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Congenital hepatic fibrosis is a rare disorder of intrahepatic bile ducts with the persistence of embryological bile duct structures in ductal plate configuration. Three siblings aged 18, 17 and 14 years old were found to have congenital hepatic fibrosis associated with a deficiency of the enzyme phosphomannose isomerase. The clinical symptoms were recurrent attacks of persistent vomiting with diarrhea and mild hepatomegaly. The biochemical abnormalities included elevated serum transferases during attacks, clotting factor deficiencies and persistent hypoalbuminemia. In the youngest patient protein-losing enteropathy was present. Liver biopsies of the three patients taken when they were 1, 3 and 14 years old showed an excess of bile duct structures in ductal plate configuration with mild fibrosis in the portal triads. In one patient the liver biopsy was repeated after 18 years and showed only a mild progression of fibrosis in the portal triads. Duodenal biopsies taken in infancy in two of the three patients did not show any abnormalities. Recognition of phosphomannose isomerase deficiency in association with congenital hepatic fibrosis and protein-losing enteropathy is important, because some of the clinical symptoms are potentially treatable by oral mannose therapy.

Objective/hypothesis: To demonstrate a correlation between the duration and specific pattern of trauma of benign lesions of the vocal folds and their histopathologic appearance. Benign lesions of the vocal folds have various macroscopic appearances. Investigations demonstrate characteristic histopathologic features for three clinically well-defined lesions: 1) vocal fold polyps, 2) Reinke edema, and 3) vocal fold nodules. It is expected that additional histological stainings can contribute to additional insight into the pathophysiology of these lesions., Study Design: Retrospective., Methods: Histological stainings were used to study the constitution of the lamina propria of the mucosa: Verhoeff-van Gieson, Masson trichrome, alcian blue and alcian blue after pretreatment with hyaluronidase., Results: Estimation of the age of a lesion was not possible. Specific observations: 1) accumulation of hyaluronic acid around vessels occurred uniquely in polyps and 2) transverse orientation of elastic fibers was more often seen in vocal fold nodules. Combinations of histopathologic findings were specific to the lesion., Conclusions: The additional stainings support our previous observations, but had no additional discriminating value in making a histopathologic diagnosis.

Unlabelled: A 12-year-old boy with tuberous sclerosis complex (TSC) presented with a large retroperitoneal tumour. Exploratory surgery revealed an infiltrative tumour originating from the pancreas, with local metastases to the lymph nodes. The histologal diagnosis was a malignant islet cell tumour. Retrospectively measured pancreatic hormone levels, however, were normal. A connection between the malignancy and TSC was demonstrated by loss of heterozygosity of the TSC2 gene in the tumour. The primary mutation Q478X in this patient was identified in exon 13 of the TSC2 gene on chromosome 16., Conclusion: Pancreatic islet cell tumours have been mainly associated with multiple endocrine neoplasia syndrome type 1. In our case we demonstrate a direct relationship of this tumour to tuberous sclerosis complex, in the absence of further signs of multiple endocrine neoplasia syndrome type 1.

An infant with neonatal Marfan syndrome is described who presented with arachnodactyly, distinctive dysmorphic features and prolapse of both atrioventricular valves and dilatation of both the aortic and pulmonary root. She died in cardiac failure shortly after pacemaker implantation, due to dysrhythmia and severe mitral insufficiency. At autopsy, apart from myxomatous changes of the valves and dilated aortic and pulmonary roots, an aneurysm of the sinus of Valsalva of the pulmonary valve and abnormal myxomatous connective tissue surrounding the AV node were also found. Molecular genetic studies showed a point mutation in the fibrillin 1 gene that creates a new N-glycosylation site, which has been described once before.

A prototype steerable 8.5 F bipolar catheter fitted with a feedback thermocouple was tested in 7 anaesthetized pigs (30 kg) guided by the electrocardiogram in order to modify the AV nodal and His-Purkinje system conductive properties. Thermal energy was delivered by a pressurized N2O tank (> 650 psi) via a cardiac cryo unit (Spembly, Hampshire, UK) into the catheter wherein gas expands resulting in a tip temperature as low as -70 +/- 2 degrees C within 10 seconds. Cryoablation under fluoroscopic and electrocardiographic guidance was applied at distinct sites in both ventricles for 60 or 120 seconds. After a follow-up period of 6 weeks, the ablation lesions found were well demarcated with small margins of hypertrophy of myocardial cells. With respect to lesion volume variability (8-207 mm3) and geometry, a relationship between the 0 degree C isothermic period and cryolesion volume was found. Results of an in vitro model corroborated this relationship. Therefore, an isothermic period probably can predict the lesion size and its geometry in terms of lesion depth. This potential therapeutic mode of transcatheter cryoablation deserves further investigation.

