Insulinoma diagnosed as drug-refractory epilepsy in an adolescent boy: a case report

Solitary insulinoma is a rare pancreatic tumor in all age groups with an estimated incidence of 1 in 250 000 persons a year. It is even rarely in childhood and mostly shows benign behavior. Cases with uncertain or malignant biology are extremely rare with less than 30 cases described in the literature. Here we report a case of pediatric insulinoma, the first in our department files in the past 20 years, with rapid clinical course following a clinical misdiagnosis as juvenile myoclonic epilepsy, which was complicated with low glucose level (20 mg/dL) and neuroglycopenia. Our case underlines some unusual features of a pediatric insulinomas presented without past medical and family history, after surgery complicated with mental retardation and recurrent epileptiform episodes. Despite the small tumor size, low Ki67 index/mitotic rate and benign immunophenotype marked by positivity for pro-insulin but negativity for β-HCG, the diagnosis was concluded as insulinoma of uncertain biological behavior due to vascular tumor invasion in agreement with the 2003 WHO Classification for Pancreatic Endocrine Neoplasms. Besides these features, perineural invasion can differentiate insulinomas of uncertain outcome from benign insulin producing tumors. Pediatric insulinomas may present misleading symptoms of epilepsy in neglected cases coming from poor socioeconomic background. Chronic insufficient blood glucose level might contribute to mental retardation and epilepsiform myoconvulsions to be prevented. Differentiation between insulinoma with benign and uncertain behavior is difficult where histological pattern and tumor immunophenotype are less important than the critical morphological parameters. Life long follow-up including regular control of blood glucose and abdominal status of patients are essential for proper assessment of clinical outcome of pediatric insulinoma.

Histopathological, immunophenotypic and clinical particularities and evolution of a case of hepatosplenic T-cell lymphoma in transformation to leukemia

We present the possibilities of diagnosis correlating the pathological, immunophenotyping and clinical aspects of a rare case of T-cell lymphoma in a 23-year-old patient with leukemic transformation. In our consideration, it is very important to describe this case because in the literature there are very few cases presented and the treatment of this type of lymphoma does not present optimal results, the evolution of the patients being from three months to two years. The treatment modality that gives the possibility to prolong survival and cure is hematopoietic stem cell transplantation.

Characterization of stress processes of Phaffia rhodozyma stress-resistant mutant

A carotenoid-less Phaffia rhodozyma mutant (MCP 325) exhibited significantly higher resistance to oxidative stressors such as menadione, H2O2 and K2Cr2O7 than its astaxanthin-producing parental strain (MCP 324). The absence of carotenoids in the mutant did not explain this phenomenon. The cause of the decreased superoxide, hydroxyl radical and glutathione contents, the increased peroxide concentration and the elevated specific activity of catalase under uninduced conditions may be a second mutation. Peroxide treatment induced specific catalase activity in the mutant but not in the parental strain. Regulation of these processes led to the result that, in spite of the mutations, the two strains exhibited the same multiplication rate and generation time.

[Bleomycin therapy for lymphangioma]

Lymphangiomas are uncommun congenital malformations of the lymphatic system, that involve the skin and subcutaneous tissues. Of the several types of treatment, surgical excision has been the preferred. There is a high recurrence rate because lymphangiomas tend to infiltrate the surrounding tissues. The bleomycin is a cytotoxic antitumoral antibiotic, that causes modifications of DNA. It has been also successfully used in intralesional injection treatment of cystic hygromas and haemangiomas, based specifically on a high sclerosing effect on vascular endothelium. We report the cases of five patients, with congenital lymphangioma, localized on the leg, in cervical and latero-thoracal region, treated with repeated intralesional bleomycin injections. The treatment indication was given by the location of this lesions and the infiltration of the surrounding vital tissues, that made the complete surgical excision impossible. Intralesional injection of bleomycin into the lymphangiomas was given at a dose, not exceeding 0,5 mg/kg of body weight, at intervals of 4 weeks. Complete resolution (n = 4) or significant improvement (n = 1) occurred in all patients treated. No other treatment was needed. We didn't notice local or general adverse effects. With this method we set the purpose to treat effectively this congenital malformations, obviating the need for invasive primary surgery or systemic treatment regimens. Toward other methods, intralesional bleomycin injections have a minimal risk of side effects (ulceration, pulmonary fibrosis).

