On-a-chip tryptic digestion of transthyretin: a step toward an integrated microfluidic system for the follow-up of familial transthyretin amyloidosis

TTR digestion on TE-chip: production of a fragment of interest allowing the therapeutic follow-up of the familial transthyretin amyloidosis.

Fractures of the odontoid process: a report of 15 cases in children younger than 6 years

Fractures of the odontoid process are rare in children. We retrospectively reviewed 15 cases in children younger than 6 years, with an average follow-up of 4 years and 3 months. Eight of these patients had neurologic involvement; magnetic resonance imaging (MRI) changes were seen in the spinal cord at the cervicothoracic junction in six. This neurologic injury was thought to be due to the major anterior displacement of the upper spine, causing spinal cord stretch at the spinal apex of the cervical and thoracic spine. Eight patients secured in forward-facing car seats were injured as the result of motor vehicle accident. Conservatively treated fractures fused without problem. By contrast, the three cases operated on as the initial management of the fracture had complications postoperatively.

[Cerebral anoxia in near-drowning of children. The prognostic value of EEG]

The retrospective electroclinical evaluation of anoxia by near-drowning in 23 children observed between 1985 and 1989 revealed 2 groups, each with a distinct evolution: the first group, with good prognosis of 17 children, which recovered consciousness without neurological complications between 2 d and 1 wk after the accident. The second group of 6 children with a poor outcome--either i), death; or ii), state of permanent injury; or iii), a high level of clinical deficits. The gravity of the early clinical state, the estimated duration of cardiorespiratory arrest, the severity of the hypothermia, the seizures and the paroxysmic activity, do not determine the severity of near-drowning encephalopathy. The EEG patterns described in correlation with the group and the clinical outcome permitted determination of prognostic criteria. A good prognostic consisted of the following: moderate background activity, sleep patterns, response to auditory and painful stimulations, and numerous beta rhythms. A bad outcome was defined by: high voltage, rhythmic delta waves; biphasic sharp waves; monotonous EEG, "burst-suppression" pattern, absence of beta rhythms. The importance of EEG recordings is emphasized performed as early as possible and until 3 or 7 d after the near-drowning. Any modification in the EEG, with attenuation or disappearance of fast frequencies and painful reactivity, appearance or enhancement of slow and biphasic sharp waves, are ominous signs and may be accompanied by the appearance of cerebral oedema and decerebration.

[Ventricular staphylococcal infections. Treatment with vancomycin by continuous venous infusion]

Thirteen cases of meningeal and/or ventricular infection and 1 case of septicaemia, all caused by staphylococci, were treated with continuous intravenous infusions of vancomycin. Repeated measurements of vancomycin plasma and CSF levels by microbiological assay or by high performance liquid chromatography showed that the antibiotic entered the CSF after 48 hours of treatment and that its concentrations in CSF remained stable at 1 to 4 micrograms/ml (mean: 2 micrograms/ml) throughout the 3 weeks' treatment period. After treatment was discontinued, vancomycin became undetectable in CSF within less than 24 hours. All the children were cured.

[Acute myocarditis simulating an anterior infarction rupture. Apropos of 2 cases]

The first case report concerns a 31 year old woman presenting clinically and electrocardiographically as an anteroseptal myocardial infarction complicated by cardiogenic shock with equalization of right heart diastolic pressures. Coronary angiography performed under circulatory assistance was normal. The patient recovered, and clinical examination 4 years after the acute episode is absolutely normal. The second case was a 37 year old man admitted in cardiogenic shock thought to be due to a large anterior myocardial infarct. Catheterisation showed equalization of right heart diastolic pressures. Pericardial aspiration was negative and the most likely diagnosis appeared to be a localised rupture of the heart. The patient underwent emergency cardiac surgery but no infarct scar was observed and opening the pericardium did not improve the haemodynamics. Coronary angiography was carried out at the 24th hour under circulatory assistance and was found to be normal. The diagnosis was corrected to that of acute myocarditis and 5 months after the acute episode clinical cure was confirmed by normal echocardiography and angiography. The only positive aetiological finding in this case was the serology to chlamydia trachomatis which as strongly positive at increasing titres. Chlamydia was isolated from the patient's urethra and a chlamydia trachomatis exocervicitis was also found in the partner. This appears to be the first reported case of chlamydia trachomatis acute myocarditis in the adult.

Longitudinal study of the human intestinal brush border membrane proteins. Distribution of the main disaccharidases and peptidases

The longitudinal distribution of the main brush border membrane hydrolases was studied in six entire human small intestine, one of which was found to be lactase-deficient. Sucrase and lactase activities were found to be highest in the jejunum, whereas glucoamylase activity rose steadily and reached its highest activity near the ileocecal valve. Maltase activity distribution was intermediate between that of sucrase and of glucoamylase. Neutral aminopeptidase, acid aminopeptidase and dipeptidyl peptidase IV activities tended to increase toward the end of the small bowel, the latter two activities rising more than the first one. Furthermore, the protein compositions of the brush border membrane in the jejunum and in the ileum were compared after electrophoresis on polyacrylamide gels and crossed-immunoelectrophoresis; protein patterns were found to be similar along the gut, and enzyme-specific activities varied in parallel with the amounts of their corresponding proteins. In the lactase-deficient intestine, the protein band corresponding to lactase was not visible. Maximal digestive capacity was thus localized in the jejunum only for disaccharides, and in the ileum for the more complex substrates, oligosaccharides, and peptides; this finding suggests that the ileum may play a greater role in their terminal digestion than is usually admitted.

[Septal rupture in elderly patients. Apropos of 2 cases treated surgically in the acute phase of myocardial infarction]

Two cases of interventricular septal rupture (VSR) in elderly patients (71 and 74 years) occurring at the 5th and 12th day of primary postero-inferior myocardial infarction, were reported. The diagnosis was made at 2D echocardiography and confirmed at catheterisation with coronary angiography. Good surgical results were obtained after operation 72 and 12 hours after VSR (9th and 12th infarct days, respectively): the first patient had a good outcome with a 2 year follow-up, but the second patient died in the 55th postoperative day, of renal failure. The authors underline the value of 2D echo in the management of acute myocardial infarction and in the detection of VSR. In addition, the advances in intensive care and surgical techniques allow early and complete cure of cardiac lesions with a low hospital mortality and significant functional improvement, even in the elderly patient.

[Polyacrylamide gel electrophoresis analysis of membrane proteins of microvilli and of a cytoplasmic fraction in 8 cases of congenital saccharose intolerance]

The protein composition of the brush border membrane and of a cytoplasmic fraction has been studied by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate in 8 children with congenital sucrose intolerance. The sucrase-isomaltase complex was not found (6 times) or in trace amounts (2 times) among the brush border membrane proteins whereas an abnormal band was visible among the cytoplasmic proteins in the 4 cases where they have been studied. These results suggest that a structural mutation affecting the signal sequence necessary for the complex to be transferred on the luminal side of the endoplasmic reticulum membrane could be at the origin of the disease.