Systemic chemotherapy for gastric carcinoma followed by postoperative intraperitoneal therapy: a final report

BACKGROUND

Because only approximately 50% of gastric carcinomas are resectable for cure, the authors hypothesized that effective systemic preoperative (neoadjuvant) chemotherapy, aimed at decreasing the size and extent of the primary tumor and eradicating distant microscopic disease, may increase the rate of resectability and have a greater impact on survival than postoperative (adjuvant) treatment alone. In addition, because the peritoneal cavity is the most common site of first recurrence after successful gastric cancer resection, intraperitoneal (IP) chemotherapy seemed a logical choice for postoperative (adjuvant) treatment.

METHODS

Fifty-nine patients with invasive primary gastric adenocarcinoma who were deemed resectable for cure entered a clinical trial that called for 2 cycles of protracted infusion 5-fluorouracil with weekly leucovorin and cisplatin chemotherapy followed by surgery. Approximately 3-4 weeks after potentially curative surgery, patients were scheduled to receive two cycles of IP 5-fluoro-2'deoxyuridine and cisplatin.

RESULTS

Of the 59 patients studied, 58 (98%) received both cycles of systemic chemotherapy. Fifty-six patients (95%) underwent surgery: 40 patients (71%) had resections intended to cure for Stage 0-IIIB disease, 15 patients (27%) had palliative surgery for Stage IV gastric carcinoma, and one patient died intraoperatively without being staged. Two patients refused surgery, and the remaining patient died of progressive disease prior to surgery. Thirty-one of the 40 patients who underwent curative surgery completed both cycles of postoperative IP therapy; 4 patients received only 1 cycle. Three patients (5%) died secondary to treatment complications. There were two operative deaths, and one patient died of peritonitis associated with Grade 4 granulocytopenia. Nine of the 40 patients (23%) whose carcinomas were resected for cure had recurrent carcinoma. With a median follow-up period now exceeding 45 months, the calculated median survival for the 59 patients entered into the trial is >4 years.

CONCLUSIONS

This program of preoperative systemic and postoperative IP chemotherapy has been found to be safe and appears to decrease gastric carcinoma recurrence rates and increase survival compared with historic controls.

Systemic chemotherapy for gastric carcinoma followed by postoperative intraperitoneal therapy: a final report

BACKGROUND

Because only approximately 50% of gastric carcinomas are resectable for cure, the authors hypothesized that effective systemic preoperative (neoadjuvant) chemotherapy, aimed at decreasing the size and extent of the primary tumor and eradicating distant microscopic disease, may increase the rate of resectability and have a greater impact on survival than postoperative (adjuvant) treatment alone. In addition, because the peritoneal cavity is the most common site of first recurrence after successful gastric cancer resection, intraperitoneal (IP) chemotherapy seemed a logical choice for postoperative (adjuvant) treatment.

METHODS

Fifty-nine patients with invasive primary gastric adenocarcinoma who were deemed resectable for cure entered a clinical trial that called for 2 cycles of protracted infusion 5-fluorouracil with weekly leucovorin and cisplatin chemotherapy followed by surgery. Approximately 3-4 weeks after potentially curative surgery, patients were scheduled to receive two cycles of IP 5-fluoro-2'deoxyuridine and cisplatin.

RESULTS

Of the 59 patients studied, 58 (98%) received both cycles of systemic chemotherapy. Fifty-six patients (95%) underwent surgery: 40 patients (71%) had resections intended to cure for Stage 0-IIIB disease, 15 patients (27%) had palliative surgery for Stage IV gastric carcinoma, and one patient died intraoperatively without being staged. Two patients refused surgery, and the remaining patient died of progressive disease prior to surgery. Thirty-one of the 40 patients who underwent curative surgery completed both cycles of postoperative IP therapy; 4 patients received only 1 cycle. Three patients (5%) died secondary to treatment complications. There were two operative deaths, and one patient died of peritonitis associated with Grade 4 granulocytopenia. Nine of the 40 patients (23%) whose carcinomas were resected for cure had recurrent carcinoma. With a median follow-up period now exceeding 45 months, the calculated median survival for the 59 patients entered into the trial is >4 years.

CONCLUSIONS

This program of preoperative systemic and postoperative IP chemotherapy has been found to be safe and appears to decrease gastric carcinoma recurrence rates and increase survival compared with historic controls.

