Spinal bone mineral density of normal and osteoporotic women in Korea

In order to define osteoporosis on the basis of bone mineral measurements, one must define an acceptable normal range or fracture threshold. It is clear that the normal range cannot be compared between different ethnic groups. We have measured spinal bone mineral density (BMD) by dual photon absorptiometry in 277 women without spinal fracture, aged 30-91 years, and in 53 women with asymptomatic spinal fracture to provide such a database for normal Korean women. Peak bone mass at the 3rd decade was 1.24 g/cm2. BMD from age 40-69 was strongly correlated with age (r = -0.7) and the annual decrease averaged 0.018gm/cm2. The rate of annual loss slowed by 50% in women after 70% years of age. Fracture threshold was evaluated at the 90th percentile for spinal BMD in patients with vertebral fractures. The fracture threshold of the vertebra was 0.94 g/cm2. Approximately 50% of normal women over 50 years of age had values below this threshold. These findings suggest that the way of developing low bone mass in Korean women is to peak high and lose fast.

Estrogen sulfotransferase of the rat liver: complementary DNA cloning and age- and sex-specific regulation of messenger RNA

Mammalian estrogen sulfotransferase (EST; EC 2.8.2.4) sulfurylates the hydroxyl group of estrogenic steroids by transferring the sulfate from a cosubstrate adenosine 3'-phosphate-5'-phosphosulfate. Sulfurylated steroids do not bind to the estrogen receptor with high affinity and, therefore, are hormonally inactive. We have purified rat liver EST and developed monoclonal antibody to this enzyme. By immunoscreening a lambda gt-11 expression library constructed from male rat liver cDNAs, the cDNA clone corresponding to EST was identified and isolated. A recombinant expression plasmid (pCMV5) containing this cDNA insert when transfected into COS-7 cells generated both immunologically and enzymatically active EST. With the help of this cDNA probe, we have explored the regulation of the EST mRNA in the liver and the possible role of this enzyme in sex hormone action. During the lifespan of male rats, only the young adult animals show hepatic androgen responsiveness. Also, estrogenic hormones strongly antagonize androgen action in the rat liver. Northern blot analysis of liver RNA derived from male rats of different ages shows that the androgen sensitivity of young adult animals is associated with a high expression of EST mRNA. During the same period, mRNA corresponding to dehydroepiandrosterone sulfotransferase is markedly (approximately 10-fold) down-regulated. Such a correlation is in concordance with the role of these enzymes in the maintenance of hepatic androgen sensitivity during young adult life by inactivating the estrogenic and sparing the androgenic steroids. Furthermore, the increase in the hepatic androgen sensitivity of androgen-treated female rats is also associated with the induction of EST.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiodysplasia of colon revisited: pathologic demonstration without the use of intravascular injection technique

The recognition of angiodysplasia either at the time of surgery or at the time of routine gross and microscopic examination has often been difficult. Until now the primary methodology used in defining the lesion has been the intravascular injection of radiopaque dyes and other compounds. This technique, however, is prohibitively time consuming and expensive, and does not encourage routine use in surgical pathology practice. We report two cases of angiodysplasia, both occurring in unlikely areas, in which the pathologic lesion was demonstrated without the use of an intravascular injection technique. One case involved 35 cm of proximal transverse colon and the other involved 23 cm of colon distal to the ileocecal valve. A simple method of demonstrating angiodysplasia by intraluminal formalin fixation (37% concentrated, unbuffered), with tying of both resected ends for 3 hours, followed by dissection of the mucosa from the muscle wall, is described. Areas of ectatic, pericryptal, thin-walled blood vessels with adjacent dilated, engorged submucosal veins are readily seen on gross direct inspection highlighted by transillumination. Histologic sections taken from these areas show early lesions of angiodysplasia characterized by ectatic, engorged submucosal veins and some dilated venules and capillaries in the mucosal lamina propria.

Effect of interferon-gamma treatment on interstitial pneumonia in a patient with severe combined immunodeficiency

In severe combined immunodeficiency disease, both T and B cell functions are diminished or absent and affected usually succumb to overwhelming infection within the first year of life. We are reporting a case with severe combined immunodeficiency, Swiss type who suffered from interstitial pneumonia which cleared by treatment with recombinant human interferon gamma. In this case, we don't know the exact mechanism which caused the clearing of the interstitial pneumonia. However, we can speculate that antiviral action and activated macrophages or monocytes, through the recombinant human interferon gamma, might exert its effect on interstitial pneumonia. Though we should extend its application to more cases of SCID with interstitial pneumonia, this report may suggests a new application for interferon-gamma as a potential corrective and therapeutic agent for interstitial pneumonia in congenital immunodeficiency diseases.

