Idiopathic lung hemosiderosis in a 3-year-old child following ductus ligation in the neonatal period

A premature girl (birth weight 1 405 g, gestational age 32 weeks) was mechanically ventilated for 36 days because of respiratory distress, pulmonary hemorrhage and ductus arteriosus. The hemodynamically active ductus was ligated on the 22nd day of life. At the age of three years a mycoplasma pneumonia and a pulmonary hemosiderosis developed. The possible etiologic role of the neonatal lung problems and the mycoplasma infection for the pulmonary hemosiderosis is discussed. Because a similar case has thus for not been reported the coincidence may be by chance.     

Molecular and immunohistochemical characterization of B-cell lymphoma-2-negative follicular lymphomas

Aberrant expression of the antiapoptotic protein BCL (B-cell lymphoma)-2 in neoplastic germinal centers is one of the diagnostic hallmarks of follicular lymphoma. If BCL-2 cannot be detected by immunohistochemistry, the distinction between florid follicular hyperplasia and follicular lymphoma might become a diagnostic challenge. Most of those cases also lack the typical t(14;18), and the underlying pathophysiologic conditions of follicular lymphoma that lack BCL-2 protein expression are largely unknown. Here, we collected 18 BCL-2-negative follicular lymphoma cases from 5 different institutions. After restaining, 9 cases proved to be truly BCL-2 negative (6 follicular lymphoma grade 2, 2 follicular lymphoma grade 3a, and 1 follicular lymphoma grade 3b). In 4 additional cases, BCL-2 was very faint (all grade 2). Of the 9 BCL-2-negative follicular lymphoma cases, 2 were negative for CD10 (22%); all showed expression of BCL-6. Apoptotic level as determined by caspase 3 was the lowest in the BCL-2-positive follicular lymphoma group (15 ± 8 mm(2)), the highest in the normal/reactive group (n = 7, 60 ± 12 mm(2)) and very similar in the BCL-2 low follicular lymphoma and BCL-2-negative follicular lymphoma groups (25 ± 13 and 33 ± 19 mm(2), respectively), assuming an intermediate position between reactive follicles and BCL-2-positive neoplastic follicles (P < .001 [Kruskal-Wallis]). Also noted was a difference in proliferation fractions between the BCL-2-positive follicular lymphoma (27% ± 15%), the BCL-2 low follicular lymphoma (30% ± 20%) and the BCL-2-negative follicular lymphoma groups (30% ± 22%). Regarding the network of follicular dendritic cells, 8 (89%) of 9 cases from the BCL-2-negative subgroup showed disrupted, weakly developed networks, whereas all of the follicular lymphoma BCL-2 low-expression cases showed a well-defined and strongly developed follicular dendritic cell network. Among BCL-2-negative follicular lymphoma, BCL-2 and BCL-6 breaks were found in 1 case each, whereas in the follicular lymphoma BCL-2 low group, only 1 case with a BCL-6 break was recorded. No statistically significant result was achieved upon assessment of BCL-2α or BCL-2β RNA or the ratio of α/β isolated by real-time-polymerase chain reaction. Taken together, BCL-2-negative follicular lymphoma did not show a BCL-2 break on the genetic level and showed both increased apoptotic and proliferation rates compared with BCL-2-positive follicular lymphoma. In our series, BCL-6 breaks were infrequent in BCL-2-negative follicular lymphoma.     

Intra-operative femoral condylar stress during arthroscopy: an in vivo biomechanical assessment

Purpose

Excessive varus and valgus stress forces during arthroscopy might exceed minimal compressive strength of cancellous bone. In extreme cases, this could lead to post-arthroscopic osteonecrosis. It was our purpose to measure the valgus and varus stress forces during arthroscopy and draw conclusions on the development of osteonecrosis.

Methods

On 24 consecutive patients undergoing arthroscopy, the maximum varus and valgus stress forces (N) were measured in vivo using a strain gauge mounted to a leg holder. The forces (N) and contact stresses (kPa) on the femoral condyles were calculated based on the measured acting lateral force at the femur fixation based on the lever principle.

