Soluble syndecan-1 and glycosaminoglycans in preeclamptic and normotensive pregnancies.

Preeclampsia, an important cause of maternal and fetal morbidity and mortality, is associated with increased sFLT1 levels and with structural and functional damage to the glycocalyx contributing to endothelial dysfunction. We investigated glycocalyx components in relation to preeclampsia in human samples. While soluble syndecan-1 and heparan sulphate were similar in plasma of preeclamptic and normotensive pregnant women, dermatan sulphate was increased and keratan sulphate decreased in preeclamptic women. Dermatan sulphate was correlated with soluble syndecan-1, and inversely correlated with blood pressure and activated partial thromboplastin time. To determine if syndecan-1 was a prerequisite for the sFlt1 induced increase in blood pressure in mice we studied the effect of sFlt1 on blood pressure and vascular contractile responses in syndecan-1 deficient and wild type male mice. The classical sFlt1 induced rise in blood pressure was absent in syndecan-1 deficient mice indicating that syndecan-1 is a prerequisite for sFlt1 induced increase in blood pressure central to preeclampsia. The results show that an interplay between syndecan-1 and dermatan sulphate contributes to sFlt1 induced blood pressure elevation in pre-eclampsia.

From malignant hypertension to hypertension-MOD: a modern definition for an old but still dangerous emergency.

The prevalence of malignant hypertension has clearly fallen with the advent of anti-hypertensive medication but has remained stable over the past 30-40 years in spite of progress in diagnosis and management of hypertension. A diagnosis of malignant hypertension is usually based on the association of severely elevated blood pressure with a Keith and Wagener stage III or IV retinopathy. We believe that this definition can be reconsidered for several reasons. Although simple and pragmatic, this definition corresponds to a time when there were few techniques for assessment of hypertensive target organ involvement, and does not take into account involvement of kidney, brain and heart; whereas the overall prognosis largely depends on how much they are affected. On the contrary, the acute blood pressure level and especially diastolic should not be a hard diagnostic criterion as it does not itself constitute the prognosis of the condition. We propose to consider that malignant hypertension with retinopathy is only one of a number of possible presentation(s) of acute hypertension with multi organ damage (hypertension multi organ damage (MOD)) and that the recognition of these hypertensive emergencies, when retinopathy is lacking, be based on acute elevation of BP associated with impairment of at least three different target organs. The objective of a new and expanded definition is to facilitate recognition of these true emergencies. The condition is more common than usually perceived and would have a much worse prognosis than the usual forms of hypertension. Early recognition and management of hypertension-MOD are fundamental to any improvement in prognosis.

Placental expression of heparan sulfate 3-O-sulfotransferase-3A1 in normotensive and pre-eclamptic pregnancies.

INTRODUCTION: The endothelial glycocalyx, consisting of membrane-bound proteoglycans and attached glycosaminoglycans plays an important role in vascular homeostasis. We aimed to assess whether glycocalyx mRNA transcripts are differentially expressed in placental tissue of pre-eclamptic and normotensive women. METHODS: We evaluated the expression of transcripts encoding for proteins involved in glycocalyx synthesis and degradation using a microarray analysis of placental mRNA obtained from pre-eclamptic and normotensive women. Participants were recruited from the department of obstetrics at a university hospital in Amsterdam, The Netherlands. The most prominent differentially expressed transcript was validated by qPCR on 112 additional placenta samples. RESULTS: Of 78 preselected genes involved in glycocalyx synthesis and degradation, only HS3ST3A1 mRNA was differentially expressed in placental tissue obtained from pre-eclamptic women (N = 12) compared to normotensive women (N = 12, fold change = 0.61, p = 0.02). Validation with qPCR in additional placental samples of 64 normotensive and 48 pre-eclamptic women confirmed that normalized mRNA expression of HS3ST3A1 was decreased by 27% (95% CI 14%-41%) in placental tissue obtained from pre-eclamptic compared to normotensive women (p < 0.001). HS3ST3A1 expression was positively correlated with neonatal birth weight in normotensive women (r = 0.35, p < 0.01) and inversely correlated with mean arterial pressure of women with pre-eclampsia (r = 0.32, p = 0.02). CONCLUSIONS: The mRNA expression of HS3ST3A1, which encodes for a 3-O sulfating enzyme of heparan sulfate (3-OST-3A1), is decreased in pre-eclamptic placental tissue. Expression of this glycocalyx synthesis transcript is correlated with maternal blood pressure and neonatal birth weight, suggesting a possible role in pre-eclampsia-associated placental dysfunction.