Unlabelled: Isolated congenital lymphoedema of the external genitalia in boys is extremely rare. It can have major physical and emotional consequences for the children. Three male patients with primary lymphoedema of the penis and scrotum are described. The first case presented with lymphoedema of the prepuce and the phallic skin that persisted after the age of 1 year. Circumcision and excision of the subcutaneous tissues of the phallic skin were successful in producing the appearance of a normal circumcised penis. The second case presented with oedema of both phallic and scrotal skin. At age 1 year only a pastous thickening of the prepuce remained, scrotal and phallic skin normalised spontaneously. Routine circumcision was successful with a 5-year follow up. The third case presented with persistent oedema of both the scrotum and the phallus. He suffered leakage of lymph requiring incontinence pads, with complicating skin infections recurring every 4-6 weeks at age 8 years. After complete peeling of the scrotal and phallic skin from subcutaneous tissue some leakage persisted, infections subsided. The cause of this disorder remains unknown, although hypoplasia of the lymphatic vessels is reported in most cases. In the literature, several congenital malformations have been associated with primary lymphoedema. These were not noted in our patients. Rarely, the lymphoedema regresses spontaneously. The treatment of persistent lymphoedema is surgical and consists of meticulous excision of all subcutaneous layers of the affected skin, combined with reconstruction of the penis and/or scrotum., Conclusion: Primary lymphoedema of the male external genitalia is an extremely rare malformation of the lymphatic vessels of unknown origin. If persistent, surgical treatment is necessary.

Unlabelled: The uptake of 18F-fluorodeoxyglucose (FDG) and L-[1-(11)C]tyrosine (TYR) was investigated in male Wistar albino rats with chemically induced dysplasia and oral squamous cell carcinoma (SCC) to correlate the uptake values with the grade of dysplasia., Methods: The palates of 54 rats was painted three times per week with 4-nitroquinoline 1-oxide to create different stages of dysplasia and SCC. After 2, 4, 6, 8, 12, 16, 20, 26 and 30 wk, these rats were investigated with PET. Immediately thereafter, the rats were killed and histologically prepared. Standardized uptake values (SUVs) of the palate of the rats were calculated and correlated with the Epithelial Atypia Index (EAI) and the thickness of the epithelial layer., Results: The TYR SUV correlated with the EAI and the epithelial thickness, 0.5 and 0.74, respectively. No correlation could be found for FDG SUV, compared to EAI and the epithelial thickness., Conclusion: For dysplasia and SCC, TYR showed higher uptake values than did FDG. It appeared that, for the detection of oral dysplasia, the tissue hyperplasia was more important than malignant features of dysplastic mucosa.

Low birthweight has been associated with diseases and disorders later in life. It has been suggested that this is caused by the impaired development of abdominal organs, especially in cases of growth retardation. Besides general malnutrition of the fetus, preferential bloodflow to the heart and brain may further deprive organs, such as liver, pancreas and kidney, of nutrients. As a result these organs may not develop properly. Anatomically, the ovary is situated close to the kidney and it is very likely that, similar to the kidney, ovarian development can be negatively affected by intra-uterine growth retardation. Placental insufficiency, which is an important cause of severe intra-uterine growth retardation, was used as a model to investigate this hypothesis. In the present study, the volume percentages of primordial follicles in the ovaries of four severely growth-retarded fetuses of different gestational ages are compared to those of four age-matched controls. It is found that these volume percentage in growth-retarded fetuses were significantly lower than those observed in the age-matched controls. It can be concluded that ovarian development is impaired in intra-uterine growth-retarded fetuses. These findings further suggest that, as a result of the premature loss of follicles, females with low birthweights may encounter fertility problems later in life.