Systemic chemotherapy for gastric carcinoma followed by postoperative intraperitoneal therapy: a final report

BACKGROUND

Because only approximately 50% of gastric carcinomas are resectable for cure, the authors hypothesized that effective systemic preoperative (neoadjuvant) chemotherapy, aimed at decreasing the size and extent of the primary tumor and eradicating distant microscopic disease, may increase the rate of resectability and have a greater impact on survival than postoperative (adjuvant) treatment alone. In addition, because the peritoneal cavity is the most common site of first recurrence after successful gastric cancer resection, intraperitoneal (IP) chemotherapy seemed a logical choice for postoperative (adjuvant) treatment.

METHODS

Fifty-nine patients with invasive primary gastric adenocarcinoma who were deemed resectable for cure entered a clinical trial that called for 2 cycles of protracted infusion 5-fluorouracil with weekly leucovorin and cisplatin chemotherapy followed by surgery. Approximately 3-4 weeks after potentially curative surgery, patients were scheduled to receive two cycles of IP 5-fluoro-2'deoxyuridine and cisplatin.

RESULTS

Of the 59 patients studied, 58 (98%) received both cycles of systemic chemotherapy. Fifty-six patients (95%) underwent surgery: 40 patients (71%) had resections intended to cure for Stage 0-IIIB disease, 15 patients (27%) had palliative surgery for Stage IV gastric carcinoma, and one patient died intraoperatively without being staged. Two patients refused surgery, and the remaining patient died of progressive disease prior to surgery. Thirty-one of the 40 patients who underwent curative surgery completed both cycles of postoperative IP therapy; 4 patients received only 1 cycle. Three patients (5%) died secondary to treatment complications. There were two operative deaths, and one patient died of peritonitis associated with Grade 4 granulocytopenia. Nine of the 40 patients (23%) whose carcinomas were resected for cure had recurrent carcinoma. With a median follow-up period now exceeding 45 months, the calculated median survival for the 59 patients entered into the trial is >4 years.

CONCLUSIONS

This program of preoperative systemic and postoperative IP chemotherapy has been found to be safe and appears to decrease gastric carcinoma recurrence rates and increase survival compared with historic controls.

Variants of chromosome 9 in phenotypically normal individuals

The human chromosome 9 displays the highest degree of structural variability. Four different types of variants are described including pericentric inversion, extra G-positive band in the q arm, additional G-positive band in the p arm and duplication of band 9q21-q22. It is important to demonstrate inheritance from a phenotypically normal individual in order to differentiate between a variant chromosome and an abnormal chromosome.

[Effects of lithium chloride and harringtonine on the differentiation, proliferation and c-myc proto-oncogene expression of HL-60 cells]

This research was to observe the effects of lithium chloride (LiCl) and Harringtonine (HT) on the proliferation and differentiation of HL-60 leukemia cells. The results obtained by liquid suspension culture, semi-solid colony culture and 3H-TdR incorporation into HL-60 cells indicated that different concentrations of LiCl (5-20 mmol/L) and HT (10(-8)-10(-5)mol/L) exerted the inhibitory effects in a dose-dependent manner on HL-60 cell proliferation respectively. When LiCl (10 mmol/L) and HT (10(-7) mol/L) were added together in the liquid culture or semi-solid culture of HL-60 cells, they showed much greater inhibitory effect than that by each agent separately. It was discovered that there was induction of the differentiation of HL-60 cells by lithium and HT and the induction of HL-60 cells differentiation by HT was markedly enhanced by the addition of low concentration of lithium. This work also showed that by treating HL-60 cells with lithium and HT, the expression of the c-myc proto-oncogene was markedly decreased as measured by RT/PCR-mRNA (P < 0.01). These findings provide some evidence of the mechanismcausing leukemic change and of the potential use of lithium and HT in the treatment of leukemia and in vitro purging of leukemic cells for autologous bone marrow transplantation.

Presence of inflammatory mediators in the tears of contact lens wearers and non-contact lens wearers

The present studies have demonstrated the levels of N-methyl histamine in tears from normal physiological states, pathological states and contact lens wear. Histamine was significantly increased in closed eye tears compared with both open and reflex tears. Tears from other ocular conditions had low levels of histamine except for environmental hypersensitivity, which contained significantly elevated levels compared to normal tear types. Interestingly, tears from asymptomatic contact lens wearers had significant levels of histamine whereas tears from contact lens adverse events had lower levels, possibly reflecting a change in histamine metabolism.

Association of ventricular arrhythmias with left ventricular remodelling after myocardial infarction

OBJECTIVE

To assess the relation between ventricular arrhythmias after myocardial infarction and left ventricular remodelling.

DESIGN

Prospective study with consecutive patients.

