[Maternally Inherited Diabetes and Deafness]

CASE REPORT

We described the follow up of a patient with diabetes mellitus type 2 who had a macular pattern dystrophy and bilateral neurosensory hearing loss. Electrophysiological studies revealed abnormal pattern electroretinography and impaired electro-oculogram responses.

DISCUSSION

Maternally Inherited Diabetes, neurosensory Deafness and generally macular pattern distrophy (MIDD syndrome), is a rare mitochondrial disease, responsible for approximately 0.5 to 2.8% of diabetes mellitus.

Epidermal growth factor receptor ligands in murine models for erythropoietic protoporphyria: potential novel players in the progression of liver injury

Activation of the epidermal growth factor receptor (EGFR) plays an important role in liver regeneration and resistance to acute injury. However its chronic activation participates in the progression of liver disease, including fibrogenesis and malignant transformation. Hepatobiliary disease represents a constant feature in the clinically relevant Fechm1pas/Fechm1pas genetic model of erythropoietic protoporphyria (EPP). Similarly, chronic administration of griseofulvin to mice induces pathological changes similar to those found in patients with EPP-associated liver injury. We investigated the hepatic expression of the EGFR and its seven most relevant ligands in Fechm1pas/Fechm1pas mice bred in three different backgrounds, and in griseofulvin-induced protoporphyria. We observed that the expression of amphiregulin, betacellulin and epiregulin was significantly increased in young EPP mice when compared to aged-matched controls in all genetic backgrounds. The expression of these ligands was also tested in older (11 months) BALB/cJ EPP mice, and it was found to remain induced, while that of the EGFR was downregulated. Griseofulvin feeding also increased the expression of amphiregulin, betacellulin and epiregulin. Interestingly, protoporphyrin accumulation in cultured hepatic AML-12 cells readily elicited the expression of these three EGFR ligands. Our findings suggest that protoporphyrin could directly induce the hepatic expression of EGFR ligands, and that their chronic upregulation might participate in the pathogenesis of EPP-associated liver disease.

Induction of hepatic aminolevulinate acid synthetase activity by isoflurane in a genetic model for erythropoietic protoporphyria

Erythropoietic Protoporphyria (EPP) is an inherited deficiency of ferrochelatase, the last enzyme of the heme pathway. Under general anaesthesia, some patients develop neurological dysfunction suggesting upregulation in heme biosynthesis similar to that described for acute porphyrias after xenobiotic administration. Our aim has been to evaluate whether Isoflurane induces alterations in the heme pathway in a mouse model for EPP. Administration of Isoflurane (a single dose of 2 ml/kg, i.p) to wild-type (+/+), heterozygous (+/Fechm1Pas) and homozygous (Fechm1Pas/Fechm1Pas) mice, was evaluated by measuring the activity of delta-aminolevulinic acid synthetase (ALA-S) and Porphobilinogen-deaminase (PBG-D) in different tissues, as well as Heme oxygenase (HO), cytochrome P-450, CYP2E1 and glutathione levels in liver. Porphyrin precursors were measured in 24 h-urine samples. Fechm1Pas/Fechm1Pas mice receiving anaesthesia show enhanced ALA-S and CYP2E1 activities in the liver and increased urinary excretion of porphyrin precursors. No alterations were found in either PBG-D or HO activities. Diminished glutathione levels suggest that anaesthesia may produce oxidative stress in these animals. In conclusion, Isoflurane induces ALA-S activity and increased excretion of porphyrin precursors in EPP mice. These findings appear to confirm our previous hypothesis and indicate that Isoflurane may be an unsafe anaesthetic not only for patients with acute porphyrias but also for individuals with non acute porphyrias.

[Regression of a choroidal metastasis from prostate adenocarcinoma after hormonal therapy]

CASE REPORT

We report a case of a patient diagnosed with prostatic adenocarcinoma with multiple bone metastases and a choroidal metastasis in his left eye. Hormonal therapy with an anti-androgen and a LH-RH agonist was followed by regression of the choroidal mass over a period of 2 months. No metastatic recurrence has been demonstrated after a follow-up period of 14 months.

DISCUSSION

Complete resolution of choroidal metastases of prostatic adenocarcinoma with hormonal therapy is exceptional, but the effect of this treatment on such metastases should be observed before recommending radiation therapy.

[Retinal cholesterol embolization after coronary angiography]

CASE REPORT

We report a patient with multiple cholesterol retinal embolism in both eyes following coronary angiography. She also had associated renal, skin and cardiac manifestations of the Cholesterol Embolization Syndrome (CES) and died 10 weeks later. Autopsy revealed cholesterol crystal emboli in several organs.

DISCUSSION

Atheromatous plaques can be ruptured and displaced during a diagnostic catheterisation, and thus can be a potential source of these massive emboli. Retinal cholesterol crystals help to establish the diagnosis of the syndrome, particularly when other systemic manifestations exist. When this complication occurs, the prognosis can be devastating because of associated multiorgan failure.

