[First detection of sentinel node in adenocarcinoma of Bartholin's gland]. / Premier cas de recherche du ganglion sentinelle dans un adénocarcinome de la glande de Bartholin.

We report the first case of detection of sentinel node in a 54 year-old woman presenting an adenocarcinoma of Bartholin's gland. Primary carcinoma of Bartholin's gland is rare and represents 2-7% of vulvar malignant lesions; this could explain the lack of consensus about treatment. The best attitude could be vulvectomy and inguinal lymphadenectomy. Pelvic lymphadenectomy is not required when no pelvic sentinel node is observed or when no metastatic inguinal node can be detected.

Advances in high-throughput screening: biomolecular interaction monitoring in real-time with colloidal metal nanoparticles.

The post-genomic era is revolutionizing the drug discovery process. The new challenges in the identification of therapeutic targets require efficient technological tools in order to be properly addressed. Label-free detection systems use proteins or ligands coupled to materials of which the physical properties are measurably modified upon specific interactions. Among the label-free systems currently available, the use of metal nanocolloids offers enhanced throughput and flexibility for real-time biomolecular recognition monitoring at a reasonable cost.

Type I interferons induce proteins susceptible to act as thyroid receptor (TR) corepressors and to signal the TR for destruction by the proteasome: possible etiology for unexplained chronic fatigue.

In some patients complaining of chronic fatigue such as those suffering from the chronic fatigue syndrome (CFS), no underlying physical cause can be clearly identified and they typically present a normal thyroid function. Several studies indicate a dysregulation in the type I interferons (IFN-alpha/beta) pathway in CFS resulting in a sustained upregulation of 2('),5(')-oligoadenylate synthetases (2-5OAS). Likewise, patients treated with IFN-alpha/beta usually complain of severe fatigue as a limiting side effect. Beside the 2-5OAS, IFN-alpha/beta induce also the expression of three closely related proteins of unknown function termed the 2-5OAS-like (2-5OASL) proteins. The amino acid sequences of the 2-5OASL proteins display 96% identity with the partial sequence of the thyroid receptor interacting protein (TRIP) 14, further contain two typical thyroid hormone receptor (TR) coregulator domains and feature two ubiquitin C-terminal domains. From these observations, we raise the hypothesis that the 2-5OASL proteins are TRIPs capable of, respectively, repressing TR transactivation and/or signaling the receptor for destruction by the proteasome. Such molecular mechanisms could explain the development of a clinical hypothyroid state in presence of a normal thyroid function.

Magnesium bioavailability from mineral water. A study in adult men.

OBJECTIVE: To assess magnesium enteral absorption from a magnesium-rich mineral water. DESIGN: Experimental study. SETTING: Department of Nuclear Medicine, Brugmann Hospital, Brussels, Belgium. SUBJECTS: Ten healthy male volunteers in the age range 25-42 y. INTERVENTION: Each subject completed two sessions in a random order. At one session, they received an oral load of 300 ml of water (containing 1.2 mmol Mg), traced with (28)Mg, and at the other session they received an intravenous injection of (28)Mg, in order to take into account the metabolism of endogenous magnesium. The dietary consumption was further noted on a weekly diary. RESULTS: The mean bioavailability was 59.1% (s.d.+/-13.6). Magnesium absorption and age were significantly inversely correlated (r=-0.68, P=0.035). CONCLUSION: Magnesium-rich mineral water is a reliable source of magnesium. Our observation of decreased magnesium absorption with age deserves further investigations. SPONSORSHIP: The study was sponsored by SEV, Bourg la Reine, France.

Correlation between inhibition, working memory and delimited frontal area blood flow measure by 99mTc-Bicisate SPECT in alcohol-dependent patients.

Recently detoxified non-neurological alcoholic patients appear to be impaired in cognitive tasks measuring inhibitory processes as well as working memory (involving storage and manipulation of information). The aim of this study was to investigate in alcoholic participants the relationship between these two cognitive functions and regional cerebral blood flow (rCBF) studied at rest in regions of interest selected on the basis of recent PET studies which explored inhibitory and working memory in normal subjects. Twenty non-neurological alcoholic patients and 20 normal volunteers were selected for a neuropsychological exploration, including assessment of inhibition processes (by means of the Hayling test) and working memory (by means of the Alpha-span task). rCBF of alcoholics was also evaluated with a semi-quantitative method using a 99mTc-Bicisate single photon emission computed tomography (SPECT) procedure. Alcoholic patients performed worse than controls in the alphabetical condition of the Alpha-span task (involving manipulation and storage of information), and on the Hayling test. Significant correlation emerged between inhibition performance and both the bilateral inferior (left BA 47, r = -0.40; right BA 47, r = -0.599) and median frontal gyrus (left BA 10, r = -0.55; right BA 10, r = -0.59), but not with the region of reference (occipital/cerebellum, r = -0.13). Coordination of storage and manipulation was correlated with bilateral median frontal (left BA 10/46, r = -0.50; right BA 10/46, r = -0.45), but not with bilateral parietal area (left BA 7, r = -0.12, right BA 7, r = -0.18). These results suggest a relationship between inhibition and working memory deficits in alcoholic patients, and regional rCBF measured in frontal areas. Clinical implications of these data related to alcohol relapse are discussed.