Background: The carcinogen 4-nitroquinoline 1-oxide (4NQO) has been used in several studies concerning experimental oral carcinogenesis to induce squamous cell carcinoma in the palatal mucosa of rats, whereas limited attention has been paid to preceding premalignant mucosal changes. The aim of this study was to describe the macroscopic and microscopic changes of the rat palatal mucosa treated with 4NQO as a function of the application time of this carcinogen., Methods: The carcinogen 4NQO was applied to the palatal mucosa of male Wistar rats three times a week for 2-26 weeks. The Epithelial Atypia Index (EAI) was used to quantify the degree of dysplasia induced by the application of 4NQO for various time intervals., Results: This study shows that the EAI increases as a function of the application time. As soon as 2 weeks following application of the carcinogen, dysplastic alterations in the mucosa were observed. The extent and grade of the dysplastic changes increased with time. At week 26, squamous cell carcinoma developed. In rats in which the application of 4NQO was discontinued earlier, the application period appeared to be in inverse proportion to the latency period i.e., the period between the last application of the carcinogen and the first clinical sign of squamous cell carcinoma. This emphasizes the premalignant character of the induced epithelial changes, because in all the rats squamous cell carcinoma eventually developed., Conclusions: From this study, we concluded that the 4NQO rat palate model is a proper model in which both premalignant epithelial lesions and squamous cell carcinoma of the oral mucosa can be studied.

Unlabelled: The uptake of L-1-[11C]-tyrosine (TYR) in cervical lymph nodes of eleven patients with squamous-cell carcinoma (SCC) of the oral cavity was studied with PET to detect lymphogenic metastases., Methods: The TYR-PET results were compared with clinical, MRI, CT, histopathologic findings and historical data of patients studied with FDG. Sensitivity, specificity, accuracy and the positive and negative predictive values were calculated., Results: TYR-PET had sensitivity of 83% and a specificity of 95%. In contrast, the sensitivity and specificity for MRI were 33% and 96%, respectively. The sensitivity and specificity for CT were 55% and 91%, respectively. TYR-PET results compared favorably with FDG., Conclusion: With TYR-PET, SCC metastases of the oral cavity can be visualized with high sensitivity and specificity. TYR-PET can be an additional tool for further evaluation of neck malignancies.

This study evaluated bone healing after mandibular swing osteotomies fixed with biodegradable poly(L-lactide) (PLLA) bone plates in four patients. A step osteotomy treated with two PLLA bone plates (n=3), and a straight osteotomy treated with one PLLA bone plate (n=1) were performed. Bone healing was uneventful in all patients; only in the patient with the straight osteotomy was callus observed. After 5.5 years, radiologic changes at the site of implantation were observed in the remaining patient. Histologic examination revealed a nonspecific foreign-body reaction on highly crystalline PLLA remnants which were still present. It is concluded that the PLLA bone plates provided enough strength to enable undisturbed bone healing. The long-term degradation results are comparable with those of other studies on as-polymerized PLLA implants.

Benign lesions of the vocal folds have various appearances. Histopathologic examination might provide the true diagnosis. Therefore, histologic slides of 74 patients (92 vocal folds) with clinically well-defined diagnoses were single-blind examined by a pathologist. Single histologic features did not differentiate between different clinical entities, but combinations make some diagnoses more likely than others. Ultrastructural examination of submucosal vessels in the three most common clinical entities (polyps, Reinke edema, and vocal fold nodules) showed an entity-unique pattern of abnormal increase of layers of basement membrane-like material. A potential pathogenetic model of benign lesions of the vocal folds is presented, employing a combination of histopathologic findings and their possible relations with various forms of trauma inducing and maintaining these lesions.

Epithelial dysplasia in the rat palatal mucosa was induced by application three times a week of the carcinogen 4-nitroquinoline 1-oxide (4NQO). With the Epithelial Atypia Index (EAI), the successive stages of 4NQO-induced epithelial dysplasia were compared with specimens of human oral epithelial dysplasia. It appeared that there was a close similarity between the histologic features of 4NQO-induced dysplasia in the rat palatal mucosa and human oral epithelial dysplasia. Thus, the 4NQO rat palate model seems to be appropriate to study and assess new treatment modalities of premalignant epithelial lesions of the oral mucosa in man.