Bioinspired artificial photonic nanoarchitecture using the elytron of the beetle Trigonophorus rothschildi varians as a 'blueprint'

An unusual, intercalated photonic nanoarchitecture was discovered in the elytra of Taiwanese Trigonophorus rothschildi varians beetles. It consists of a multilayer structure intercalated with a random distribution of cylindrical holes normal to the plane of the multilayer. The nanoarchitectures were characterized structurally by scanning electron microscopy and optically by normal incidence, integrated and goniometric reflectance measurements. They exhibit an unsaturated specular and saturated non-specular component of the reflected light. Bioinspired, artificial nanoarchitectures of similar structure and with similar properties were realized by drilling holes of submicron size in a multilayer structure, showing that such photonic nanoarchitectures of biological origin may constitute valuable blueprints for artificial photonic materials.

Role of S-methylmethionine in the plant metabolism

S-methylmethionine (SMM), a naturally occurring, biologically active compound, is a free amino acid derivative, which is increasingly recognised as playing an important part in the plant metabolism. SMM, which is synthesised from methionine, is involved in crucial processes in the S metabolism, such as the regulation of methionine and S-adenosyl methionine levels, the methylation processes taking place in cells, and the transport and storage of sulphur in certain phases of development. It is of great importance in the development of resistance to abiotic and biotic stress factors, as it is a direct precursor in the biosynthesis of the osmoprotectants and other S-containing compounds involved in defence mechanisms, while also influencing the biosynthesis of major plant hormones such as polyamines and ethylene. The present paper discusses our increasing understanding of the role played by SMM in the plant metabolism and its possible role in the improvement of traits that enable plants to overcome stress.

Comparative detection of high-risk HPV (16, 18, 33) in cervical bioptic material of county hospital of Tg. Mures

The purpose of this study was to collect data about the incidence of high-risk HPV (16, 18, 33) types in paraffin embedded cervical bioptic material, including LSIL, HSIL and cervical cancers using immunohistochemistry and nested PCR methods. In our study were included randomly selected 10 LSIL, 18 HSIL and 30 cervical cancer cases. We analyzed the expression of HPV in this specimens with immunohistochemistry used DAKO K1H8 antibody and CHEMICON Mab HPV 16, 16 antibody using LSAB method and Tiramin amplification method, and nested PCR for HPV 16, 18 and 33. In LSIL cases three, in HSIL cases eight and in carcinoma 20 cases were positive for HPV 16 or 18 for immunohistochemistry or PCR. Although this proportion in lower than those reported in the literature, our work signals the existence of the infection in our country and presents a relatively cheap diagnostic method.

Investigations on the adaptability of maize lines and hybrids to low temperature and cadmium

In the course of the Maize Consortium Project, investigations were made on the defence mechanisms employed by maize against various abiotic stress factors (low temperature, cadmium) and on the effects exerted by two compounds (S-methylmethionine, salicylic acid) capable of improving the stress resistance of plants to certain abiotic stresses. Salicylic acid (SA) was found to inhibit the uptake of cadmium (Cd), but caused damage to the roots, including a reduction in the activity of phytochelatin synthase (PCS), which meant that preliminary treatment with SA aggravated the damaging effect of Cd. It was also proved that as the result of 2-day treatment with Cd, there was a continuous rise in the Cd level in the plants, more Cd being accumulated in young leaves than in older ones. The PCS activity increased greatly after 24 hours, both in the leaves and in the roots, declining again after 2 days. The effect of SA was examined in both the hybrids and their parental lines, and the effect of this compound on the intensity of alternative respiration was also investigated. A comparison of chilling tolerance data and antioxidant enzyme activity indicated that these two parameters were not directly correlated to each other, i.e. antioxidant enzyme activity values could not be used to draw reliable conclusions on the chilling tolerance of maize lines and hybrids. With regard to the interaction between alternative respiration and salicylic acid, it was proved that exogenous hydrogen peroxide caused a similar increase in the ratio of alternative respiration to that observed after salicylic acid treatment. Abbreviations: SA, salicylic acid; Cd, cadmium; PCS, phytochelatin synthase; SMM, S-methylmethionine; PCs, phytochelatins; PAR, photosynthetically active radiation; TTC, triphenyl tetrazolium chloride; KCN, potassium cyanide; PSII, 2nd photochemical system; POD, guaiacol peroxidase; APX, ascorbate peroxidase; GR, glutathione reductase