Extrapulmonary tuberculosis in patients with human immunodeficiency virus infection

The annual number of cases of culture-proven extrapulmonary tuberculosis (TB) at our hospital increased from 47 cases in 1983 to 113 cases in 1988. At least 43% (199) of 464 consecutive patients with extrapulmonary TB during this 6-year period were infected with the human immunodeficiency virus (HIV); since HIV serologic testing was not performed routinely the true HIV prevalence is likely to be higher. Of the HIV-infected patients, 59% were intravenous drug users, 31% were Haitian, 3% were homosexual males, 1% were perinatally-infected infants, and 6% did not have a known risk factor for HIV infection. Ninety-eight percent of the HIV-infected patients were black (84%) or hispanic (14%). The HIV-infected patients were more likely than the control patients to have either disseminated, genitourinary, intra-abdominal, mediastinal, or concurrent pulmonary TB. Fever was nearly universal among the HIV-infected patients, but was absent in about one-third of the control patients. Among untreated HIV-infected patients, disease progression was rapid and nearly always fatal. Among HIV-infected patients who received treatment, the response to therapy, as judged by hospital survival and time to defervescence, was similar to that of the control patients. Despite the extensive tuberculous dissemination among the HIV-infected patients, the diagnosis of TB was difficult and often delayed. In addition to the decrease in tuberculin reactivity and the atypical chest radiograph patterns, there was a need to consider other HIV-related infections in the differential diagnosis. Although sputum specimens grew M. tuberculosis in greater than 90% of the HIV-infected patients in whom they were obtained, sputum AFB stains were positive in less than 50%. Blood and urine specimen cultures were positive in 56% and 77% of the HIV-infected patients in whom these specimens were obtained, but did not provide a means of early diagnosis. Cerebrospinal fluid and pleural fluid were abnormal in nearly all patients with involvement of these sites but were rarely AFB-positive and were, therefore, only suggestive of TB. Procedures such as biopsies and aspirates of peripheral lymph nodes, visceral lymph nodes, liver, and bone marrow provided the highest immediate diagnostic yields with rates between 50% and 90%. These procedures must be considered early in the course of illness in HIV-infected patients with suspected extrapulmonary TB due to the rapidly progressive nature of this often fatal but usually treatable infection.

Reduced spinal bone mass in patients with uterine cervical cancer

Bone destruction and hypercalcemia are well-recognized complications in a variety of neoplasms without bone metastasis. Reduction in the volume of trabecular bone has been confirmed by histomorphometric study, but not by bone densitometer. We measured spinal bone mineral densities by dual-photon absorptiometry in 85 patients with invasive uterine cervical cancer and compared them with measurements from 148 control women. When adjusted for age and menopause duration, mean bone mineral density in patients with uterine cervical cancer was 12.8% lower (P = .0003) and age-matched percentiles were 9.1% lower (P = .0003) than in control women. The deficits in bone mineral density and age-matched percentiles were confined to the uterine cervical cancer patients in their fifties, ie, less than 5 years' menopause duration. Serum concentrations of calcium, phosphate, creatinine, and alkaline phosphatase were not different between control women and the patients with uterine cervical cancer. The results suggest that women with uterine cervical cancer have an increased risk of developing osteoporosis.

[An exploratory study toward a theoretic construction of hope]

A written association test has been conducted to establish the concept, the meaning and the process of hope. The test consists of the major question: List of three words related to "hope". The question was given to 55 nurses (rehabilitation/cancer/internal medicine care wards units) and 61 patients. A total of 289 words have been collected, and the collection was analyzed with categorization by the value or meaning of listed words. The analysis yields three major categories, namely, componants of hope, metaphores/symbols, and synonyms. The three major categories may be further partitioned into subcategories. The results are significant to define the nature of the hope and process of the hope. These understanding will facilitate the development of effective methods of nursing or chronic or cancer patients disabled.

Immunocytochemical estrogen and progestin receptor assays in breast cancer with monoclonal antibodies. Histopathologic, demographic, and biochemical correlations and relationship to endocrine response and survival

Breast cancer specimens from 600 women were assayed for estrogen receptors (ER) using an immunocytochemical assay (ICA) employing the monoclonal antiestrophilin antibody H222 Sp gamma. Results showed significant correlation with biochemical ER determinations as well as with tumor grade and menopausal status. In 449 cases, results of progesterone receptor assay by ICA using the monoclonal anti-PgR antibody KD 68, also correlated significantly with biochemical PgR measurements. The ERICA/PgRICA positivity was significantly more frequent in postmenopausal white women. Colloid carcinomas were most likely to be ERICA positive and PgRICA positive whereas medullary carcinomas were most often negative. In 47 patients with advanced mammary carcinoma, results of ERICA and PgRICA were more closely related to endocrine response than those of ER and PgR by dextran-coated charcoal assay (DCC). In 339 women with Stage I or Stage II breast cancer, ERICA was significantly associated with disease-free survival. Analysis by Cox's proportional hazard model, however, showed PgRICA to be the best predictor of survival and disease-free survival in 197 women at the same stages of disease. These data indicate that ICA is more predictive of prognosis than biochemical ER and PgR. The ease of ICA performance coupled with these results indicate that the method is an acceptable substitute for DCC in analyzing breast cancers for ER/PgR.