A 'made in one piece' skeleton in a 22-year-old man suffering from sickle cell anaemia.

A 22-year-old African male with known sickle cell anaemia was referred by a Congolese medical centre with a request to improve his poor physical condition. He was unable to walk, stand or sit because his large joints and his spine were either ankylosed or very rigid. Radiographs showed joint fusion from the third to the fifth cervical vertebrae, of both hips, of the left knee, and a bilateral osteonecrosis of the humeral head. There was no scintigraphic evidence for an active osteomyelitis (99mTc-MDP (methyldiphosphonate) bone scan, Tc monoclonal antigranulocyte scan and 99mTc sulphur colloid scan). To improve his mobility the right femoral head was resected in June 1997; 14 days later the left femoral head was resected. Four months after the resection of the right hip, a right uncemented total hip prosthesis was implanted on this side. One month later the same type of hip arthroplasty was performed on the left side. During the postoperative rehabilitation period the patient regained autonomy. We have found no previous reports of such severe and multiple joint complications in a single patient suffering from sickle cell anaemia.

Quantitative ultrasound and dual X-ray absorptiometry measurements of the calcaneus in patients on maintenance hemodialysis.

It has been suggested that quantitative ultrasound measurements (QUS), which reflect mainly bone density, could be influenced by bone micro-architecture. The aim of the study was to assess whether the relationship of QUS to dual X-ray absorptiometry (DXA) would reflect abnormalities of bone structure observed in renal osteodystrophy. QUS and bone mineral density of the calcaneus (BMDc) were measured by DXA in 30 patients on maintenance hemodialysis and 34 age- and gender-matched controls. QUS parameters and BMDc were significantly lower in hemodialysis patients than in controls (speed of sound [SOS] and broadband ultrasound attenuation [BUA], p = 0. 030; stiffness, p = 0.003; BMDc, p = 0.006). Bone measurements were not correlated with serum parathyroid hormone (PTH). The regression lines of SOS, BUA, and stiffness to BMDc were not significantly different from that of the controls. When dividing the patients into two subgroups according to their median PTH (203 pg/mL), the slopes of the regression lines of BUA to BMDc were significantly different between these two subgroups (p = 0.052). The slope of the subgroup with PTH

Presurgical localization of abnormal parathyroid glands using a single injection of technetium-99m methoxyisobutylisonitrile: comparison of different techniques including factor analysis of dynamic structures.

Single-tracer methoxyisobutylisonitrile (MIBI) imaging is considered to be a sensitive method for the localization of abnormal parathyroid glands. The aims of this study were to determine which of the analytical techniques described for this method - visual comparison of early (15-min) and late (120-min) images, use of time-activity curves (TACs) generated on regions of interest and factor analysis of dynamic structures (FADS) - corresponds best with surgical findings, and to ascertain the potential overall contribution of presurgical scintigraphy. Fifty-five patients were studied, 34 of whom presented with primary hyperparathyroidism (HPT) and 21 with secondary HPT. After a 925 MBq injection of technetium-99m MIBI, a 40-min dynamic acquisition was performed and static images were acquired at 5, 20, 40 and 120 min using a gamma camera equipped with a pinhole collimator. The dynamic series were submitted to FADS, an attractive non-operator-dependent technique, and TACs were generated on regions of interest after the visual comparison of early and 120-minute images (15'-120'). The presumed localizations of abnormal glands were compared with a sketch drawn by the surgeon. Sensitivity was defined as the percentage of true-positive localizations and was 84.4%, 74% and 65% in adenoma and 76%, 66.6% and 45% in hyperplasia for 15'-120', FADS and TACs, respectively. Surgical accuracy, i.e. the percentage of patients accurately and completely described, was 72%, 56% and 59% in adenoma and 53%, 30% and 22% in hyperplasia for 15'-120', FADS and TACs, respectively. The visual comparison method scored best in all cases. FADS was found to be sensitive in cases of adenoma but was handicapped by more false-positive localizations. TACs were particular inefficient in hyperplasia. With respect to the detection of adenomas, we found a relationship between the gland weight and scintigraphic positivity. This dependence on gland weight was not found in hyperplasia. The poorer results obtained with all techniques for surgical accuracy can be explained by the need for a complete scintigraphic description of all pathological glands found by the surgeon in a patient. This study demonstrates that the 15'-120' visual comparison method is more efficient and less cumbersome than TAC or the attractive FADS technique. However, it was less efficient than neck exploration by an experienced surgeon. Therefore, in our institution, scintigraphic studies are now only requested in selected cases of HPT, usually primary HPT and cases undergoing re-operation.

