Nodular hyperplasia of the gastrointestinal tract after liver transplantation: role of immunosuppressive therapy? A case report.

Nodular lymphoid hyperplasia (NLH) of the gastrointestinal tract is a rare disease usually reported in patients with congenital or acquired immunodeficiency and chronic gastrointestinal infections. However, no case of NLH in a patient receiving immunosuppressive therapy has been reported to date. We describe the case of a woman who developed chronic diarrhea related to NLH 9 years after liver transplantation. Other causes of diarrhea and NLH were excluded. Her immunosuppressive regimen consisted on mycophenolate mofetil (MMF) and tacrolimus. Reduction of MMF dose improved symptoms but led to a rising aminotransferase level. Given the risk of graft rejection, MMF at full dose was resumed and she was started on symptomatic treatment for diarrhea. The role of immunosuppressive drugs in the pathogenesis of NLH may be related to the reduction of T- and B-lymphocyte proliferation and decreasing antibody production. NLH will further develop to compensate functionally inadequate lymphoid tissue, as reported in congenital immunodeficiency states.

Sclerosing stromal tumour of the ovary: two case reports.

Sclerosing stromal tumours are rare benign ovarian neoplasms of the sex cord stromal that occur predominantly in the second and third decades of life. Herein, we report two cases of sclerosing stromal tumour of the ovary. The two patients were 16 and 45 years old and both presented with pelvic pain. Ultrasonography demonstrated a heterogeneous solid mass of the left and right ovary, respectively, with some cystic foci in the second tumour. Laboratory tests including tumour markers and serum hormonal assays were normal in both cases. The two patients underwent left and right salpingo-oophrectomy, respectively. Microscopically, the tumours showed a pseudolobular pattern with cellular areas separated by oedematous and collagenous areas. The cellular areas were richly vascularized, with a hemangiopericytic pattern, and were composed of an admixture of theca-like and spindle-shaped cells. Immunohistochemical studies showed that the tumour cells were positive for smooth muscle actin, inhibin and vimentin, but negative for cytokeratin. The final pathological diagnosis was sclerosing stromal tumour. Postoperative course was uneventful for both patients.

Coexistence of xanthogranulomatous cholecystitis and gallbladder adenocarcinoma: a fortuitous association?

Xanthogranulomatous cholecystitis is a relatively uncommon variant of chronic cholecystitis, characterized by marked thickening of the gallbladder wall and dense local adhesions. Not only does xanthogranulomatous cholecystitis mimic malignancy, it can also be infrequently associated with gallbladder carcinoma in 0.2% to 35.4% of cases. Herein, the authors report a new case of xanthogranulomatous cholecystitis concomitant with gallbladder adenocarcinoma in a 65-year-old female patient. Because of its overlapping clinical, radiological and macroscopic findings with gallbladder cancer, definitive diagnosis of xanthogranulomatous cholecystitis relies on extensive sampling and thorough microscopic examination of the surgical specimen to exclude the possibility of coexisting tumour. It is still a matter of debate whether xanthogranulomatous cholecystitis is truly a precursor of gallbladder carcinoma or if it is just an incidental finding. This aspect needs to be explored in the future with further studies.

Localized ileal giant pseudopolyposis in Crohn's disease: a case report.

Localized giant pseudopolyposis is a rare complication in inflammatory bowel disease defined as a pseudopolyp (isolated or clustered) larger than 1.5 cm in size. Giant pseudopolyps are more commonly found in ulcerative colitis compared to Crohn's disease and mainly involve the left colon. A 26-year-old male patient with a two-year history of Crohn's disease was admitted with increasing abdominal pain, vomiting, anorexia, weight loss and fever. On physical examination, the abdomen was diffusely tender. Computed tomography showed diffuse irregular thickening of the ileal wall and stenosis of the terminal ileum. The patient underwent ileo-cecal resection with re-anastomosis. The ileal portion of the resected specimen harboured multiple finger-like pedunculated polyps, with the smallest measuring 0.5 cm and the largest measuring 1.8 cm. Histologically, the polyps were consistent with granulation tissue. No evidence of dysplasia or malignancy was found. The post-operative course was uneventful considering one month follow-up. This report illustrates an unusual case of giant pseudopolyposis involving the ileum in a patient with Crohn's disease. The natural history of these lesions, as well as their optimal management, remain uncertain.

[Results of primary repair of injuries to the median and ulnar nerves at the wrist]. / Résultats de la réparation primaire des plaies du nerf médian et du nerf ulnaire au poignet.

