Interferon-gamma-induced factor binding to the interleukin-4-responsive element of CD23b promoter in human tonsillar mononuclear cells: role in transient up-regulation of the interleukin-4-induced CD23b mRNA

Stimulation of human tonsillar mononuclear cells with interleukin-4 (IL-4) and interferon-gamma (IFN-gamma) rapidly induced the activation of distinct nuclear factors with different mobilities, both of which bind the IL-4 response element (IL-4RE) of CD23b promoter as examined by electrophoretic mobility shift assays (EMSA). Co-treatment of IL-4 and IFN-gamma induced, in addition to the two distinct complexes, a new complex with an intermediate mobility. The IL-4-induced complex reacted with anti-STAT (signal transducers and activators of transcription) 6, resulting in a supershift whereas the formation of the IFN-gamma-induced complex was inhibited by anti-STAT 1. The intermediate complex appeared to react with both anti-STAT 6 and anti-STAT 1. Although IFN-gamma alone did not induce CD23 mRNA transcription, Northern blot analysis revealed a transient up-regulation of the IL-4-induced CD23 mRNA by IFN-gamma within 2 h of IFN-gamma treatment in these tonsillar cells. The results suggest that the IL-4RE of the IL-4-inducible gene can accommodate both IL-4- and IFN-gamma-activated factors, such as STAT 6 and STAT 1, either in homodimeric or heterodimeric forms and the binding of these different proteins to the respective promoter may play a potential regulatory role in the IL-4-inducible gene expression.

In vitro stimulation of cumulus-cell expansion by human cord serum in mouse oocyte-cumulus complexes

PURPOSE

The aim of this study was to test whether human cord serum (HCS) containing gonadotropins has an effect on the expansion of oocyte-cumulus complexes (OCCs).

METHODS

The concentration of follicle stimulating hormone (FSH) and luteinizing hormone (LH) was measured in HCS by radioimmunoassay (RIA). After short-term culture (4 hr) with or without OCCs, medium containing 0.4% bovine serum albumin (BSA) as control or 10% HCS was collected and analyzed for its concentration of estradiol, progesterone, and testosterone.

RESULTS

The FSH concentration was at the basal level, but the LH level was as high as 142.4 mIU/ml in both natured and denatured serum. Undetectable levels of steroids were observed in control media with or without OCCs. In contrast, a moderate amount of steroid hormones was detected in culture medium containing HCS. OCCs secreted a minute amount of steroid hormones in response to HCS. Similar patterns of cumulus expansion were observable by treatment with HCS, human chorionic gonadotropin (hCG), or HCS plus hCG after 4, 8, or 22 hr of culture. However, no cumulus expansion was observed in controls.

CONCLUSION

These results suggest that LH in HCS induces cumulus expansion but does not affect the secretion of steroid hormones by OCCs during culture.

Identification of cytochrome P450 1A1 in human brain

We have isolated cDNA fragments that were originated from P450 1A1 in human brain by polymerase chain reaction (PCR) analysis. Their size matched up to what we expected based on the reported P450 1A1 mRNA sequence of human breast carcinoma cell line MCF-7. To confirm proper PCR products, they were subcloned and their nucleotide sequences were determined. This result showed that PCR products were actually derived from P450 1A1 mRNA in human brain. We demonstrated for the first time that human brain contains a P450 1A1-dependent metabolism system which seems to be important for understanding the metabolism of endogenous and exogenous compounds.

