo and breast milk substitute formula) were investigated in this cross-sectional study. Fatty acid composition of erythrocyte membrane phosphatidylethanolamine (PE), phosphatidylcholine and sphingomyeline lipids was determined by high-resolution capillary gas-liquid chromatography. The most pronounced diet-related differences were seen in PE lipids. Values of PE alpha-linolenic acid (0.07 [0.05] vs 0.26 [0.18] vs 0.19 [0.19], median [range from the 1st to the 3rd quartile], exclusively breastfed vs. exclusively formula fed vs combined diet), eicosapentaenoic acid (0.19 [0.13] vs 0.35 [0.23] vs 0.27 [0.31]) and dihomo-gamma-linolenic acid (1.34 [0.42] vs 1.86 [0.62] vs 1.58 [0.73]) were significantly lower in exclusively breastfed infants than in those fed formula, exclusively or partially. In contrast, PE AA (26.48 [2.50] vs 24.34 [4.74] vs 24.94 [3.64]) and DHA (4.93 [2.91] vs 3.51 [2.14] vs 3.58 [2.27]) values were significantly higher in exclusively breastfed infants than in the other two groups.

CONCLUSION

In full-term infants aged 2 to 12 mo, erythrocyte membrane AA and DHA values are significantly higher with exclusive breastfeeding than with partial breastfeeding or exclusive feeding of formula without AA and DHA.

[Ultrasound-guided hydrostatic reduction of intussusception]

In our country, the hydrostatic reduction is performed in three different ways. 1. A method with negative contrast material (gas enema) and fluoroscopy is performed only in one hospital. 2. A second method is performed with the use of Gastrographin and guided with ultrasound examination, and finally controlled with x-ray, this method is used in the most places. 3. Sonographically guided enema using physiological saline solution which has been performed by the authors for five years is only used in the Transdanubian region and is getting more and more popular in the resent years. The case history of 34 patients with intussusception was analysed retrospectively and the results of hydrostatic reduction with ultrasound guidance were reviewed. In 22 of 34 patients vomiting was noticed, blood in the stool was found in approximately one-third of all cases, the abdominal pain as the most important sign was presented by all patients. In 24 of 34 patients with intussusception, a single hydrostatic reduction was completely successful, but 10 patients were operated on. With the use of author's method, the following advantages were noticed: control X-ray examination was not needed, and in cases of multiple intussusception of the small intestines all of the lesions were detected.

Inverse association between trans isomeric and long-chain polyunsaturated fatty acids in cord blood lipids of full-term infants

BACKGROUND

Previous studies showed significant inverse correlations between values of trans isomeric and long-chain polyunsaturated fatty acids in plasma lipids of preterm infants and healthy children aged 1-15 y.

OBJECTIVE

We sought to evaluate the same correlations in full-term infants at birth.

DESIGN

We studied healthy full-term infants (n = 42) born after normal pregnancies and deliveries. All infants had a family history of atopy (both parents or one of the parents and a sibling had atopic symptoms). The fatty acid composition of venous cord blood lipids was determined by high-resolution capillary gas-liquid chromatography.

RESULTS

The mean (+/-SEM) sum of trans fatty acids was 0.49 +/- 0.02% by wt in phospholipids, 2.47 +/- 0.20% by wt in cholesterol esters, 1.73 +/- 0.09% by wt in triacylglycerols, and 1.59 +/- 0.07% by wt in nonesterified fatty acids. Linear correlation analysis showed significant inverse correlations between the sum of trans fatty acids and both arachidonic acid and docosahexaenoic acid in phospholipids (r = -0.56, P < 0.001, and r = -0.48, P = 0.01, respectively), cholesterol esters (r = -0.52, P < 0.001, and r = -0.39, P = 0.018, respectively), and nonesterified fatty acids (r = -0.41, P = 0.007, and r = -0.41, P = 0.006, respectively).