Histologic disappearance of locally advanced vaginal cancer after combination chemotherapy

Clinically and histologically complete disappearance of local tumor and pelvic sidewall involvement was achieved in a patient with primary advanced squamous cell carcinoma of the vagina administered combination chemotherapy prior to operation. Radical hysterectomy, total vaginectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymphadenectomy, and paraaortic lymph node biopsy were performed after seven courses of combination chemotherapy with vinblastine, bleomycin, and cis-platinum. This encouraging result warrants further investigation of combination chemotherapy in other patients.

Serum levels of soluble interleukin-2 receptor in pulmonary tuberculosis

It is well known that the activation of cell mediated immunity has an important role in the pathogenesis of pulmonary tuberculosis and the production of the protective immunity against Mycobacterium tuberculosis. During the activation of T-cell by Interleukin-1 released from the macrophage, not only Interleukin-2 but also the soluble Interleukin-2 receptor (sIL-2R) molecule is released into the extracellular fluid. In vitro study reveals that the level of this sIL-2R is well correlated with the degree of activation of the T-cell. We therefore carried out this study to evaluate the significance of the serum IL-2R level in determining the disease activity of pulmonary tuberculosis. The level of sIL-2R was measured by sandwich ELISA method. The level of sIL-2R in 42 patients with bacteriologically -proven active pulmonary tuberculosis (29 far and moderately advanced pulmonary tuberculosis, age: 30.3 +/- 10.3 yrs; 13 minimal pulmonary tuberculosis, age: 34.4 +/- 15.3 yrs) was 1111 +/- 424 mu/ml, which was significantly higher than the normal control group (age: 31.0 +/- 9.9 yrs) (365 +/- 143 mu/ml) and inactive pulmonary tuberculosis group (age: 37.3 +/- 16.9 yrs) (465 +/- 131 mu/ml). But there was no significant difference between 29 patients with advanced pulmonary tuberculosis (1138 +/- 405 mu/ml) and 13 patients with minimal pulmonary tuberculosis (1051 +/- 474 mu/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Infantile myofibromatosis

We report a case of infantile myofibromatosis in a male infant with involvement of the lungs and subcutaneous tissue. We studied our case by light microscopy, immunohistochemistry and electron microscopy. The results reveal that this entity is of a myofibroblastic nature. We reviewed 165 cases including our case. We believe this is the first report in Korea of infantile myofibromatosis with pulmonary involvement.

Traumatic isolated intracerebral hemorrhage in children

Among 314 children with craniocerebral injury, 21 were diagnosed as having traumatic, isolated intracerebral hemorrhage (TIICH) by computed tomography (CT) from 1980 to 1986 (basal ganglia, 7; frontal, 8; parietal, 2; frontoparietal, 1; temporoparietal, 1; intraventricular, 1; midbrain, 1). The level of consciousness was assessed according to the Children's Coma Score (CCS) and CT scan was subsequently repeated to evaluate the change in TIICH. The patients were classified into three types according to their clinical courses and CT findings: type I (4 cases), type II (14 cases), and type III (3 cases). Of the 21 cases, conservative treatment was given in 15 and surgical treatment in 6. The outcome showed: good recovery in 1, fair recovery in 7, poor recovery in 2, and death in 2. Type III had a poor prognosis. We discuss the mechanism of the formation of TIICH and speculate that impact to the head caused shear strain in the small perforating vessels and at the junction between white and gray matter which, in turn, caused vascular rupture.

[The effect of muscle relaxation training on patients with insomnia complaints]

This study was performed to examine the effect of muscle relaxation training on patients with insomnia complaints. The subjects were selected those who have taken poor sleep below 240-300 minutes per day, between 16-15 ages, without organic brain syndromes. Using the Budzinski's muscle relaxation training tapes the patients have been gotten the muscle relaxation training daily during four weeks and examined the state anxiety with Spielberger's Trait-State Anxiety Scale, and investigated Sleep amounts, Blood pressure, Pulse rates, Respiratory rates before and after the muscle relaxation training. The results were as follow: 1. The mean of the State anxiety after the muscle relaxation training (41.8 +/- 6.4) was significantly lower than that of before training (54.2 +/- 7.0) (p less than 0.001). 2. The mean of systolic blood pressure after the training (114.3 +/- 7.8 mmHg) was significantly lower than that of before training (139.0 +/- 9.8) (p less than 0.001). 3. The mean of Pulse rate after the training (89.2 +/- 3.0) was significantly lower than that of before training (103.9 +/- 7.4) (p less than 0.001). 4. The mean of Respiratory rate after the training (18.6 +/- 1.0) was significantly lower than that of before training (22.8 +/- 1.3) (p less than 0.001). 5. The mean of Sleep amount after the muscle relaxation training (459.8 +/- 52.4 minutes) was significantly increased than that of before training (287.3 +/- 30.3) (p less than 0.001).

