Half-dose gadolinium-enhanced MR imaging with magnetization transfer technique in brain tumors: comparison with conventional contrast-enhanced MR imaging

OBJECTIVE

The purpose of this study was to determine whether half-dose enhanced MR imaging with magnetization transfer (MT) saturation can replace standard-dose enhanced MR imaging without MT saturation in patients who have brain tumors.

SUBJECTS AND METHODS

Three sets of enhanced T1-weighted MR images were prospectively obtained for each of 25 patients with 32 brain tumors; the first conventional MR images without MT were obtained after administration of standard-dose (0.1-mmol/kg) gadopentetate dimeglumine. Within 1 week, patients underwent administration of one half-dose (0.05 mmol/kg) of the contrast medium, and then two sets of enhanced T1-weighted images were obtained with and then without MT. The degree of contrast enhancement was assessed qualitatively for all 32 tumors and quantitatively for 26 tumors. In the quantitative analysis, we compared mean values for tumor-brain contrast-to-noise ratios in three sets of images.

RESULTS

The visual conspicuity of enhancing lesions in half-dose T1-weighted MR images with MT was comparable with that of standard-dose conventional T1-weighted MR images in 43% of cases including most extraaxial tumors. In approximately 75% of cases, the degree of enhancement of the lesions was similar for half-dose T1-weighted images obtained with and without MT. Overall, mean values for tumor-brain contrast-to-noise ratios were significantly lower in half-dose T1-weighted images with MT than in standard-dose T1-weighted images. Also, mean values for tumor-brain contrast-to-noise ratios were significantly higher in half-dose T1-weighted images with MT than in half-dose T1-weighted images without MT.

CONCLUSION

Because half-dose enhanced MR imaging with MT yields enhancement comparable with that of standard-dose enhanced conventional MR imaging in less than 50% of cases, the former technique would replace the latter in only limited cases such as selected extraaxial tumors.

Retrospective comparison of infusional 5-fluorouracil, doxorubicin, and mitomycin-C (modified FAM) combination chemotherapy versus palliative therapy in treatment of advanced gastric cancer

About one-third of patients with gastric cancer are unresectable at the time of diagnosis. Their median survival is < 6 months, with a grave prognosis. The purpose of this study was to assess the efficacy of a modified FAM (mFAM) regimen in advanced gastric cancer. We retrospectively reviewed the clinical records of 409 advanced gastric cancer patients who had not received curative surgery. Among 409 patients, 202 patients were treated with an mFAM regimen (infusional 5-FU + doxorubocin + mitomycin-C), and 207 patients received no chemotherapy (control group). No differences were found in clinical parameters between the two groups. The 1-year survival rates were 34.1% for the mFAM-treated group and 22.5% for the control group (p = 0.0135). In subset analysis, a higher 1-year survival rate was demonstrated in patients with mFAM and palliative surgery. Of the 154 evaluable patients in the mFAM-treated group, the response rate was 17.5%. In these patients, median response duration was 30 weeks, and progression-free survival was 23 weeks. Overall toxicity of mFAM regimen was relatively tolerable and reversible. In conclusion, FAM combination chemotherapy, which has been used as a standard therapy, prolonged survival after modification of the administration schedule and combination with palliative surgery. A prospective randomized study is warranted to confirm this conclusion from our retrospective study.

Radiological findings in serous surface papillary carcinoma of the ovary. Case reports

Serous surface papillary carcinoma (SSPC) is a malignant tumor originating from the surface epithelium of the ovary, and is characterized by macroscopic normal ovaries accompanied by diffuse peritoneal dissemination. Therefore diagnosis of SSPC cannot usually be made preoperatively. We report on two cases of SSPC in which US, CT, and MR demonstrated nodularities along the surface of the normal-sized ovaries, adjacent organs and pelvic peritoneum in addition to findings of peritoneal seeding. These imaging findings may suggest the correct preoperative diagnosis of SSPC.

