Progressive elongation of lower member by callotasis in the child: Results of 36 lengthenings

The authors reviewed a series of 36 progressive lengthenings of the lower member by callotasis (22 femur and 14 tibia) in 33 patients with an inequality of length of the lower member (ILLM). Median age was 13 years; etiology was dominated by infection, congenital defects, and trauma. The lengthening procedure was completed in 26 children; it was necessary to abandon seven lengthening attempts. Median lengthening achieved was 45 (range 30–100) mm. Complications were frequent, with 66 during the different stages (184%). Most were benign (40); seven were determined to be grave, requiring abandonment of the lengthening; while 17 were judged as serious and required an unforeseen supplementary general anesthesia. Upon review of these results, it appears that progressive lengthening is an attractive technique with considerable benefits. However, management is not simple and complications are frequent, requiring close collaboration between the nursing team, the child, and the child's parents. For patient and family, the psychological benefits of this procedure are considerable.     

Effect of 6 months of exercise and isoflavone supplementation on clinical cardiovascular risk factors in obese postmenopausal women: a randomized, double-blind study

OBJECTIVE: To investigate whether 6 months of exercise combined with isoflavone supplementation could improve clinical risk factors that predispose to cardiovascular disease in obese postmenopausal women. DESIGN: This was a randomized, double-blind, controlled trial in which 50 healthy obese postmenopausal women were divided into two groups and assigned to isoflavone supplementation (n=25) or a placebo (n=25) for 1 year. For the last 6 months, both groups participated in an exercise program (three times per week), at the end of which cardiovascular disease risk factors were compared between groups. Body composition (using dual-energy x-ray absorptiometry), metabolic profile (blood lipids, fasting insulin, fasting glucose, sex hormone-binding globulin, C-reactive protein) were determined at baseline and at 6 and 12 months. RESULTS: We observed a significant effect of exercise and isoflavone supplementation on body weight, total and abdominal fat mass (kilograms and percentage), body mass index, appendicular fat-free mass, fat-free mass/fat mass ratio, and sex hormone-binding globulin, but not with exercise alone. No difference was observed for other biochemical characteristics, although the quantitative insulin sensitivity check index increased equally in both groups. Conversely, although not significant, we observed a tendency for a treatment effect on body mass index (P=0.07) and on absolute (kilograms) (P=0.07) and percentage of (P=0.053) abdominal fat mass, whereas no effect of treatment was found for other variables using the Mann-Whitney test. CONCLUSIONS: Compared to an aerobic exercise program alone, 70 mg/day of isoflavones combined with exercise may promote significant improvements in body composition parameters that are known to influence cardiovascular disease risk in postmenopausal women.     

Multimodal architectonic subdivision of the caudal ventrolateral prefrontal cortex of the macaque monkey

The caudal part of the macaque ventrolateral prefrontal cortex (VLPF) is part of several functionally distinct domains. In the present study we combined a cyto- and a myeloarchitectonic approach with a chemoarchitectonic approach based on the distribution of SMI-32 and Calbindin immunoreactivity, to determine the number and extent of architectonically distinct areas occupying this region. Several architectonically distinct areas, completely or partially located in the caudal VLPF, were identified. Two areas are almost completely limited to the anterior bank of the inferior arcuate sulcus, a dorsal one—8/FEF—which extends also more dorsally and should represent the architectonic counterpart of the frontal eye field, and a ventral one—45B—which occupies the ventral half of the bank. Two other areas occupy the ventral prearcuate convexity cortex, a caudal one—area 8r—located just rostral to area 8/FEF and a rostral one—area 45A—which extends as far as the inferior frontal sulcus. Area 45A borders dorsally, in the proximity of the principal sulcus, with area 46 and, ventrally, with area 12. The present data show the existence of two distinct prearcuate convexity areas (8r and 45A), extending other architectonic subdivisions of the caudal VLPF and providing a new, multiarchitectonic frame of reference for this region. The present architectonic data, together with other functional and connectional data, suggest that areas 8/FEF, 45B and 8r are part of the oculomotor frontal cortex, while area 45A is a distinct entity of the VLPF domain involved in high-order processing of nonspatial information.     

Giant uterus-like mass of the uterus

Uterus-like masses, such as cavities lined by endometrium-type mucosa surrounded by bundles of smooth muscle cells, may strikingly resemble the uterus. In this report, we describe a case of a uterus-like mass of the uterus in a 35-year-old woman.     

Calcified liver hydatid cyst compressing the gall bladder

A 48-year-old male patient was admitted to suffering from hydatid disease located in the gall bladder. Although Morocco remains an endemic area for echinococcosis, this presentation of the disease was rare. The pericyst was tightly attached to the liver. Complete pericystectomy with cholecystectomy was done. Histopathology confirmed the presence of a calcified hydatid cyst of the gall bladder. Perioperative adjuvant medical therapy with albendazole was administered. After a 2-year follow-up, no recurrence occurred.     