Two-year survival: preoperative adjuvant chemotherapy in the treatment of cervical cancer stages Ib and II with bulky tumor

The effect of preoperative adjuvant chemotherapy on the 2-year survival rate of patients with locally advanced cervical cancer (stages Ib and II with bulky tumour) was evaluated. The 54 patients first received initial chemotherapy of vinblastine, bleomycin, and cis-platinum in a combined regimen (VBP) and then radical hysterectomy. The overall histologic response rate to chemotherapy of the primary tumor confirmed in the surgical specimen was 81% including microscopic or no evidence of disease (41%, Grade III or IV). A lower than expected incidence of lymph node metastasis (20%) was found. All nodal metastasis was noted in patients with Grades I or II (P = 0.0034). Median follow-up was 36 months (range 26-60 months). Three recurrences (6%) appeared and those patients died of the disease within 24 months. Thus the 2-year tumour-free survival rate was 94%. The patients who had positive nodes more often experienced recurrence (27 vs 0%) and a lower 2-year survival rate (72 vs 100%) (P = 0.0067). All of these recurrences were found in patients with three or more positive nodes. This preliminary study suggest that preoperative adjuvant chemotherapy (VBP) is effective (1) in reducing tumour volume or the stage of the disease, (2) in curing the lymph node involvement, and (3) in improving the 2-year tumour-free survival rate. A prospective randomized study comparing radical surgery alone with preoperative adjuvant chemotherapy followed by radical surgery is in progress.

Successful treatment of cervical pregnancy by cervical evacuation after use of methotrexate

A case is described with cervical pregnancy successfully treated by two 8-day courses of methotrexate and leucovorin rescue with cervical evacuation. The apparent beneficial outcome suggests that cervical evacuation after the use of methotrexate and leucovorin rescue will be considered for treatment of cervical pregnancy whenever uterine preservation is desirable.

Maternal and fetal survival following surgery and chemotherapy of endodermal sinus tumor of the ovary during pregnancy: a case report

An ovarian endodermal sinus tumor was found in a patient with a 15-week intrauterine gestation. She received conservative surgery and six courses of combination chemotherapy from 16 weeks' gestation, and delivered a normal term infant at 37 weeks' gestation. Two other courses of combination chemotherapy including cisplatin were added. No residual tumor was found at subsequent exploration, and she is alive 33 months after the original diagnosis without any evidence of recurrence. We believe this is the first reported case of maternal survival past 2 years and the earliest chemotherapy done in the early second trimester of pregnancy without resulting in fetal abnormalities.

Unusual precipitins in pathological human sera

In conducting double diffusion gel precipitation tests, unexpected, strong precipitation reactions were noticed between a serum originating from a renal graft recipient and many pathological human sera. The highest frequency of positive reactions were produced by sera of patients with infectious mononucleosis (83%), chronic Epstein-Barr virus infections (72%), rheumatoid arthritis (57%), lepromatous leprosy (57%), and AIDS (44%). The precipitin in these pathological sera was identified as an antibody of IgM variety and the precipitinogen in the transplantation serum was shown to be a thermostable component with beta-globulin mobility. No explanation of the nature of reactions observed can be given at present.

The acoustic stimulation test in the anencephalus: preliminary results

It is not yet clear whether the acoustic stimulus influences the fetus by auditory or vibrational pathways. The anencephalic fetus is an interesting model for the study of the pathway for receipt of acoustic stimulation because of the near absence of cerebral hemispheres. After the traditional nonstress test (NST), the response to acoustic stimulation was assessed in eight fetal heart rate (FHR) recordings of six anencephalic fetuses of gestational age between 18 and 39 weeks. Although four preterm fetuses demonstrated nonreactive results in the NST, two term fetuses revealed reactive NSTs. However, none of these six anencephalic fetuses responded to acoustic stimulation. These data suggest that the cerebral cortex is the origin or transmission route of the FHR response to acoustic stimulation. We hypothesize that the normal fetus might receive externally applied sounds via auditory pathways rather than vibratory pathways, at least in term pregnancy.

Detection of antigens from gram-negative bacilli in urine of children with urinary tract infections. I. Common antigen of Enterobacteriaceae

Enterobacterial common antigen (ECA) has attracted considerable interest since the original publication by Kunin in 1962. In the present study we demonstrated this antigen directly in the urine from patients with urinary tract infections (UTI) elicited by enterobacteria. Sheep erythrocytes were incubated with UTI urine; this resulted in their coating with ECA, which was studied by means of hemagglutination by anti-ECA serum. Test tube hemagglutination and the more simple slide hemagglutination were employed and with both procedures similar results were obtained. Positive results were observed in 94-99% of urine specimens from enterobacterial UTI collected in The Buffalo Children's Hospital in the 1960s. ECA in urine could also be demonstrated by hemagglutination inhibition. In this test, antibodies in anti-ECA serum were neutralized as a result of incubation of this serum with urine, and agglutination by the antiserum of sheep erythrocytes coated with a standard ECA preparation was prevented or reduced. By means of this latter test, ECA could be demonstrated in 67-88% of urine specimens from enterobacterial UTI. The possible diagnostic application of these tests has been discussed.