Unlabelled: The uptake of 2-deoxy-2-[18F]fluoro-D-glucose (FDG) in neck lymph nodes of twelve patients with a squamous-cell carcinoma of the oral cavity was studied with PET in order to detect and locate lymphogenic metastases., Methods: The results of FDG-PET imaging were compared with clinical, MRI and histopathologic findings. Standardized uptake values (SUV) were also calculated., Results: A sensitivity of 91% and a specificity of 88% were calculated for FDG-PET. In contrast, a sensitivity of 36% and a specificity of 94% were calculated for MRI. Calculated SUVs for reactive lymph nodes, metastatic lymph nodes and the primary tumor were undifferentiated., Conclusion: Using FDG-PET, lymph node metastases of squamous-cell carcinomas of the oral cavity can be visualized with a high sensitivity and specificity. FDG-PET can be an improvement in the evaluation of the neck.

A neonate with respiratory distress due to a right pneumothorax is presented. After drainage of the pneumothorax, atelectasis of the entire right lung developed. Because the atelectasis persisted, bronchoscopy was performed. On bronchoscopy the carina and right main-stem bronchus could not be visualized. Thoracotomy showed that the right main-stem bronchus was obstructed by a space-occupying lesion that was originating from the right upper lobe. Therefore, a sleeve resection of the right upper lobe was performed, and the right main-stem bronchus was reconstructed. Microscopic examination of the resected right upper lobe showed multiple chondromata. The lesions were located both in the lung parenchyma immediately beneath the pleura and in the bronchial wall. Pulmonary chondromata are rarely diagnosed in children. To our knowledge, this is the youngest patient ever presented with pulmonary chondromata.

Psammomatoid ossifying fibroma (POF) is a diagnostic designation for a sinonasal or orbital fibroosseous lesion characterized by numerous small round mineralized spherules lying in a fibroblastic stroma. We report 3 cases. One occurred in the frontal sinus of an 18-years-old male; 1 in the frontal sinus of a 20-year-old male and 1 in the maxillary sinus of a 36-year-old male. Rather limited excision resulted in a disease-free follow-up time from 2 to 6 years. The histomorphology of POF was compared with other fibro-osseous lesions of the craniofacial skeleton including the jaws. It appeared that POF is similar to cemento-ossifying fibroma occurring in the jaws and the necessity for different names for lesions only differing in their site of occurrence is considered to be at least debatable.

Recently there has been an increased interest in the possible role that viruses and especially the Human Papilloma virus (HPV) could play in the etiology of lesions of the oral mucosa. A distinction has to be made between the so-called low-risk types of the virus (HPV-2, 6, 11, 13 and 32) which can be found in benign oral mucosal lesions, and the high-risk type (HPV-16), which predominantly is found in malignant oral mucosal lesions.

A cytogenetic study of an eccrine spiradenoma and two lymph node metastases, with a growth pattern and microscopic appearance typical for benign eccrine spiradenoma, revealed a 46,XY-5,del(16)(q22),+mar(t(?;5)(?::5q13----5qter)) karyotype. The finding of the same abnormal karyotype in the tumor and the metastases suggests a relationship between the chromosomal abnormalities and the clinical malignant behavior of this morphologic benign tumor.

A 30-year-old woman with mixed connective tissue disease presented with acute abdominal pain and signs of blood loss. At cholecystectomy she appeared to have lost a considerable amount of blood into the biliary tract due to bleeding of the gall bladder. Microscopic examination showed vasculitis of the gall bladder wall. Hemobilia has not been described before as a complication in mixed connective tissue disease.

We have compared the response of mice heterozygous for the Slj allele-which have a stromal defect resulting in mild macrocytic anemia-and their normal +/+ littermates to manipulations of the erythron to further characterize the effects of the Slj allele on hemopoiesis. CFU-S kinetics in Slj/+ mice following plethorization or induction of anemia did not differ from similarly treated +/+ littermates. Under all circumstances, however, Slj/+ mice had a smaller splenic CFU-S population than similarly treated +/+ mice. Slj/+ and +/+ mice responded similarly to induction of hemolytic anemia with a large rise in 59Fe incorporation in spleen and blood. Hypertransfused Slj/+ mice were shown to have a diminished response to exogenous erythropoietin in spleen and blood as compared with their +/+ littermates. We conclude that the regulation of CFU-S kinetics in mutant Slj/+ mice is not anomalous as has been reported to be the case in Sl/Sld mice. The defective stromal tissue of Slj/+ mice, however, does not support a normal-sized CFU-S population, which leads to decreased influx of progenitor cells into the erythropoietin-responsive cell compartment, causing the diminished response of plethorized Slj/+ mice to exogenous erythropoietin.