Induction of differentiation of the human histocytic lymphoma cell line U-937 by hypericin

Hypericin, a photosensitizing plant pigment, was found to be a potent inducer of differentiation of human myeloid leukemia U-937 cells. At a concentration of 0.2 microM, hypericin exhibited 50% growth inhibition. An effect on cell differentiation by hypericin was assessed by its ability to induce phagocytosis of latex particles, and to reduce nitroblue tetrazolium (NBT). Approximately 51% of 0.2 microM hypericin-treated cells were stained with NBT and 63% showed phagocytic activity. In order to establish whether hypericin induces differentiation of U-937 cells to macrophage or granulocyte, esterase activities and cell sizes were measured. When U-937 cells were treated with 0.2 microM and 0.15 microM of hypericin, the alpha-naphthyl acetate esterase activity was increased by 38.4% and 48.1%, respectively, but naphthol AS-D chloroacetate esterase activity was not influenced. The size of hypericin-treated cells in terms of cell mass was larger than that observed in untreated cells as determined by flow cytometry. Protein kinase C (PKC) inhibitor, NA-382, decreased the NBT reducing activity of hypericin, whereas a cAMP-dependent protein kinase A (PKA) inhibitor, H-89, did not show any influence on the differentiation. These results indicate that hypericin triggers differentiation toward monocyte/macrophage lineage by PKC stimulation.

Significant cholinergic role in secretin-stimulated exocrine secretion in isolated rat pancreas

Effects of intrapancreatic cholinergic activation by electrical field stimulation (EFS) on secretin-stimulated pancreatic exocrine secretion were investigated in the totally isolated perfused rat pancreas. EFS at 15 V, 2 ms, and 8 Hz for 45 min markedly increased spontaneous pancreatic secretion. This increase was completely inhibited by tetrodotoxin (1 microM) but not by hexamethonium (100 microM). Atropine (2 microM) significantly reduced the EFS-evoked volume flow and amylase output by 52% and 80%, respectively. EFS further increased the secretin (12 pM)-stimulated pancreatic secretion of fluid and amylase. The increases of the two parameters were significantly suppressed by atropine by 28% and 72%, respectively. Interestingly, EFS significantly increased concentrations of somatostatin-like immunoreactivity in portal venous effluents. When pertussis toxin (200 ng/ml) or rabbit antisomatostatin serum (0.1 ml/10 ml; titer of 1:50,000) was intra-arterially administered, EFS further increased the secretin-stimulated pancreatic secretion. In conclusion, the activation of intrapancreatic cholinergic neurons potentiated the secretin action on pancreatic exocrine secretion in the rat. This potentiating effect was significantly reduced by local somatostatin released during EFS that activated intrapancreatic cholinergic tone.

A potent anti-diabetic agent from Kalopanax pictus

To search for the anti-diabetic principle from the stem bark of Kalopanax pictus, seven kinds of chemical constituents including hedearagenin glycosides and phenolic glycosides were isolated. The anti-diabetic evaluation of these isolates in the streptozotocin-induced diabetic rats exhibited that kalopanaxsaponin A has a potent anti-diabetic activity in contrast to a mild activity of hedearagenin. In addition, significant hypocholesterolemic and hypolipidemic activities of kalopanaxsaponin A and hedearagenin were observed. The structure-activity relationship of kalopanaxsaponin A was also investigated in the present work.

Afferent innervation of the rat pancreas: retrograde tracing and immunohistochemistry in the dorsal root ganglia

This study was undertaken to determine the segmental organization of the dorsal root ganglion (DRG) cells that give rise to pancreatic afferents containing a certain neuropeptide in the rat. These cells were examined using retrograde tracing combined with immunohistochemistry. Injection of horseradish peroxidase (HRP) into the pancreas resulted in the labeling of cells in bilateral T5-L2 DRGs, with most labeled cells lying at T10-T11. Injection into the duodenal (right), splenic (left), and entire lobes consistently produced more labeled cells significantly in the right, left, and right DRGs, respectively. Calcitonin gene-related peptide (CGRP)-, substance P (SP)-, somatostatin (SOM)-, and galanin (GAL)-immunoreactive (IR) cells in the DRGs (T9-T12) were found in -52, 17, 8, and 6%, respectively, but neuropeptide Y- and vasoactive intestinal polypeptide-IR cells were not found. About 88% of HRP-labeled cells in DRGs (T9-T12) contained CGRP, and approximately 16% of them contained SP. Although SOM- and GAL-IR cells were localized in the DRGs, these cells innervating the pancreas could not be found. In brief, these results show that bilateral (not similar in cell number on each side) DRG cells innervate the duodenal or splenic pancreas, and the majority of these cells that project to the pancreas contain CGRP and SP.