Results

The maximum contact stress during varus on the medial condyle was significantly lower in patients with intact meniscus (mean?±?standard error of the mean: 243?±?29?kPa) than in patients with meniscus-deficient knees (520?±?61?kPa; P?<?0.01). A similar finding was obtained for the maximum contact stress during valgus on the lateral condyle: 630?±?72?kPa in patients with intact meniscus compared to 2,173?±?159?kPa in patients with meniscus-deficient knees (P?<?0.01). In 19 patients (79%), the maximum contact stress was higher during valgus than during varus. The maximum contact stress on the lateral condyle during valgus was significantly higher for more experienced surgeons (P?=?0.01).

Conclusion

The maximum contact stresses in knees with intact menisci did not exceed the critical threshold of the compressive strength in cancellous bone. However, the maximum contact stresses in meniscus-deficient knees were frequently higher than the threshold. However, these stresses were much lower than those during daily activities and therefore unlikely to lead to post-arthroscopic osteonecrosis.

Level of evidence

Diagnostic study, Level II.     

Analysis of selected oncogenes (AKT1, FOS, BCL2L2, TGFbeta) on chromosome 14 in granulosa cell tumors (GCTs): a comprehensive study on 30 GCTs combining comparative genomic hybridization (CGH) and fluorescence-in situ-hybridization (FISH)

In previous studies, we have demonstrated a number of cytogenetic alterations in granulosa cell tumors (GCTs), especially on chromosomes X, 12, 14, and 22. However, little is known about specific loci on 14q, which could play an important role in tumor pathology. Therefore, we assessed four important genes in 30 GCTs using fluorescence-in situ-hybridization (FISH). Comparative genomic hybridization (CGH) was performed on paraffin-embedded material. Then, we applied FISH with gene-specific DNA probes for AKT1 (14q32.32), FOS (14q24.3), BCL2L2 (14q11.2-q12), and TGFbeta3 (14q24), and tried to find a correlation between CGH, FISH, tumor stage, and survival. In CGH, 7 of 30 cases (23.3%) showed complete gains on chromosome 14. FISH of the four loci revealed gains of hybridization signals in 8 of 30 cases (26.6%), indicating trisomy of the whole chromosome arm. The same aberration was detected by FISH in 2 of 30 cases (6.6%), which were negative using CGH. One case (1 of 30; 3.3%) was found to have a gain on chromosome 14 by CGH, which could not be confirmed by FISH. A correlation with tumor stage or survival could not be established. Our results suggest that GCTs may be characterized by trisomy of chromosome 14. A specific oncogene that could play a particular role in the tumorigenesis of GCTs was not identified on chromosome 14.     

Can clinical examination cause a Stener lesion in patients with skier's thumb?: A cadaveric study

Approximately one-third of all injuries of the upper limb and 7% of all injuries in skiing affect the ulnar collateral ligaments of the thumb metacarpophalangeal joint (skier's thumb). In some patients the collateral ligaments are displaced proximally over the adductor aponeurosis, resulting in a so-called Stener lesion. In these cases surgical treatment is indicated. We hypothesized that a Stener lesion could be provoked by clinical stability testing in patients with a skiers thumb and performed a cadaveric study on 10 Thiel fixated cadaver hands. For clinical stability testing, the thumb was manually deviated in radial direction in both 30° flexion and extension of the MP-joint. It was performed with maximum strength by two hand surgeons after sequential detachment of the ulnar collateral ligaments. After every sequence, it was assessed if the clinical stability testing had caused a Stener lesion. All of the 10 cadavers showed identical results while testing the clinical stability. A decreased stability was only found after cutting both parts of the ulnar collateral ligaments. A Stener lesion could not be provoked in any of the cadavers at any time by clinical stability testing. Summarizing our findings we conclude that a proper performed clinical stability testing of the thumb MP joint is a safe maneuver, which does not lead to a Stener lesion in patients with skier's thumb.     

