Global DNA hypomethylation occurs in the early stages of intestinal type gastric carcinoma

BACKGROUND

Global DNA hypomethylation has been found in the premalignant stages of some neoplasms and has been implicated as an important factor for tumour progression.

AIMS

The aim of this study was to evaluate whether DNA hypomethylation occurs during the process of gastric carcinogenesis.

METHODS

Gastric specimens were obtained from 49 patients and histologically classified as: normal 10, superficial gastritis 14, chronic atrophic gastritis with intestinal metaplasia 15, and intestinal type of gastric carcinoma 10. Global DNA methylation was assessed by incubating DNA with (3H)-S-adenosylmethionine and Sss1 methylase. A higher incorporation of (3H) methyl groups reflects a lower degree of intrinsic methylation.

RESULTS

A graduated increase in (3H) methyl group incorporation into DNA was found over the range extending from normal gastric mucosa, to superficial gastritis and to chronic atrophic gastritis (136,556 (24,085) v 235,725 (38,636) v 400,998 (26,747 dpm/micrograms/DNA respectively; p = 0.0002). No further increase was found in specimens from patients with carcinoma. No differences were found between extent of DNA methylation in neoplastic or non-neoplastic mucosa from patients with gastric carcinoma. Hypomethylation of DNA increased substantially with severe atrophy (p = 0.01) or with type III intestinal metaplasia (p = 0.15).

CONCLUSIONS

Global DNA hypomethylation occurs in the early stages of gastric carcinogenesis, and it may be a novel biomarker of gastric neoplasia, useful in monitoring the response to chemopreventive agents.

LASIK for high myopia: one year experience

BACKGROUND AND OBJECTIVE

Laser in situ keratomileusis (LASIK) is a technique combining the advantages of lamellar corneal surgery (not disturbing Bowman's layer) with the precision of excimer laser surgery. It can be used to correct myopia in a wide range of diopters. In this study we present our data on the first 34 consecutive cases of myopia correction by LASIK.

PATIENTS AND METHODS

Thirty four eyes of 27 patients with myopia ranging from -10.00 to -22.50 diopters (D) were operated with LASIK. The follow-up was from six months to one year. The mean age was 33.02 +/- 7.98 years, 32.4% were males and 67.6% were females. Surgery was always performed with the Chiron Automated corneal shaper resecting a corneal flap of 160 mu and then ablating the stromal bed (OZ 4.50 mm) with the Summit OmniMed 5.0 excimer laser. The parameters used to assess the results were predictability, safety (variation of spectacle corrected visual acuity), stability, and patient satisfaction.

RESULTS

Of the patients, 67.65% were between -1.00 and +1.00 at 6 months; 44.11% of eyes retained the same spectacle corrected visual acuity, 11.76% gained 1 line, 26.47% gained 2 lines, 8.82% lost 1 line and 8.82% lost 2 lines. Refraction at 1 month was 0.07 +/- 1.99 (range, -4.00 to +4.00); at 3 months 0.61 +/- 1.69 (range, -4.25 to +2.25); and at 6 months 0.81 +/- 1.71 (range, -4.75 to +2.25). Of the patients, 85.3% were happy with the procedure. Complications included two dislocated caps in the immediately post-operative period and two cases of epithelial ingrowth under the cap. Two eyes developed irregular astigmatism. These complications were found in the first two sessions of surgery and are related to the learning curve of the method.

CONCLUSION

Results suggest that LASIK is a viable method for correction of high myopia with few complications and may have advantages over keratomileusis and PRK as it combines the best features of both methods--it preserves Bowman's layer and has the excimer laser precision. Refining the nomogram of ablation should result in even better results.

Clinical profile and management of post infarction left ventricular pseudoaneurysm

Three patients with left ventricular pseudoaneurysm are presented. Two patients had inferior and one had an anterolateral wall Q wave myocardial infarction. Echocardiography with Doppler colour imaging provided the diagnosis in one case, whereas the correct diagnosis was possible on left ventriculography in all. Successful surgery using patch closure of the defect in all patients and bypass grafting of the diseased coronary vessels was done in 2 cases. Angiographic follow-up in one case revealed excellent result and during 18 to 30 months of clinical follow-up, all patients are asymptomatic.

Prenatal diagnosis of GM2-gangliosidosis B1 variant

Prenatal diagnosis in a pregnancy at risk for a juvenile B1 variant of GM2-gangliosidosis was carried out. The biochemical study of the cultured amniocytes and the affected fetal brain is reported. The results obtained show that the sulphated artificial substrate can be used in the diagnosis of B1 variant, but not the neutral one. The accumulation of GM2-ganglioside in the fetal brain of the B1 juvenile form and an infantile form of GM2-gangliosidosis (0 variant) was compared.