Identification and activation mechanism of the interleukin-4-induced nuclear factor binding to the CD23(b) promoter in human B lymphocytes

CD23 is a B cell activation antigen involved in B cell proliferation and production of IgE, of which two isoforms are known. While CD23(a) is constitutively expressed in B cells, the expression of CD23(b) is specifically induced by interleukin-4 (IL-4) or selected mitogenic stimuli. We have previously shown that CD23(b) is a primary response gene rapidly activated by IL-4 in resting human B cells. We now report the identification of a nuclear factor binding to the IL-4-response element (IL-4RE) in CD23(b) promoter in purified human tonsillar B cells. Activation of this factor, named NF-IL-4/CD23, occurred within 5 min after IL-4 treatment in a cycloheximide-insensitive manner. The activation was sensitive to phosphatases and inhibitors of protein tyrosine kinases, but it was not sensitive to inhibitors of protein kinase C. This behavior, in fact, closely correlates with the IL-4-induced activation mechanism of CD23 gene expression. In transformed B cell line Raji, where the IL-4-induced CD23 mRNA expression was hardly detected, no activation of NF-IL-4/CD23 was noted. The activation was also observed that although a sequence highly homologous to the IL-4RE of the CD23(b) promoter is present in the CD23(a) promoter, the IL-4-induced factor did not bind the sequence. These results strongly suggest that NF-IL-4/CD23 acts as an IL-4 signal transducer leading to CD23(b) gene activation in human B cells. Further characterization of this factor is now in progress, including comparison with STAT6, recently shown to be involved in IL-4 signal transduction and transcriptional activation.

Immunocytochemical localization of calcium-binding protein calretinin containing neurons in cat visual cortex

The distribution and morphology of neurons containing calretinin in area 17 of the cat visual cortex were studied. The calcium-binding protein calretinin was localized by antibody immunocytochemistry. Most of the calretinin-labeled neurons were located in layers I, II, and III. There were few calretinin-labeled cells in the other layers. The labeled neurons varied in morphology. The majority of the labeled neurons had small round or oval somas with long processes traveling perpendicular to the pial surface. Many small multipolar neurons were also labeled by this antibody. These results indicate that the calcium-binding protein calretinin is contained both in specific layers and selective cell types in the cat primary visual cortex.

Effect of erythromycin on gastric emptying in healthy individuals assessed by radio-opaque markers and plasma acetaminophen levels

We simultaneously recorded gastric emptying of radio-opaque markers (ROMs) and monitored serial changes in plasma acetaminophen (AAP) levels to demonstrate the relationship between the ROM and the AAP methods, and we investigated the effect of a single intravenous dose of erythromycin (EM) on gastric emptying in healthy human subjects. After an overnight fast, subjects were randomized to receive either placebo or EM lactobionate (Abbott, North Chicago, IL, USA) 250 mg intravenously in a single dose, given immediately before a standard meal. Subjects ingested 1.5 g of AAP and ROMs with the test meal. A supine plain abdominal radiograph was taken 1, 2, 3, and 6 h after ingestion of the test meal. Peripheral blood samples were obtained 0, 0.5, 1, 1.5, 2, 3, and 6 h after ingestion of the test meal. EM significantly accelerated gastric emptying of ROMs. By 6 h, no markers remained in the stomach in any of the subjects in the placebo or EM groups. By 120 min, half of the ROMs had passed into the duodenum in 12.5% of subjects after placebo, whereas EM injection resulted in gastric emptying of half of the ROMs in all subjects. There was no difference in plasma AAP concentration between the placebo and EM groups. There were significant correlations between maximum plasma AAP concentration and gastric emptying of ROMs 120 min after ingestion (r = 0.546; P = 0.019), and between time of maximum plasma AAP concentration and gastric emptying of ROMs 120 min after ingestion (r = -0.568; P = 0.014). The time taken to reach the peak concentrations ranged from 30 to 90 min after ingestion, whereas most ROMs were emptied 120 min after ingestion. We conclude that the gastric emptying assessed by ROMs and by serial changes in plasma AAP level are good, non-invasive, clinically applicable tests, with a significant correlation between the two tests. A single intravenous dose of EM had a prokinetic effect on gastric emptying, assessed by ROMs, in healthy human subjects.