Haemorrhagic nephritis and enteritis of geese: pathomorphological investigations and proposed pathogenesis

Haemorrhagic nephritis and enteritis of geese as a new disease was first described in Hungary in 1969. The authors identified the causative agent of the outbreaks occurring in 1969 as a polyomavirus by PCR in 2001. In order to study the pathogenesis of the virus, one-day-old goslings were infected with tissue homogenate that tested positive for polyomavirus by PCR. Morphological, light and transmission electron microscopic (TEM) examinations have revealed that goose haemorrhagic polyomavirus replicates in the endothelial cells of the blood vessels and capillaries of diseased birds. Infection causes damage and necrosis of the endothelial cells. The virus was not observed in the parenchymal cells. Oedema and haemorrhages found throughout the body may be due to the dysfunction or functional deficiency of endothelial cells damaged by the virus.

Effect of propranolol on heart rate variability in patients with end-stage renal disease: a double-blind, placebo-controlled, randomized crossover pilot trial

BACKGROUND

Low heart rate variability (HRV) is an independent risk factor of cardiac mortality in patients with end-stage renal disease (ESRD). It has been explained by uremic parasympathetic neuropathy. Sympathetic overactivity can also reduce HRV. Our aim was to determine whether there is vagal activity in ESRD patients that is masked by sympathetic activity.

METHODS

The effect of propranolol on HRV was examined in 13 patients with ESRD, aged 20.1 +/- 7.6 years without diabetes. All patients were given intravenous propranolol (0.05 mg/kg) once and placebo once in a randomized, double-blind way, with an interval of 6.6 days (mean, range: 2-9). Propranolol was administered before hemodialysis treatment, after 40 minutes supine resting period. HRV was registered for 10 minutes, during supine, before and after the injection. Patients' HRV data were compared to that of 29 age-matched healthy controls.

RESULTS

Initially, both high-(HFV) and low-frequency (LFV) bands of heart rate variability were lower in ESRD patients compared to controls (p < 0.001 for both). Propranolol resulted in a significant increase of HFV (propranolol: AlgHFV = 0.182 (0.027 - 0.337), placebo: deltalgHFV = -0.029 (-0.128 - +0.070); p = 0.032). Elevation of LFV was not significant. Six patients had an elevated plasma norepinephrine and/or epinephrine level. Plasma dopamine level was elevated in all but 1 patient (mean: 432 pmol/l, 95% CI: 320-543) and showed an inverse relationship with the increase of IgHFV secondary to propranolol (r = -0.66, p = 0.014).

CONCLUSIONS

Low HFV of ESRD patients can be improved by beta-adrenergic blockade. It demonstrates that there is some vagal activity in ESRD that is masked by sympathetic activity. Therefore, altered sympathovagal balance of ESRD patients should be taken into consideration in the assessment of vagal uremic neuropathy.

A synthetic derivative of the natural product rocaglaol is a potent inhibitor of cytokine-mediated signaling and shows neuroprotective activity in vitro and in animal models of Parkinson's disease and traumatic brain injury