Tay-Sachs disease: intron 7 splice junction mutation in two Portuguese patients

A single nucleotide transversion (G-->C) in the 5' donor site of intron 7 of the beta-hexosaminidase alpha-chain gene was identified in two Portuguese patients with infantile Tay-Sachs disease. One patient was found to be homozygous and the other a compound heterozygote with the four-base insertion in exon 11 on the other allele. In fibroblasts from the homozygous patient the beta-hexosaminidase alpha mRNA was observed as a nearly undetectable fast migrating band. Through cDNA-PCR amplification and hybridization with full length alpha cDNA several fragments of smaller size than the normal transcript were detected, most of them lacking exon 7. We propose that this point mutation in the 5' donor site of intron 7 of the beta-hexosaminidase alpha-chain gene is responsible for an inefficient and abnormal processing of the mutant transcript, resulting in functional abnormality.

Coronary artery reoperations using arterial conduits: immediate and early results

This study deals with results of coronary artery reoperations in 21 males aged 54.4 +/- 6.6 years. Native vessel coronary disease at first and second operation was nearly the same (2.7 +/- 0.6 vs 2.8 +/- 0.4 vessel, p = NS). Graft attrition and deterioration in left ventricular ejection fraction (55.9 +/- 9.2 initial vs 36 +/- 15 at reoperation, p < 0.001) necessitated reoperation in majority. Recurrence of angina (71%) and left ventricular failure (23.8%) were the clinical indicators for reoperation. Procedure was successful in 20 (95%) and had to be abandoned in 1 due to severe pericardial and sternal adhesions. Arterial grafts were utilised in 90% (18 cases, Group A and B). Total arterial revascularisation (Group A) was done in 9 (45%) using Y graft 6, combination of both mammary arteries 2, and by both mammary and inferior epigastric artery in 1. Group B patients had arterial grafts (bilateral IMA 1, Y graft 1, bilateral IMA + gastroepipolic 1, RIMA 4, and LIMA 2) in addition to a venous graft. Two patients (group C, 10%) had only venous grafts. There was no in hospital mortality or morbidity and at 10 +/- 5.2 months follow up, all are asymptomatic with negative stress test at 3 months followup in 8 cases. We conclude that coronary artery reoperations using arterial conduits can be performed safely with excellent immediate and early results.

X-linked adrenoleukodystrophy in patients with idiopathic Addison disease

The two main causes of primary adrenal disease are tuberculosis and auto-immune adrenal destruction. The latter is responsible for about 70% of the cases of primary adrenal insufficiency (Addison disease). Commonly referred to as a rare cause of adrenal failure is X-linked adrenoleukodystrophy (ALD), a demyelinating peroxisomal disorder affecting 1: 20,000 Caucasian males. Albeit primary adrenal insufficiency is a rare entity per se, we decided to study patients with idiopathic Addison disease and establish the frequency of ALD as a cause of adrenal insufficiency. The biochemical defect of ALD was found in 5 out of 24 patients. The small number of cases in our series led us to include in our analysis the published results of two other groups of investigators. This analysis indicates that the proportion of cases in which Addison disease is attributable to ALD is age dependent. It is highest when the adrenal insufficiency manifests before 15 years. This study clearly demonstrates that the proportion of ALD in patients presenting primary adrenal insufficiency has been under-estimated.

CONCLUSION

Addison disease manifesting during the first decade of life has a high likelihood of being the first sign of X-linked adrenoleukodystrophy.

Gaucher disease: N370S glucocerebrosidase gene frequency in the Portuguese population

In the Portuguese population the most frequent form of Gaucher disease is type 1. The N370S glucocerebrosidase gene mutation accounts for 63% of mutated alleles. The frequency of this mutation was accurately determined in the Portuguese population, which does not present an Ashkenazi Jewish genetic background. A gene frequency of 0.0043, with 95% confidence limits between 0.0023 and 0.0063, was obtained studying the genomic DNA of 2000 blood cards randomly sampled from the national neonatal screening program. On the basis of this frequency a significantly high number of homozygotes for the N370S mutation should be expected in the Portuguese population. This finding supports the idea that the majority of homozygotes for this mutation present a very mild clinical phenotype and remain undiagnosed.

Molecular characterisation of type 1 Gaucher disease families and patients: intrafamilial heterogeneity at the clinical level

Type 1 Gaucher disease families were studied in an attempt to establish a phenotype/genotype correlation in affected persons and also to identify carriers accurately. In the Portuguese type 1 Gaucher patients, screening for mutations N370S, L444P, R463C, and 1066 + 1 G-->A allowed the identification of 85% of the alleles among unrelated patients. A subclinical case with genotype N370S/1066 + 1 G-->A was identified in one family in which there were three other symptomatic sibs. To our knowledge this is the first subclinical case with a genotype other than N370S/N370S. No genotype-phenotype correlation could be established and considerable clinical heterogeneity was found even among sibs with the same genotype. The data collected on the origins of the Gaucher families indicated two areas in northern Portugal where a higher frequency of the disease may be expected to exist.