Temporal corneal phacoemulsification in patients with filtered glaucoma

OBJECTIVE

To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that underwent prior trabeculectomy.

DESIGN

Retrospective case-control study.

PATIENTS

Forty consecutive patients who underwent temporal clear corneal phacoemulsification subsequent to trabeculectomy (trabeculectomy-phacoemulsification group) were identified, and 40 control patients who underwent trabeculectomy alone (trabeculectomy group) were matched to the case patients for length of follow-up, age, IOP, number of antiglaucoma medications, number of 5-fluorouracil injections, race, sex, and diagnosis.

MAIN OUTCOME MEASURES

Intraocular pressure before vs 1 year after phacoemulsification in the trabeculectomy-phacoemulsification group compared with IOP in the trabeculectomy group and survival analysis of IOP control after trabeculectomy in the 2 groups.

RESULTS

In the trabeculectomy-phacoemulsification group, IOP 1 year after phacoemulsification was not significantly different from the prephacoemulsification IOP value (P = .65). Kaplan-Meier survival analysis showed that the rates of IOP control 3, 6, and 9 years after trabeculectomy in the trabeculectomy-phacoemulsification group were 80%, 66%, and 44%, respectively; in the trabeculectomy group, these were 79%, 69%, and 55%, respectively. These survival curves were not statistically different (P = .55).

CONCLUSION

Cataract surgery by temporal clear corneal phacoemulsification in eyes with filtering blebs after trabeculectomy does not adversely affect long-term IOP control.

Functional analysis of the evolutionary conserved arginine 182 residue in human glutathione S-transferase P1-1

The mutational replacement of Arg182 with threonine markedly decreased the specific activities for GSH-conjugation reaction. The Kcat of R182T for GSH-[1-chloro-2,4-dinitrobenzene] conjugation reaction was about 100-fold smaller than that of the wild type. On the other hand, the affinity for GSH of R182T was not significantly affected. The pKa of the thiol group of GSH bound in R182T was approximately 0.9 pK units higher than those in the wild type, but the Kcat/Km1-chloro-2,4-dinitrobenzene values at high pH were not so much lower than those of the wild type. The thermostability of R182T was significantly lower than that of the wild type. Therefore, Arg182 seems to be important for the construction of the active enzyme structure.

Expression of the nicotinic acetylcholine receptor subunit, alpha9, in the guinea pig cochlea

Acetylcholine is a major neurotransmitter of the cochlear efferent system. Based on its high level of expression in hair cells, the recently cloned nicotinic receptor subunit, alpha9 [Elgoyhen et al., Cell 79 (1994) 705-715], is likely to be the postsynaptic receptor for acetylcholine in hair cells either as a homomeric complex or with other subunits yet to be identified. To further study this receptor, we cloned and sequenced alpha9 cDNA from the guinea pig organ of Corti library [Wilcox and Fex, Hear. Res. 62 (1992) 124-126]. The sequence of the guinea pig alpha9 cDNA is similar to that of the rat, with identities of 85% and 89% at the nucleotide and amino acid levels, respectively. Most differences are in the cytoplasmic loop domain between the transmembrane segments 3 and 4. We also observed minor differences in the putative ligand binding regions. Pharmacological differences between acetylcholine receptors on outer hair cells of rat and guinea pig have been reported, and the minor structural changes we observe could account for these differences. Reverse transcription-polymerase chain reaction analysis showed a high expression of alpha9 in the organ of Corti while expression was low or not detected in the spiral ganglion. In situ hybridization histochemistry showed expression of alpha9 mRNA in both inner and outer hair cells, with much higher expression in outer hair cells than in inner hair cells. In the inner hair cell, silver grains were more abundant over the basal part of the cell than over the apical part. Immunocytochemistry showed a pattern of distribution of the alpha9 protein similar to that seen for mRNA with in situ hybridization. Immunolabeling was most intense at the bases of both inner and outer hair cells. To determine the effect of hair cell loss on alpha9 expression, hair cells were destroyed by either systemic or local application of kanamycin. This treatment led to a down regulation of alpha9 in hair cells; this down regulation appeared to precede hair cell degeneration. In the spiral ganglion, a transient up regulation of alpha9, as determined by RT-PCR, was seen 4-6 weeks after kanamycin treatment.