Detection of antigens from gram-negative bacilli in urine of children with urinary tract infections. II. Thermostable bacterial proteins

An enzyme immunoassay for detection of bacterial antigens in urine specimens from urinary tract infections (UTI) was developed. The antigens detected in infections by Enterobacteriaceae: Escherichia coli, Enterobacter aerogenes, and Proteus sp. were different from the enterobacterial common antigen (ECA). They were digested by trypsin and were characterized by remarkable thermostability; their molecular weights were approximately 34,000 and 31,000. They were detected by means of antisera to ECA or to suspension of E. coli. The frequency of positive results with urine specimens from enterobacterial UTI was 87-99%. In contrast, the urine specimens of UTI by Pseudomonas aeruginosa were positive in fewer than 20% with anti-E. coli sera, but were positive in more than 85% in tests with antiserum to P. aeruginosa. The possible diagnostic application of the described tests was discussed.

A comprehensive study of immunological abnormalities in Korean hemophiliacs

To determine laboratory evidence suggesting immunological abnormalities in persons with hemophilia, we evaluated the immunological status of 75 Korean hemophiliacs, seronegative for human immunodeficiency virus (HIV) antibodies, who have been treated only with Korean factor VIII concentrates. From this study, it was shown that Korean hemophiliacs had decreased CD4 levels, increased CD8 levels, and decreased CD4:CD8 ratios. Diminished lymphocyte response to the mitogens, phytohemagglutinin and concanavalin A, and decreased natural killer cell activity were observed in the hemophiliacs. In addition, production of interleukin-II in the hemophiliacs was lower than in the healthy controls. The percentage of B lymphocytes was significantly reduced but the serum levels of immunoglobulin (Ig) G were elevated. However, the serum Ig A and Ig M levels were normal. This study demonstrated a high frequency of immunological abnormalities in HIV antibody negative Korean hemophiliacs treated only with domestic factor VIII concentrates.

A nonimmunoglobulin precipitin to tissue extracts in pathological human sera

An alpha-globulin component was noted in pathological human sera, which produced gel precipitation reactions with extracts of human and animal liver. The highest incidence of the precipitin was found in malaria (95%), renal graft rejection (81%), and rheumatoid arthritis (57%). The precipitinogen was thermostable and ethanol soluble; of two precipitation lines formed by this component, one merged into identity reaction with a line produced by commercial lecithin of bovine origin. The possible diagnostic application of the reactions noted was considered.

Preoperative adjuvant chemotherapy in the treatment of cervical cancer stage Ib, IIa, and IIb with bulky tumor

Thirty-five previously untreated patients with stage Ib, IIa, and IIb squamous cell carcinoma of uterine cervix with bulky mass (more than 4 cm) were treated with initial chemotherapy of vinblastine, bleomycin, and cis-platinum combined regimen (VBP, one to five courses) and subsequent radical surgery. The effectiveness of the preoperative chemotherapy was evaluated in the surgical specimen. The overall clinical response rate was 89% and included a complete response in 16 (46%) and a partial response in 15 patients (43%). There were no differences in the response rate by age, stage, or the geographic contour of the tumor. The number of chemotherapeutic courses correlated well with the response of the primary tumor (P = 0.0004) up to three courses. Histologic examination of the resected primary tumor revealed no evidence of disease (Grade IV) in 44% of complete responders, microscopic foci (Grade III) in 38% (6), and macroscopic disease (Grade II) in 18% (3). Of 15 patients with stage IIb, 11 (73%) had a stage-down. Lymphnode metastases after chemotherapy were found in 26% (9/35) of the patients. All nodal metastases were found among the patients who had a partial response or a stable disease, and none was found in those with a complete response (P = 0.0029). This preliminary study suggests that initial chemotherapy before surgery is effective in reducing tumor volume or stage of the disease providing better circumstances for surgery, offers selection of high-risk groups of patients requiring additional chemotherapy, and might be able to eliminate effectively diseases in lymphnodes and possibly micrometastases. This regimen is now being evaluated to test its impact on survival.

Active site modification of 4-aminobutyrate aminotransferase with ATP analogs

The dialdehyde of oxidized 1,N6-etheno-ATP and adenosine triphosphopyridoxal were used as probes of the catalytic site of 4-aminobutyrate aminotransferase. Both compounds react with lysine residues critically connected with aminotransferase activity. The binding of 1 mol of oxidized 1,N6-etheno-ATP per mol of enzyme or the binding of 1 mol of adenosine triphosphopyridoxal abrogates catalytic activity. The presence of substrate alpha-ketoglutarate (4 mM) prevents inactivation of the aminotransferase by either one of the ATP analogs. Reduction of the enzyme modified with oxidized 1,N6-etheno-ATP yields a chromophore which displays a maximum of emission at 415 nm and a fluorescent lifetime of 21.6 ns. The degree of exposure of the ethenoadenine ring to collisional encounters with the strong quencher KI was determined at pH 7.0. The ethenoadenine ring of the bound ligand is partially shielded from collisional encounters with the quencher. Steady-state emission anisotropy measurements of the bound ligand reveal that oxidized 1,N6-etheno-ATP is not rigidly attached to the protein matrix. It is postulated that the catalytic domain of 4-aminobutyrate aminotransferase is accessible to bulky reagents of greater length than the substrates 4-aminobutyrate and alpha-ketoglutarate.

