Biomedical subjects
Publications and source records attributed to D Aubert.
Numerous diseases can lead to multinodular lesions of liver and spleen; surgical biopsy can be required for the etiologic diagnosis. Among these diseases, systemic cat scratch disease has been recently described. Macroscopical appearance of the lesions is evocative and must be known by surgeons. Three children with systemic cat scratch disease involving liver and spleen are reported.
To determine their prognostic and diagnostic values for toxoplasmosis in immunodepressed subjects, we assayed immunoglobulin A (IgA) and IgE antibodies by means of immunocapture (IC) tests, with revelation done by using a suspension of T. gondii (ICT). We also carried out a simultaneous analytical study of IgG antibodies on cellulose acetate membranes by using the comparative immunological profile method and an enzyme-linked immunofiltration assay (ELIFA). A total of 1,238 samples (serum, cerebrospinal fluid, and aqueous humor from 318 patients) were tested. IgA and IgE antibodies were detected in all heart, kidney, and liver transplant recipients with clinical manifestations of toxoplasmosis; IgA was detected in the aqueous humor of a patient with chorioretinitis. In patients with AIDS-related toxoplasmosis, including the cerebral form, IgA and IgE antibodies or a significant modification of ELIFA IgG values were observed in 38, 19, and 25% of patients, respectively. IgM was detected by ICT only in 12% of patients and aided the diagnosis in 1 of 71 patients. IC tests for specific IgA and IgE alone and combined with ELIFA were positive in 39 and 46% of patients who developed clinical toxoplasmosis, respectively. In a serial study of 16 patients in whom at least one of these three tests was positive, a significant immunological signal sometimes preceded clinical onset by 1, 6, and even 17 months. Similarly, in a group of human immunodeficiency virus-infected patients with evidence of previous exposure to T. gondii but no clinical manifestations, IgA, IgE, and IgA and/or IgE antibodies were detected in only 11, 4, and 12% of patients, respectively. These two situations point to peripheral T. gondii reactivation. IgA and IgE emerged as interesting markers of the risk of toxoplasmosis in immunodepressed patients. They may also provide valuable assistance in the diagnosis of toxoplasmosis, especially because tests for specific IgM are disappointing. However, at least one in two patients with toxoplasmosis showed no detectable immunological reaction, suggesting that this polyisotypic approach should be combined with other noninvasive methods such as gene amplification.
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We used a double pigtail ureteral stent in 16 children (aged 15 days to 13 years). Indications included: pyeloplasty (12 cases with 2 anastomotic leakages and 1 acute post-operative renal retention), renal trauma (1 case), difficult ureterocystoneostomy (1 case), urinary ascites (1 case), and abdominal tumor compression (1 case). This drainage procedure provides a useful alternative to an external tube diversion (standard ureteral stent or nephrostomy). In pediatric urology, the double stent offers the advantages of exceptional patient tolerance, drainage security and efficiency, and short hospital stay. In our experience, stents were removed on an out-patient basis under general anesthesia but non-endoscopic removal will be possible when smaller magnetic retrievers become available in the urologic armamentarium.
Avian leukosis virus-derived vectors were constructed with an internal transcriptional promoter and various 3' non-coding sequences. Deletions were introduced into the downstream U3 long terminal repeat (LTR) to obtain self-inactivation of LTR-mediated transcription after one round of replication. However, 3' non-coding sequences appeared to determine not only self-inactivation of the vectors but also gene transfer efficiency. Further analysis revealed the influence of these sequences on both internal gene expression and RNA packaging. One construct permitted gene transfer while inactivating 5' LTR-promoted transcription.
We used double pigtail ureteral stent in 16 children (aged 15 days to 13 years old). Indications included: pyeloplasty (12 cases with 2 anastomotic leakages and 1 acute postoperative renal retention), renal trauma (1 case), difficult ureterocystoneostomy (1 case), urinary ascites (1 case), and abdominal tumor compression (1 case). This drainage procedure provides a useful alternative to an external tube diversion (standard ureteral stent or nephrostomy). In pediatric urology, the double pigtail stent offers the advantages of exceptional patient tolerance, drainage security and efficiency, and short hospital stay. In our experience, stents were removed in an outpatient basis under general anesthesia but non endoscopic removal will be possible when smaller magnetic retrievers become available in urologic armamentarium.