A prospective study of the accuracy of clinical examination evaluated by arthroscopy of the knee

The diagnostic accuracy of clinical examination for internal derangement of the knee were evaluated by arthroscopy in 195 patients (200 knees). Radiographs were available and 50 patients had magnetic resonance imaging. The clinical diagnosis was correct in 104 knees (52%), incomplete in 70 (35%) and incorrect in 26 (13%). When there was a single abnormality the diagnosis was correct in 70%, but when more than 3 lesions were discovered the figure was 28%. All individual lesions were diagnosed correctly in more than 90%. The lesions most difficult to diagnose were chondral fractures, partial tears of the anterior cruciate ligament and loose bodies. Knees with acute lesions and those with a single diagnosis were significantly easier to diagnose (p < 0.01). Age, sex, MRI and the surgeon were not significant.

Eosinophil cationic protein (ECP) level and its correlation with eosinophil number or IgE level of peripheral blood in patients with various skin diseases

Eosinophil cationic protein (ECP) is a cationic protein derived from eosinophil granulocytes, and has been studied mainly in atopic diseases and considered as a useful marker of disease activity in atopic dermatitis. We measured the serum ECP levels in patients with various skin diseases (n = 875) and in normal healthy controls (n = 79), and evaluated the correlation between ECP level and blood eosinophil number, or ECP and IgE levels. Serum ECP levels were significantly higher in patients with drug eruption (15.8 +/- 1.7 micrograms/l), psoriasis (15.1 +/- 6.0 micrograms/l), acute urticaria (13.9 +/- 1.4 micrograms/l) than in healthy controls (4.5 +/- 0.3 micrograms/l) (P < 0.05) and also significantly elevated in patients with elevated eosinophil numbers (15.2 +/- 1.0 micrograms/l) compared to those in patients with normal eosinophil numbers (8.8 +/- 0.3 micrograms/l) (P < 0.001). Serum ECP level and eosinophil number in peripheral blood were also correlated in patients with psoriasis (gamma = 0.82, P < 0.01), drug eruption (gamma = 0.31, P < 0.01) and acute urticaria (gamma = 0.20, P < 0.05). However, no correlation between ECP and IgE levels in all of the patients was found. Among the patients with chronic urticaria, ECP levels showed an increasing trend in patients with angioedema, cold urticaria and dermographic urticaria as compared with those in healthy controls. Our results suggest that, even though the role of ECP released from activated eosinophils is still unknown, its measurement might be of help to understand the pathogenesis of some skin disorders.

Adult T-cell leukemia/lymphoma with features of CD30-positive anaplastic large cell lymphoma--a case report

We experienced a 58-year-old Korean man with adult T-cell leukemia/lymphoma with features of histologically anaplastic large cell lymphoma involving the skin and testis. The patient had cutaneous nodules in both extremities and a palpable right testicular mass. Right orchiectomy was performed and specimens of removed testicle and skin nodules showed immunohistologically anaplastic large cell lymphoma with T-cell phenotype, and CD30 antigen was positive. A human T-cell lymphotropic virus type 1 (HTLV-1) antibody titer was over 1 : 256 and integration of HTLV-1 proviral DNA pX gene was identified in the peripheral blood mononuclear cells and lymphoma tissue by polymerase chain reaction. Peripheral blood and bone marrow did not show any evidence of characteristic neoplastic T-cells.

