Tissue transglutaminase antibodies in celiac disease, comparison of an enzyme linked immunosorbent assay and a dot blot assay.

AIMS: The purpose of our study is to determine the sensitivity, specificity and predictive values of an enzyme linked immunosorbent assay (ELISA) and a dot blot assay for the detection of IgA class anti-tissue transglutaminase antibodies (IgA-AtTGA) and to compare these results with those of IgA class anti-endomysium antibodies (IgA-AEA), IgA class anti-reticulin antibodies (IgA-ARA) and IgA class anti-gliadin antibodies (IgA-AGA). PATIENTS: Serum samples from 143 patients (97 children, 46 adults) with untreated celiac disease (CD) confirmed by intestinal biopsy and 74 disease controls (64 children, 10 adults) were studied. Methods. - The anti-tissue transglutaminase antibodies were detected by dot blot assay and an ELISA using guinea pig tissue transglutaminase (gp-tTG) as antigen. The anti-endomysium antibodies were detected by an indirect immunofluorescence technique on cryostat sections of human umbilical cord. The anti-reticulin antibodies were also investigated by indirect immunofluorescence on cryostat sections of kidney, liver and stomach of rat. The anti-gliadin antibodies were determined by an ELISA. RESULTS: The sensitivity of an ELISA for the detection of anti-tissue transglutaminase antibodies was 86% in children and 87% in adults and the sensitivity of dot blot assay was 57% in children and 54% in adults. The specificity of an ELISA and dot blot for the detection for anti-tissue transglutaminase antibodies was, respectively, 96% and 88% lower than that of anti-endomysium antibodies (100%). The sensitivity of anti-gliadin antibodies was 97% in children and 91% in adults and their specificity was 85%. The sensitivity of anti-reticulin antibodies was 94% in children and 87% in adults. Their specificity was 100%. CONCLUSIONS: The sensitivity and specificity of an ELISA for the detection of anti-tissue transglutaminase antibodies were better than that of dot blot assay. However, this dot blot assay could screen four celiac patients who have not had anti-tissue transglutaminase antibodies by an ELISA. The sensitivity of anti-endomysium antibodies was better than that of anti-tissue transglutaminase antibodies, anti-reticulin antibodies and anti-gliadin antibodies but in children aged less than 2 years, the sensitivity of anti-gliadin antibodies was better than that of anti-tissue transglutaminase antibodies.

[Esophageal mucocele: report of 2 pediatric cases]. / Mucocèle oesophagienne à propos de deux observations pédiatriques.

Two cases of esophageal mucocele in pediatric patients are reported: two children of 5 and 9 years respectively underwent surgical isolation of the esophagus and esophagocoloplasty for caustic stenosis related to accidental ingestion of caustic soda. Clinical pattern of mediastinal compression was proved with cervical fistulous tract in one case. In both cases, thoracic computed tomography was a sensitive imaging method to demonstrate the mucocele and its extension. Esophageal mucocele is rarely described in children, especially following esophageal corrosive stricture.

[Mucocele of the appendix. Retrospective study of 10 cases]. / Les mucocèles appendiculaires. Etude rétrospective à propos de 10 cas.

PURPOSE: The purpose of our work was to assess the value of abdominal sonography (US) and computed tomography (CT) in the preoperative diagnosis of appendiceal mucocele. MATERIAL: and methods. We retrospectively reviewed 10 cases of mucocele of the appendix, 7 cases without pseudomyxoma peritonei, and 3 cases with pseudomyxoma peritonei. All cases were investigated radiologically by plain film and US, barium enema was performed in 3 cases and CT in 5 cases. RESULTS: Mucoceles of the appendix are rare and their clinical presentation is not specific. US confirms the appendicular involvement, but often poses the differential diagnosis with acute inflammation, abscess or localized appendicular peritonitis. CT appears as a mandatory examination since it allows accurate preoperative diagnosis period. In this series, the diagnosis was made preoperatively in the 5 cases where CT had been performed. CONCLUSION: US is useful to confirm the abnormal pattern of the appendix but does not allow accurate diagnosis of mucocele. CT is more specific and accurate for diagnosis of mucocele of the appendix.

