Herpes simplex esophagitis in immunocompetent hosts.

Over four months, three cases of biopsy-proven herpes simplex esophagitis were seen at Centre hospitalier Pierre-Boucher, Longueuil, in young adult males with no evidence of immunosuppression and negative serological testing for antibody against the human immunodeficiency virus. Clinical presentation consisted of odynophagia, fever and retrosternal chest pain. All patients rapidly improved with acyclovir therapy.

Snoring, apnea, and nasal resistance.

OBJECTIVE: To understand the impact of the nose in relation to snoring, to increased and decreased nasal resistance and sleep, to nasal anatomy and physiology in snorers and apneic patients, and to nocturnal episodes of respiratory obstruction in relation to nasal obstruction. DESIGN: A select group of patients, in whom nasal reconstruction and uvulopalatopharyngoplasty (UPPP) were combined, were studied. A review of the literature is included. METHODS: A questionnaire was given to all patients. MAIN OUTCOME MEASURES: Patients' snoring improvement was evaluated postoperatively. RESULTS: Overall, 174 of the 180 patients (97%) believed their snoring to be improved postoperatively after combined nasal reconstruction and UPPP were done. CONCLUSION: A review of the literature, a review of snorers' pathophysiology, and the results of this study show that nasal surgery and UPPP combined are effective in improving snoring.

Pleomorphic soft tissue myogenic sarcomas of adulthood. A reappraisal in the mid-1990s.

325 diverse sarcomas, 39 rhabdomyosarcomas (RMS), including all histologic variants, and 135 leiomyosarcomas (LMS) were identified. Within these two groups, 18 (46%) of the RMS and 14 (10%) of the LMS represented pleomorphic variants. These neoplasms were studied by morphology (histology and ultrastructure) and by immunohistochemical methods employing antibodies to intermediate filaments (vimentin and desmin) and actin isoforms [alpha-smooth (sm) and alpha-sarcomeric (sr) actins]. Twenty-four pleomorphic malignant fibrous histiocytomas (MFH) and eight pleomorphic liposarcomas (LS) were examined in a similar fashion. By light microscopy, the pleomorphic RMS, LMS, and MFH were indistinguishable, as each was dominated by pleomorphic cells disposed in a haphazard growth pattern; moreover, many featured fascicular, storiform, and sclerotic zones. The distinction between these neoplasms became apparent only following immunohistochemistry and/or ultrastructural study. All pleomorphic RMS disclosed rudimentary sarcomeres and exhibited the following cytoskeletal profile: vimentin (+) (18 of 18), desmin (+) (14 of 18), alpha-sr actin (+) (18 of 18) and alpha-sm actin (+) (five of 18). All the pleomorphic LMS featured smooth-muscle differentiation of variable degrees in the form of cytoplasmic bundles of microfilaments and associated dense bodies; their cytoskeletal profile was vimentin (+) (14 of 14), desmin (+) (seven of 14), alpha-sr actin (+) (none of 14), and alpha-sm actin (+) (eight of 14). The latter was demonstrated in all moderately differentiated, but absent or only focally expressed in poorly differentiated variants. All pleomorphic MFH and LS were devoid of myogenic (skeletal or smooth) ultrastructural features and expressed vimentin solely. This combined morphological and immunohistochemical study illustrates the following: First, these pleomorphic sarcomas are often indistinguishable by histologic growth pattern alone; thus, an accurate diagnosis requires study with all of these techniques. Second, pleomorphic myogenic sarcomas are restricted to adults and are not uncommon neoplasms among pleomorphic sarcomas: RMS (28%), LMS (21%), MFH (38%), and LS (13%). Third, the study defines desmin-negative and alpha-sm actin-positive pleomorphic RMS, and desmin-negative and alpha-sm-actin-negative pleomorphic LMS.

Initial characterization of cells derived from human periodontia.

