Hematometrocolpos in an adolescent female treated for pelvic Ewing sarcoma

Radiation therapy is often used to achieve local control of pelvic Ewing sarcoma in children. The effects of radiation on the female reproductive tract have been well documented in adults with gynecological malignancies, but the long-term consequences of pelvic radiation in pre-pubertal or adolescent girls are not as well described. We report a case of hematometrocolpos developing in an adolescent previously treated with chemotherapy and radiation therapy for pelvic Ewing sarcoma. We describe the clinical presentation, radiographic features, gross pathology, treatment strategies, outcome, as well as putative predisposing factors and preventative interventions.     

Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation

BACKGROUND: Despite the increasing use of Roux-en-Y gastric bypass (RYGBP) in the treatment of morbid obesity, data about postoperative nutritional deficiencies and their treatment remain scarce. OBJECTIVE: The aim of this study was to evaluate the efficacy of a standard multivitamin preparation in the prevention and treatment of nutritional deficiencies in obese patients after RYGBP. DESIGN: This was a retrospective study of 2 y of follow-up of obese patients after RYGBP surgery. Between the first and the sixth postoperative months, a standardized multivitamin preparation was prescribed for all patients. Specific requirements for additional substitutive treatments were systematically assessed by a biologic workup at 3, 6, 9, 12, 18, and 24 mo. RESULTS: A total of 137 morbidly obese patients (110 women and 27 men) were included. The mean (+/-SD) age at the time of surgery was 39.9 +/- 10.0 y, and the body mass index (in kg/m(2)) was 46.7 +/- 6.5. Three months after RYGBP, 34% of these patients required at least one specific supplement in addition to the multivitamin preparation. At 6 and 24 mo, this proportion increased to 59% and 98%, respectively. Two years after RYGBP, a mean amount of 2.9 +/- 1.4 specific supplements had been prescribed for each patient, including vitamin B-12, iron, calcium + vitamin D, and folic acid. At that time, the mean monthly cost of the substitutive treatment was $34.83. CONCLUSION: Nutritional deficiencies are very common after RYGBP and occur despite supplementation with the standard multivitamin preparation. Therefore, careful postoperative follow-up is indicated to detect and treat those deficiencies.     

Outer membrane vesicles as acellular vaccine against pertussis

In this study the development and evaluation of outer membrane vesicles (OMVs) obtained from Bordetella pertussis as vaccines against pertussis disease is described. SDS-PAGE, immunoblot techniques and gel electrophoresis associated to tandem mass spectrometry were used to describe the composition of the OMVs obtained from B. pertussis Tohama CIP 8132 strain. These techniques revealed the presence of the main well-known pertussis surface immunogens in the OMVs such as pertactin, adenylate cyclase-haemolysin, pertussis toxin, as well as the lipo-oligosaccharide (LOS). A total of 43 proteins were identified by mass spectrometry. Some of them were predicted to have outer membrane or periplasmic location and the others with cytoplasmic or unknown location. The characterized pertussis OMVs were used in murine B. pertussis intranasal (i.n.) challenge model to examine their protective capacity when delivered by different routes. Killed detoxified whole-cell B. pertussis bacteria were used as reference. For intraperitoneal (i.p.) immunization, aluminum hydroxide was used as adjuvant. Since i.n. treatment with OMVs as well as killed whole-cell bacteria enhanced markers of innate immune response such as TNFalpha, IL-6 and CCL20, i.n. immunizations were performed with no adjuvant added. Immunized BALB/c mice were intranasally challenged with sublethal doses of B. pertussis. Significant differences between immunized animals and the PBS treated group were observed (p<0.001). Adequate elimination rates (p<0.005) were observed in mice immunized either with OMV or whole-cell bacteria. Comparable results were obtained with both types of immunization route. In view to their capacity to induce airways innate and protective immunity in the mouse model, OMVs obtained from B pertussis are candidates to be used to protect against pertussis.     