Cerebral blood flow in just detoxified alcohol dependent patients. A 99 m Tc-HMPAO-SPECT study.

Chronic alcohol abuse is responsible for several organic brain disorders. However, even the most characteristic of them are largely underdiagnosed by routine procedures. Therefore, there is need for sensitive, noninvasive and low-cost diagnostic procedures. 99m-Tc-HMPAO-SPECT could be an interesting candidate in this indication, because it estimates the distribution of the cerebral blood flow and the metabolic activity of the brain with a good resolution. We used this technique in 17 healthy volunteers and in a sample of 50 patients dependent on alcohol, without other major physical or mental disorder. SPECT was performed during the attendance of these patients in an inpatient detoxification program. We observed abnormal SPECT in 34 patients, but only in 2 volunteers (p < 0.001). The main abnormality was heterogeneity of the distribution of the tracer. SPECT abnormalities appear to be due nor to withdrawal syndrome, nor to medication. On the contrary, they are correlated with stigmata of heavy alcoholism. Furthermore, a genetic vulnerability to alcohol was suspected because SPECT abnormalities are more frequent in patients with an history of drinking problems in their relatives.

Tomoscintigraphy of the lumbar spine: prospects and clinical application.

In an in vivo prospective study, we examined the lumbar spine of 18 patients presenting with a first episode of acute low-back pain with single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). Scintigraphic activity at L2 was considered 100%, and the other levels were quantified in relation to L2. MRI scans were rated for disc signal intensity on T2-weighted images. The results show that an abnormal intervertebral MRI signal corresponds with an abnormal image on tomoscintigraphy. On tomoscintographic profiles, the disappearance of the 'discal dip' corresponds well with degeneration on MRI. Furthermore, a positive MRI at one level appears to influence other levels at which a significantly higher scintigraphic activity was observed. Of patients with acute LBP 50% had a normal disc SPECT; it is concluded that in these cases a non-discal origin for the pain must be sought.

Influence of patient's weight on dual-photon absorptiometry and dual-energy X-ray absorptiometry measurements of bone mineral density.

Lumbar spine bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) (Hologic QDR 1000) and by 153Gd dual-photon absorptiometry (DPA) (Novo Lab 22a) in 120 postmenopausal women. Though a high correlation existed between the two techniques, the ratio between DXA and DPA values was not constant. Using DXA we observed a higher dependence of BMD on weight than in the DPA measurements. To investigate the different behaviour of DXA and DPA machines with weight, we analysed the effects of increasing thickness of soft tissue equivalents on the BMD of the Hologic spine phantom and on the BMD equivalent of an aluminium standard tube. Increasing tissue-equivalent thickness caused the phantom BMD measured by DPA to decrease significantly but had not effect on the DXA measurements. The different behaviour of DPA and DXA equipment with regard to the phantoms could account for the differences observed in the relations between BMD and weight in the patients. Using multiple regression we studied the influence of weight and body mass index on the relation between BMD measured by the two techniques. The introduction of either of these variables into the regression resulted in an improvement of the prediction of the DXA values from the DPA values. However, the residual standard error of the estimate was still higher than the combined precision errors of the two methods, so that no simple relation allows a conversion of BMDDPA into BMDDXA. Our results confirm that BMD is positively correlated with weight in postmenopausal women; the influence of weight on BMD is blunted when the Novo Lab 22a DPA machine is used for measuring bone mineral.

Bone marrow transplantation corrects the splenic reticuloendothelial dysfunction in sickle cell anemia.