We have isolated and analysed a 2 kb region of the mitochondrial genome of Arabidopsis thaliana (Columbia) showing a high level of nucleotide identity with the mitochondrial (mt) rps14 small-subunit ribosomal protein gene from Oenothera berteriana and Vicia faba, as well as with an open reading frame (ORF) located upstream of the nad3 locus in O. berteriana. The rps14 locus is present as a single copy in the A. thaliana mt genome and has a translational stop codon located near the initiation codon, as well as a deletion of one nucleotide that disturbs the coding sequence. The cloning and sequencing of nine amplified mt rps14 cDNAs clearly demonstrated that this gene is transcribed and that the mRNA precursors are edited at three positions, all involving C-to-U conversions. No editing events changing the stop codon and restoring the correct coding sequence were witnessed within the 9 individual cDNA clones. Therefore, we conclude that the single rps14 sequence of the mitochondrial genome from A. thaliana is in fact a pseudogene that is transcribed and edited but not translated.
The authors report a case of posterior epispadias associated with complete ventral urethra only discovered during the urethroplasty phase of the operation. This malformation is a rare form of urethral duplication and should be considered in any case of apparently isolated posterior epispadias.
Ligand-activated retinoic acid receptor alpha (RAR alpha) and c-ErbA alpha repress the AP-1-mediated transcriptional activation of the interstitial collagenase gene promoter by specifically decreasing the activity of the AP-1 transcription factor. On the other hand, the v-ErbA oncoprotein fails to repress the AP-1 activity and acts as a dominant negative oncoprotein by overcoming the repression of the AP-1 activity induced by RAR alpha and c-ErbA alpha. This maintenance by v-ErbA of a fully active AP-1 complex is correlated with the abrogation by this same oncogene product of the growth-inhibitory response of chicken embryo fibroblasts to retinoic acid treatment. This new mechanism of action of v-ErbA together with its previously discovered dominant repressor effect on transcription of thyroid hormone-activated target genes may explain the contribution of the v-erbA oncogene to sarcomatogenic and leukemogenic transformation.
A rapid protocol has been established for sexing forensic samples by the Polymerase Chain Reaction method. Three sets of primer were used, two specific for Y chromosome repetitive sequences and one specific for X chromosome repetitive sequences. Detailed procedures of experiments, the controls and the applications to testing bloodstains and a vaginal swab are presented. The sensitivity of the test and problems due to contamination are discussed.
Three techniques have been developed for single-stage repair of posterior hypospadias: free skin grafts, free bladder mucosal grafts, and pedicle preputial grafts. This multicenter retrospective study of 178 children who underwent surgery for posterior hypospadias was designed to compare the results achieved with these procedures. Free skin grafts (15 cases) resulted in the most frequent complications, and in particular the most severe strictures; in our opinion this technique should be abandoned. Pedicle preputial grafts (133 cases) gave the greatest number of successes from the outset, and should be preferred whenever the dimensions of the prepuce are sufficient for urethroplasty. Results with bladder mucosal grafts (30 cases) were not as good as with preputial grafts, but this technique remains the only solution when the meatus is in a very posterior position, and for children who have already undergone multiple operations.
Oncocytoma is an exceptionally rare renal tumor in children. We report on one case of a twelve-year-old girl treated by nephrectomy.
To obtain stable and constitutive expression of histone H5 at levels comparable to those observed in normal chicken erythrocytes, an avian self-inactivating retroviral vector was used to transfer the H5 gene into cells which do not express this protein. The vector, pDAH5, was obtained by removing the CAAT and TATA boxes of the 3'LTR of the avian leukosis virus RAV-2 and inserting the H5 sequence. Infection of QT6 quail cells with the recombinant virus (DAH5) led to the stable integration of the foreign H5 gene at low copy number, to the formation of correctly initiated mRNA transcripts and to the production of H5 protein. The amount of H5 expressed was equivalent to that of a mature chicken erythrocyte. Expression of histone H5 in DAH5 transformed cells, such as QT6 or AEV-ES4, transformed chicken embryo fibroblasts had only slight effects on the growth rate and did not inhibit cell replication. Conversely, the effect of H5 expression on normal quail and chicken fibroblasts was dramatic: cells acquired the aspect of quiescent fibroblasts, grew very slowly, and nuclei looked compacted, often extruded from the cell. The H5 histone produced in QT6-transformed cells was found to be phosphorylated while in normal chicken fibroblasts the protein lacked this posttranslational modification. It is proposed that the chromatin-condensing role of histone H5 is inhibited by its phosphorylation.