Right-sided endocarditis complicating an atrial septal defect

We report the case of a 45-year-old male patient not addicted to narcotic who presented with an infective endocarditis on the pulmonary valve. He was found to have an uncomplicated secundum-type atrial septal defect. This association is an extremely rare event.

Circulating IgG response to stromelysin-3, collagenase-3, galectin-3 and mesothelin in patients with pharynx/larynx squamous cell carcinoma

With the aim of identifying tumor-associated antigens that could be potential markers and/or targets of diagnostic and/or therapeutic approaches, we studied the occurrence of circulating IgG antibodies to human stromelysin-3, collagenase-3, galectin-3 and mesothelin, by Western blot against their purified recombinant forms, in the sera of 50 patients with pharynx/larynx squamous cell carcinoma (PLSCC), as well as in the sera of 50 healthy blood donors. Overall, antibodies to collagenase-3 were detected in 50% of all the cancer patients and 16% of the blood donors examined; this percentage difference was statistically significant (p = 0.00066). With respect to anti-galectin-3 antibodies, the percentages were 32% and 18%, respectively, but they were not statistically different (p = 0.16). Low levels of antibodies to stromelysin-3 and to mesothelin were detected in sera from only two cancer patients. No significant correlations were found in the present study between the presence of antibodies to these proteins and tumor site, clinical and T stages, lymph node involvement, DNA ploidy and histological grade of differentiation of the primary tumors. To our knowledge, this is the first report on the detection of circulating IgG to collagenase-3 in cancer patients. Some of the percentages found here in certain groups of patients are among the highest reported of circulating antibodies to any tumor component studied so far. The monitoring and the use of human antibodies to collagenase-3 could be of diagnostic and therapeutic interest.

New chromosomal regions with high-level amplifications in squamous cell carcinomas of the larynx and pharynx, identified by comparative genomic hybridization

Squamous cell carcinomas of the head and neck generally exhibit complex karyotypes. To gain better knowledge of the changes in the subgroup of laryngeal and pharyngeal squamous cell carcinoma, chromosomal gains and losses were investigated in 42 predominantly late-stage tumours, using comparative genomic hybridization. On average, 11.2 gains and 6.8 losses were found. Gains were detected in high frequencies at 1q, 3q, 5p, 7q, 8q, 11q13, 17q, and 18p, and losses at 3p, 4p, 5q, 11qter, and 18q. Neither the number nor the type of abnormalities, nor the occurrence of specific chromosome changes, was found to be related to DNA ploidy, tumour stage, or degree of differentiation. Apart from low-level gains, many high-level amplifications were identified, in particular 3q24-qter (15 cases). Other regions recurrently involved were 11q13 (7 cases), 18p (5 cases), 18q11.2 (4 cases), and 8q23-24 and 11q14-22 (3 cases). Many of these amplified regions have not been reported before. Over half of all loci harbour genes coding for growth factors and growth factor receptors, suggesting an important role for such genes in squamous cell tumourigenesis and in the progression of late-stage tumours.

[Traumatic maculopathies]

PURPOSE/METHODS

We reviewed all patients seen urgently on our Hospital and we studied those that present contusive pathology of the anterior pole with macular repercusion.

RESULTS/CONCLUSIONS

Post-traumatic maculopathies are usually produced by contusion, namely: rupture of the choroid, chorioretinitis sclopetaria, postraumatic macular hole, commotio retinae (Berlin's oedema) and Purtscher's retinopathy was reported. With the presentation of these clinical cases, some of which are very typical, we aim to show the functional sequelae some patients suffer.

Pigment production by Streptococcus agalactiae in quasi-defined media

A quasi-defined medium that supports the growth of Streptococcus agalactiae as pigmented colonies has been developed. The medium contains starch, a peptic digest of albumin, amino acids, nucleosides, vitamins, and salts. The presence of free cysteine, which could be replaced with other sulphur-containing compounds and to a lesser degree by reducing agents, was required for pigment formation.

Cell proliferation activity and kinetic profile in the prognosis and therapeutic management of carcinoma of the pharynx and larynx

Prognosis and management of carcinoma of the pharynx and larynx is now based on the morphologic analysis of the tumor spreading, differentiation grading, and type of microscopic invasion. The DNA ploidy status and the cell proliferation activity analyzed by flow cytometry give us complementary information about the prognosis and the management and support of the patients. We performed a study of 91 cases of carcinoma of the larynx and pharynx by means of flow cytometry. Forty-three patients were treated by surgery alone, and 48 patients also received radiotherapy. Fifty-five were aneuploid (60%); this percentage increased to 74% in the pharynx area and fell to 47% at the larynx level. The aneuploid tumors showed worse behavior in the patients treated by surgery alone compared with those who also received radiotherapy. The S-phase fraction was high in aneuploid tumors, in positive lymph nodes, and in advanced stages. The S-phase fraction was higher in poorly differentiated tumors. In patients treated by surgery alone, we noticed that by combining both cytometric variables two different kinetic profiles could be defined related to the patients' behavior. The diploid tumors with a low S phase had the greatest rates of survival, whereas diploid tumors with a high rate of S phase and aneuploids had a lower rate.