Differential induction of hepatic microsomal epoxide hydrolase by alkyl sulphides and alkyl ethers in rat

1. Previous studies have shown that the expression of certain cytochromes P450 and major glutathione S-transferases (GSTs) is differentially modulated by alkyl sulphide treatment. The current study was designed to examine the influence of several alkyl sulphides and alkyl ethers on the induction of hepatic microsomal epoxide hydrolase (mEH) in rat. 2. Northern blot analysis has shown that treatment of rats with allyl disulphide (ADS) or allyl sulphide (AS) (50 mg/kg/day, 7 days) resulted in 5-6-fold increases in mEH mRNA levels, whereas allyl ether failed to stimulate mEH gene expression. Rats treated with propyl disulphide (PDS) or propyl sulphide (PS) exhibited increases in mEH mRNA levels, although the relative increases were less than those produced by ADS or AS. Propyl ether failed to increase hepatic mEH mRNA levels. Immunoblot analyses confirmed that allyl and propyl sulphides induce hepatic mEH protein, with the agents containing allyl moiety being more effective. 3. Treatment of rats with ADS at 100 mg/kg resulted in 9-14-fold increases in mEH mRNA levels at 12 and 24 h post-treatment respectively, whereas AS caused a maximal increase at the 24-h time point. Animals treated with PDS or PS exhibited time-related increases in mEH mRNA levels, resulting in 2-6-fold elevations at 72-h post-treatment. The changes in mEH mRNA levels after ADS or AS treatment appeared to be more rapid than those after PDS or PS. The rank order for increases in mEH mRNA levels was ADS > AS > PS > PDS. The result of immunoblot analysis was consistent with that of Northern blot analysis. 4. Rats treated with isopropyl sulphide (IPS), butyl sulphone, tert-butyl sulphide, sec-butyl sulphide or butyl sulphide (100 mg/kg/day) showed 3-5-fold increases in the mEH mRNA levels at 3 days post-treatment. IPS treatment caused a similar increase in the mRNA level to that of PS, whereas the induction efficacy of PDS was lower than that of PS or IPS. Treatment with butyl sulphone as well as the structural isomers of butyl sulphides caused approximately 3-fold elevations in mEH mRNA levels. 5. These results provide evidence that alkyl sulphides, but not alkyl ethers, are capable of increasing mEH mRNA levels and that the organosulphur compounds with the allyl moiety are more effective in stimulating the mEH gene than are saturated alkyl sulphides. The comparable increase in mEH mRNA by butyl sulphone as well as the necessity of sulphur atom suggests that sulphone metabolites from the alkyl sulphides might be the ultimate inducers of mEH.

High level of urokinase-type plasminogen activator is a new prognostic marker in patients with gastric carcinoma

BACKGROUND

Prognosis of gastric carcinoma is related to invasion and metastasis. Evidence has accumulated that invasion and metastasis in solid tumors require the action of tumor-associated proteases, which promote the dissolution of the surrounding tumor matrix and the basement membrane. The serine protease urokinase-type plasminogen activator (uPA) and its inhibitor, plasminogen activator inhibitor-1 (PAI-1), appear to have a major function in these processes. Recent reports have demonstrated that expression of these proteolytic enzymes is elevated in breast and colon carcinoma and that it can be associated with invasiveness and poor prognosis. Therefore, the authors evaluated whether the expression and activation of uPA and PAI-1 might be of clinical value as a tumor/biologically defined risk factor in patients with gastric carcinoma.

METHODS

Enzyme-linked immunoadsorbent assays were used to test for uPA antigens and PAI-1 in tissue extracts of normal and cancerous tissue from 160 gastric carcinoma patients who were enrolled in the Yonsei Cancer Center Study Group.

RESULTS

Both uPA and PAI-1 levels were significantly higher in cancerous tissues than in normal tissues (uPA: 9.4 +/- 8.7 vs. 5.3 +/- 3.1 ng/mg protein cytosol; PAI-1: 10.9 +/- 9.1 vs. 5.8 +/- 2.9 ng/mg protein cytosol), (P < 0.001, respectively). Both high uPA and PAI-1 levels were associated with differentiation of the tumor (P = 0.04 and P = 0.004, respectively), and a high PAI-1 level was associated with lymph node metastasis at an advanced stage (P = 0.003 and P = 0.04, respectively). There was a correlation between the levels of uPA and PAI-1 expression in cancerous tissues (correlation coefficient = 0.57). In univariate analysis, a high level of uPA or PAI-1 was associated with a short relapse free survival, but in multivariate analysis only a high level of uPA was an independent prognostic parameter for a short relapse free survival for gastric carcinoma patients.