[Abdominal actinomycosis. Report of 4 clinical cases studied with radiography]. / Actinomycose abdominale. A propos de 4 observations radiocliniques.

We report 4 cases of pathologically proven abdominal actinomycosis. US and CT demonstrated an infiltrative abdominal mass with ill-defined margins and heterogeneous enhancement after IV contrast. The ileo-cecal region was involved in one case; the mass appeared following cholecystectomy and recurred 3 years after surgical resection in one case; and no predisposing factor was identified in the 2 other cases. In one of these, recurrence was observed 12 years after the first episode. Actinomycosis must be included in the differential diagnosis of invasive abdominal lesions with "malignant" appearance.

[Tuberculous mesenteric lymphadenitis: a case report]. / La lymphadénite mésentérique d'origine tuberculeuse: à propos d'un cas.

The authors report a case of mesenteric tuberculous lymphadenitis which mimic a pancreatic cystadenoma. They emphasize ultrasound and CT scan features which lead to the recognition of tuberculosis and permit a percutaneous fine needle biopsy. Laparotomy seems the most reliable method for a positive diagnosis. The place of different imaging methods is discussed.

[Radioclinical profile of cardiopericardial hydatid: report of 17 cases]. / Profil radioclinique du kyste hydatique cardiopéricardique: à propos de 17 cas.

Hydatid cysts concerning the heart are rare, accounting for 0.5 to 2% of all hydatic sites. The risk of serious complications in this location makes rapid diagnosis and surgical treatment essential. The aim of our study is to clarify the role of imaging in the diagnosis of the disease and to propose an adequate strategy. We report on 17 patients who underwent surgery for cardiopericardial hydatid cyst in the cardiovascular and thoracic unit of Sahloul hospital in Sousse from January 1988 to December 1998. Clinical investigation included in all cases chest X ray, ECG and ultrasonography (US). A computed tomography (CT) scan was performed in 14 cases, magnetic resonance imaging in three cases, transesophageal US in five cases, and coronary angiography in fsix cases. Examination for other hydatic sites was realized in all cases, and brain CT was performed in four cases. The hydatid cyst was variably localized in the left ventricle wall (five cases), the right ventricle (five cases), the pericardium (five cases), the interventricular septum (four cases), the right auricle (one case) and the left auricle (one case). The existence of other cardiac hydatid sites was found in 12 cases. All patients underwent surgery. Outcome was favorable in 14 cases, with a mean of 3 years and 5 months survey. Three patients died. The combination US-CT scan allowed a precise topographical inventory, reducing the need for MRI to the complicated cases and to the rare cases of inconclusive results by US-CT scan.

[Cystic renal cancers. Review of 6 cases]. / Les cancers du rein d'aspect kystique. A propos de 6 observations.

The authors present six cases of cystic renal cancers which raised preoperative and intraoperative diagnostic difficulties. Computed tomography is currently the most reliable diagnostic examination. The diagnosis of complicated benign cyst must be made cautiously and persistence of doubtful images must lead to surgical exploration. The authors try to up-date the diagnostic strategy for atypical cysts based on recent progress in medical imaging and propose a practical approach to treatment.

[Testicular microlithiasis]. / La microlithiase testiculaire.

Testicular microlithiasis is an uncommon condition in which calcified concretions fill the lamina of seminiferous tubules. It has a specific appearance on sonography with diffuse intra testicular echogenic foci without acoustic shadows. Testicular microlithiasis can be associated with various entities and frequently with primary testicular neoplasm. The authors report a new case of testicular microlithiasis diagnosed by sonography in a 14-year-old boy with epididymo-orchitis. Based on a review and discussion of the literature, the authors emphasize the importance of regular and protracted ultrasound follow-up and monitoring of serum tumour markers to allow early detection of primary testicular neoplasm.

