Benign cutaneous epithelioid Schwannoma: case report and review of the literature

Benign peripheral nerve sheath tumors are relatively common. They are mostly characterized by the presence of delicate S-shaped spindle cells and myxoid stroma. Although variants with epithelioid foci can be present, the pure epithelioid variant of benign cutaneous schwannoma is extremely rare. It was first reported as cutaneous epithelial schwannoma by Kindblom et al in 1998. Since then, only six cases have been reported. Care should be taken not to misdiagnose them as malignant neoplasms. Their diagnosis can be problematic as their histopathologic features may overlap with those of other soft-tissue and melanocytic tumors. We report a case of cutaneous epithelioid schwannoma and review of the literature.     

Antimicrobial activity of stratum corneum lipids from normal and essential fatty acid-deficient mice

Among the cutaneous effects of an essential fatty acid deficient (EFAD) diet are hyperdesquamation, increased transepidermal water loss (TEWL), and altered lipid profiles, characteristics also common to inflammatory dermatoses. Because fatty acids are antimicrobial, we examined the indigenous skin flora of normal and EFAD hairless mice, and compared the antimicrobial efficacy of lipids extracted from their stratum corneum. EFAD mice supported 100-fold more bacteria than normal mice, and were the only group from which Staphylococcus aureus were routinely isolated. Despite this greater carriage, in vitro experiments demonstrated that EFAD lipids are more lethal than normal lipids against Streptococcus pyogenes, S. aureus, S. epidermidis, Micrococcus sp., and a coryneform. Skin fungi were equally susceptible to both extracts. After thin layer chromatography, the most active fractions were found to be glycosphingolipids and phospholipids. EFAD extracts had 35% more free fatty acids and 75% more glycosphingolipids; normal extracts had more triglycerides and phospholipids. S. aureus strain 502A survived equally well on EFAD as on normal mice. Normal lipids applied on EFAD mice had no additional effect, but EFAD lipids on normal mice brought about a 35% reduction of the inoculated bacteria. If the mice were pretreated with alcohol, carriage of strain 502A was reduced by 71%. If instead the mice were previously washed with acetone to increase TEWL, a 97% reduction of the staphylococcus occurred. The application of normal flora to such acetone-washed mice decreased the efficacy to 76%. EFAD and normal lipids on human subjects were equally ineffective in eliminating strain 502A.(ABSTRACT TRUNCATED AT 250 WORDS)     

The Staphylococcus aureus receptor for fibronectin

The Staphylococcus aureus binding site for human fibronectin was determined by unique biologic assays based upon the specific adherence of the bacterium to nasal epithelial cells. Fibronectin treatment of S. aureus caused a reduction in adherence tallies on high granular and fully keratinized cells compared to controls (p less than 0.05; p less than 0.001). Spinous and low granular cells showed no significant differences. The cell wall materials N-acetyl-D-glucosamine, N-acetyl muramic acid, and protein A were unable to inhibit the coupling of fibronectin to S. aureus. Only ribitol teichoic acid had this property. Furthermore, fibronectin could neutralize the adherence-blocking ability of teichoic acid, which affects keratinized cells. Thus, teichoic acid seems to be a receptor for fibronectin.     

Mycobacterium tuberculosis embB codon 306 mutations confer moderately increased resistance to ethambutol in vitro and in vivo

Ethambutol (EMB) is a major component of the first-line therapy of tuberculosis. Mutations in codon 306 of embB (embB306) were suggested as a major resistance mechanism in clinical isolates. To directly analyze the impact of individual embB306 mutations on EMB resistance, we used allelic exchange experiments to generate embB306 mutants of M. tuberculosis H37Rv. The level of EMB resistance conferred by particular mutations was measured in vitro and in vivo after EMB therapy by daily gavage in a mouse model of aerogenic tuberculosis. The wild-type embB306 ATG codon was replaced by embB306 ATC, ATA, or GTG, respectively. All of the obtained embB306 mutants exhibited a 2- to 4-fold increase in EMB MIC compared to the wild-type H37Rv. In vivo, the one selected embB306 GTG mutant required a higher dose of ethambutol to restrict its growth in the lung compared to wild-type H37Rv. These experiments demonstrate that embB306 point mutations enhance the EMB MIC in vitro to a moderate, but significant extent, and reduce the efficacy of EMB treatment in the animal model. We propose that conventional EMB susceptibility testing, in combination with embB306 genotyping, may guide dose adjustment to avoid clinical treatment failure in these low-level resistant strains.     