In sickle cell anemia (SCA), the loss of reticuloendothelial function is the result of vasoocclusive events occurring in the spleen. Such asplenia occurs early in the course of the disease and is considered to be permanent in late childhood. In this report, three patients 10, 11, and 14 years of age suffering from severe SCA and found to be asplenic were treated by bone marrow transplantation (BMT). Before transplantation, all three patients had loss of reticuloendothelial splenic function, as assessed by the presence of abundant Howell-Jolly bodies on blood smears and absence of technetium 99m (99mTc) splenic uptake. After BMT, Howell-Jolly bodies disappeared from blood smear, whereas 99mTc isotopic scan found normal isotope uptake. Our data indicate that BMT can correct "permanent asplenia" in SCA patients. However, it remains to be determined if such treatment can also correct other SCA-related organ dysfunctions.

Contribution of remote cortical dysfunction to the pathogenesis of subcortical aphasia: A (99m)Tc-HMPAO SPECT study.

Remote cortical effects of deep-seated lesions were studied by (99m)Tc-hexamethyl-propylenenamine oxime single-photon emission computed tomography at about 50 days after stroke in a population of 16 right-handed aphasic patients. A left-sided regional cortical hypoperfusion was present in all cases. Significant relations were observed between the severity of verbal expression disorders and the degree of regional cortical flow decrease, suggesting that, from a given level of remote dysfunction, the affected cortical areas no longer would be able to play their functional role in language elaboration. There was no difference between the degree of cortical hypoperfusion, whether the morphological lesion was of thromboembolic or hemorrhagic origin.

Rol de la scintigrafía renal 99m TC-DMSA en el diagnóstico de localización y evolución de la infección urinaria en niños / Renal scintigraphy TC99M-DMSA diagnosis of localization and evaluate urinary infection in children

Cincuenta y un niños en quienes presentando los criterios clásicos clínicos y biológicos fueron diagnosticados un primer episodio de Infección Urinaria Complicada (Pielonefritis aguda). Se realizaron una ecografia renal y una scintigrafia renal 99m TC-DMSA dentro de las 24 horas seguidas a su admisión. Una uretrocistografía miccional y un control de la 99m TC-DMSA fueron realizadas después del episodio agudo. Defectos corticales renales en 47 exámenes (92,2 por ciento) fueron detectados con 99m TC-DMSA y en 28 (55 por ciento) a la ecografía. La scintigrafía renal 99m TC-DMSA es entre todas las técnicas de imagenería para evaluar el tracto urinario superior; la que más ayuda en la localización de la infección urinaria y en la identificación de niños susceptibles de desarrollar cicatrices renales.

Use of a urea breath test versus invasive methods to determine the prevalence of Helicobacter pylori in Zaire.

The prevalence of Helicobacter pylori infection in Zaire was determined by means of a [14C] urea breath test in 133 asymptomatic subjects, by culture and histological examination of biopsies in 324 consecutive endoscopy patients with chronic epigastric complaints, and by both the breath test and culture/histology in a subset of 92 patients. Sixty healthy Belgian students or hospital laboratory workers were also included for comparison. The prevalence of Helicobacter pylori was significantly higher in asymptomatic Zairian subjects (77.4%) than in the Belgians (30%; p less than 10(-6)). Infection was also acquired much earlier in life in Africans, 66% of the children aged 5 to 9 years already being infected versus none of the Belgian subjects below the age of 20 years. In Zaire, however, the prevalence of Helicobacter pylori in patients with gastroduodenal disorders (87.5%) was similar to that in the group of asymptomatic subjects (77.5%) after adjustment for age and other epidemiological parameters (gender, place of residency, education level, smoking and drinking habits) in a multivariate analysis. The high rate of acquisition of Helicobacter pylori infection in Zaire emphasizes the need to consider the baseline prevalence of Helicobacter pylori in a defined population when studying its association with various diseases.

Bone blood flow and in vitro proliferation of bone marrow and trabecular bone osteoblast-like cells in ovariectomized rats.

Ovariectomy in the rat induces a rapid osteopenia associated with an elevated bone turnover. One hundred and twenty-day-old rats were ovariectomized (OVX) or sham-operated (n = 6-8 per group and per time period studied). 45Ca accretion rate and bone blood flow (microspheres trapping technique) in the femurs were determined at 28, 42, 84, and 119 days after ovariectomy. Both parameters were markedly increased by 84 days and subsided thereafter. At the 42nd day, when bone turnover was maximal, bone marrow and trabecular bone cultures were obtained from sham-operated and ovariectomized animals (n = 10/group). Proliferation rate of bone marrow cells and trabecular osteoblast-like cells estimated by fibroblast colony-forming units (FCFU) efficiency and cell counting was markedly increased in primary and secondary cultures in ovariectomy. These data fitted well with the enhanced number of osteoblasts observed in situ in the long bone metaphyses of estrogen-depleted animals. As estrogens were shown in the literature to inhibit proliferation of the red cell line and of other hemopoietic lines, it is possible that estrogens, through a general mechanism, inhibit hemopoietic and stromal lines and also the proliferation of bone marrow-derived trabecular bone cells.