Phase I study of a candidate vaccine based on recombinant HIV-1 gp160 (MN/LAI) administered by the mucosal route to HIV-seronegative volunteers: the ANRS VAC14 study

One goal of HIV vaccination is to achieve high mucosal levels of specific secretory IgA (SIgA). In order to elicit specific SIgA antibodies against human immunodeficiency virus type-1 (HIV-1), a vaccine must be administered by the mucosal route, to the nasal or vaginal mucosa for example. We report here the results of the first phase I, randomized, open-label trial designed to assess the mucosal tolerability and immunogenicity of a candidate vaccine (recombinant protein HIV-1 gp160MN/LAI with or without DC-Chol adjuvant) administered by the nasal or vaginal route. Thirty-four female volunteers with a mean age of 46 years were vaccinated. There were 465 adverse events, of which 65 were considered related to the vaccine. No severe adverse events were related to the vaccine, and no difference in terms of tolerability was observed between the sites of vaccination or between the vaccine formulations. None of the volunteers reported that study participation affected their intimate or broader social relationships. No anti-gp160 activity was found between week 4 and week 48 in serum, saliva, or cervicovaginal and nasal secretions. These results show that a mucosal HIV vaccine can be well tolerated when administered by the nasal or vaginal route.     

Independent role of blood pressure on cardiovascular risk factors in nondiabetic,obese African-American women with family history of type 2 diabetes: Implications for metabolic syndrome components

African-American women (AAW) suffer disproportionately from hypertension and its consequences. We investigated the significance of systolic and diastolic blood pressure (SBP/DBP) as components of metabolic syndrome (MetS) in nondiabetic, overweight/obese AAW. We studied 258 AAW (mean age, 42.4 ± 8.4 years and body mass index (BMI), 33.4 ± 8.0 kg/m²) in a cross-sectional manner. We estimated the prevalence of MetS and its components using Adult Treatment Panel (ATP III) criteria, insulin sensitivity (Si), insulin resistance (HOMA-IR), and cardiovascular disease risk factors according to the tertiles of blood pressure (BP). Mean age and BMI did not differ with increases in BP tertiles. At screening, 35.7% of our subjects were hypertensive. MetS was found in 32.2% of our AAW. Prevalence of MetS increased as the tertiles of BP increased (SBP = first [10.5%], second [15.1%], third [58.1%], and DBP = first [9.3%], second [23.3%], third [54.7%]). We found that the components of Adult Treatment Panel (ATP) did not track with the corresponding BP tertiles. However, the prevalence of individuals meeting ATP III criteria for BP was highest in the third tertile of both SBP and DBP. Consequently, the prevalence of MetS was highest in the third vs. first and second tertiles. Using linear regression analysis, SBP and DBP did not correlate with the conventional cardiovascular risk factors, HOMA-IR, or Si. In overweight/obese AAW, we found the components of MetS do not track with BP. In the absence of elevated BP, the prevalence of MetS appears to be very low in overweight and obese AAW. Conversely, elevated BP or hypertension was associated with remarkably higher rates of MetS in our AAW. Therefore BP criteria constitute an important and independent determinant of ATP III definition of MetS in AAW.     

Randomized follow-up study of resected NSCLC patients: conventional versus 18F-DG coincidence imaging

The aim of this study was to compare the utility of gamma camera using a coincidence detection system imaging (CDET) with 18-fluorodeoxyglucose to conventional imaging techniques in the detection of recurrence of non-small cell lung cancer. Sixty-nine patients were randomized into two groups for follow-up after surgery from October 2000 to December 2002. Each patient was evaluated every 6 months by conventional technique imaging in group A (n=33) or CDET imaging in group B (n=36) over two years. The direct costs of each procedure were evaluated. The major endpoint was the number of recurrences or new tumours detected. The two groups were similar. A total of 25 recurrences was detected (9 in group A and 16 in group B). Overall survival was similar in the two groups. CDET imaging was more expensive. CDET imaging provides earlier detection of recurrence, but does not modify survival outcome. Further studies are necessary to demonstrate the impact, if any, of 18-FDG imaging.