The N370S mutation in the glucocerebrosidase gene of Portuguese type 1 Gaucher patients: linkage to the PvuII polymorphism

The mutation N370S accounts for 63% of the mutated glucocerebrosidase alleles of Portuguese type 1 Gaucher patients. It has been shown previously that this mutation is linked to the Pv1.1- form of the PvuII polymorphism and suggested that the N370S mutation in glucocerebrosidase alleles has an Ashkenazi Jewish origin. We have found that in Portuguese type 1 Gaucher patients this mutation is also invariably associated with the Pv1.1- haplotype, despite the fact that there is no evidence of Ashkenazi Jewish background in this population.

Identification of Gaucher disease carriers: glucocerebrosidase antigen and DNA analysis

Detection of Portuguese carriers for Gaucher disease with urine samples as a source of enzyme was carried out using an immunological procedure employing an anti-glucocerebrosidase monoclonal antibody and by DNA analysis for the presence of the two glucocerebrosidase mutations most frequently found in Portuguese Gaucher patients. Patients, obligate and putative carriers, and individuals unrelated to patients were analyzed. It was found that the vast majority of carriers for the two tested mutations (N370S and L444P), as well as obligate carriers for as yet unidentified mutations, could be distinguished from control subjects with this relatively easy and economic immunological procedure. Furthermore, results obtained for control subjects suggested a high frequency of carriers for the N370S mutation in the Portuguese population. It is concluded that this procedure may be useful in mass screening for carrier detection prior to DNA analysis, particularly in the study of non-Ashkenazi populations in which a significant number of mutations associated with Gaucher disease remain unidentified.

Histochemical Studies of Jelly Coat of Marthasterias glacialis (Echinodermata, Asteroidea) Oocytes

Histochemical studies revealed the presence of two major polysaccharides in the oocyte jelly coat (JC) of Marthasterias glacialis: a fibrillar component that contains carboxylic and sulfated groups and a loose component composed of neutral or weakly acidic polysaccharides. When isolated JC was submitted to cellulose acetate electrophoresis (CAE) and then stained with alcian blue, three bands appeared, of which one remained at the origin and two migrated toward the anode. Glycosaminoglycan-like molecules isolated from JC were separated by CAE into three main moving bands, two that present an Rf similar to that of the intermediary moving band of total JC and one that has an Rf similar to that of the faster moving band of total JC. These bands also have critical electrolyte points similar to those of total JC. Chondroitinase ABC mainly attacked the faster moving band, whereas protease and hyaluronidase seemed to digest all bands. These results and the Rfs of isolated and standard glycosaminoglycans after mono- and bidimensional CAE suggest that the glycosaminoglycan-like molecules bear some resemblance to chondroitan sulfate, heparan sulfate, and hyaluronic acid.

Management of chronic myeloid leukemia in chronic phase with autologous stem cell transplantation and alpha-2 interferon: cytogenetic and clinical results

Forty-eight patients with chronic myeloid leukemia (CML) in chronic phase (CP) were treated by autologous stem cells transplantation (ASCT) and alpha Interferon (IFN) with three approaches: 1) ASCT at diagnosis followed by IFN, 2) ASCT post IFN with cells collected after an interval from IFN discontinuance, followed by IFN, 3) ASCT in patients selected by cytoconversion obtained with IFN, performed soon after IFN discontinuance. Following ASCT, a major karyotype response (more than 65% Ph1 negative cells, MKR) was observed at least once in 40%, 53% and 83% of patients from the three groups, respectively. At last follow-ups (median 39, 40 and 21 months, respectively) 19%, 13% and 67% of patients still present a MKR with 2 patients from group 1 and 4 patients from group 3 being 100% Ph' negative. Projected survival from diagnosis is 77% at 52 months for patients from group 1 and 47% at 75 months for patients from group 2. Present data indicate that 1) IFN can stabilize results obtained with ASCT, 2) ASCT can potentiate responses to IFN, 3) combined ASCT and IFN can improve survival. Longer follow-up of patients and randomized studies are required to define the real impact on disease outcome by these treatment approaches.

Identification of GM2-gangliosidosis B1 variant carriers

GM2-gangliosidosis B1 variant, considered a rare disorder with a wide geographical and ethnic distribution, appears to be exceptionally frequent in Portugal. In order to establish a carrier detection method for this disease we have determined the ratio of enzymatic activities against 4MUGS and 4MUG in urine from B1 variant obligate carriers and controls, using the total extract and the Hex A immunobound to a monoclonal antibody. The Hex A immunoassay was applied to the identification of carriers in B1 variant families and the results obtained were compared with those from DNA analysis. The reliability and feasibility of the Hex A immunoassay make it a suitable method for B1 variant carrier screening, which is particularly important for the prevention of this severe neurological disease in the population at risk.