Many acute and chronic neurodegenerative diseases are characterized by a localized inflammatory response and constitutive activation of the transcription factors nuclear factor-kappa B (NF-kappa B) and activator protein-1 (AP-1) as well as their upstream activating signaling cascades. Ample evidence indicates the implication of these processes in the pathogenesis of several diseases of the central nervous system. In this study, we show that a synthetic derivative of the natural product rocaglaol (compound A) displays potent anti-inflammatory properties in human endothelial and murine glial cells in vitro. Compound A inhibited cytokine- and lipopolysaccharide-induced release of various cytokines/chemokines and of nitric oxide as well as expression of the adhesion molecule endothelial leukocyte adhesion molecule-1 and the inducible enzymes nitric-oxide synthase and cyclooxygenase-2. As shown by immunocytochemistry and immunoblotting, compound A inhibited NF-kappa B and AP-1 activity in mixed glial cultures. Compound A exhibited neuroprotective activity in vitro and in vivo. 1-Methyl-4-phenylpyridinium-induced damage of mesencephalic dopaminergic neurons was significantly decreased, and long-term treatment of 1-methyl-4-phenyl-1,2,3,6,-tetrahydropyridine-injected mice with compound A significantly and dose-dependently reduced dopaminergic neuronal cell death. In addition, shortterm application of compound A to rats suffering from traumatic brain injury induced by subdural hematoma resulted in a significant reduction of the cerebral infarct volume. These results suggest that by inhibiting NF-kappa B and AP-1 signaling, compound A is able to reduce tissue inflammation and neuronal cell death, resulting in significant neuroprotection in animal models of neurodegeneration.

Increased nuchal translucency and decreased fetomaternal transfusion after chorionic villus sampling

OBJECTIVE

To investigate the relationship between nuchal translucency (NT) and fetomaternal transfusion (FMT) after chorionic villus sampling (CVS).

METHODS

The level of FMT was determined in 272 viable, singleton pregnancies in which 10-14-week ultrasound scanning, NT measurement and CVS for fetal karyotyping had been performed. The pre-CVS NT was measured transvaginally, and the women were divided into two groups, i.e. those with NT < 2.5 mm (Group 1) or >or= 2.5 mm (Group 2). The level of FMT was determined via the maternal serum alpha-fetoprotein levels before and after CVS. FMT was analyzed in relation to the pre-CVS NT.

RESULTS

Of the 272 pregnancies, 213 were in Group 1 and 59 in Group 2. The mean levels of FMT after CVS were 23.3 +/- 12.2 and 5.4 +/- 2.9 micro L in Groups 1 and 2, respectively (P < 0.01). An FMT > 100 micro L was found in 19 cases in Group 1, whereas the maximum in Group 2 was 67.2 micro L. Aneuploidies were diagnosed in 17 cases, 15 (88.2%) of them in Group 2. When the pregnancies with adverse outcome were excluded from the two groups, a higher level of FMT was observed in Subgroup 1 than in Subgroup 2 (P < 0.01).

CONCLUSIONS

The mean level of FMT after CVS was significantly lower in pregnancies with an increased pre-CVS NT, a relationship observed in euploid pregnancies also. An increased pre-CVS NT seems to be inversely correlated with the FMT increase after CVS. Further studies are planned to investigate the background to this phenomenon.

Pulse and continuous oral norfloxacin treatment of experimentally induced Escherichia coli infection in broiler chicks and turkey poults

Experimental colibacillosis was produced in 40 healthy, 7-day-old broiler chickens and turkeys by intratracheal injection of 1 x 10(8) CFU/chick and 1.23 x 10(9) CFU/poult bacteria of an O1:F11 strain of Escherichia coli, respectively. Two days before E. coli challenge all chicks were vaccinated with a live attenuated strain of infectious bronchitis virus (H-52). This model of infection--at least in chicken--proved to be useful for evaluating the efficacy of antimicrobial medication, by recording mortality, body weight gain, pathological alterations and frequency of reisolation of E. coli. Using this model, the efficacy of two different dosing methods of norfloxacin (continuous and pulse dosing) was evaluated. The once-per-day pulse dosing of norfloxacin administered via the drinking water at 15 mg/kg body weight proved to be more efficacious than the continuous dosing method of 100 mg/L for 5 days in chickens, while there were no convincing differences between the two treatment regimens in turkeys. The results confirmed earlier observations on the pharmacokinetic properties of norfloxacin in chicks and turkeys (Laczay et al., 1998).