The authors report 2 cases of functional intestinal pseudo-obstruction in infancy associated with intestinal and urologic anomalies. In the first case many intestinal obstructions occurred from the age of 3 weeks and the boy was operated on at 14 months of age. A short small bowel and an intestinal malrotation were found at surgery; the alimentary canal was completely aperistaltic, and an ileostomy was performed. Further operations were carried out, for obstruction due to adhesions, and lastly to perform another ileostomy. An antenatal diagnosis of megacystis had been made with ultrasonography. In the second case, the pseudo-obstruction syndrome occurred at the age of 1 month, due to a volvulus of the small bowel with malrotation. A second operation, one month later because of lack of intestinal transit showed an aperistaltic bowel and a colostomy was performed. The intestinal continuity was set up again at the age of 9 months and a fractional feeding was started. A megacystis was found during urologic investigations. Growth is correct for both children at 3 years of age. A review of the literature allowed to list the most frequent digestive or extradigestive anomalies associated with this syndrome.
The authors present their experience (24 children) with the endoscopic subureteral injection of Teflon paste in the correction of secondary vesicoureteral reflux: reimplantation failure; ureterocele; obstructive bladder; exstrophy; postchemocystitis, and Hutch's diverticulum. Of these 24 cases (31 refluxing ureters), 18 were treated with success. Each cause justifies a comment on the particularities of its endoscopic treatment. The 'sting' can be particularly attractive to cure secondary reflux, avoiding the difficulties and complications of open surgical reimplantation.
17 centers answered an inquiry on the endoscopic treatment of vesicoureteral reflux. 844 children were reviewed representing 1,290 ureters treated by endoscopic injection of Teflon. The first results in cases of primary or secondary reflux showed a success rate of 82.3%. All authors report low morbidity and excellent tolerance of this technique. In view of the long-term prognosis, these results should be reanalyzed, the median follow-up presently being 1 year. The next logical step should be the development of implant material with a higher biocompatibility but the identical physical properties as Teflon.
A prospective study was carried out in 44 patients treated by intensive chemotherapy inducing a prolonged neutropenia (granulocytes less than 0.5.10(9)/l). All the patients were isolated in protected rooms, received a pathogen-free diet and nonabsorbable oral antibiotics. After double-blind randomization, 22 patients received 2 g of Ceftriaxone (Cef) in a daily infusion beginning on the first day of chemotherapy; and 22 patients received 2 g of placebo (P) under the same conditions. Prophylaxis was continued until the neutropenia resolved (granulocytes greater than 0.5.10(9)/l) or until the onset of infectious symptoms. 19 patients in each group developed febrile episodes, occurring significantly later in the Cef group (16.6 days versus 10.6 days in the P group). No Cef-resistant organism was isolated. Finally, the time at which apyrexia was obtained after the beginning of curative antibiotherapy was the same in both groups. The routine intravenous administration of Cef in combination with nonabsorbable antibiotics is a useful approach in reducing the risk of infection in the neutropenic host.
A post-operative follow-up in 21 cases of Congenital diaphragmatic hernia (C.D.H.) was carried out on 2 groups of patients. The first consisted in patient treated a long time ago by different anaesthetic methods which were not very precise. The other sample was recent, and a strict anesthetic procedure was used, analgesia and curarization with mechanical ventilation. Post-operative complications decreased on the ratio of 1/7, the intensive care stay being halved. The overwhelming importance of the correct anaesthetic procedure was underlined. An overall survival rate of 76% gives hopes for a better future for patients suffering from this malformation.