The reversible oxidation of vicinal SH groups in 4-aminobutyrate aminotransferase. Probes of conformational changes

4-Aminobutyrate aminotransferase is inactivated by preincubation with iodosobenzoate at pH 7. The reaction of 2 SH residues/dimer resulted in formation of an oligomeric species of Mr = 100,000 detectable by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The subunits cross-linked via a disulfide bond are dissociated by addition of 2-mercaptoethanol which also restores full catalytic activity (Choi, S. Y., and Churchich, J.E. (1985) J. Biol. Chem. 260, 993-997). The substrate 2-oxoglutarate prevents inactivation of the enzyme by iodosobenzoate and the subsequent formation of one disulfide bond, whereas 4-aminobutyrate has no effect on the reactivity of SH groups with iodosobenzoate. Modified 4-aminobutyrate aminotransferase (containing 1 disulfide bond) catalyzes a half-transamination reaction; but it is unable to react with 2-oxoglutarate to generate the aldimine form of the enzyme. The spectroscopic properties (fluorescence yield and polarization of fluorescence) of PMP bound to the modified enzyme are different from those of pyridoxamine phosphate (PMP) bound to the native enzyme. The polarization of fluorescence values of PMP bound to the cross-linked enzyme, excited over the spectral range 310-370 nm, are greater (25%) than those of the cofactor of the native enzyme. An increase in the polarization values implies that the motion of PMP is restricted when the subunits are cross-linked via a disulfide bond.

Comparative review of diagnostic accuracy in tubal pregnancy: a 14-year survey of 1040 cases

This paper summarizes our experience from 1972-1985 with the changing tools used in the diagnosis of ectopic pregnancy. The study was divided into three time periods based on the diagnostic methods used in each. In the first period (1972-1975), diagnosis was by culdocentesis and the urine pregnancy test. In the second period (1976-1978), diagnostic laparoscopy was added. Finally, in the third period (1979-1985), serum beta-human chorionic gonadotropin (beta-hCG) assay and pelvic ultrasonography were added. A rising trend in diagnostic accuracy was observed from the first period to the third. The predictability and the negative predictive value of diagnostic tests in the third period were 96.3 and 94.9%, respectively--significantly higher than in the first and second periods. The incidence of unruptured tubal pregnancy increased significantly, from 27.6% in the first and the second periods to 42.5% in the third period. Laparoscopy, ultrasonography, and serum beta-hCG assay each revealed a positive rate of more than 90% in the diagnosis of tubal pregnancy. Laparoscopy had the highest positive predictive value as a single test in the third period. Among suspected cases, however, laparoscopy was found to have a low accuracy in discriminating between tubal pregnancy and infection. The combination of serum beta-hCG testing and ultrasonography produced a 99% positive predictive value, and revealed a higher degree of accuracy in the diagnosis of tubal pregnancy than any other single test or combination of tests.

Effects of tethering on regional spinal cord blood flow and sensory-evoked potentials in growing cats

The spinal cords of 2-week-old kittens were tethered by fixing the end of the filum terminale to the lower sacrum, to study the effects of tethering and untethering on regional spinal cord blood flow (rSCBF), sensory-evoked potentials (SEPs) and clinical features. Progressive sensorimotor deficits and incontinence were observed in all the tethered cats. Cord tethering induced a reduction of rSCBF in the distal spinal cord close to the tethering (L3) by 32% of the normal flow 2 weeks after tethering and by 67% 10 weeks after tethering. Untethering of the cord resulted in an increase of rSCBF, restoring it to the normal level in the group untethered 2 weeks after tethering, but rSCBF did not increase in the group untethered 8 weeks after tethering. The changes in SEPs were observed whenever rSCBF was below 14 ml/100 g per minute. Suppression of the early components of SEPs was observed 2 weeks after tethering and the components were progressively altered in amplitude and latency during the experimental period. It is assumed that early untethering can improve the spinal cord blood flow as well as the function of the cord.

Acute pulmonary embolism treated with tissue plasminogen activator

Recombinant human tissue-type plasminogen activator (rt-PA) was given via a peripheral vein to 36 patients with angiographically documented pulmonary embolism. The regimen was 50 mg/2 h followed by repeat angiography and, if necessary, an additional 40 mg/4 h. By 6 h, 34 of 36 patients had angiographic evidence of clot lysis, slight in 4, moderate in 6, and marked in 24. The quantitative score improved 21% by 2 h and 49% by 6 h. Fibrinogen decreased 30% from baseline at 2 h and 38% from baseline at 6 h. 2 patients had major complications: in one, bleeding from a pelvic tumour required surgery; in the other, who had had coronary artery bypass surgery eight days earlier, pericardial tamponade developed. These initial results in selected patients make a case for expanded investigational use of peripheral intravenous rt-PA in pulmonary embolism.