Treatment of experimentally induced Pasteurella multocida infections in broilers and turkeys: comparative studies of different oral treatment regimens

Experimental fowl cholera was induced in 60 healthy 10-week-old broiler chickens and 8-week-old turkeys by intramuscular inoculation with approximately 80 colony-forming units (cfu) of Pasteurella multocida X-73 strain and with approximately 70 cfu of P. multocida P-1059 strain, respectively. This method of infection proved to be useful for evaluating the efficacy of anti-microbial medication, by measuring mortality, weight gain, pathological responses and frequency of re-isolation of P. multocida. The efficacies of two different dosing methods, continuous and pulse dosing, were compared. Using the continuous-dosing method, norfloxacin was administered to drinking water at 100 mg/l for 5 days in chickens. Efficacies were slightly improved compared with pulse dosing at 15 mg/kg bodyweight for the same length of time. The opposite was observed in turkeys, to the degree of control of mortality and maintenance of weight gain.

The selective 5-HT(1A) receptor agonist repinotan HCl attenuates histopathology and spatial learning deficits following traumatic brain injury in rats

The selective 5-HT(1A) receptor agonist Repinotan HCl (BAY x3702) has been reported to attenuate cortical damage and improve functional performance in experimental models of cerebral ischemia and acute subdural hematoma. Using a clinically relevant contusion model of traumatic brain injury, we tested the hypothesis that a 4-h continuous infusion of Repinotan HCl (10 microg/kg/h i.v.) commencing 5 min post-injury would ameliorate functional outcome and attenuate histopathology. Forty isoflurane-anesthetized male adult rats were randomly assigned to receive either a controlled cortical impact (2.7 mm tissue deformation, 4 m/s) or sham injury (Injury/Vehicle=10, Injury/MK-801=10, Injury/Repinotan HCl=10, Sham/Vehicle=10), then tested for vestibulomotor function on post-operative days 1-5 and for spatial learning on days 14-18. Neither Repinotan HCl nor the non-competitive N-methyl-D-aspartate receptor antagonist MK-801, which served as a positive control, improved vestibulomotor function on beam balance and beam walk tasks relative to the Injury/Vehicle group, but both did significantly attenuate spatial learning and memory deficits on a water maze task. Repinotan HCl also reduced hippocampal CA(1) and CA(3) neuronal loss, as well as cortical tissue damage, compared to the Injury/Vehicle group at 4 weeks post-trauma. No significant difference in histological outcome was revealed between the Repinotan HCl- and MK-801-treated groups.These findings extend the therapeutic efficacy of Repinotan HCl to a contusion model of experimental brain injury and demonstrate for the first time that 5-HT(1A) receptor agonists confer neuroprotection and attenuate spatial learning deficits following controlled cortical impact injury. This treatment strategy may be beneficial in a clinical context where memory impairments are common following human traumatic brain injury.

Four years experience of first-trimester nuchal translucency screening for fetal aneuploidies with increasing regional availability

BACKGROUND

A prospective screening study was carried out at the regional genetic and perinatal center in South Hungary in order to determine the efficiency of first-trimester nuchal translucency screening for fetal aneuploidies, following augmentation of the availability of nuchal translucency screening in the region by the inclusion of newly-trained hospital sonographers.

METHODS

Nuchal translucency thickness was measured by transvaginal sonography in 7,044 women with singleton or multiple pregnancies at weeks 10-12. Fetal karyotyping was performed when the nuchal translucency was . or = 2.5 mm, and in women with fetuses at high cytogenetic risk.

RESULTS

Follow-up was performed in 6,841 of the 7,044 screened women. An abnormal karyotype was found in 33 cases (0.48%). The level of increased nuchal translucency was 4.5% at a cutoff of > or = 2.5 mm, and 2.8% at a cutoff of > or = 3 mm. Seventeen cases of trisomy 21, eight of trisomy 18, four of trisomy 13, one of 45,X, one of triploidy and two cases with other chromosomal abnormalities were detected. In the 33 fetuses with a chromosomal abnormality, the nuchal translucency thickness was <2.5 mm in a case of trisomy 18, > or = 2.5 mm in 32 cases and > or = 3 mm in 28 cases. With cutoffs of 2.5 mm and 3 mm, the sensitivity was 96.97% and 84.85%, respectively.

CONCLUSIONS

Application of a nuchal translucency thickness cutoff of 2.5 mm is highly efficient for the screening of fetal aneuploidies at 10-12 weeks. This efficiency can be maintained by increasing the regional availability of nuchal translucency screening through the inclusion of newly-trained hospital sonographers.

