Immunohistochemical detection of Helicobacter pylori infection in gastric biopsies of urea breath test-positive and -negative pediatric patients

Helicobacter pylori (H. pylori) is a common cause of gastritis in both children and adults, and its incidence increases every year. The aims of this study were to evaluate the histopathologic features of H. pylori gastritis and to compare immunohistochemical with histochemical [hematoxylin-eosin (HE) and Giemsa] staining of gastric biopsy specimens for the detection of H. pylori infection from urea breath test (UBT) (-) and UBT (+) children. Seventy-eight gastric biopsies from pediatric patients who were administered UBT were included in this study. Gastric biopsy specimens were evaluated histopathologically and graded according to the Sydney system. HE, Giemsa and immunohistochemical staining was performed for the identification of H. pylori. The frequency of H. pylori gastritis was higher in the antrum than corpus. All biopsies with H. pylori colonization showed chronic inflammation with activity. By using immunohistochemical method, coccoid forms of H. pylori and spiral bacteria with low density were observed easily. With histochemical staining, 1/10 (10%) UBT (-) biopsies were H. pylori (+), while with immunohistochemical staining, 3 of the biopsies from UBT (-) patients were found to be H. pylori (+). Biopsies from 65 of 78 (83.3%) UBT (+) patients were H. pylori (+) with histochemical staining, but only 53 of these biopsies were found to be H. pylori (+) immunohistochemically. We conclude that immunohistochemical staining is more specific than histochemical staining and UBT for the detection of H. pylori infection.

The triad of nesidioblastosis, congenital neuroblastoma and glomerulocystic disease of the newborn: a case report

Neuroblastoma is the most common malignant tumor of the newborn, comprising 20% of all malignancies encountered during the neonatal period. We herein report a newborn who was born after 29 weeks' gestation and died unexpectedly at the 12th hour of life with no response to vigorous cardiopulmonary resuscitation. Autopsy findings revealed a right pararenal mass; microscopic examination showed neuroblastoma. Although the pancreas was grossly normal, its microscopic sections revealed a reduced number of islets of Langerhans and dispersion of the islet cells throughout the exocrine cells of the pancreas, and immunocytochemistry for the pancreatic hormones confirmed the dispersion of the islet cells. Final pathologic interpretation thus concluded the presence of nesidioblastosis. Furthermore, microscopic examination of the kidney showed glomerulocystic disease. Although the association of congenital neuroblastoma and nesidioblastosis has recently been defined as a new complex, neurocristopathy, the triad of congenital neuroblastoma, nesidioblastosis and glomerulocystic disease of the newborn has not been reported previously. To our knowledge, our case is the first reported newborn presenting with this triad. In conclusion, the association of nesidioblastosis and/or renal glomerulocystic disease should be kept in mind when encountering a case of congenital neuroblastoma. However, whether the presence of glomerulocystic disease in association with those other neurocristopathic pathologies is a coincidental finding or shares a common pathophysiological mechanism remains to be determined.

Galactorrhea-associated granulosa cell tumor in a child

Granulosa cell tumor of the ovary is a rare form of ovarian cancer in children. An 11-year-old girl was admitted with complaints of galactorrhea and abdominal mass. Abdomino-pelvic ultrasound and computed tomography revealed an ovarian tumor. Her prolactine and estradiol levels were increased but luteinizing hormone and follicle-stimulating hormone were decreased. An exploratory laparotomy revealed a giant solid mass, which was completely removed and determined as juvenile granulosa cell tumor. The clinical, hormonal, and radiological findings and the therapy of galactorrhea associated with granulosa cell tumor in a child are discussed. To our knowledge, this is first time it has been described in childhood.

Congenital contractural arachnodactyly and femoral fracture in a newborn infant: a causal relationship or a coincidence?

Congenital contractural arachnodactyly (CCA, Beals syndrome) is an autosomal-dominant connective tissue disorder characterized by multiple flexion contractures, arachnodactyly, severe kyphoscoliosis, abnormal pinnae, and muscular hypoplasia. Although it is a connective tissue disorder affecting bone structure and formation, coexistence of bony fractures in CCA patients have not been reported before. In this article we report a newborn infant diagnosed with CCA who developed a femoral fracture possibly due to abnormal bone structure and birth injury in spite of cesarean delivery.

Transient intrauterine hypotension causes apoptosis in fetal rat brain and affects learning

Hypotensive episodes are frequent during pregnancy, and their functional effect on fetal brain has not been studied. We produced systemic hypotension for 30 min during mid-gestation in pregnant rats and examined their offspring on postnatal days 1 and 28. When compared with sham controls, the brain of the hypotensive group contained more TUNEL-positive cells in the hippocampal and periventricular regions on both time points. Spatial learning assessed by water milk maze test was impaired in 28-day-old pups of the hypotensive mothers. According to these results, transient maternal hypotension can induce apoptotic cell death in fetal brain and affect learning. Similar mechanisms may be considered and investigated in the pathogenesis of human learning disorders.

Prenatal diagnosis of laryngeal atresia

Prenatal diagnosis of congenital atresia of the larynx is difficult but is possible by the findings of increased lung echogenicity and size coexisting with fetal ascites in ultrasonography. Sonographic findings may not always be typical. We report on a case of congenital laryngeal atresia diagnosed prenatally by the findings of fetal hydrops and hyperechogenic lungs. Our case presented with oligohydramnios. We also review syndromes that demonstrate laryngeal anomalies.

Apoptosis in the developing human brain: a preliminary study of the frontal region

BACKGROUND

Natural cell death due to apoptotic mechanisms has been described in various species. Relatively few studies examined this process in humans.

AIM

To investigate the distribution of apoptosis in fetal brain tissue.

DESIGN

We examined apoptosis in the frontal region of human fetal brain by the TUNEL method in nine fetuses with no neurological conditions, gestational age 14-26 weeks, and three fetuses with structural anomalies of the nervous system (lumbar meningomyeloceles, n=2, hydrocephalus, n=1).

RESULTS

In normal fetuses, TUNEL-positive cells were most concentrated in the intermediate zone (IZ) and between 18 and 22 weeks of gestation; cortical apoptosis was not prominent. The fetus with hydrocephalus had increased numbers of TUNEL-positive cells while those with neural tube defects did not differ from normals.

CONCLUSION

The definition of normally occurring apoptosis may provide a basis for further studies directed at central nervous system (CNS) malformations.

Ataxia and peripheral neuropathy: rare manifestations in Henoch-Schönlein purpura

Henoch-Schönlein purpura (HSP) is a multisystemic vasculitis. Nervous system involvement is usually underestimated. Headaches, mental status changes and seizures are the most frequent neurologic symptoms. Ataxia and mononeuropathy are both very rare. We present an 11-year-old boy with HSP who suffered from ataxia during the initial presentation and peripheral neuropathy at the time of a relapse. Brainstem vasculitic involvement was shown by magnetic resonance imaging, while cranial tomography was normal. All the neurologic symptoms and signs resolved following bolus methylprednisolone administration. Ten months later he had a second course of HSP with skin and renal involvement. A percutaneous renal biopsy, which was performed due to persistent hematuria, revealed mesangial proliferation with IgA deposition. During that period the patient experienced pain and numbness in the right foot and leg; electromyography showed signs of mononeuritis multiplex involving the right posterior tibial nerve. The patient responded to steroid therapy.