Remote cortical dysfunction in aphasic stroke patients.

We studied the effect of deep-seated left hemispheric lesions on cortical blood flow in 18 right-handed aphasic stroke patients. Regional cerebral blood flow was measured at rest and during the performance of a functional naming test using the two-dimensional xenon-133 inhalation method. Compared with 10 controls, at rest the patients showed regional cortical hypoperfusion in the left frontoparietal region. In the controls, activation patterns from the rest to the test condition involved mainly the left hemisphere areas. In the patients, a lack of blood flow change was observed in several areas that were usually hypoperfused at rest. However, in patients with slight verbal expression disorders there were obvious blood flow increases in other brain regions in both hemispheres. Such cortical functional reorganization and the presence of a remote cortical dysfunction could play a role in the pathophysiology of language disorders.

Effects and interactions of 17 beta-estradiol, T3 and 1,25(OH)2D3 on cultured osteoblasts from mature rats.

Osteoporosis being frequently associated with hyperthyroidism and, mostly after menopause, with deficiency in estrogens, we tried to elucidate the interactions of estrogens and triiodothyronine (T3) with calcitriol by using cultured osteoblast-like cells obtained from mature rat bone. The tested parameters included [3H]thymidine incorporation, evaluation of the alkaline phosphatase activity of the cell layer and osteocalcin production in the culture medium. At physiological concentrations, 17 beta-estradiol and T3 stimulated alkaline phosphatase activity, did not enhance osteocalcin production and slightly inhibited [3H]thymidine incorporation. At higher concentrations, 17 beta-estradiol decreased the alkaline phosphatase and osteocalcin response to calcitriol whereas T3, although decreasing alkaline phosphatase activity, markedly increased the osteocalcin secretion elicited by calcitriol. These observations emphasize the complex physiology of osteoblasts and confirm different behaviors of alkaline phosphatase and of osteocalcin as markers of bone turnover.

Remote effect of deep-seated vascular brain lesions on cerebral blood flow.

We measured regional cerebral blood flow using the xenon-133 inhalation method, at approximately 1 month after onset, in 60 stroke patients who had no evidence of major carotid artery stenosis or occlusion. Their single lesions (43 infarcts and 17 hematomas) were located in the capsulothalamolenticular region, sparing the cortex. Hemispheric mean cerebral blood flow was reduced on the side of the lesion in 25 patients and on both sides in 20. Regional hypoperfusion was observed in 46 patients (ipsilaterally in 34, bilaterally in 10, and contralaterally in two). Regional hypoperfusion was observed most frequently in the frontal lobe, particularly in the motor and premotor cortices of the prerolandic area. The 46 patients with regional hypoperfusion were compared with the 14 patients without regional hypoperfusion, considering the size and location of the lesion as well as the functional and analytic motor performances. As a rule, the lesion was slightly smaller and more posterior and the functional (p less than 0.001) and analytic (p less than 0.05) motor performances were significantly better in the 14 patients without regional hypoperfusion. Since the xenon-133 inhalation method examines cortical blood flow, we can attribute blood flow reductions resulting from deep-seated lesions to a functional depression akin to diaschisis. Interpretation of the clinical consequences and pathogenesis of this phenomenon requires further sequential and pathologic studies.

Anaemia and marrow blood flow in the rat.

An increase in bone marrow blood flow has been previously described in anaemic rabbits and dogs. We examined the effect of haemorrhage and haemolysis in female Sprague-Dawley rats, with the hypothesis that high blood flow was related to hyperplasia of bone marrow tissue and that the increase would affect bone as well. Blood flow was measured in tibia and femur by the microspheres trapping method. Chronic anaemia was accompanied at day 32 by a marked increase (factor of 1.7-1.9) in blood flow to bone marrow and to bone. On the other hand, no increase in blood flow was observed in chronic compensated anaemia, showing that anaemia per se and not stimulation of erythropoiesis was responsible for the increase. We then explored the effect on blood flow of two factors associated with anaemia. Erythropoietin 4 U/d for 4 d failed to induce any increase in bone and marrow blood flow. Systemic hypoxia (76 mmHg for 3 d) reduced the fraction of cardiac output conveyed to bone and marrow by 40-50%, but this decrease was more than compensated by an increase in cardiac output. We conclude that neither erythropoietin nor low tissue pO2 is the direct cause for the increase in bone and marrow blood flow observed in anaemia.