Meningitis and midline facial deformity

A baby with unilateral cleft lip, midline cleft palate and hypertelorism developed meningitis in the first 48 h of life. Examination of the nasopharynx showed a soft tissue mass, which was confirmed as a basal encephalocele by computed tomography. There was also congenital hydrocephalus and the corpus callosum was absent. Surgical treatment included repair of the anterior basal skull defect, repair of the lip and palate, and ventriculo-peritoneal shunt. There is currently evidence of developmental delay and right-sided visual impairment due to Morning Glory syndrome. This case demonstrates that basal encephalocele should be considered in any baby with midline facial deformity who develops meningitis.     

Recurrent vaginitis as a result of sexual transmission of IgE antibodies

The role of the man in the etiology of recurrent vaginitis was examined in three women who reported an association between coitus and the initiation of clinical symptoms. The patients' disorders consisted of vaginal pruritis, burning, a white discharge, and painful coitus. Vaginal pH in each case was 4.5. Microscopic examination of wet mounts of vaginal secretion had no clue cells and no organisms other than lactobacillus. One culture was positive for Candida albicans; however, successful treatment of the C. albicans vaginitis did not eliminate the patient's symptoms. Semen samples from the patients' partners were negative for C. albicans. One of the seminal fluids had highly elevated concentrations of total IgE. The other two semen samples contained IgE antibodies that were reactive with a particulate fraction of vaginal fluids obtained from their wives. In contrast, vaginal fluids from the patients were all negative for IgE antibodies to their partner's semen. Use of a condom during coitus ended the recurring cycles of vaginitis in all three women. Vaginitis may be induced by an allergic reaction initiated by the transfer from men to women during coitus of IgE antibodies reactive either to antigens of the female genital tract or components of semen. Men allergic to female vaginal secretions, to vaginal microbes or their products, or to semen represent a previously unrecognized noninfectious vector for this disorder.     

Detection and characterization of immune complexes in the circulation of infertile women

The incidence of circulating immune complexes (CICs) was evaluated in sera from 39 female partners of infertile marriages and from 38 fertile women. Fifteen (38%) of the infertile women had CICs, as determined by the Raji cell assay, in levels ranging from 300 to 8000 micrograms/ml; whereas only 1 (3%) of the fertile women displayed CICs (P less than 0.001). Analysis of the CICs from nine of the women following polyethylene glycol precipitation and acid dissociation revealed that four contained C1q and three contained an antigen reactive with rabbit antibody to human spermatozoa. These latter three women all lacked free sperm antibody, as determined by enzyme-linked immunosorbent assay and agglutination. Thus, CICs are not uncommon as a manifestation of infertility in females. Their presence may lead to an underestimation of sperm antibody levels and may be indicative of underlying infection or autoimmunity.     

Inhibition of Candida albicans--induced lymphocyte proliferation by lymphocytes and sera from women with recurrent vaginitis

To investigate whether there was an immunologic basis for recurrent Candida albicans-induced vaginitis, peripheral blood lymphocytes were isolated from six women with this disorder and from six healthy control women. No differences were observed in the proliferative responses of peripheral blood lymphocytes to mitogens. However, only the control peripheral blood lymphocytes proliferated in response to a C. albicans extract. Furthermore, patients' lymphocytes or serum suppressed the proliferative response of control lymphocytes to C. albicans but not to mitogens. Women with recurrent C. albicans vaginitis appear to produce Candida-specific suppressor lymphocytes which block the cellular immune response to this organism.     

Cell-free 27 kDa heat shock protein (hsp27) and hsp27-cytochrome c complexes in the cervix of women with ovarian or endometrial cancer