The leukocyte mobilizing polyanions dextran sulphate (DS) and polymethacrylic acid (PMAA) were administered to AKR and (C57BL x CBA) F1 mice at various times after transplantation of syngeneic lymphoma cells. In nonleukaemic mice DS and PMAA increased the number of circulating leukocytes 3--4-fold. The extent of leukocyte mobilization in leukaemic mice depended on the interval between transplantation of the lymphoma cells and injection of the polyanion. During the development of leukaemia in AKR as well as in (C57BL x CBA) F1 mice the capacity to react upon injection of polyanions with leukocyte mobilization gradually decreased. For DS, this decrease started before the number of leukocytes increased in the peripheral blood. On the other hand, the capacity for PMAA-induced leukocyte mobilization was fully preserved for several more days. In heavily leukaemic mice neither DS nor PMAA could further increase the number of peripheral blood leukocytes. In such mice the distribution pattern of leukaemic blast cells, small lymphocytes, granulocytes and monocytes was also hardly or not affected by injection of the polyanion.

We have compared four assays to detect hemopoietic stromal damage induced by various cytostatic agents in young (4-week old) and adult (12-week old) mice. These assays included: (a) quantitation of the hemopoietic stem cell content of subcutaneously implanted spleens and femurs, (b) quantitation of fibroblastic colony-forming units per femur and spleen, (c) quantitation of the growth of normal hemopoietic progenitor cells in irradiated cytostatic drug-treated mice, and (d) measurement of splenic hemopoietic stem cell accumulation in response to bacterial lipopolysaccharide-induced hemopoietic stress. Busulfan caused a short- and long-term hemopoietic stromal defect. However, the four assays used showed different kinetics and severity of the stromal damage. Cyclophosphamide treatment resulted in a short-term stromal damage which was repaired within one week to three months, depending on the assay used. Methotrexate and vincristine did not cause long-term stromal damage as measured by the four assays used, whereas a short-term splenic stromal damage was detected using the subcutaneous implantation technique. No significant differences in stromal sensitivity to drug treatment were observed between young and adult mice. The presented data suggest that the four assays used to study stromal integrity measure different components of the hemopoietic microenvironment, and indicate that the use of a single assay may well lead to erroneous interpretations.

We studied the ability of the hemopoietic organ stroma to recover from damage inflicted by 5 or 7 Gy gamma radiation administered during a period of stromal growth in 4-week-old mice. Irradiation resulted in an immediate depletion of femoral colony-forming fibroblastic progenitors (CFU-F) down to 10-20% of age-matched control values. A full recovery to normal numbers occurred between 120 and 240 days after irradiation and was followed by a secondary decrease 1 year after irradiation. This secondary decrease was accompanied by a decrease in the femoral CFU-S and CFU-C content. Femoral CFU-F attained normal numbers and it was demonstrated to occur from surviving CFU-F and could not be enhanced or prolonged following infusion of unirradiated bone marrow cells after irradiation. During the transient CFU-F recovery the hemopoietic stroma remained severely damaged as judged by the regenerative capacity of spleen and femur stroma after subcutaneous implantation, and the ability of the spleen to accumulate CFU-S in response to lipopolysaccharide injection. We have reported earlier that in similarly irradiated adult mice, no restoration of femoral CFU-F was observed. This difference between 4-week-old and adult mice could not be explained by a difference in in vitro radiosensitivity of CFU-F or in their in vivo regeneration kinetics following irradiation and subsequent lipopolysaccharide injection. We conclude from these observations that the recovery kinetics of the CFU-F population is different in young and adult irradiated mice, infused CFU-F do not contribute to CFU-F regeneration in an irradiated femur, CFU-F are not the sole determinants of stromal regeneration in femur and spleen following irradiation.