Congenital bronchoesophageal fistula associated with esophageal diverticulum in the adult

Congenital bronchoesophageal fistula is a rare clinical entity in adults. This anomaly may cause various symptoms such as respiratory infections, coughing bouts when eating or drinking, and even hemoptysis. The fistula can cause symptoms in childhood but may not appear until adulthood. We recently experienced a case of congenital bronchoesophageal fistula associated with esophageal diverticulum in an adult. A 63-year-old woman was admitted to our hospital due to chest discomfort, sore throat and coughing bouts when eating. An empyema with lung abscess had occurred eight years previously. Results of the physical examination were unremarkable. A Barium swallowing revealed a medium-sized diverticulum at the right anterior aspect of the esophagus, which had developed a fistulous connection with the right lower lobe bronchus. The patient was treated by fistulectomy and lobectomy of the right lower lobe. The postoperative course was smooth and uneventful.

Radiation-induced apoptosis in different pH environments in vitro

PURPOSE

The effect of environmental pH on the radiation-induced apoptosis in tumor cells in vitro was investigated.

METHODS AND MATERIALS

Mammary adenocarcinoma cells of A/J mice (SCK cells) were irradiated with gamma-rays using a 137Cs irradiator and incubated in media of different pHs. After incubation at 37 degrees C for 24-120 h the extent of apoptosis was determined using agarose gel electrophoresis, TdT-mediated dUTP-biotin nick end labeling (TUNEL) staining, flow cytometry, and release of 3H from 3H-thymidine labeled cells. The clonogenicity of the cells irradiated in different pH medium was determined, and the progression of cells through the cell cycle after irradiation in different pHs was also determined with flow cytometry.

RESULTS

Irradiation with 2-12 Gy of gamma-rays induced apoptosis in SCK cells in pH 7.5 medium within 48 h as judged from the results of four different assays mentioned. Radiation-induced apoptosis declined as the medium pH was lowered from 7.5 to 6.4. Specifically, the radiation-induced degradation of DNA including the early DNA breaks, as determined with the TUNEL method, progressively declined as the medium pH was lowered so that little DNA fragmentation occurred 48 h after irradiation with 12 Gy in pH 6.6 medium. When the cells were irradiated and incubated for 48 h in pH 6.6 medium and the medium was replaced with pH 7.5 medium, DNA fragmentation promptly occurred. DNA fragmentation also occurred even in pH 6.6 medium when the cells were irradiated and maintained in pH 7.5 medium for 8 h or longer post-irradiation before incubation in pH 6.6 medium. The radiation-induced G2 arrest in pH 6.6 medium lasted markedly longer than that in pH 7.5 medium.

CONCLUSION

Radiation-induced apoptosis in SCK cells in vitro is reversibly suppressed in an acidic environment. Taking the results of four different assays together, it was concluded that early step(s) in the apoptotic pathway, probably the DNA break or upstream of DNA break, is reversibly halted by an acidic environment in irradiated cells. Radiation-induced G2 arrest is prolonged in an acidic environment indicating that the suppression of radiation-induced apoptosis and prolongation of radiation-induced G2 arrest in an acidic environment are related.

Circumferential profiles of peripapillary surface height with confocal scanning laser ophthalmoscopy