INTRODUCTION: Wounds on the palmar side of the wrist affecting the median or ulnar nerves are responsible for motor and sensory sequelae, severe pain and cold intolerance. MATERIALS AND METHODS: Thirty-nine patients with 40 nerve sections were retrospectively reviewed with a mean follow up of 23 months. The median nerve alone was affected 20 times, the ulnar nerve seven times and both nerves simultaneously 13 times. In 75% of the cases, there was an associated vascular injury (radial artery and/or ulnar artery). The average number of tendons cut was 4.25. RESULTS: After repair of the median nerve, 71% of patients recovered antepulsion and opposition that was normal or possible against resistance. The strength was approximately 70% of the opposite side. The sensitive recovery was good (S3 in>or=50% of cases) but it was accompanied by cold intolerance one out of two patients. After repair of the ulnar nerve, 29% of the cases had an ulnar claw hand, 71% of patients recovered sensitivity greater or equal to S3 but with cold intolerance in 42% of the cases. The combined median and ulnar sections had a poorer sensory-motor prognosis. Revision surgery was necessary in 12 of these cases. CONCLUSION: Sensory recovery after an isolated ulnar nerve lesion at the wrist is better than after an isolated median nerve lesion but there is no difference in the motor recovery. Combined median and ulnar lesions have an especially bad prognosis and may require secondary palliative surgery. The existence of nerve contusion and a high number of tendon injuries were factors associated with a poorer prognosis.

[Fibrous dysplasia of the rib. Ten case reports]. / Dysplasie fibreuse costale. A propos de dix cas.

PURPOSE OF THE STUDY: Fibrous dyplasia is a rare sporadic disease accounting for 0.8% of primary bone tumors. This benign pseudotumor results from proliferation of fibrous tissue in bone and the production of immature bone tissue without an osteoblastic crown. The disease can involve one or more bones, ribs are rarely involved. We report a series of 10 cases of costal fibrous dysplasia. CASE REPORTS: This series of 10 cases was collected over a period of 10 years (1996-2005). There were five men and five women, mean age 38.4 years, range 27-52 years. One rib was involved in eight patients, two ribs in two. Pain was the most frequent symptom. Plain X-rays showed signs suggestive of fibrous dysplasia. To confirm the diagnosis, rib resection was performed in all ten patients. Pathology examination provided the diagnosis. The postoperative period was uneventful in all patients and all are recurrence free at mean 50 months follow-up. DISCUSSION: Management of fibrous dysplasia can be simple surveillance in the majority of patients. Nevertheless, in the event of a single focus, particularly in a rib, fibrous dysplasia can raise a difficult problem of differential diagnosis with malignant tumors. Surgical resection is therefore required in selected cases.

[Beta 2-microglobulin amyloidosis presenting as intestinal perforation in a haemodialysis patient]. / Amyloïdose de type beta2-microglobuline révélée par une perforation intestinale chez une hémodialysée chronique.

Long term haemodialysis patient is subject to several complications such as generalised amyloidosis which is the result of deposits of beta2-microglobulin not depurated by haemodialysis. Digestive location causes ischemic accidents such as ulcer, infarctus, digestive haemorrhage, pseudo-obstruction and perforation manifested by a surgical emergency. Our observation is the 6th case of intestinal perforation caused by amyloidosis deposit reported in the literature.

[Clear cell tumor of the lung. A case report with review of the literature]. / La tumeur à cellules claires du poumon. A propos d'un cas avec revue de la littérature.

Clear-cell tumor of the lung is a rare entity of unknown etiology and histogenesis. This neoplasm typically presents as an asymptomatic, peripheral, sharply rounded mass in the lung, and histologically composed of large cells with a clear cytoplasm rich in glycogen, blended with an abundant network of sinusoid-type vessels. Immunohistochemical and ultrastructural procedures lead to diagnosis. We describe a primary pulmonary clear cell "sugar" tumor observed in a 28-year-old woman, and give a review of the literature. Clinical aspects, differential diagnosis, therapy and histogenetic aspects are discussed.

[Duodenal metastatic leiomyosarcoma of the uterus. A case report]. / Métastase duodénale d'un leiomyosarcome utérin. A propos d'une observation.