CONCLUSIONS

These data indicate that uPA is a new independent variable for the identification of high risk gastric carcinoma patients. Therefore, therapy targeting uPA can be applied as a new biologic treatment modality for these individuals.

Relationship between p53 overexpression and gastric cancer progression

The relationship between p53 overexpression and clinicopathologic variables in gastric cancer was evaluated using 304 paraffin-embedded gastric tumor tissues. DO7, a murine monoclonal antiserum to p53 protein, was used for the immunohistochemical analysis. Positive staining was found in 129 tumors (42.2% of all tumors). Overexpression of p53 was not associated with sex, location of the tumor in the stomach or the type of Borrman's tumor. The overexpression rate of p53 protein was 30.4% (28/92) in stage II and 47.6% (101/212) in stage III (p = 0.007). While there was no significant association between p53 protein accumulation and T stage, there was a significant association with N stage, i.e. p53 overexpression was 27.4% (17/62) in the node-negative group and 46.3% (112/242) in the node-positive group (p = 0.011). In 79 patients, in whom corresponding primary gastric tumor and regional lymph node metastases were available, overexpression was found in 34 (43%) primary tumors and in 38 (48.1%) node samples, with a concordance rate of 67.1% in terms of p53 expression. Mean numbers of regional lymph node involvement by the tumor were 6.1 in the group with p53 overexpression and 5.2 in the group showing no immunoreactivity (p = 0.051). These findings suggest that p53 overexpression is related to gastric cancer progression and that immunoreactivity in the metastatic lymph nodes show the dependency on p53 expression in the primary tumor.

Correlation between K-ras gene mutation and prognosis of patients with nonsmall cell lung carcinoma

BACKGROUND

Mutations at codons 12, 13, and 61 of the three ras genes, H-ras, K-ras, and N-ras, convert these genes into active oncogenes. It appears that ras gene mutations can be found in a variety of tumor types. The purpose of this study was to evaluate the clinical significance of K-ras gene mutation in nonsmall cell lung carcinoma (NSCLC).

METHODS

The authors analyzed 58 NSCLC patients for mutations at codons 12, 13, and 61 of the K-ras gene and correlated the findings with the tumor stage and patient survival. Polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and the direct nucleotide sequencing method were used to detect mutations after amplification of ras specific sequences by PCR.

RESULTS

Fourteen mutations (24%) of ras genes were found, all at codon 12 of the K-ras gene. GGT to GAT transition was the predominant mutational pattern. There was a significant association between K-ras mutation and the tumor stage (i.e., the higher the stage, the higher the mutation rate) (P = 0.014). Using univariate analysis, the presence of K-ras mutation in paraffin embedded tissue from patients who received treatment with curative intent was associated with a shorter survival (P = 0.039). The median survival duration for patients with or without K-ras mutation was 9 and 30 months, respectively. The Cox proportional hazards model also predicted a higher risk for patients with K-ras mutations (P = 0.047).

CONCLUSIONS

K-ras mutations, present in a subset of NSCLC, are associated with tumor progression and shortened patient survival.

Rapid down-regulation of tyrosine hydroxylase expression in the olfactory bulb of naris-occluded adult rats

