Noonan-like syndrome with loose anagen hair: a new syndrome?

We present three children with short stature, the same facial phenotype, macrocephaly, enlarged cerebral spinal fluid spaces, short neck with redundant skin, severe GH deficiency, mild psychomotor delay with attention deficit/hyperactivity disorder (ADHD), mild dilatation of the pulmonary root in two of them, and a unique combination of ectodermal abnormalities. Their appearance, not completely typical of Noonan syndrome, the behavioral phenotype, GH deficiency, darkly pigmented and hairless skin, and the unusual aspect of the hair, defined as loose anagen hair syndrome did not fit any known condition. We postulate that these children may represent a distinct, previously unreported syndrome that we would name "Noonan-like syndrome with loose anagen hair".     

Clinical,immunological, and molecular analysis in a large cohort of patients with X-linked agammaglobulinemia: an Italian multicenter study

A questionnaire-based retrospective clinical and immunological survey was conducted in 73 males with a definite diagnosis of X-linked agammaglobulinemia based on BTK sequence analysis. Forty-four were sporadic and 29 familial cases. At December 2000, the patients' ages ranged from 2 to 33 years; mean age at diagnosis and mean duration of follow-up were 3.5 and 10 years respectively. After the mid-1980s all but 2 were on intravenous immunoglobulin (IVIG) substitution therapy, with residual IgG >500 mg/dl in 94% of the patients at the time of enrollment. Respiratory infections were the most frequent manifestation both prior to diagnosis and over follow-up. Chronic lung disease (CLD) was present in 24 patients, in 15 already at diagnosis and in 9 more by 2000. The cumulative risk to present at diagnosis with CLD increased from 0.17 to 0.40 and 0.78 when the diagnosis was made at the ages of 5, 10, and 15 years respectively. For the 9 patients who developed CLD during follow-up, the duration of follow-up, rather than age at diagnosis; previous administration of intramuscular immunoglobulin; and residual IgG levels had a significant effect on the development of CLD. Chronic sinusitis was present in 35 patients (48%), in 15 already at diagnosis and in 20 by 2000. Sistemic infections such as sepsis and meningitis/meningoencephalitis decreased over follow-up, probably due to optimal protection provided by high circulating IgG levels reached with IVIG.     

Seeing or not seeing where your hands are

Previous findings have demonstrated the existence of a visual peripersonal space centered on the hand in humans and its modulatory effects on tactile perception. A strong modulatory effect of vision on touch perception was found when a visual stimulus was presented near the hand. In contrast, when the visual stimulus was presented far from the hand, only a weak modulatory effect was found. The aim of the present study was to verify whether such cross-modal links between touch and vision in the peripersonal space centered on the hand could be mediated by proprioceptive signals specifying the current hand positions or if they directly reflect an interaction between two sensory modalities, i.e., vision and touch. To this aim, cross-modal effects were studied in two different experiments: one in which patients could see their hands and one in which vision of their hands was prevented. The results showed strong modulatory effects of vision on touch perception when the visual stimulus was presented near the seen hand and only mild effects when the vision of the hand was prevented. These findings are explained by referring to the activity of bimodal neurons in premotor and parietal cortex of macaque, which have tactile receptive fields on the hand, and corresponding visual receptive fields in the space immediately adjacent to the tactile fields. One important feature of these bimodal neurons is that their responsiveness to visual stimuli delivered near the body part is reduced or even extinguished when the view of the body part is prevented. This implies that, at least for the hand, the vision of the hand is crucial for determining the spatial mapping between vision and touch that takes place in the peripersonal space. In contrast, the proprioceptive signals specifying the current hand position in space do not seem to be relevant in determining the cross-modal interaction between vision and touch.     