Antibodies to the 27 kDa heat shock protein (hsp27) are present in some women with ovarian and endometrial cancers but not in women with nonmalignant conditions or healthy women. The appearance of these antibodies suggests that the corresponding protein (hsp27) may be present in an extracellular form in gynecologic cancer patients. Synthesis of hsp27 is upregulated in gynecologic cancers and inhibits induction of apoptosis. We now report the detection of hsp27 as well as hsp27-cytochrome c complexes in cell-free endocervical or posterior vaginal specimens from women with endometrial or ovarian cancer. Specimens were obtained with a cotton swab from 209 consecutive patients seen by a gynecologic oncologist. After removal of cellular components, aliquots of supernatants were assayed by ELISA for hsp27, using cytochrome c bound to microtiter plate wells, and for hsp27-cytochrome c complexes, using antibodies to cytochrome c and hsp27. Among 47 women with ovarian cancer, 38.3% were positive for hsp27 and 27.7% had hsp27-cytochrome c complexes. Similarly, among 52 women with endometrial cancer, 34.6% were hsp27-positive and 30.8% had hsp27-cytochrome c complexes. In contrast to the women with ovarian or endometrial cancer, of the 86 women with benign diagnoses only, 10.5% had cervical hsp27 (p < 0.002) and 8.1% had hsp27-cytochrome c complexes (p < 0.004). Among ovarian cancer patients, hsp27 was identified in 44.0% of the 25 women with active disease as opposed to 17.6% of the 17 patients in remission (p < 0.05). In women with stage 1-2 active ovarian cancer, 8 of 10 (80.0%) were hsp27-positive as opposed to 3 of 14 (21.4%) stage 3-4 patients (p < 0.01). For hsp27-cytochrome c complexes, 50% of ovarian cancer patients with active stage 1-2 disease as opposed to 21.4% with stage 3-4 disease were positive. Among women with endometrial cancer, only 10 of the 52 patients had active disease and 44 were in stage 1-2. For this malignancy, there was no relation between detection of hsp27 or hsp27-cytochrome c and active disease or cancer stage. Our results suggest that cell-free hsp27 and hsp27-cytochrome c complexes can be detected in the lower genital tract of women with ovarian and endometrial cancers. Identification of these biomarkers may be beneficial in the early diagnosis of these malignancies.     

Interleukin 1 receptor antagonist gene polymorphism in women with vulvar vestibulitis

OBJECTIVE: Vulvar vestibulitis is a chronic inflammatory syndrome of unknown cause and pathogenesis. We examined the relation between vulvar vestibulitis and polymorphisms in the gene coding for the interleukin 1 receptor antagonist, a naturally occurring down-regulator of proinflammatory immune responses. STUDY DESIGN: Cells from the lower genital tract of 68 women with vulvar vestibulitis, 343 women with no history of vulvodynia, and 40 women with human papillomavirus cervical infection were tested by polymerase chain reaction for the different alleles of the gene encoding for interleukin 1 receptor antagonist. The presence of human papillomavirus in the specimens was determined by polymerase chain reaction with the use of degenerate consensus primers to the conserved L1 gene. RESULTS: Allele 2 of the gene encoding the interleukin 1 receptor antagonist was present in homozygous form in 52.9% of women with vulvar vestibulitis. In marked contrast only 8. 5% of the control women and 2.5% of women with human papillomavirus were homozygous for this allele (P 相似文献   

Expression of differential nitric oxide synthase isoforms in human normal gastric mucosa and gastric cancer tissue

The present study investigated the expression and distribution of three isoforms of nitric oxide synthase (NOS) in different anatomical regions of the human stomach and in gastric neoplastic tissues by immunohistochemistry using specific antibodies. Intracellular localization of individual isoenzymes of NOS was detected in normal gastric mucosa. Gastric cancer tissues had a marked reduction of all three NOS isoforms expression. The expression of the endothelial NOS, neuronal NOS and inducible NOS in the tumor tissue was significantly lower than in normal gastric mucosa (P = 0.01, P = 0.02, P < 0.01, respectively). In the tumor tissue the expression of inducible NOS was significantly lower than the expression of both constitutive forms of NOS (P < 0.01). There was a tendency to higher expression of both constitutive forms of NOS in earlier stages T2 of the tumor compared to advanced T4 tumor. In contrast, the expression of inducible NOS was higher than in the advanced T4 tumor than in the earlier stages T2 of the tumor. The mapping of the expression of endothelial NOS, neuronal NOS and inducible NOS in human stomach showed higher expression of NOS isoforms in the distal third than in the proximal third of the stomach (P = 0.03, P = 0.04, P = 0.01, respectively). We conclude that there is greater expression of NOS in the stomach corpus and in antrum than in the proximal third of the normal human stomach mirroring the anatomical predilection of common pathological changes in this part of the human stomach. Furthermore, there was loss of the expression of individual isoenzymes in gastric neoplasms.