In most sensory systems, afferent innervation regulates morphological and biochemical characteristics of target cells for a limited time during development. Sensory deprivation experiments in adult rats also have suggested a critical period for afferent influences on olfactory bulb structure and function. Previous odorant deprivation studies that employed unilateral naris closure in neonatal rats demonstrated down-regulation of the catecholamine biosynthetic enzyme tyrosine hydroxylase (TH) in dopamine neurons intrinsic to the olfactory bulb. Accompanying the altered biochemical parameters was a decrease in bulb size. To distinguish between deprivation-induced alterations in TH expression secondary to developmental sequelae and those occurring in mature neurons, the consequences of unilateral naris closure were assessed in young adult rats. In agreement with previous studies significant postnatal increases occurred in TH expression and total protein, an indication of bulb size. At 30 days post-closure, total protein was unaltered in the ipsilateral olfactory bulb but showed a small (12.9%), significant decline at 60 days. In contrast to the limited morphological consequences of odor deprivation, profound reductions occurred in TH expression. TH activity ipsilateral to the closure decreased significantly by 14 days post-closure and remained depressed for up to 6 months. In parallel with enzyme activity, TH immunoreactivity did not decline in the first few days post-closure. In situ hybridization revealed that TH mRNA levels decreased rapidly, i.e., by 2 days post-closure, reached a nadir at 1 month, and remained depressed for at least 6 months. The capacity of odor deprivation in the adult rat olfactory system to down-regulate TH expression suggests that this phenotypic alteration occurs independently of a presumed critical period.

Overexpression of c-ErbB-2 protein in gastric cancer by immunohistochemical stain

An immunohistochemical stain to the c-ErbB-2 protein was performed in 225 paraffin-embedded tissue blocks from patients with locally advanced gastric cancer who underwent curative resection. The overexpression of the c-ErbB-2 protein was observed in 27.4% of the patients. The c-ErbB-2 positivity showed a statistically significant correlation with nodal status and stage. The patients with an overexpression of the c-ErbB-2 protein had a tendency to a shorter survival than those without, but it was not statistically significant (p = 0.08). The 5-year survival rate after surgery was 54% in the negative staining group to the c-ErbB-2 protein and 49% in the positive staining group. This suggests that the c-ErbB-2 protein has a possible role in lymph node metastasis. Therefore overexpression of the c-ErbB-2 protein is a useful indicator of disease progression in gastric carcinoma patients who received curative surgery.

Molecular mechanism for alkyl sulfide-modulated carbon tetrachloride-induced hepatotoxicity: the role of cytochrome P450 2E1, P450 2B and glutathione S-transferase expression

The modulation of CCl4-induced hepatotoxicity in response to alkyl sulfides and alkyl ethers including allyl disulfide (ADS), allyl sulfide (AS), allyl ether (AE), propyl disulfide (PDS), propyl sulfide (PS), propyl ether (PE) and butyl sulfide (BS) was studied. Whereas pretreatment of rats with either ADS or AS (50 mg/kg, 7 days) blocked a CCl4-induced increase in plasma alanine aminotransferase (ALT) activity by 91 and 56%, respectively, AE, PDS, PS, PE or BS treatment enhanced CCl4-induced ALT activity by 52, 55, 238, 25 or 86%, respectively. Histochemical examinations supported the results of plasma ALT activity. Injection of GdCl3 to PS-pretreated rats failed to block the potentiated ALT increase, whereas GdCl3 completely prevented vitamin A-enhanced elevation of ALT activity. AS treatment completely blocked PS-potentiated CCl4 intoxication. Concomitant treatment of animals with both PS and vitamin A followed by a CCl4 insult resulted in super-potentiation of CCl4-induced hepatotoxicity, suggesting that the mechanism of PS-enhanced hepatotoxicity differs from that caused by vitamin A. Pyridine or phenobarbital potentiation of CCl4-induced increases in ALT activity implys that cytochrome P450 2E1 (P450 2E1) and P450 2B expression may be associated with the increased toxicity. P450 2E1 expression appeared to be associated with the alkyl sulfide-modulated hepatotoxicity, as evidenced by both immunoblot analyses and metabolic activity. P450 2B immunoblot analysis revealed that either AS or PS substantially induced hepatic P450 2B1/2 levels. Thus, PS-enhanced CCL4 hepatotoxicity may be related in part with P450 2B induction. ADS, AS or PS treatment caused increases in the glutathione S-transferase (GST) conjugating activity toward 1-chloro-2,4-dinitro-benzene. ADS, AS or PS induced Ya and Yb1 subunits by 2- to 3-fold. ADS or AS treatment also significantly elevated the levels of Yc subunits. PS failed to induce Yc expression, although this agent effectively increased Yb2 expression. Northern blot analyses revealed that ADS and AS concomitantly stimulated GST Ya, Yb1 and Yc2 gene expression, whereas PS increased the levels of Ya, Yb1, and Yb2 mRNA, but not Yc2 mRNA levels. The expression of GST subunit Yc2 in response to these compounds might be associated with hepatoprotective effects. These results demonstrate that ADS and AS have distinct capability of blocking CCl4-induced hepatotoxicity, whereas certain saturated alkyl sulfides rather potentiate CCl4-induced hepatotoxicity and that the underlying mechanism is associated with P450 2E1 and P450 2B expression, and possibly with certain GST expression.