The studies presented in this report describe an initial characterization of cell types derived from explants of human periodontia. Cell cultures were established from human periodontal ligament (PL4, PL7), gingival tissue (GF2), and alveolar bone (BP1) by means of explant techniques and monolayer culture. Cells were studied at passage numbers 2-4 and were characterized on the basis of morphological, biochemical, and proliferative parameters. Subconfluent cells did not have distinct morphologies useful in distinguishing them from one another. At confluence, PL4 and BP1 cells formed multilayered cultures of randomly oriented cells, while PL7 and GF2 cells grew in a monolayer of parallel cells. Biochemically, PL4 and BP1 cells exhibited characteristics consistent with an osteoblast-like phenotype. These included a significant increase in PTH-stimulated cyclic AMP and high basal levels of alkaline phosphatase activity, which were decreased on exposure to PTH and increased after stimulation by 1.25 dihydroxyvitamin D3. In contrast, PL7 and GF2 cells exhibited basal alkaline phosphatase levels that were low, and cyclic AMP levels were not modulated by PTH stimulation. Cell populations PL7 and GF2 did not proliferate in culture medium supplemented with 3% platelet-poor plasma. After the addition of platelet-derived growth factor (PDGF) to this medium, the proliferation of these cell populations was equal to that in media supplemented with 10% fetal bovine serum. In contrast, PL4 and BP1 cells did proliferate in culture medium supplemented with 3% platelet-poor plasma. The addition of PDGF to the medium resulted in only a moderate increase in the proliferation of cell populations PL4 and BP1.(ABSTRACT TRUNCATED AT 250 WORDS)

[Snoring: physiopathology, surgical treatment and a modified uvulo-palato-pharyngoplasty]. / Le ronflement: physiopathologie traitement chirurgical et technique modifee d'uvulo-palato-pharyngoplastie.

Sleep apnea, now recognized as a specific clinicopathological entity, had received little attention until late 1960 when described by Gastaud. Since that time, following the works of Ikematsu, Guillemineault and Fujita, there has been rapid extension in the knowledge and understanding of sleep problems and associated surgery. Snoring, whether part of the sleep apnea syndrome or alone, may be explained with the help of an aerodynamic model comparing the pharynx to a Starling resistance. The factors nasal obstruction, abnormal mass in the upper respiratory airways and transmural resistance are discussed in the light of this model. To modify some of the above factors, surgical techniques have been described. We feel these conventional techniques do not take into account the normal healing process of inverted double C scars. We have modified the classic technique by sectioning the palatopharyngeus muscle and used Z-plasty to close the surgical defect. This is followed by a limited resection of the soft palate. As a consequence, the soft palate is being brought forward in the healing process and the oropharynx AP diameter is enlarged. This minimal type of resection of the soft palate precludes complications of velopharyngeal incompetency or relative pharyngeal stenosis. We have studied 200 snorers and operated on 90 of them, 25 according to the standard technique and 65 with the modified technique. The modified technique, while limiting the amount of palate to be removed and also the morbidity, is easy to standardize and offers as good results with fewer risks.

The potential role of platelet-derived growth factor as an autocrine or paracrine factor for human bone cells.

Platelet-derived growth factor, PDGF, is a potent mitogen for cells of mesenchymal origin such as fibroblasts, smooth muscle cells and glial cells. PDGF is thought to have the potential to act as both a paracrine and an autocrine factor. Studies described here extend these observations to human bone-derived cells. Exogenous PDGF induces biologic activity in two human osteogenic sarcoma cell lines and in one of these, the two PDGF genes, PDGF-1 and PDGF-2/c-sis are expressed. In addition, PDGF stimulates proliferation of normal osteoblastic cells derived from adult human cancellous bone. The expression of the PDGF-1 gene but not the PDGF-2/c-sis gene is demonstrated in normal human adult bone-derived cells by Northern blot analysis and synthesis of PDGF is shown by immunoprecipitation with PDGF antisera. These studies indicate that PDGF has the potential to act as a paracrine or autocrine regulator of bone cells.