A case report of tracheobronchitis by herpes simplex virus, type I

Herpes simplex virus (HSV) infection of the lung and lower respiratory tract has been thought to be a rare and fatal disease, usually in patients with immunosuppression, severe burns, or prolonged intubation. However, recently, increasing numbers of patients have been reported to have a localized infection and some of them have recovered without specific therapy.

In Korea, there has been yet no proven case of HSV infection of the lower respiratory tract. Recently, we saw a case of localized HSV infection of the tracheobronchus. A 78-year-old male patient was admitted in acute respiratory failure, with COPD and old pulmonary trberculosis. After the clinical condition improved, a bronchoscopy was done which revealed a localized area of swelling, hyperemia, and mucosal irregularity at the lower trachea and right upper lobar bronchus. Bronchial brushing and biopsy showed typical cytologic changes including intranuclear inclusion body. Viral culture of a bronchial washing revealed a growth of HSV, type I. The patient died of unrelated, acute myocardial linfarction.

Effects of prophylactic chemotherapy for persistent trophoblastic disease in patients with complete hydatidiform mole

Seventy-one patients with complete hydatidiform mole were prospectively randomized into two groups: one group (39 patients) was treated with a single course of methotrexate and citrovorum factor rescue as chemoprophylaxis; the other group (32 patients) was not treated. After molar evacuation, four patients from the treated group (10.3%) and ten patients from the untreated group (31.3%) developed persistent trophoblastic disease. The time interval from evacuation of the mole to diagnosis of persistent trophoblastic disease was longer in the treated group than in the untreated group (9.5 +/- 2.4 weeks versus 5.1 +/- 1.6 weeks, P less than .05). Among high-risk patients, there was a lower incidence of persistent trophoblastic disease in the treated group than in the untreated group (14.3 versus 47.4%, P less than .05). Among low-risk patients there was no difference between the groups (5.6 versus 7.7%, P greater than .05). All 14 patients with persistent trophoblastic disease achieved complete remission with therapeutic chemotherapy. More courses of chemotherapy were required until complete remission in the treated group than in the untreated group (2.5 +/- 0.5 versus 1.4 +/- 0.5, P less than .005). These findings suggest that even though chemoprophylaxis reduces the incidence of persistent trophoblastic disease in patients at high risk, it increases tumor resistance and morbidity. Although prophylactic chemotherapy with methotrexate and citrovorum factor rescue may be helpful for high-risk patients who cannot be followed or whose compliance is in question, careful follow-up remains the most important way to identify patients who should receive chemotherapy.

Primary chemotherapy and postoperative adjuvant chemotherapy in the treatment of squamous cell carcinoma of the uterine cervix

Two cases with squamous cell carcinoma of the cervix stage IIB with primary tumor mass about 2 X 2 X 2 cm were treated with primary chemotherapy of cis-platinum, 20 micrograms/m2 body surface intravenously daily for 5 consecutive days. Papanicolaou smear turned negative after two courses of chemotherapy in both cases. One of those was followed by radical hysterectomy with lymphadenectomy which confirmed that there was no evidence of disease by histopathology. The third case with stage IIIB and bulky tumor with involvement of pelvic and left common iliac lymph nodes was treated with simple hysterectomy followed by adjuvant chemotherapy with the same medication described above. Complete responses were obtained in all three cases and they are now doing well in a tumor-free state for 26, 30, and 28 months, respectively.

Hepatocarcinogenicity of diethylnitrosamine to the self-fertilizing hermaphroditic fish Rivulus marmoratus (Teleostomi: Cyprinodontidae)

The larvae, 3 days post hatching, of self-fertilizing hermaphroditic fish Rivulus marmoratus were exposed to diethylnitrosamine (DENA) (CAS: 55-18-5; N-nitrosodiethylamine) at levels of 50-400 ppm for 2 hours. At 3-month intervals, the exposed fish were sampled until 9 months postcarcinogen treatment. Hepatomas were induced in 6- and 9- month groups of the 100-ppm-treated and 200-ppm-treated fish. An exposure of fish larvae to 400 ppm DENA also produced similar tumors on 3-, 6-, and 9-month groups. The tumor incidences were clearly dose dependent. These results offered the possibility of the use of R. marmoratus as a suitable model for experimental carcinogenesis.

A procedure for staining cartilage and bone of whole vertebrate larvae while rendering all other tissues transparent

A new procedure for clearing and differentially staining skeletons of vertebrate larvae is described. body pigments of fixed specimens are bleached by treatment with alkaline H2O2. This process markedly enhances the transparency of alcian blue-alizarine red S stained whole animals without damaging the specimens. This procedure should be useful for analyzing skeletal structures in studies of embryology, comparative anatomy and teratology of small vertebrates.