[Acute pyelonephritis and subcapsular hematoma revealing nephroblastoma at the age of 15 years]. / Pyélonéphrite aiguë et hématome sous-capsulaire révélant un néphroblastome à l'âge de 15 ans.

BACKGROUND: Nephroblastoma' the most common renal tumor in children between 1 and 5 years, occurs rarely in the oldest child. CASE REPORT: A 16-year-old teenager suffered from acute pyelonephritis caused by Klebsiella pneumoniae. Renal ultrasonography showed a left subcapsular hematoma; the CT scan confirmed the finding and also showed renal scarring. However, a second CT scan showed pulmonary nodules suggestive of metastasis, a diagnosis that was confirmed by needle biopsy of pulmonary lesions. Recovery was obtained after chemotherapy and nephrectomy with a 3-year-follow-up. CONCLUSION: This nephroblastoma was particular because its development in an adolescent, its association with acute pyelonephritis and subcapsular hemorrhage.

[Retroperitoneal schwannoma. Diagnostic and therapeutic outcome]. / Schwannome rétropéritonéal. Démarche diagnostique et thérapeutique.

Two cases of retroperitoneal benign schwannoma are described with a review of literature. Are analysed the clinical and anatomopathologic features of this rare tumor and the methods of diagnosis. The treatment is the surgical ablation of the tumor commonly easy and complete. When malignancy is established, adjuvant procedures add little to life expectancy and total surgery is done likely to be effective.

[Value of imaging in the assessment of malignant fibrous histiocytoma of the soft tissues]. / Place de l'imagerie dans le bilan des histiocytomes fibreux malins des parties molles.

Malignant fibrous histiocytoma (MFH) is a rare and potentially highly malignant sarcoma. The authors report 6 cases of MFH in various sites: two in the chest wall, one in the pelvis, two in the gluteal zones and one on the scalp. Ultrasonography and computed tomography were the main imaging methods used in the assessment of the structure and extension of the tumor. A poor prognosis was noted in four cases: death within a few months in the two thoracic sites, recurrence in the pelvic and scalp lesions, radical surgery allowed recovery in two cases. A review of the literature showed that MRI and CT are complementary in the initial staging and follow-up of these patients.

[Adrenal tumors in Beckwith-Wiedemann syndrome. Apropos of a case]. / Tumeurs surrénaliennes dans le syndrome de Beckwith-Wiedemann. A propos d'un cas.

A case of a neonate with Beckwith-Wiedemann syndrome is presented. Antenatal sonography detected a right adrenal cystic mass confirmed in post-natal which resolved spontaneously within 1 month. The child developed an adrenal adenoma detected by abdominal sonography at six months of surveillance. The authors review the different adrenal lesions possibly associated with Beckwith-Wiedemann syndrome and specially the pseudo-tumorous lesions. The value of abdominal sonography in the neonatal periods and in the surveillance of children with Beckwith-Wiedemann syndrome is emphasized.

[Ultrasonographic aspects of kidney pelvis tumors associated with infectious hydronephrosis of lithiasic origin]. / Aspects échographiques des tumeurs pyéliques sur hydronéphrose infectée d'origine lithiasique.

The ultrasonographic findings of 4 patients with surgically confirmed urothelial tumors associated with calculic pyonephrosis are presented. All the involved were markedly enlarged and hydronephrotic with obstructive calculi, stigmata of pyonephrosis and, an echoic pelvic mass, extending in calyceas in 2 cases. The sonographic appearance correlated well with the gross pathological findings. The histological types were 2 squamous cell carcinomas, 1 adeno-squamous cell carcinoma and 1 transitional carcinoma. The chronic calculic irritation was proved to induce squamous and glandular metaplasia. The subsequent squamous carcinoma and adenocarcinoma were documented in the literature. The preoperative diagnosis of the associated tumor was rarely done. The sonographic features reported are highly suggestive of urothelial tumor and may lead to an accurate preoperative diagnosis.