Value of retinal examination in hypertensive encephalopathy.

The presence of grade III or IV hypertensive retinopathy (HRP) is considered to distinguish hypertensive urgencies from emergencies. However, case-reports suggest that these retinal changes may be lacking in patients with hypertensive encephalopathy. To assess the frequency of grade III and IV retinopathy in this hypertensive emergency, we conducted a retrospective cohort study. We retrieved 162 patients with malignant hypertension and 34 patients (17%) fulfilled the predefined criteria for hypertensive encephalopathy. Data on retinal examination were incomplete for 6 patients (18%), thus leaving 28 patients who were analysed for the presence or absence of grade III and IV HRP. In 9 (32%) patients with hypertensive encephalopathy, grade III or IV HRP was absent, 11 (39%) patients presented with grade III and 8 (29%) patients with grade IV retinopathy. Patients without retinal abnormalities were on average 13 years younger (P=0.05), more often black (P=0.02) and displayed lower blood pressure (BP) values (P=0.04 for systolic and diastolic BP). A substantial proportion of patients with hypertensive encephalopathy lack grade III or IV HRP. This suggests that the decision to admit these patients should not only rely on the presence of grade III and IV retinopathy alone, but should also include a careful neurological examination.

[Role of computed tomography in pulmonary aspergillosis. 20 cases]. / Apport de la tomodensitométrie dans l'aspergillose cavitaire. 20 observations.

OBJECTIVE: Aspergilloma is the most common form of pulmonary aspergillosis. The purpose of this work was to compare computed tomographic findings with features observed on standard radiographs. PATIENTS AND METHODS: We retrospectively reviewed 20 cases of pulmonary aspergilloma. These patients (mean age 36 years) were followed after cure of pulmonary tuberculosis and consulted for hemoptysis. All underwent computed tomography (CT) and standard radiographic explorations. Serology was positive for Aspergillus in 16 cases and clinical and radiographic findings led to the diagnosis in the 4 others. Both supine and prone positions were used for thoracic CT. Slice thickness was 5 mm without contrast injection. RESULTS: In many cases, standard films evidenced the typical mycetoma seen as a rounded mass of soft tissue density filling a portion of a preexisting cavity or as an air crescent sign, but atypical alveolar opacities, aeric images without aspergillosis colonization and parenchymal destruction predominated in certain cases. The CT-scan demonstrated these features even better revealing the typical cavity in 80% of the cases or an air crescent in 20%. Mobility of the fungus ball was demonstrated by comparison of the prone and supine images. The characteristic CT features allowed certain diagnosis of aspergilloma in 6 patients with atypical radiographic or serologic results. DISCUSSION: Computed tomography is highly contributive to the diagnosis of pulmonary aspergillosis, particularly in case of small cavities that may be missed on the standard films. Recognition of the mobility of the fungal ball enables differentiation from a tumor or infectious lesion. CT is also helpful for guiding transparietal treatment. CONCLUSION: A computed tomography series should be obtained in former tuberculosis patients consulting for hemoptisis.

[Hydatid cyst of the mediastinum: 2 cases]. / Kyste hydatique du médiastin. A propos de 2 cas.

Hydatid cysts of the mediastinum are very uncommon. We report two cases of mediastinal hydatic cyst. The first case was located in the cardiophrenic recess while the other was within both the heart and mediastinum. A review of the imaging findings and value of various techniques is presented.

[Urethral polyps in children: an unusual cause of obstruction of the lower urinary tract]. / Polype urétral chez l'enfant: une cause rare d'obstruction du bas appareil urinaire.

We report an unusual case of urethra polyp in a young child which caused obstruction of the lower urinary tract. Endoscopy was successful.

[Cystic lymphangioma of the pancreas. Apropos of a case]. / Lymphangiome kystique du pancréas. A propos d'un cas.

A new case of pancreatic cystic lymphangioma is reported in a young woman. The authors discuss its clinic and histologic features and emphasize the complementary findings of ultrasonography and CT scan which are similar to the other sites of cystic lymphangioma in adults.