[Otorhinolaryngeal and phonation aspects of gastroesophageal reflux disease]

Experts dealing with patients of chronic upper and lower airway disorders have drawn a lot of interest in the last decades to gastrooesophageal reflux disease (GORD). Nowadays it is obvious that 'occult GORD' may be an aetiological factor in this group of patients. GORD may has a role in lot of organic laryngeal diseases and functional voice disorders. Symptoms are triggered by gastric content refluxed into the oesophagus, which cause irritation and inflammation. At laryngeal and phoniatric examinations gastrointestinal signs might remain hidden behind chronic cough, hoarseness and globus sensation. Authors summarise the diagnostic and therapeutic possibilities of GORD and its typical laryngeal and phoniatric manifestations. Although the first step is medication of GORD, it might come to surgical intervention of the laryngeal alterations, sometimes followed by voice therapy as well. Authors draw attention to patients after laryngectomy, whose voice rehabilitation therapy is extremely hindered by medical therapy resistant GORD. These patients may benefit of anti-reflux surgery.

Neuroprotective and behavioral effects of the selective metabotropic glutamate mGlu(1) receptor antagonist BAY 36-7620

This study characterized the neuroprotective and behavioral effects of (3aS,6aS)-6a-naphtalen-2-ylmethyl-5-methyliden-hexahydro-cyclopenta[c]furan-1-on (BAY 36-7620), a novel, selective and systemically active metabotropic glutamate (mGlu)(1) receptor antagonist. In the rat, neuroprotective effects were obtained in the acute subdural hematoma model (efficacy of 40-50% at 0.01 and 0.03 mg/kg/h, i.v. infusion during the 4 h following surgery); whereas in the middle cerebral artery occlusion model, a trend for a neuroprotective effect was obtained after triple i.v. bolus application of 0.03-3 mg/kg, given immediately, 2 and 4 h after occlusion. Hypothermic effects were mild and only obtained at doses which were considerably higher than those at which maximal neuroprotective efficacy was obtained, indicating that the neuroprotective effects are not a consequence of hypothermia. BAY 36-7620 protected against pentylenetetrazole-induced convulsions in the mouse (MED: 10 mg/kg, i.v.). As assessed in rats, BAY 36-7620 was devoid of the typical side-effects of the ionotropic glutamate (iGlu) receptor antagonists phencyclidine and (+)-5-methyl-10,11-dihydroxy-5H-dibenzo(a,d)cyclohepten-5,10-imine (MK-801). Thus, BAY 36-7620 did not disrupt sensorimotor gating, induce phencyclidine-like discriminative effects or stereotypical behavior, or facilitate intracranial self-stimulation behavior. Although behavioral stereotypies and disruption of sensorimotor gating induced by amphetamine or apomorphine were not affected by BAY 36-7620, the compound attenuated some behavioral effects of iGlu receptor antagonists, such as excessive grooming or licking, and their facilitation of intracranial self-stimulation behavior. It is concluded that mGlu(1) receptor antagonism results in neuroprotective and anticonvulsive effects in the absence of the typical side-effects resulting from antagonism of iGlu receptors.

Immunohistochemical features of paragangliomas

Immunohistochemistry is part of the routine diagnosis of the neuroendocrine tumors. In our study, we included 52 paragangliomas with various localizations by routine histology and immunohistochemistry. In order to increase the diagnostic specificity, a complex immunohistochemistry panel has been performed consisting of Bcl-2, Ki-67, Bax and Pituitary Adenylate Cyclase-Activating Peptide (PACAP), somatostatin, VIP and Calcitonin Gene Related Peptide (CGRP). After heat induced antigen retrieval, the immunostaining was performed by StreptABC using DAB as a chromogen. We were the first to demonstrate the presence of Bax and PACAP in paragangliomas. Some of the used markers are of prognostic value. The relationship between Bcl-2 and Bax is decisive in generating the final response to the input apoptotic signals. The Ki-67 antigen staining has gained wide acceptance in prognostic evaluation of other tumor types. We noted a small number of Ki-67 positive cases, which signifies a low mitotic activity of these tumors and a relatively high number of Bax positivities (32.9%) and the much lower number of Bcl-2 positivities (11.39%), and could explain the benign behaviour of paragangliomas.