Prognostic significance of FLT3 internal tandem duplication in Egyptian acute myeloid leukemia and normal cytogenetics

Internal tandem duplication of the FLT3 gene (FLT3/ITD) has been linked to a poor outcome in acute myeloid leukemia (AML). However, the prognostic value of FLT3/ITD in various cytogenetic risk groups is still a matter of debate. The aim of this study was to evaluate the prognostic significance of FLT3/ITD in patients with de novo AML and normal cytogenetics (NC-AML). Diagnostic samples of 39 patients were investigated by PCR of exons 14 and 15 of the FLT3 gene in patients with AML. Subgroups included 26 patients with normal cytogenetics, 8 patients with t(15;17), 4 patients with t(8;21), and 1 patient with inv (16). FLT3/ITD was found in 6/39 (15.4%) AML cases. By cytogenetic subgroups, there were 4/6 normal cytogenetics, 1/6 t(15;17) and 1/6 t(8;21) positive patients. Patients were M1, 3/13; M2, 2/12; M3, 1/9; M4, 0/4; and M5, 0/1. The patients were followed up for a mean of 34.5 ± 2.3 months. The complete remission rates for the FLT3/ITD+ and FLT/ITD? groups were 50% vs 63.6% in normal cytogenetics, while the relapse rates were 50% vs 28.6% in normal cytogenetics. Interestingly, disease-free survival (DFS) at 3?years was significantly different in patients with normal cytogenetics: DFS was 5% in patients with FLT3/ITD+ vs 30% of patients with FLT3/ITD? (P?=?0.001). Although based on a study with a limited number of AML patients, our data suggest a high prognostic value of FLT3/ITD in patients with normal/favorable cytogenetics. Further study on a larger scale is recommended.     

Operative laparoscopy in tubal pregnancy: preoperative ultrasonographic measurement of hemoperitoneum as a predictor of blood loss and outcome

OBJECTIVE: To study the relationship of ultrasonographic measurement of hemoperitoneum to estimated blood loss and outcome of operative laparoscopy in ectopic pregnancy. STUDY DESIGN: Retrospective study of all tubal pregnancy patients with preoperative ultrasonographic evidence of hemoperitoneum who underwent laparoscopy as part of the procedure at a tertiary referral center over a 3.5-year period. The largest transabdominal and transvaginal measurements of pelvic fluid collections in anterior-posterior, transverse and cranial-caudal dimensions were measured from all available preoperative ultrasound films. Patient characteristics, volume of estimated blood loss and complications were reviewed. RESULTS: A total of 29 patients were included in the study. Twenty-one underwent successful laparoscopic treatment (group 1). Four patients underwent conversion from laparoscopy to laparotomy because of bleeding (group 2). Four patients underwent conversion because of adhesions (group 3). There were no significant differences in patient characteristics. The single largest ultrasonographc diameter of pelvic fluid collection in any dimension seemed to correlate with estimated blood loss volume (R2 =.659; p <0.05), with significant volume present in those with a maximum diameter > 7 cm. The mean diameter of greatest measurements was significantly different between groups 1 and 2 and between groups 2 and 3 (p<0.05). However, such measurements did not predict the success of laparosocpic surgery. CONCLUSION: The greatest ultrasonographic measurement of pelvic fluid collection > or = 7 cm in any dimension appears to serve as a marker of significant hemoperitoneum. Hemoperitoneum alone does not appear to predict the outcome of surgery, and otherfactors should be considered prior to performing operative laparoscopy in ectopic pregnancy.     

Clinico-laboratory study on children with auto-immune hepatitis in Upper Egypt

Background and study aimsAuto-immune hepatitis (AIH) in children is a rare chronic progressive liver disorder. It is characterised serologically by high aminotransferase levels, elevated immunoglobulin G (IgG) and the presence of autoantibodies. AIH is divided into two types according to the autoantibody profile. This study aims to assess frequency, clinical manifestations, biochemical features and outcome of AIH in children attending Assuit University Hospitals in Upper Egypt with acute icteric hepatitis and seronegative viral markers (anti-hepatitis A virus (HAV) IgM, HbsAg, anti-hepatitis C virus (anti-HCV) Ab).Patients and methodsThe study includes 34 children with AIH, diagnosed on the basis of the International Scoring Criteria of Auto-immune Hepatitis, recruited from Assuit University Hospitals, during the period from January 2005 to December 2009. All patients received prednisolone 2 mg kg^–1 day^–1. Follow-up was done for 1 year.ResultsAmong 34 children diagnosed as AIH, 24 were females (70.5%) and 10 were males (29.5%). Jaundice represented the most consistent finding in all patients. According to the autoantibody profile, 25 children were classified as type 1 and nine children were classified as type 2. Corticosteroid therapy was started. Complete remission was observed in 67.6% of patients and partial remission in 17.6%. There was no significant statistical difference in clinical and biochemical features of AIH in patients regarding the response to treatment. Mild side effects of steroid therapy were encountered in 48.2% of patients. After complete withdrawal of corticosteroids, six patients (20.7%) developed relapse.ConclusionAIH type 1 was the main form of AIH in children referred to Assiut University Hospitals. Girls were more affected than boys. AIH type 1 exhibited a more active, ongoing immunologic process. Steroid alone can be used successfully in most cases. Children with AIH type 2 had a higher frequency of relapse after corticosteroid withdrawal. Further studies on a larger number of cases and long-term follow-up are recommended.