CONCLUSION

Because trans fatty acids in the fetal circulation must originate from the maternal diet, our results indicate that maternal exposure to trans fatty acids may represent a previously neglected variable that inversely influences long-chain polyunsaturated fatty acid status in full-term infants at birth.

Polyunsaturated fatty acids in plasma lipids of obese children with and without metabolic cardiovascular syndrome

Previously we reported significantly higher values of gamma-linolenic acid (GLA, 18:3n-6), dihomo-gamma-linolenic acid (DHGLA, 20:3n-6), and arachidonic acid (20:4n-6) in plasma lipid classes in obese children than in nonobese controls. In the present study, fatty acid composition of plasma phospholipids (PL) and sterol esters (STE) was determined by high-resolution capillary gas-liquid chromatography in obese children with and without metabolic cardiovascular syndrome [MCS: defined as simultaneous presence of (i) dyslipidemia, (ii) hyperinsulinemia, (iii) hypertension, and.(iv) impaired glucose tolerance] and in nonobese controls. Fatty acid composition of PL and STE lipids did not differ between obese children without MCS and controls. Obese children with MCS exhibited significantly lower linoleic acid (LA, 18:2n-6) values in PL (17.43 [2.36], % wt/wt, median [range from the first to the third quartile]) than obese children without MCS (19.14 [3.49]) and controls (20.28 13.80]). In contrast, PL GLA values were significantly higher in obese children with (0.13 [0.08]) than in those without MCS (0.08 [0.04]), whereas STE GLA values were higher in obese children with MCS (1.04 [0.72]) than in controls (0.62 [0.48]). DHGLA values in PL were significantly higher in obese children with MCS (4.06 [0.74]) than in controls (2.69 [1.60]). The GLA/LA ratio was significantly higher, whereas the AA/DHGLA ratio was significantly lower in obese children with MCS than in obese children without MCS and in controls. In this study, LA metabolism was affected only in obese children with but not in those without MCS. In obese children with MCS, delta6-desaturase activity appeared to be stimulated, whereas delta5-desaturase activity appeared to be inhibited. Disturbances in LA metabolism may represent an additional health hazard within the multifaceted clinical picture of MCS.

Cerebral blood flow and glucose metabolism in mitochondrial disorders

OBJECTIVE

To investigate cerebral metabolism by 2-[18F]fluorodeoxy-d-glucose (FDG) uptake using PET and cerebrovascular reverse capacity by transcranial Doppler sonography (TCD) in different mitochondrial diseases (mitochondrial myopathy; mitochondrial encephalopathy, lactacidosis, and stroke-like episodes [MELAS]; and chronic external ophthalmoplegia).

BACKGROUND

Previous studies on individual patients with mitochondriopathies revealed abnormal accumulations of mitochondria in endothelium, smooth muscle cells, and pericytes of blood vessels in different parts of the nervous system (cerebrum, cerebellum, sural nerve) and skeletal muscle. On this basis, some investigators suggested a pathogenic role of vascular involvement in the MELAS syndrome and other encephalopathies. smhd1

DESIGN/METHODS

The authors investigated neuronal metabolism and cerebrovascular involvement with PET in 5 cases and with TCD with acetazolamide stimulation in 15 cases. The patients were divided into three groups: 1) interictal MELAS (n = 4); 2) progressive external ophthalmoplegia (n = 6); and 3) pure mitochondrial myopathy and neuropathy (n = 5). The results were compared with those from matched normal control subjects. The diagnoses were based on clinical phenotype as well as histopathologic and molecular analysis.

RESULTS

Cerebral glucose uptake was impaired in all patients, both with and without CNS symptoms, particularly in the occipital and temporal lobes. The vasoreactivity of the small arterioles to acetazolamide did not differ significantly between the patients and healthy control subjects or between the different groups of mitochondrial disorders.

CONCLUSIONS

MELAS does not appear to be a functional disturbance of arterioles leading to an ischemic vascular event. The clinical symptoms in MELAS are not the result of a mitochondrial angiopathy but are the consequences of a mitochondrial cytopathy affecting neurons or glia. There is no correlation between the decreased glucose metabolism and the duration of the disease.