The purpose of this study was to compare the circumferential profiles of relative peripapillary retinal surface height (RPSH) between normal and glaucoma, with a confocal scanning laser ophthalmology (CSLO), and to examine the ability of the mean height to distinguish glaucoma from normal. Fifty-three patients with open-angle glaucoma and forty-three normal subjects matched for age, race and refractive error were studied. To extract circumferential profiles, we developed software to quantify RPSH from images obtained with a CSLO (Heidelberg Retina Tomograph (HRT), Heidelberg Engineering, Germany, Software: IR1-V1.11) outside the optic disc margin every 50 microns. Mean heights from circumferential profiles were calculated and compared between normal and glaucoma. Receiver operating characteristic (ROC) curves were used to evaluate sensitivity and specificity of the mean height to discriminate normal from glaucoma subjects. T he average (+/- SD) visual field mean deviation in the glaucoma group was -4.8 +/- 3.4dB. The average height of each circumference increased from the disc margin to 250 microns away in both normal and glaucoma subjects. There were statistically significant differences for the mean height (P < 0.001) between the two groups. The largest difference between normal and glaucoma was found in the inferior sector compared with the other sectors (p < 0.001). The sensitivity, specificity and diagnostic precision of the mean height were 83%, 67% and 76%, respectively. The mean height from the circumferential profiles of RPSH can be used as a useful marker to identify early glaucoma.

P53 overexpression in gastric adenocarcinoma with Helicobacter pylori infection

Gastric carcinogenesis has been studied in various aspects. Helicobacter pylori (Hp) infection and mutation of the p53 tumor suppressor gene have recently been argued to be important factors of gastric carcinogenesis. There have been many studies to determine the precise mechanism of how Hp is related to gastric cancer, but it is so far still unknown. We studied the relationship of Hp infection and p53 overexpression and tried to discover some significance in clinicopathologic factors such as age, sex, stage, site, differentiation and gross morphology. Ninety-six patients who were diagnosed with gastric cancer at Severance Hospital, Yonsei University Medical College from November 1995 to March 1996, and 96 control patients of non-ulcer dyspepsia (NUD) were studied by endoscopic biopsy of normal gastric tissue and cancer tissue. They also underwent the CLO (Delta West, Melbourne, Western Australia) test for Hp positivity and p53 immunohistochemical stain for p53 positivity. These data were analyzed for comparison with the clinicopathologic characteristics of gastric cancers. In conclusion, the differentiated group cancer had a significantly high Hp positivity and p53 positivity. There is a possibility that Hp infection and p53 tumor suppressor gene mutation might be significantly related in the gastric carcinogenic process of well- and moderately-differentiated adenocarcinomas, but further study is necessary to determine more direct clues on the carcinogenic roles of these factors.

Temporal corneal phacoemulsification combined with superior trabeculectomy. A retrospective case-control study

OBJECTIVE

To determine the results of temporal corneal phacoemulsification combined with separate-incision superior trabeculectomy plus low-dose 5-fluorouracil compared with trabeculectomy plus low-dose 5-fluorouracil.

DESIGN

Retrospective case-control study.

PATIENTS

Forty consecutive case patients who underwent temporal corneal phacoemulsification combined with superior trabeculectomy plus low-dose 5-fluorouracil (case [combined surgery] group) and 40 control patients, matched for age race, preoperative intraocular pressure (IOP), number of preoperative antiglaucoma medications, and number of 5-fluorouracil injections, who underwent trabeculectomy alone plus low-dose 5-fluorouracil (control [trabeculectomy] group).

MAIN OUTCOME MEASURES

Survival analyses for IOP control compared between the 2 groups.

METHODS

The medical records of 40 consecutive case patients were reviewed to determine the effect of their treatment on IOP, visual acuity, and requirement for glaucoma medications. In the control group, 40 eyes (1 eye per patient) were randomly selected for comparison with the case group. In both groups, the trabeculectomy was located superiorly and performed with the same technique and using a limbus-based conjunctival flap. In the case group, temporal corneal phacoemulsification immediately preceded trabeculectomy and used a 3.2-mm incision and a 1-piece silicone intraocular lens. All patients received 3 or 4 subconjunctival 5-fluorouracil injections of 5 mg each within the first 11 postoperative days. Patients were followed up for at least 1 year. Success of surgery was defined as an IOP of less than 22 mm Hg and a 20% or more reduction from the preoperative level on 2 consecutive follow-up visits, regardless of the use of antiglaucoma medications.