Salvage of an ischemic limb by laser angioplasty: description of a new technique

A 62-year-old male with severe claudication and rest pain of the left leg resulting from a totally occluded superficial femoral artery and a 95% stenosis of the deep femoral artery was treated with laser angioplasty after attempts at surgical revascularization were unsuccessful. A 200 mu silica fiber was inserted through a catheter and advanced into the lesion using 2 watts of delivered energy from an argon laser source. The fiber was then withdrawn from the lesion using 7 watts of energy to enlarge the lumen. No complications occurred, and posterior tibial blood flow was reestablished, as shown by Doppler flow measurements and resolution of clinical symptoms. We report a new technique of transcatheter fiberoptic-directed argon laser radiation (laser angioplasty) for the treatment of occlusive vascular disease.

Catalytic and structural properties of trypsin-treated 4-aminobutyrate aminotransferase

4-Aminobutyrate aminotransferase (EC 2.6.1.19, 4 aminobutyrate:2-oxoglutarate aminotransferase) is cleaved by trypsin, yielding an enzymatically active species which can be separated from the split peptides by gel filtration. The shortened enzyme derivative gives one band (Mr = 95,000) on polyacrylamide gradient gel electrophoresis. Changes in protein conformation induced by tryptic digestion were studied by fluorescence spectroscopy. The native enzyme tagged with the chromophore fluorescein yields a rotational relaxation time of 106 ns, whereas the trypsin-digested enzyme gives a rotational relaxation time of 33 ns. The decrease in rotational relaxation time is attributed to flexibility of the polypeptide chain with enhanced rotational freedom of the probe covalently linked to one thiol group. The reactivity of sulfhydryl groups toward 5,5'-dithiobis(2-nitrobenzoic acid) is also affected by trypsin cleavage. More--SH groups (2.6/dimer) become reactive toward 5,5'-dithiobis(2-nitrobenzoic acid) as a result of trypsin digestion. Local conformational fluctuations are induced as a result of tryptic cleavage, but the catalytic sites remain intact. The peptides released from 4-aminobutyrate aminotransferase were characterized by fingerprint analysis and their amino acid composition determined.

Successful pregnancy after transabdominal cervical evacuation of cervical pregnancy

Cervical pregnancy was managed by transabdominal cervical evacuation. Three years later, the woman was delivered of a healthy male infant by cesarean section.

Rotational dynamics of 4-aminobutyrate aminotransferase

The fluorescence dye 1-anilinonaphthalene-8-sulfonate (ANS) was used as a probe of non-polar binding sites in 4-aminobutyrate aminotransferase. ANS binds to a single binding site of the dimeric protein with a Kd of 6 microM. Nanosecond emission anisotropy measurements were performed on the ANS-enzyme in an effort to detect independent rotation of the subunits in the native enzyme. The observed rotational correlation time (phi = 65 ns) corresponds to the rotation of a rather rigid dimeric structure. The microenvironment surrounding the natural probe pyridoxal-5-P covalently bound to the dimeric structure was explored using 31P-NMR at 72.86 MHz. In the native enzyme, the pyridoxal-5-P 31P-chemical shift is pH-independent, indicating that the phosphate group is well protected from the solvent. The correlation time determined from the 31P-spectrum of the aminotransferase exceeds the value calculated for the hydrated spherical model (phi = 40 ns). It is concluded that the phosphate of the pyridoxal-5-P molecule is rigidly bound to the active site of 4-aminobutyrate aminotransferase.

4-Aminobutyrate aminotransferase, reaction of P'P2-bis(5'-pyridoxal) diphosphate with lysyl residues connected with catalytic activity

4-Aminobutyrate aminotransferase is inactivated by preincubation with bispyridoxal-5-P (mixing molar ratio, 20:1) at pH 7.0. The reaction with bispyridoxal-5-P under pseudo-first order conditions proceeds at a slow rate (kobs = 0.03 min-1). The extent of chemical modification was determined by measuring the spectroscopic properties of P-pyridoxyl and P-pyridoxine chromophores formed after reduction of the enzyme reacted with P'P2-bis(5'-pyridoxal) diphosphate. Reduction with NaBH4 results in the incorporation of approximately 2.1 P-pyridoxyl residues/dimer. Thus, the blocking of 2 lysyl residues/dimer is needed for inactivation of the aminotransferase. The time course of inactivation is significantly affected by variations in the pH of the reaction mixtures. Plots of Kobs versus pH indicate the reaction of the bifunctional reagent with lysyl residues characterized by low pK values (pK = 7.3). The substrate alpha-ketoglutarate (10 mM) affords complete protection against inactivation, whereas pyridoxal-5-P failed to prevent the inactivation of the enzyme by bispyridoxal-5-P. It is postulated that binding of alpha-ketoglutarate to lysyl residues is the major factor contributing to stabilization of the catalytic site. Several lines of experimental evidence indicate that inactivation of the aminotransferase cannot be related to dissociation of the cofactor from the catalytic site. The bifunctional reagent bispyridoxal-5-P blocks lysyl residues other than those involved in the binding of the cofactor.