The digestive metastases of uterine leiomyosarcoma are rare. We report a case of a duodenal tumor detected in a 50 year-old woman, 3 years after she underwent a total hysterectomy for uterine leiomyosarcoma. The stenosing duodenal mass was thought to be a mesenchymal tumor. A pancreaticoduodenectomy was performed. The resected lesion was morphologically similar to the uterine leiomyosarcoma. In fact, the histopathological study confirmed a submucosal tumor with typical features of the uterine leiomyosarcoma. Immunohistochemistry was performed and it showed negative CD117 and CD 34. Markers displayed positivity for actin smooth muscle and desmin. Considering the patient history and the immunohistochemical observations, we diagnosed a duodenal metastasis of uterine leiomysarcoma. Through this exceptional observation we want to emphasize the epidemiological and the pathological features of the metastatic uterine leiomyosarcoma. We will also point out the progress of tumoral cells and the histopathological distinctive criteria with a primitive digestive mesenchymal tumor.

Eicosapentaenoic and docosahexaenoic acids reduce PGH synthase 1 expression in bovine aortic endothelial cells.

To enlighten the mechanism of inhibition of prostacyclin (PGI2) production by n-3 fatty acids, eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, cultured endothelial cells were incubated with albumin bound-EPA or -DHA for 22 h. Under these conditions, PGI2 formation in response to bradykinin, calcium ionophore or exogenous arachidonic acid was equally inhibited by 50%, suggesting that the inhibition might occur downstream the phospholipase step, likely at the level of PGH synthase and/or PGI2 synthase activities. Western blot analysis indicated that the mass of the constitutive isoform of PGH synthase (PGH synthase 1), but not PGI2 synthase, was significantly reduced in n-3 fatty acid-enriched cells. In subsequent experiments, PGH synthase 1 mRNA level, measured by northern blotting, was also decreased in n-3 supplemented cells. This reduction was not due to mRNA destabilization. None of these parameters were altered by similar enrichment with oleic acid (OA). These results suggest that EPA and DHA may affect PGH synthase 1 expression, presumably at the transcriptional level.

Docosapentaenoic acid (22:5,n-3): metabolism and effect on prostacyclin production in endothelial cells.

Eicosapentaenoic acid (EPA, 20:5,n-3) and docosahexaenoic acid (DHA, 22:6, n-3), the two main fatty acids of fish oil, have been shown to inhibit prostacyclin production and to be actively interconverted, leading to the accumulation of docosapentaenoic acid (DPA, 22:5,n-3) in endothelial cell phospholipids. We have investigated the effect of supplementing endothelial cells with DPA on their capacity to produce prostacyclin. We found that endothelial cells incubated for 22 h with 25 microM DPA bound to albumin (fatty acid/albumin ratio of 1.3) produced two-fold less prostacyclin compared to control cells when stimulated with endogenous arachidonic acid-mobilizing agents such as bradykinin and calcium ionophore A23187. Since the formation of prostacyclin from 0.1-15 microM exogenous arachidonic acid was also reduced, it is suggested that prostacyclin inhibition observed in DPA-treated cells might not proceed from a reduction of arachidonic acid availability only. Such an inhibition was already observed after 1 h incubation of the cells with DPA, and with 2-20 times lower DPA concentrations. The inhibition might depend on EPA which was formed by retroconversion of DPA.

Cross-reactivity of delta 17-6-keto-PGF1 alpha with 6-keto-PGF1 alpha antibodies.

The cross-reactivity of the PGI3 metabolite, delta 17-6-keto-PGF1 alpha, with antibodies against 6-keto-PGF1 alpha for radioimmunoassays (RIA) has been investigated. Delta 17-6-keto-PGF1 alpha was obtained either from commercial sources or after its purification from endothelial cells. In the latter case, primary cultured bovine aortic endothelial cells were incubated for 20 min at 37 degrees C with 10 microM eicosapentaenoic acid (EPA) in the presence of 2 microM 13-hydroperoxy-octadecadienoic acid, and activator of the EPA cyclooxygenation, and the 6-keto-PGF1 alpha and beta 17-6-keto-PGF1 alpha produced were separated by RP-HPLC. Then, cross-reactivities of the commercial and purified beta 17-6-keto-PGF1 alpha with 6-keto-PGF1 alpha antibodies were determined and found not to exceed 10%. In addition, the amounts of prostacyclin-related compounds detected by direct measurements in media of cells loaded with EPA were compared with those obtained after purification of 6-keto-PGF1 alpha. In accordance with the cross-reactivity data, we found that RIA in media mainly measured 6-keto-PGF1 alpha, the beta 17-6-keto-PGF1 alpha formed being undetected at 90%. It is concluded that 6-keto-PGF1 alpha antibodies generally used for RIA of 6-keto-PGF1 alpha are highly specific since they can discriminate a metabolite bearing an additional double band such as the PGI3 metabolite beta 17-6-keto-PGF1 alpha.