Neurotrophin-4/5 maintains the cholinergic phenotype of axotomized septal neurons

We examined the effect of intraseptal or intracerebroventricular (i.c. v.) infusions of NT-4/5 or intraseptal infusions of NGF on the level of immunohistochemical staining of choline acetyltransferase (ChAT)and the low-affinity nerve growth factor receptor (LNGFR)in the rat medial septum following unilateral transection of the fimbria. The extent of cell loss in the septum ipsilateral to the lesion, determined by cell counts of ChAT-immunopositive neurons and expressed as a ratio comparing the lesioned to the intact sides, was 0.28 in animals that received an infusion of phosphate-buffered saline (PBS). The ratios were 0.97 and 1.07 in animals that received an infusion of NT-4/5 into the ipsilateral ventricle and septum respectively. Septal infusions of NGF produced a ratio of ChAT-immunopositive cells of 1.03. The ratios of LNGFR-immunopositive neurons increased from 0.50 in PBS-infused animals to 0.79 and 0.83 in animals infused with NT-4/5 via the i.c. v. infusion of NT-4/5 or septal infusion of NT-4/5 or NGF. As determined by immunohistochemical staining, NT-4/5 infused into the lateral ventricle was detected in the periventricular portions of the forebrain ipsilateral to the infusion, while NT-4/5 or NGF infused intraseptally was detected in much of the septum, bilaterally. Furthermore, exogenous NT-4/5 or NGF was detected in numerous neuronal perikarya in the medial septal and diagonal band nuclei. These data demonstrate that, as with NGF, i.c.v. as well as septal infusions of NT-4/5 can maintain the phenotype of basal forebrain cholinergic neurons following axotomy.

Targeted expression of the ret/PTC1 oncogene induces papillary thyroid carcinomas

The ret/PTC oncogene, a rearranged form of the ret proto-oncogene, has been found to be restricted to human papillary thyroid carcinomas. This report shows that transgenic mice with thyroid-targeted expression of the ret/PTC1 oncogene developed thyroid carcinomas with considerable similarities to human papillary thyroid carcinomas, particularly in the nuclear cytologic features and the presence of local invasion. Our findings indicate that ret/PTC2 is not only a biomarker associated with papillary thyroid carcinomas, but is also the only proven specific genetic event leading to the development of papillary thyroid carcinoma.

Specificity of DNA binding activity of the Bacillus subtilis catabolite control protein CcpA

CcpA was purified from Escherichia coli BL21 (lambda DE3)/pLysS carrying plasmid pTSC5, which was constructed by inserting the ccpA gene into the polycloning site of pGEM4. The purified protein migrated in sodium dodecyl sulfate-polyacrylamide gel electrophoresis with an apparent mass of 38 kDa but was eluted from a calibrated Bio-Gel P-100 column with an apparent mass of 75 kDa. Western blot (immunoblot) analysis revealed the presence of CcpA in E. coli BL21 (lambda DE3)/pLysS/pTSC5, which carries ccpA, and in wild-type Bacillus subtilis 168 but not in E. coli BL21 (lambda DE3)/pLysS/pGEM4 or in B. subtilis WLN-29, in which ccpA is inactivated by transposon Tn917 insertion. Purified CcpA bound to DNA containing amyO and retarded its mobility in electrophoretic mobility shift analysis. Complete retardation of the DNA required 75 ng of CcpA per assay. In DNase protection analysis, CcpA bound to DNA containing amyO and protected a region spanning amyO when either DNA strand was labeled. Mutant forms of amyO not effective in catabolite repression were not retarded by CcpA.