[Clinical and pathologic description of stroke patients (1990-1994)]

Data relating to stroke patients at a department of internal medicine (50 beds) in a county teaching hospital were studied in period 1990-1994. In this five-year period, 1184 patients were admitted because of some forms of stroke. The mortality due to the stroke was 16.8% (199 patients, deceased group). Autopsy was performed on 159 of these 199 patients (autopsy rate: 79.8%). Age- and sex-matched controls were selected from the survivors (n = 159). The main risk factors of stroke were analyzed in both groups: hypertension, cardiac events (decompensation, atrial fibrillation, and old myocardial infarction), previously verified diabetes, and recurrent stroke in the history. The mean hospital nursing time for the survivors was 12.3 +/- 6.3 days, while that in the deceased 7.2 +/- 7.6 days.

RESULTS

1. Hypertension was present to similar extents in both groups (survivors: 82.1%, deceased group: 77.8%) 2. Decompensation occurred in 5% vs 18.2% fibrillation in 11.3% vs 13.8%, and old myocardial infarction in 5.6% vs 18.2% 3. Diabetes was observed in 21.3% vs 36.4% and 4. Recurrent stroke in 22.6% vs 39.6%. These risk factors strongly predicted the outcome of the stroke. Other recently observed factors (haemorrhagic form, conscious state, time of hospital admission, seasonal variation, higher erythrocyte sedimentation rate, hyperglycaemia, proteinuria, early deep vein trombosis) revealed also significant differences between survivors and deceased patients. Since pulmonary thromboembolism was twice as frequent in the deceased patients as in the survivors, early heparin prevention is necessary immediately after computer tomography which excluded the haemorrhagic type of cerebrovascular diseases.

[Evaluation of captopril-enalapril replacement therapy in hypertensive patients under ambulatory blood pressure monitoring]

Authors performed a comparative study of replacement of captopril (2-3x daily) therapy with once daily enalapril. Blood pressure was measured by 24-hour ambulatory monitoring. The study enrolled 62 patients with mild to moderate hypertension. Captopril was previously administered 2-4 times per day, in mean dose of 74.4 mg, for 3.2 years as an average. After a 4 x 4 weeks study period the final enalapril dose was 15 mg, once in the morning. Enalapril was administered as monotherapy in 36 cases. During the trial mean blood pressure decreased from 140 +/- 14/85 +/- 9 mmHg to 125 +/- 12/76 +/- 7 mmHg (p < 0.01), diurnal index increased from 12/10% to 15/11%. Enalapril treatment lowered daytime percent time elevation index (PTI) from 56 +/- 30% to 27 +/- 23% (p < 0.05), nighttime PTI from 64 +/- 34% to 37 +/- 35% (p < 0.05), and hyperbaric impact values from 183 +/- 152 mmHg x hour to 97 +/- 128 mmHg x hour (p < 0.01). Adverse effects of both drugs were rare and mild, enalapril caused no changes in overall quality of life. Improvement of antihypertensive efficacy after a switch to enalapril treatment could be related to better compliance achieved by once-daily dose, and tight out-patient blood pressure control. The authors concluded that after a 16 weeks of therapy, once-daily enalapril administration was more effective and compliant in reducing blood pressure, than 2-4 times per day captopril treatment, when measured by 24-hour ambulatory blood pressure monitoring.

[Case report of a twin-monster, dicephalus, dibrachius (author's transl)]

The dicephalus dibrachius twin malformation is a rare developmental anomaly. Spontaeous birth is impossible. Prenatal diagnosis of this condition is difficult though essential to prevent danger to the life of the mother. Radiological examination before birth is necessary. Auscultation and bimanual examination only may lead to the erroneous diagnosis of a twin pregnancy, as in this case, where in the end a cesarean sectionwas performed because unseparated twins were suspected.