RESULTS

The mean (+/-SD) postoperative IOP was statistically higher in the case group than in the control group at each follow-up interval (P < .05). The mean (+/-SD) IOP reductions at 1 year were 6.8 +/- 5.5 mm Hg and 10.3 +/- 7.6 mm Hg (39.2% +/- 18.8%) in the case and control groups, respectively (P = .04). The reductions in the mean (+/-SD) number of antiglaucoma medications at 1 year were 1.6 +/- 0.9 and 2.0 +/- 1.0 in the case and control groups, respectively (P = .06). In the case group, the mean visual acuity beyond the first postoperative month was significantly better than at baseline (P < .001). Kaplan-Meier survival analysis showed that the cumulative success rates at 2 years were 62.1% and 85.8% in the case and control groups, respectively. The survival time to failure was significantly shorter (P = .04) in the case group by the log-rank test.

CONCLUSIONS

Combined surgery for cataract and glaucoma is associated with less long-term IOP reduction compared with trabeculectomy alone despite identical trabeculectomy techniques used in both groups. Nevertheless, combined surgery lowers IOP and reduces the long-term requirement for antiglaucoma medications. This technique is appropriate in selected patients with coexisting cataract and glaucoma.

Nitinol self-expanding stents: when severe twisting occurs, self-expansion may ensue after a waiting period

One of the major disadvantages of nitinol endocoil stents is said to be incomplete deployment leading to twisting and stent dysfunction. We report a patient with irresectable pancreatic head cancer where severe twisting of the nitinol stent occurred which resolved on the day after stent insertion; the stent took its normal shape ten days later, whereafter the patient lived without stent-related problems for one year until his death. This shows that prospective management rather than immediate stent extraction may be warranted in such cases of stent dysfunction.

Temporal corneal phacoemulsification in filtered glaucoma patients

PURPOSE

To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that had prior trabeculectomy.

DESIGN

Retrospective case-control study.

PATIENTS

Forty consecutive patients (cases; TRAB-PHACO group) who underwent temporal corneal phacoemulsification subsequent to trabeculectomy were identified. Forty patients (controls; TRAB group) who had trabeculectomy alone were matched to the cases for length of follow-up, age, IOP, number of anti-glaucoma medications, number of 5-fluorouracil (5-FU) injections, race, sex and diagnosis.

MAIN OUTCOME MEASURES

Comparison of IOP before and one year after phacoemulsification in the TRAB-PHACO group, and comparison with the TRAB group. Survival analysis of IOP control after trabeculectomy in the TRAB-PHACO and TRAB groups.

RESULTS

In the TRAB-PHACO group, IOP one year after phacoemulsification was not significantly different from the pre-phacoemulsification IOP value (p = 0.65). Kaplan-Meier survival analysis showed that the rates of IOP control at 3, 6 and 9 years after trabeculectomy in the TRAB-PHACO group were 80%, 66% and 44%; in the TRAB group these were 79%, 69% and 55%. These survival curves were not statistically different (p = 0.55).

CONCLUSIONS

Cataract surgery by temporal clear corneal phacoemulsification in eyes with filtering blebs after trabeculectomy does not adversely affect long term IOP control.

Effects of triterpenoid glycosides of the dammaran series and their aglycons on phase transitions of dipalmitoylphosphatidylcholine

The effects of triterpenoid glycosides from Korean red ginseng Panax C.A. Meyer and their aglycons on the phase transitions of model DPPC membranes were studied by microcalorimetry. Glycosides Rb1, Rg1, 20(S) protopanaxadiol only slightly interacted with the DPPC gel phase and caused no formation of new phases. At concentrations close to equimolar values, the glycosides slightly disturbed the packing of lipids and induced the formation of the second phases with more dense lipid packing but smaller sizes of the cooperative domains as compared with pure lipid. Cholesterol (3%) produced no effect on the DPPC interaction with Rb1, Rg1 and panaxatriol but affected the DPPC interaction with panaxadiol. At equimolar panaxadiol/DPPC ratio and in the presence of 3% cholesterol, panaxadiol completely eliminated the main transition.