1-Benzylimidazole induces rat hepatic microsomal epoxide hydrolase with the elevation of its mRNA levels

The effects of 1-benzylimidazole on the expression of microsomal epoxide hydrolase (mEH) gene were examined in rat. Immunoblot analyses showed that hepatic microsomes isolated from rat treated with 1-benzylimidazole at 25, 50 or 100 mg/kg/day for 3 or 6 days exhibited 2-3-fold increases in mEH levels, relative to control microsomes. Northern and slot blot analysis revealed that 1-benzylimidazole is effective in increasing hepatic mEH mRNA levels at 24 h post-treatment (i.e. 4-5-fold). Hepatic mEH mRNA levels were elevated from 4-4- to 8-fold following 1-benzylimidazole administration in a time-dependent manner. These results demonstrated that 1-benzylimidazole induces mEH protein in rat and that the induction is primarily associated with accumulation of mEH mRNA levels.

Differential expression of rat microsomal epoxide hydrolase gene by imidazole and triazole antimycotic agents

Previous studies from this laboratory revealed that imidazole antimycotic agents, including ketoconazole and clotrimazole, induce microsomal epoxide hydrolase (mEH) and that the mEH induction involves large increases in mRNA with transcriptional activation. To establish whether these compounds elevate mEH mRNA levels in a dose-related manner and whether triazole antimycotic agents, fluconazole and itraconazole, affect mEH gene expression to similar extents, hepatic mEH mRNA levels were quantified in rats by RNA blot analyses using an mEH cDNA probe. Treatment of rats (males) with ketoconazole caused approximately 4-, 10-, and 11-fold increases in mEH mRNA levels at 24-hr posttreatment at the doses of 50, 100, and 200 mg/kg body weight, respectively, whereas mEH mRNA levels were increased approximately 18-fold at 24 hr after a single administration of clotrimazole at 50 mg/kg body weight or at greater doses, with EC50 value being noted as 20 mg/kg body weight. Fluconazole elevated mEH mRNA levels by 2-, 3-, and 6-fold at the doses of 50, 100, and 200 mg/kg body weight, respectively. However, hepatic microsomes isolated from rats treated with fluconazole for 3 days failed to exhibit significant elevation in mEH protein levels, as assessed by immunoblot analyses. No significant increase in mEH mRNA nor protein levels was observed at 1 or 3 days after treatment of rats with itraconazole (200 mg/kg body weight/day). To characterize gender-related differences in hepatic mEH gene expression in response to azole antimycotic agents, the effects of ketoconazole and clotrimazole were examined in females.(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of tyrosine hydroxylase in the aging, rodent olfactory system

Tyrosine hydroxylase (TH) mRNA, immunoreactivity, and activity were examined as a reflection of dopamine expression in juxtaglomerular neurons intrinsic to the olfactory bulbs of young (6-month-old), middle aged (18-month-old), and aged (25- to 29-month-old) rats and mice. TH expression was maintained at levels observed in young animals in the olfactory bulbs of aged animals from two mouse strains, C57Bl/6JNia and C57Bl/6NNia, and one rat strain, an F1 hybrid between F344 and Brown Norway strains. The parental F344 rat strain exhibited reductions in TH expression of about 20% in 26- to 29-month-old animals as compared to 6- and 18 month-old rats. However, there was significant inter-animal variability. Some aged F344 rats had TH levels that were similar and others had activity levels that were 50% of those in young and middle aged animals. Neither the general condition of the animals nor the presence of adrenal tumors predicted the individuals with reduced TH expression. Olfactory bulb size, estimated from protein content, did not differ between rats and mice of different ages. In addition, expression of olfactory marker protein, a protein found primarily in mature olfactory receptor neurons, also was unchanged indicating the maintenance of afferent innervation. These data suggest that, in contrast to other brain dopamine systems, the expression of the dopamine phenotype is maintained in the aging olfactory bulb.