[Retroperitoneal lymphocele occurring in a child after nephrectomy and treated by percutaneous drainage]. / Lymphocèle rétropéritonéal apparu chez un enfant après néphrectomie et traité par drainage percutané.

Lymphocele is a rare complication of kidney surgery in pediatric practice. Recent treatment consists in long term percutaneous drainage. The case reported was diagnosed 9 years after nephrectomy and improved with 3 weeks percutaneous drainage.

[Cancer of the penis: the value of systematic biopsy of the superficial inguinal lymph nodes in clinical N0 stage patients]. / Cancer du pénis: valeur de la biopsie systématique des ganglions inguinaux superficiels chez les patients N0 clinique.

From 1985 to 1991, bilateral surgical biopsy of the superomedial group of superficial inguinal lymph nodes, considered to be the first draining nodes, was performed in 24 patients with clinical stage T1-3 N0 M0 squamous cell carcinoma of the penis at the same time as surgical treatment of the primary. This procedure was technically successful in every case, but no lymph node metastases were detected. As bilateral biopsy was negative in these 24 patients, clinical surveillance was implemented: review every 2 months for 2 years and self-palpation by the patient. Seven patients (29.1%) developed one or more suspicious ilio-inguinal lymph nodes after a mean interval of 11.85 +/- 8.02 months: 1) In 6 patients, bilateral ilio-inguinal lymph node dissection was then performed, confirming the neoplastic nature of the inguinal node metastases without iliac metastases in 3 of these patients. 2) As the remaining patient presented with unilateral iliac node metastases, proven histologically by surgical biopsy, systemic chemotherapy was introduced prior to ipsilateral inguinal lymph node dissection. This finding questions the theory according to which the sentinel superomedial inguinal node constitutes the first draining node and demonstrates the existence of several pathways of lymphatic drainage towards superficial and deep inguinal nodes. This biopsy, which was always negative in our series, is insufficient to guide our therapeutic approach in clinical N0 patients. The decreased complication rate following inguinal lymph node dissection should certainly encourage us to prefer surgery, particularly superficial inguinal lymph node dissection with preservation of the great saphenous vein.

[Survival of Salmonella paratyphi B and Pseudomonas aeruginosa in seawater after incubation or washing in the presence of osmolytes]. / Survie du Salmonella paratyphi B et du Pseudomonas aeruginosa dans l'eau de mer après incubation ou lavage en présence d'osmolytes.

The authors have compared the survival in seawater of Salmonella paratyphi B and Pseudomonas aeruginosa cells grown at low or high osmolarity, in the presence of organic osmolytes: glycine betaine, choline, proline, and glutamate. The four substrates enhanced the survival potential of S. paratyphi B while only glycine betaine protected P. aeruginosa. In addition only S. paratyphi B cells were more resistant after a preliminary growth at high osmolarity. Both bacteria were sensitive to osmotic down-shock, sensitization of S. paratyphi B being inversely proportional (p greater than or equal to 0.01) to the osmolarity of the medium used to wash cells. The transit in wastewater, at low osmolarity, can therefore modify the behavior of these pathogens in the marine environment.

[Bone anomalies in von Recklinghausen disease]. / Anomalies osseuses dans la maladie de Von Recklinghausen.

28 cases of neurofibromatosis are reported. Principals bone anomalies are reviewed. The skeletal manifestations are numerous and varied. These anomalies interest specially cranial vault, spheno-orbital area and vertebral spine. It is imperative to keep in mind skeletal manifestations because neurologic and cutaneous signs can be absent.

Ureteral valves: report of a case diagnosed by antegrade pyelography.

Ureteral valves are an uncommon cause of upper urinary tract obstruction. The majority of cases are discovered only at surgery or autopsy. We report a case diagnosed by antegrade pyelography under sonographic guidance and we review the literature.