Transport Characteristics of Peptidomimetics. Effect of the Pyrrolinone Bioisostere on Transport Across Caco-2 Cell Monolayers

Purpose. To compare the permeation characteristics of amide bond-containing HIV-1 protease inhibitors and their pyrrolinone-containing counterparts across Caco-2 cell monolayers, a model of the intestinal mucosa. Methods. Transepithelial transport and cellular uptake of three pairs of amide bond-containing and pyrrolinone-based peptidomimetics were assessed in the presence and absence of cyclosporin A using the Caco-2 cell culture model. The potential of the peptidomimetics to interact with biological membranes was estimated by IAM chromatography. Results. In the absence of cyclosporin A, apical (AP) to basolateral (BL) flux of all compounds studied was less than the flux determined in the opposite direction (i.e., BL-to-AP). The ratio of the apparent permeability coefficients (P_app) calculated for the BL-to-AP and AP-to-BL transport (P_BLAP/P_APBL) varied between 1.7 and 36.2. When individual pairs were compared, P_BLAP/P_APBL ratios of the pyrrolinone-containing compounds were 1.5 to 11.5 times greater than those determined for the amide bond-containing analogs. Addition of 25 M cyclosporin A to the transport buffer reduced the P_BLAP /P_APBL ratios for all protease inhibitors to a value close to unity. Under these conditions, the amide bond-containing peptidomimetics were at least 1.6 to 2.8 times more able to permeate Caco-2 cell monolayers than were the pyrrolinone-containing compounds. The intrinsic uptake characteristics into Caco-2 cells determined in the presence of 25 M cyclosporin A were slightly greater for the amide bond-containing protease inhibitors than for the pyrrolinone-containing analogs. These uptake results are consistent with the transepithelial transport results determined across this in vitro model of the intestinal mucosa. Conclusions. The amide bond-containing and pyrrolinone-based peptidomimetics are substrates for apically polarized efflux systems present in Caco-2 cell monolayers. The intrinsic permeabilities of the amide bond-containing protease inhibitors are slightly greater than the intrinsic permeabilities of the pyrrolinone-based analogs through Caco-2 cell monolayers.     

In vitro-Untersuchungen mit E. coli-L-Asparaginase an lymphatischen Rinderleukämiezellen und verschiedenen Transplantationstumoren

Zusammenfassung Die Wirkung von E. coli-L-Asparaginase auf die Nucleinsäure- und Proteinbiosynthese wurde an Zellsuspensionen lymphatischer Leukämiezellen und verschiedener Transplantationstumoren untersucht. Hierbei wurde beobachtet, daß dieses Enzym eine deutliche Senkung des¹⁴C-Thymidineinbaus an Leukämiezellen des Rindes hervorruft, ein Effekt, welcher durch Zusatz von L-Asparagin und L-Glutamin nicht aufhebbar war. Bei Zellen des Walker- und Yoshida-Ascitestumors der Ratte fanden sich eine Hemmung der¹⁴C-Thymidin- und¹⁴C-Leucininkorporation, während die L-Asparaginase bei Asciteszellen des Crocker-Sarkoms der Maus lediglich eine Senkung des¹⁴C-Leucineinbaus bewirkte. Die Ursache für das Verhalten des¹⁴C-Thymidineinbaus bei bestimmten Tumorzellen bleibt zunächst ungeklärt.

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Summary Ascites cells derived from various transplantation tumours and leukemic lymphocytes have been employed to study the in-vitro effects of E. coli L-asparaginase on protein and nucleic acid biosynthesis. Bovine lymphocytes obtained from a cow suffering from chronic lymphatic leukemia showed a marked inhibition of¹⁴C-thymidine incorporation not reversible by L-asparagine and L-glutamine addition. With Walker ascites and Yoshida ascites of the rat, this effect has been found to be accompanied by a comparable inhibition of¹⁴C-leucine uptake, while in cells from mouse crocker ascites under the same conditions only¹⁴C-leucine incorporation was decreased. Although some specific investigations have been performed on nucleic acid biosynthesis in presence of L-asparaginase, the mechanisms of action — with respect to the rapid inhibition of¹⁴C-thymidine uptake into lymphatic cells — are still unknown.

     

Neurophysiological testing in long-standing cystinosis

Neurophysiological data of two brothers with long-standing cystinosis are presented. Both patients showed a distally symmetrical myopathy affecting the arms more than the legs. Myopathy occurred before the onset of polyneuropathy or signs of central nervous involvement.