Veränderte Aktivitäten der Enzyme des Energiestoffwechsels in Thrombocyten von Patienten mit Lebercirrhose und Splenomegalie

Zusammenfassung 1. Die Aktivitäten von 28 Enzymen aus verschiedenen Abschnitten des Energiestoffwechsels wurden in isolierten Thrombocyten von 17 gesunden Menschen und 15 Patienten mit gesicherter Lebercirrhose gemessen.2. Die für Gewebe bekannte Proportionskonstanz der Enzymaktivitäten des zentralen Segmentes der Glykolyse (TIM, GAPDH, PGK, GPM und EN) findet sich auch in den Thrombocyten als Ordnungsprinzip. Die mitochondrial lokalisierten Enzyme NAD-spezifische Isocitratdehydrogenase und Glycerophosphatoxydase wurden erstmalig in Thrombocyten mit relativ hoher Aktivität nachgewiesen.3. Die Plättchen von Patienten mit Lebercirrhose und Milzvergrößerung infolge portaler Hypertension zeigten signifikant erhöhte Enzymaktivitäten in allen untersuchten Stoffwechselwegen, insbesondere der mitochondrial lokalisierten Enzyme. Funktionell bedeutsam erscheinen der ausgeprägte Anstieg der Mg⁺⁺-aktivierbaren ATPase, die gleichbleibende Aktivität der Fructose-6-Phosphatkinase und eine Verminderung der Lactatdehydrogenase. Bei der Patientengruppe mit Cirrhose ohne Milzvergrößerung lagen fast alle gemessenen Aktivitäten der Thrombocyten im Normbereich.4. Es wird ein Patient mit Lebercirrhose ohne Milzvergrößerung beschrieben, dessen Thrombocyten um den Faktor 8 höhere Aktivitäten fast aller gemessenen Enzyme aufwiesen. Auch in diesen Plättchen zeigte die Lactatdehydrogenase eine Aktivitätsverminderung gegenüber der Norm.5. Ein Enzymdefekt der Plättchen wie bei Thrombasthenie wurde bei Lebercirrhose nicht gefunden. Nach unseren Kenntnissen über die Enzymausstattung von Blutzellen handelt es sich bei den Thrombocyten mit höherer Enzymaktivität um eine jugendliche Zellpopulation. Die Pathogenese wird besonders hinsichtlich der Rolle der vergrößerten Milz diskutiert.

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Summary 1. The activities of 28 enzymes from different pathways of energy producing metabolism were measured in the isolated platelets of 17 normal persons and 15 patients with proven cirrhosis of the liver.2. In mammalian tissues a constant proportion between the enzymes of the central segment of the glycolytic pathway (TIM, GAPDH, PGK, GPM, EN) has been described. This constant proportion has been demonstrated also in the platelets. The mitochondrially localized enzymes NAD-specific Isocitratdehydrogenase and Glycerophosphatoxidase have been measured for the first time in platelets with a high activity.3. The platelets of patients with liver cirrhosis and splenomegaly following portal hypertension showed significant higher enzyme activities in all investigated pathways, mainly in the citric acid cycle. Functionally important could be the marked increase of the Mg⁺⁺ activated ATPase, the unaltered activity of the Phosphofructokinase and a lowered activity of the Lactatdehydrogenase in these platelets. The patients with cirrhosis but without a large spleen had normal enzyme activities of the platelets.4. One patient is described with cirrhosis without splenomegaly who had an elevation of nearly all measured enzymes by a factor 8 in his platelets. The LDH showed a decreased activity.5. No enzyme defect in the platelets of cirrhotic patients as in thrombasthenia was found. Basing on our knowledge of the enzyme equipment of blood cells the conclusion is drawn that the platelets with higher enzyme content represent a young cell population. The pathogenesis is discussed with special reference to the role of the enlarged spleen.

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Teilergebnisse wurden vorgetragen auf dem 2. Symposium der European Association for the Study of the Liver, Göteborg, 1967 und der 24. Tagung der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten, Hamburg 1967.     