This paper describes the kinetics of fibroblastic colony forming units (CFU-f) in murine blood after phenylhydrazine-induced haemolytic anaemia and their subsequent migration into haemopoietic organs. Murine blood contained 5.3 +/- 0.8 CFU-f per 10(6) nucleated cells. Absence of particle ingestion and factor VIII-related antigen in addition to the enzyme pattern in CFU-f-derived cells confirmed that these cells did not have a macrophage-like or endothelial nature. Phenylhydrazine treatment of mice resulted in a 3-fold increase in blood CFU-f numbers which was accompanied by increases in blood cellularity and granulocyte-macrophage progenitor numbers. When both partners of CBA/N and CBA/T6T6 mice in parabiosis had been treated with phenylhydrazine, spleens and femoral bone marrow of both mice were shown to contain partner-derived CFU-f. These data suggest that circulating CFU-f represent a stromal cell population which can migrate into haemopoietic organs.

We investigated the in vitro effects of ASTA-Z-7595, ASTA-Z-7557, ASTA-Z-7654, and 4-hydroperoxycyclophosphamide (4HC) on murine stromal fibroblastoid colony-forming units, committed hemopoietic progenitors (erythroid burst-forming units and granulocyte/macrophage colony-forming units), and pluripotent hemopoietic stem cells assayed by the spleen colony-forming unit (CFU-s) assay. In general, the drugs showed a time-and dose-dependent effect on colony-forming unit survival, and the relative toxicities were in the order in which the drugs are listed above. We found a relative sparing of day 12 CFU-s compared with day 7 CFU-s and committed hemopoietic and stromal progenitors, although colony size of day 12 CFU-s was reduced. Our results support two possible mechanisms for delayed or inadequate hemopoietic reconstitution in clinical studies using bone marrow purged with 4-hydroperoxycyclophosphamide or ASTA-Z-7557, i.e., damage to (a) transplantable stromal cells or (b) the hemopoietic stem cells.

We studied the short- and long-term effects of a fractionated injection of cis-diamminedichloroplatinum (II) (CDDP) upon the haemopoietic stroma and the haemopoietic precursor cell compartment of young and adult mice. The integrity of the stromal microenvironment was investigated using three different assays including quantification of (a) the fibroblastoid progenitor cell compartment, (b) the regenerative capacity after subcutaneous implantation of spleen and femur, and (c) the growth of normal bone marrow progenitors in lethally irradiated CDDP-treated mice. CDDP treatment induced a slight anaemia which lasted for the observation period of 1 year, and could not be restored by infusion of normal bone marrow cells. The population size of haemopoietic progenitors was severely decreased immediately after CDDP treatment and the CFU-S recovery in the bone marrow was slow and temporary. Stromal function was significantly decreased and normalization occurred within approximately 40 d, depending on the stromal parameter measured. Subsequently, the regenerative capacity of the stroma showed a second decrease which was still detected at 1 year. This pattern of stromal damage has not been reported for any other cystostatic agent. Since the other two assays did not detect a second decrement in stromal integrity it is implied that the three stromal assays used detect different stromal functions. We conclude that CDDP treatment of both young and adult mice results in severe short-term damage and a late occurring secondary regenerative defect of the haemopoietic organ stroma.

We investigated a haemopoietic stromal defect, in mice heterozygous for the Slj allele, during haemopoietic stress induced by treatment with bacterial lipopolysaccharides (LPS) or lethal total body irradiation (TBI) and bone-marrow cell (BMC) reconstitution. Both treatments resulted in a comparable haemopoietic stem cell (CFU-s) proliferation in Slj/+ and +/+ haemopoietic organs. There was no difference in committed haemopoietic progenitor cell (BFU-e and CFU-G/M) kinetics after TBI and +/+ bone-marrow transplantation in Slj/+ and +/+ mice. The Slj/+ mice were deficient in their ability to support macroscopic spleen colony formation (65% of +/+ controls) as measured at 7 and 10 days after BMC transplantation. However, the Slj/+ spleen colonies contained the same number of BFU-E and CFU-G/M as colonies from +/+ spleens, while their CFU-s content was increased. On day 10 post-transplantation, the macroscopic 'missing' colonies could be detected at the microscopic level. These small colonies contained far fewer CFU-s than the macroscopic detectable colonies. Analysis of CFU-s proliferation-inducing activities in control and post-LPS sera revealed that Slj/+ mice are normal in their ability to produce and to respond to humoral stem-cell regulators. We postulate that Slj/+ mice have a normal number of splenic stromal 'niches' for colony formation. However, 35% of these niches is defective in its proliferative support.