Original Article: Streptokinase Modifies in Vitro Platelet Aggregation by Two Mechanisms: Reduced Aggregation due to Fibrinogenolysis and Enhanced Aggregation via an Immunological Reaction

Both inhibition and enhancement of platelet aggregation have been observed after exposure to streptokinase (SK) in vitro. Recently we have shown that inhibition of aggregation appears to be related to the fraction containing the fibrinogen degradation product, fragment E. In addition, SK may initiate platelet aggregation by a mechanism involving specific anti-SK antibodies and plasminogen. Two monoclonal antibodies (MoAbs) (PL2-49 and LeoA1) were used to assess the immunological activation of platelets in SK-induced platelet aggregation and in SK-enhanced ADP-induced platelet aggregation. The anti-SK titers in healthy volunteers' and patients' (previously treated with SK for acute myocardial infarction) plasma, were measured using a one-site non-competitive ELISA. Serum from patients was used for the purification of IgG anti-SK by affinity chromatography. We confirmed that the degree of fibrinogen degradation is a major determinant of the aggregation inhibition induced by SK. SK-induced platelet aggregation and SK-enhanced ADP-induced platelet aggregation require the interaction of the Fc domain of the anti-SK antibodies with the FcyRII located on the platelet membrane, since they are blocked by the MoAb IV-3 directed against FcyRII. Classification of the subjects according to their responses to specific MoAbs (PL2-49 and LeoA1) supports the essential role played by immunological activation of platelets in SK-induced platelet aggregation and in SK-enhanced ADP-induced platelet aggregation. The ability of anti-SK antibodies to promote SK-induced platelet aggregation and SK-enhanced ADP-induced platelet aggregation, seems to result from the interaction between two separate mechanisms: the fist mechanism is based on immunological activation of platelets and the second is related to the intervention of a defined subset of anti-SK antibodies.     

Genetic testing and first presymptomatic diagnosis in Moroccan families at high risk for breast/ovarian cancer

Germline mutations in the BRCA1 and BRCA2 genes highly predispose to breast and ovarian cancers and are responsible for a substantial proportion of familial breast and ovarian cancers. No female individuals from families from Morocco affected by breast cancer with mutations of these genes have previously been reported, and clinicians in Morocco are unaccustomed to dealing with healthy female individuals carrying mutations in the BRCA genes. This study aimed to report the initial experience of a group of Moroccan investigators carrying out predictive genetic testing to detect a known familial mutation in healthy Moroccan females with a high risk of developing breast cancer and to introduce supervision of these asymptomatic female carriers as a new approach in the prevention and early diagnosis of breast and ovarian cancers in Morocco. Presymptomatic diagnosis was carried out using DNA genetic testing in 5 healthy Moroccan female individuals from three families with an elevated risk of developing breast cancer. These are the first Moroccan families reported to be affected by breast cancers associated with BRCA mutations. Presymptomatic diagnosis was carried out for breast cancer in 5 female individuals from three Moroccan families with BRCA mutations. Two of the families are the first reported incidence of the founder mutation Ashkenazi BRCA1-185_186delAG in Moroccan patients. The third family carried the known BRCA2 mutation c.5073dupA/p.trp1692metfsX3. We tested the presence of these mutations in 5 asymptomatic healthy females from the three families. Two sisters from family 1 carried the BRCA1-185_186delAG mutation, whereas the third female individual from family 2 carried the c.5073dupA/p.trp1692metfsX3 mutation. However, one healthy female individual and her mother from family 3 did not carry the familial mutation of the BRCA1 gene. This study found BRCA mutations in three asymptomatic subjects, suggesting that this is the first step towards the development of persistent medical monitoring of females from families with a history of breast and ovarian cancers. Consequently, it is crucial for oncologists in Morocco to initiate the supervision of healthy female individuals with genetic defects which may lead to hereditary cancers.     

Impairment of the ABCA1 and SR-BI-mediated cholesterol efflux pathways and HDL anti-inflammatory activity in Alzheimer's disease

The aim of our study was to investigate the effect of Alzheimer's disease (AD) on the cholesterol efflux capacity and anti-inflammatory activity of HDL. HDL and apoA-I were isolated from 20 healthy subjects and from 39 AD patients. Our results showed that serum- and HDL-mediated cholesterol efflux is significantly impaired in AD patients. This impairment of serum and HDL cholesterol efflux capacity was significantly inversely correlated to the AD severity as evaluated by MMSE scores. Results obtained from SR-BI-enriched Fu5AH and ABCA1-enriched J774 cells revealed that AD impaired the interaction of HDL and apoA-I with both the ABCA1 transporter and SR-BI receptor. Purified apoA-I from AD patients also failed to remove free excess cholesterol from ABCA1-enriched J774 macrophages. Interestingly, the decrease in plasma α-tocopherol content and the increase in MDA formation and HDL relative electrophoretic mobility indicated that AD patients had higher levels of oxidative stress. The anti-inflammatory activity of HDL was also significantly lower in AD patients as measured by the level of ICAM-1 expression. In conclusion, our study provides evidence for the first time that the functionality of HDL is impaired in AD and that this alteration might be caused by AD-associated oxidative stress and inflammation.