Acute adrenal insufficiency associated with heparin-induced thrombocytopenia

Although the thrombotic risk of heparin-induced thrombocytopaenia (HIT) is well recognized and may affect any vascular bed, the involvement of adrenal veins has been less commonly described. We report the case of a 86-year-old woman who developed bilateral massive adrenal haematoma associated with HIT, resulting in acute adrenal insufficiency. After immediate discontinuation of heparin and starting therapy with danaparoid and hydrocortisone, the clinical evolution was favourable, although adrenal failure was irreversible. When abdominal pain, hypotension and fever occur during heparin therapy, associated with a drop in platelet count, acute adrenal insufficiency secondary to HIT should be considered, as early diagnosis is essential for the treatment of this life-threatening complication.     

Impact of rapid microbial identification directly from positive blood cultures using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry on patient management

For septic patients, delaying the initiation of antimicrobial therapy or choosing an inappropriate antibiotic can considerably worsen their prognosis. This study evaluated the impact of rapid microbial identification (RMI) from positive blood cultures on the management of patients with suspected sepsis. During a 6-month period, RMI by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was performed for all new episodes of bacteraemia. For each patient, the infectious disease specialist was contacted and questioned about his therapeutic decisions made based on the Gram staining and the RMI. This information was collected to evaluate the number of RMIs that led to a therapeutic change or to a modification of the patient's general management (e.g. fast removal of infected catheters). During the study period, 277 new episodes of bacteraemia were recorded. In 71.12% of the cases, MALDI-TOF MS resulted in a successful RMI (197/277). For adult and paediatric patients, 13.38% (21/157) and 2.50% (1/40) of the RMIs, respectively, resulted in modification of the treatment regimen, according to the survey. In many other cases, the MALDI-TOF MS was a helpful tool for infectious disease specialists because it confirmed suspected cases of contamination, especially in the paediatric population (15/40 RMIs, 37.50%), or suggested complementary diagnostic testing. This study emphasizes the benefits of RMI from positive blood cultures. Although the use of this technique represents an extra cost for the laboratory, RMI using MALDI-TOF MS has been implemented in our daily practice.     

Intraepithelial p63‐dependent expression of distinct components of cell adhesion complexes in normal esophageal mucosa and squamous cell carcinoma

TP63 gene is a member of TP53 tumor suppressor gene family that encodes several protein isoforms involved in the process of epithelial stratification and in epithelial‐mesenchyme interactions. TP63 is amplified in a significant proportion of squamous cell carcinoma of the esophagus (ESCC), resulting in the hyper‐expression of ΔNp63 as the major p63 isoform. To better understand the contribution of this high expression to tumorigenesis, we have analyzed the impact of intraepithelial p63 expression on the expression of cell adhesion complexes in normal esophagus and in ESCC cell lines. Cells expressing p63 showed an adhesion pattern characterized by lack of tight junctions and presence of adherens junctions. Cell differentiation was accompanied by a decrease in p63 and by a shift to adhesion patterns involving tight junctions. Silencing of p63 mRNA in ESCC cell lines resulted in a similar shift, characterized by increased expression of component of tight junctions, decreased cell‐to‐cell communication and downregulation of cell proliferation. These results indicate that ΔNp63 may contribute to esophageal squamous carcinogenesis by maintaining cell adhesion patterns compatible with cell proliferation.     

Muscle stretching and motoneuron excitability

Summary Change of motoneuron excitability has been studied during the three basic modalities of slow or static stretching of the human soleus muscle. Tendon (T) and Hoffmann (H) reflexes were analyzed during static stretching (SS). The H response was compared in SS, in SS preceded by a maximal isometric contraction of the muscle or contraction-relaxation (CR) and during stretching of the muscle by contracting the antagonistic muscles (AC). During progressive dorsiflexion of the foot there is a significant difference (p<0.05) between T and H reflexes during SS, although the amplitude of direct motor (M) response, evoked by a maximal stimulation of the motor nerve, is not changed. The maximal joint mobilization during SS, CR and AC modalities appears to be closely related to the decrease in the H response during stretching. This decrease is significantly (p<0.05) smaller in SS than in AC or CR. In this last method, the duration of the maximal isometric contraction does not affect the results. In these three basic stretching procedures, the H reflex quickly recovers as soon as the manoeuvre is interrupted. It is suggested that changes in muscle motoneuron pool excitability closely control joint mobilization during slow or static stretching. The inhibition of the motoneurons observed during SS, CR and AC modalities is limited to the duration of the stretching manoeuvre.This work was supported by the Fonds National de la Recherche Scientifique of Belgium, the Conseil de la Recherche of the University of Brussels, the Reckitt and Colman Foundation