Veränderungen von α-Ketoglutarsäure,Brenztraubensäure und Diphosphopyridinnucleotid bei chronischen Leberkranken

Zusammenfassung Bei 41 Kranken mit Lebercirrhose wurden die -Ketoglutarsäure, die Brenztraubensäure und das Diphosphopyridinnucleotid enzymatisch bestimmt. — Als Normalwerte wurden gefunden für -KGS=0,14 mg-%±0,05, für BTS=0,77 mg-%±0,19 und für DPN=1,57 mg-%±0,14.Die Leberkranken wurden nach ihrer klinischen Symptomatologie in Schweregrade eingeteilt und eine Zuordnung von klinischem Schweregrad und biochemischen Werten vorgenommen.Dabei zeigt sich, daß die Werte für -KGS gut der klinischen Symptomatologie entsprechen. Diese Werte betrugen für Grad 0=0,21 mg-%±0,08, für Grad 1=0,37 mg-%±0,09, für Grad 2=0,48 mg-%±0,13 und für Grad 3=0,61 mg-%±0,27.Die Werte für BTS zeigten keine so gute Übereinstimmung mit der klinischen Symptomatologie.Die Werte für DPN lagen für alle klinischen Grade mit wenigen Ausnahmen im Normalbereich.Auszugsweise vorgetragen auf der Tagung der Deutschen Gesellschaft für Physiologische Chemie, Hamburg, 28. 9. 56²⁷ und (G. A. M.) auf dem Jahrestreffen der American Association for the Study of the Liver, Chicago, 8. 11. 56³².In dieser Arbeit wurden folgende Abkürzungen benutzt: -Ketoglutarsäure (-KGS); Brenztraubensäure (BTS); Diphosphopyridinnucleotid (DPN); Glutaminsäuredehydrogenase (GluDH); Milchsäuredehydrogenase (MDH); Alkoholdehydrogenase (ADH).     

DRD4 exon 3 variants are not associated with symptomatology of major psychoses in a German population

We previously reported an association of DRD4 exon 3 long alleles with delusional symptomatology, independently from psychiatric diagnoses [Am. J. Med. Genet. 105 (2001) 283; Psychiatry Res. 80 (1998) 129]. The aim of this investigation was to replicate these results in an independent sample from Germany. We studied 394 subjects, affected by bipolar disorder (n = 32), schizoaffective disorder (n = 45), and schizophrenia (n = 317). All affected subjects were evaluated using the Operational Criteria for Psychotic Illness (OPCRIT) checklist. DRD4 variants were not associated with symptomatology of major psychosis. Our present results, obtained in an independent German sample, did not confirm the association between DRD4 variants and delusional symptomatology. However it should be considered that the original sample included a much higher rate of mood disorders and this could partially explain the discrepancy.     

NK-DC interaction: on the usefulness of auto-aggression

In recent years a number of studies have highlighted the novel concept that the actual role of natural killer (NK) cells is not only confined to the destruction of virus-infected cells or tumors. Indeed NK cells, by interacting with myeloid DCs during the early phases of inflammation, appear to play a crucial role in shaping both innate immune reactions (within inflamed peripheral tissues) and adaptive immune responses (in secondary lymphoid compartments). Interestingly, this novel function assigned to NK cells is essentially mediated through the aggression of normal immature myeloid DCs. Only DCs undergoing optimal maturation become refractory to NK cell killing and will obtain the permission to prime Th1 cells after migration to lymph nodes.     

A novel mutation of varicella-zoster virus associated to fatal hepatitis.

BACKGROUND: Lethal varicella in immunocompetent hosts is rare and its pathogenesis is largely unknown. The discovery of glycoprotein E (gE) mutants showing attributes consistent with increased virulence in vitro and in animal models, provided a possible molecular mechanism underlying a more aggressive virus infection. However, these mutants have never been associated with unusually severe clinical cases. OBJECTIVES: To varicella-zoster virus (VZV) mutations that correlate with increased virulence. RESULTS: We report a case of fatal hepatitis caused by a VZV bearing a novel mutation on the 3B3 monoclonal antibody epitope of gE in an immunocompetent host. CONCLUSIONS: This report describes a mutant VZV responsible for an aggressive clinical course in an immunocompetent host. Linking these severe clinical presentations of VZV infection to virus mutations might provide insights into the underlying pathogenic mechanisms.