Performance of thiophilic adsorption chromatography in the purification of rat IgG2b monoclonal antibodies from serum- and protein-free culture supernatants

The usefulness of thiophilic adsorption chromatography for the purification of rat IgG2b monoclonal antibodies has been evaluated. This approach has not shown specificity for immunoglobulins; therefore, to minimize potential interferences, the purification was carried out from supernatants of hybridomas grown in serum- and protein-free conditions. The protein purity of the six final antibody preparations assayed was always >/= 97%. In addition to the easiness of this procedure, which enables one-step antibody purification, the materials employed are rather inexpensive and milligram amounts of antibody can be recovered from 1 L of supernatant. Overall, the purification of rat IgG2b monoclonals under the conditions reported here offers an advantageous alternative to other more expensive and cumbersome methods.

Pleomorphic adenoma of the salivary glands: prospective clinicopathologic and flow cytometric study

BACKGROUND

Primary surgery is the appropriate treatment for most pleomorphic adenomas of the salivary glands. However, no reliable criteria have been established to predict tumors with aggressive features.

METHODS

In 44 patients treated for salivary pleomorphic adenoma, clinicopathologic features and flow cytometric findings were recorded. S-phase fractions were classified as low (0%-1%), intermediate (1.1%-5%), and high (>5%). The relationship between clinicopathologic parameters and flow cytometric DNA analysis was assessed with the Pearson's correlation coefficient.

RESULTS

The mean tumor size was 24.4 mm. Microscopically, myxoid structures predominated in 61.4% of cases. Only five specimens showed high S-phase fractions. All samples were DNA diploid (mean coefficient of variation 3.2%). S-phase fraction and tumor size correlated significantly (r = 0.73, P = 0.003). Two patients with recurrent tumors had high S-phase fractions both on the first resected specimens and at the time of the second operation.

CONCLUSIONS

The S-phase fraction may be a valuable predictor of aggressive behavior in salivary pleomorphic adenomas. High S-phase fractions were associated with higher tumor size and a greater tendency to recur.

Use of Granada medium to detect group B streptococcal colonization in pregnant women

Direct inoculation onto Granada medium (GM) in plates and tubes was compared to inoculation into a selective Todd-Hewitt broth (with 8 microg of gentamicin per ml and 15 microg of nalidixic acid per ml) for detection of group B streptococci (GBS) in pregnant women with 800 vaginal and 450 vaginoanorectal samples. Comparatively, GM was found to be as sensitive as the selective broth for the detection of GBS in vaginal specimens and more sensitive than selective broth for the detection of GBS in vaginoanorectal samples (96 versus 82%). The use of GM improved the time to reporting of a GBS-positive result by at least 24 h and reduced the direct cost of screening. We have also found that the inconvenience of anaerobic incubation of GM plates can be avoided when a cover slide is placed upon the inoculum, because aerobic incubation in GM plates with cover slides causes GBS to develop the same pigmentation that it develops with incubation under anaerobic conditions. These data support the routine use of GM plates or tubes as a more accurate, easier, and cheaper method of identification of GBS-colonized women compared to the enrichment broth technique.

Cell cycle flow cytometric analysis in the diagnosis and management of colorectal carcinoma

OBJECTIVE

To establish prognostic models and protocols for individualized management in colorectal carcinoma patients based on both clinical and DNA flow cytometric parameters.

STUDY DESIGN

Prospective study of 88 colon carcinoma patients with a minimum follow-up of 12 months, operated on with the intent to cure and not treated with radiotherapy or chemotherapy. All the cases were subjected to a clinical evaluation: age, sex, tumor localization and size, histologic grade, tumor stage, disease-free interval, survival and flow cytometric study (ploidy, DNA index and S-phase fraction [SPF]).

RESULTS

From the total of 88 neoplasms studied, 56 (63.6%) were from males and 32 (36.4%) from females; 30 (34%) were located in the right side of the colon, 7 (8%) in the transverse colon and 51 (58%) in the left side of the colon. Eleven (12.5%) were stage I, 52 (59.1%) stage II and 25 (28%) stage III. Forty-two (47.7%) were diploid and 46 (52.3%) aneuploid. The S-phase mean was 14.6% (12% for diploids and 16.9% for aneuploids). During the follow-up period, 26.1% of diploid tumors recurred, whereas aneuploid tumors recurred in 36.9% (P < .05). SPF from diploid and aneuploid tumors was analyzed separately.

CONCLUSION

Regarding relapse-free interval, the behavior of diploid tumors with a high SPF was similar to that of aneuploid ones. Two kinetic profiles were established, favorable (diploid tumors with low S phase) and unfavorable (diploid with high S phase and all aneuploid tumors), that had significant prognostic value for progression and survival and that allowed identification of patients at high risk of recurrence. We formulated a prognostic index according to SPF and tumor stage that has discriminatory capacity for biologic behavior in colorectal tumors.