A 6.1 kb 5' upstream region of the mouse tryptophan hydroxylase gene directs expression of E. coli lacZ to major serotonergic brain regions and pineal gland in transgenic mice

Tryptophan hydroxylase (TPH) catalyzes the first step of serotonin biosynthesis in serotonergic neurons and neuroendocrine cells. Serotonin influences diverse vital physiological functions and is thought to play an important role in several human psychiatric disorders. To localize DNA element(s) important for serotonergic tissue-specific expression of TPH, 6.1 kb of the 5' flanking region of the mouse TPH gene was fused to the coding region of the E. coli lacZ gene, and expression of the resulting fusion gene was analyzed in transgenic mice. The 6.1 kb of 5' flanking sequence was able to direct the expression of a lacZ reporter gene to serotonergic tissues in six lines of transgenic mice. A high level of lacZ expression in transgenic mice carrying the fusion gene was detected in the pineal gland as well as a moderate level of lacZ expression in serotonergic brain regions such as the median and dorsal raphe nuclei, the nuclei raphe magnus and raphe pallidus. In contrast, a smaller 5' flanking sequence of 1.1 kb directed no detectable serotonergic tissue-specific lacZ expression in five lines of transgenic mice. These results presented in this paper suggest first that DNA elements critical to serotonergic tissue-specific expression reside between -6.1 kb and -1.1 kb of 5' flanking region of the mouse TPH gene, but second that this region confers a restricted tissue-specific expression.

Interrupted circular suture: bleeding control during cesarean delivery in placenta previa accreta

Rapid accumulation of blood from the placental separation site during cesarean delivery for placenta previa obscures the surgical field and quickly leads to deterioration of the patient's vital signs. We used the following technique in eight cases of intractable bleeding among 49 cesareans for placenta previa. Following failure to control the bleeding by suture at the placental separation site via the lower segment cesarean incision, the vessels were ligated using interrupted 2-3-cm sutures at 1-cm intervals in a circle around the bleeding area on the serosal surface of the uterus. The sutures were placed as deeply as possible in order to reach the endometrium. This led to a marked decrease in bleeding and allowed the small vessels to be easily identified and ligated. The amount of blood transfused and the operation time were gradually reduced as we became adept in the use of this procedure. Our experience suggests that this technique could reduce the use of hysterectomy in cesarean for placenta previa.

Window operation: an alternative treatment method for Bartholin gland cysts and abscesses

Recently, we developed the "window operation" as a more effective way to treat Bartholin gland cysts and abscesses. The window operation was used to treat 25 Bartholin cysts and 22 Bartholin abscesses during a 3-year period from October 1, 1986 to September 30, 1989. Under local anesthesia, a small piece of skin including the cyst wall was excised in an oval shape, and suturing was performed along the excised margin. Postoperative antibiotics were given in cases of acute inflammation. A new mucocutaneous junction was observed at the 4-week postoperative checkup. No complications or recurrences have been observed during the study period. The window operation can be an alternative method of treatment for Bartholin gland cysts or abscesses.

A case of laboratory-acquired murine typhus

We encountered a 32-year-old Korean woman who developed murine typhus in a laboratory. She worked as a technician in a laboratory for rickettsial disease. Immunofluorescence test with rickettsial antigen (R. typhi) was positive at 1: 320 on admission and 1: 1280 after 4 weeks. A dose of 200 mg of doxycycline for 7 days proved to be effective for her condition.

Intramural hematoma of the esophagus: unusual complication of esophageal variceal sclerotherapy

The authors report a case of esophageal hematoma in a 35-year-old man after esophageal variceal sclerotherapy with intravariceal injection of 5% ethanolamine oleate. A huge submucosal hematoma of the esophageal wall was demonstrated endoscopically and radiologically. Resolution occurred spontaneously after conservative treatment.

Coronal positioning of tissue previously treated with freeze-dried dura mater grafts. Report of a case

Root surfaces exposed to the oral environment may present a variety of problems to dental patients. Mucogingival surgical procedures represents one approach to the management of these concerns. Procedures currently in use often require two or three wounds, and sometimes two surgical sessions. Recent observations suggest that an allograft, freeze-dried dura mater, amy serve as a donor material in mucogingival surgery. This report describes the use of coronally positioned flap procedures to treat residual areal of recession 4 years after placement of freeze-dried dura mater allografts.