[Etiology of lower respiratory infections in hospitalized infants]

As a contribution to knowledge about the etiology of lower respiratory tract infections (LRI) in infants, 235 patients aged one year or less admitted to a children's hospital at northern metropolitan area of Santiago, Chile along years 1987 throughout 1989 with radiologically confirmed diagnosis were studied. Infants were eligible only if their symptoms lasted for not more than five days and their hospital stay was less than two days. Controls consisted on 74 healthy infants. A search for presumptive etiology was done by means of usual bacteriological procedures (pharyngeal swabs and blood cultures), plus latex test for type b Haemophilus influenzae (Hib) and Streptococcus pneumoniae (SP) in concentrated urine specimens; indirect immunofluorescence (IF) for specific Chlamydia trachomatis (CT) IgM; serological tests, isolation and IF in pharyngeal aspirates for syncytial respiratory virus (SRV), influenza, parainfluenzae and adenoviruses were also used. Evidence of viral infection was detected from 135/235 (57.5%) of cases and 21/74 (28.3%) controls, SRV being the most common. From 18/119 and 2/119 studied patients Hib and SP antigens were respectively detected, but urinary antigens were also present in 6/24 controls, raising questions about this test's specificity. IF titers of 1:32 or higher for CT were found in 5/80 patients, all younger than 5 months. It was possible to perform the whole set of available methods in 80 patients, in 70% of which some evidence of a known etiologic agent was found. Serology alone gave etiological clues in only 30% of these cases and usual microbiological cultures of throat swabs and blood from none of them. No combinations of age, fever, respiratory rate, apnea, bronchial obstructive syndrome, white blood cell counts over 15,000 or of band forms over 500 per cu mm, erythrocyte sedimentation rates, reactive C protein and x-ray findings allowed differential diagnosis between presumptive bacterial or viral etiology, except in one case of an infant presenting with pleural effusion and positive antigenuria for Hib.

Severe anemia is an important negative predictor for survival with disseminated Mycobacterium avium-intracellulare in acquired immunodeficiency syndrome

Disseminated Mycobacterium avium-intracellulare (MAI) in patients with the acquired immunodeficiency syndrome (AIDS) is usually unresponsive to antimycobacterial therapy. We examined clinical and laboratory characteristics of MAI organisms and their relationship to the length of survival. We studied factors influencing survival and compared these in 76 patients with AIDS with and without MAI. Serum levels of p24 antigen and erythropoietin, and CD4-positive helper T-lymphocytes in blood were assessed in 36 additional patients with various clinical stages of HIV infection. In patients with MAI infection, survival was significantly related only to total lymphocyte count, hematocrit, platelet count, and sex. Of these, hematocrit and total lymphocyte count were the only linear predictors of survival. Anemia was significantly more profound in patients with AIDS and MAI than in the other patients. This anemia in patients with MAI could not be ascribed to increased peripheral destruction of red cells, deficient nutritional factors, or erythropoietin production, HIV viral or bacterial load, or a general effect on other blood elements such as neutrophils or platelets. The influence of MAI on survival in patients with AIDS did depend upon whether the MAI occurred as an index infection or was preceded by other opportunistic infections. Patients with other preceding opportunistic infection lived for a much shorter duration from the time of diagnosis of MAI.

Activity of glucocerebrosidase in extracts of different cell types from type 1 Gaucher disease patients

Glucocerebrosidase activity in extracts of leukocytes, Epstein-Barr virus transformed lymphocytes and fibroblasts from Portuguese Type 1 Gaucher disease patients was studied. The residual glucocerebrosidase activity in all extracts from patients was less than 25% if measured in the presence of bile salt taurocholate. However, if measured in the absence of bile salt the residual enzyme activity in extracts from patients was cell type specific: it was severely reduced in the case of fibroblasts, mildly reduced in the case of lymphoblasts and not significantly reduced in the case of leukocytes. The glucocerebrosidase activity in extracts from all control cell types was stimulated by taurocholate. In the patients the enzyme activity in fibroblasts extracts was also stimulated but that in lymphoblasts and leukocytes was inhibited by the bile salt. The differences in glucocerebrosidase activity (in the absence of taurocholate) in extracts from different cell types from Gaucher disease patients are attributable to differences in the proportion of glucocerebrosidase present as a monomer with low activity (form I) and as a highly active aggregate (form II) that may also contain sphingolipid activator protein 2 (SAP-2). In extracts from leukocytes and lymphocytes from Type 1 Gaucher disease patients, but not in those from fibroblasts, a relatively high proportion of enzyme is present in aggregated form with near normal specific activity.