METHODS

97 patients with acute myocardial infarction underwent serial echocardiographic examinations (days 1, 2, 3, and 7, and after 3 weeks) to determine end diastolic volume, end systolic volume, and ejection fraction; volumes were normalised for body surface area and expressed as indices. Holter monitoring was performed on the day of the final echocardiogram. Coronary angiography was performed in 88 patients before hospital discharge.

RESULTS

Complex ventricular arrhythmias (defined as Lown class 3-5) were found in 16 of 97 patients. In logistic regression models, variables predictive of complex ventricular arrhythmias were end systolic volume index on admission (b = 0.054, P = 0.015) and end diastolic volume index after three weeks (b = 0.034, P = 0.012). Complex arrhythmias were also related to the increase of end diastolic and end systolic volume indices throughout the study (F = 5.62, P = 0.046, and F = 6.42, P = 0.017, respectively by MANOVA). A two stage linear regression model of ventricular volume versus time from infarct showed that both intercept (initial volume) and slope (rate of increase) were higher for patients with complex arrhythmias in both diastole and systole (P < 0.001 for all).

CONCLUSIONS

Complex ventricular arrhythmias after myocardial infarction are related to the increase of left ventricular volume rather than to depressed ejection fraction. Complex arrhythmias may be an aetiological factor linking left ventricular remodelling with higher mortality, but larger follow up studies of patients with progressive left ventricular dilatation after myocardial infarction are necessary to answer these questions.

[Mutation of p53 gene in the transformed fibroblasts detected by nonradioisotopic single strand conformation polymorphism analysis]

The human embryonic lung fibroblasts transformation was induced by chemical mutant Glycidyl Methacrylate (GMA) in vitro. Transformed clonies were isolated and then exon 5 and exon 8 of p53 gene were specifically amplified by polymerase chain reaction. Amplified fragments were detected by using silver stained single strand conformation polymorphism analysis. The results showed that exon 8 altered in the transformed cells, indicating that p53 gene played an important role in the human embryonic lung fibroblasts transformation induced by GMA.

Biofeedback therapy for bowel dysfunction following low anterior resection

Faecal incontinence and intractable constipation after low anterior resection (LAR) can be refractory to expectancy and appropriate anti-diarrhoeal or laxative medications. The efficacy of anorectal biofeedback therapy (BF) in this clinical situation was prospectively assessed. Eleven patients [5 men and 6 women; mean age 64.8 years; standard error of the mean (SEM) 3.3 years] had either faecal incontinence or intractable constipation which did not settle with medications, for at least 6 months [mean 33.3 (SEM 6.1) months] after LAR. They all underwent 4 sessions of outpatient BF. Assessment was by continence questionnaire and anorectal physiology tests, which were administered before and after BF. In 6 of 6 incontinent patients, weekly incontinent episodes were decreased [14.8 (SEM 2.1] before, 1.8 (SEM 0.8) after; P < 0.05) and anti-diarrhoeal drug requirements were reduced (needed in 6 before, 0 after; P < 0.05) after BF. In the 5 intractible constipation patients, the weekly stool frequency was improved [3 (SEM 0.5) before, 8.9 (SEM 1.6) after; P < 0.05] after BF. There were no significant changes in the anorectal physiology parameters after BF. At a mean follow-up of 12.9 (SEM 1.6) months, there were no regressions or complications. BF is a safe option for refractory bowel dysfunction following LAR.

Systemic chemotherapy for gastric carcinoma followed by postoperative intraperitoneal therapy: a final report

BACKGROUND

Because only approximately 50% of gastric carcinomas are resectable for cure, the authors hypothesized that effective systemic preoperative (neoadjuvant) chemotherapy, aimed at decreasing the size and extent of the primary tumor and eradicating distant microscopic disease, may increase the rate of resectability and have a greater impact on survival than postoperative (adjuvant) treatment alone. In addition, because the peritoneal cavity is the most common site of first recurrence after successful gastric cancer resection, intraperitoneal (IP) chemotherapy seemed a logical choice for postoperative (adjuvant) treatment.

METHODS

Fifty-nine patients with invasive primary gastric adenocarcinoma who were deemed resectable for cure entered a clinical trial that called for 2 cycles of protracted infusion 5-fluorouracil with weekly leucovorin and cisplatin chemotherapy followed by surgery. Approximately 3-4 weeks after potentially curative surgery, patients were scheduled to receive two cycles of IP 5-fluoro-2'deoxyuridine and cisplatin.

RESULTS

Of the 59 patients studied, 58 (98%) received both cycles of systemic chemotherapy. Fifty-six patients (95%) underwent surgery: 40 patients (71%) had resections intended to cure for Stage 0-IIIB disease, 15 patients (27%) had palliative surgery for Stage IV gastric carcinoma, and one patient died intraoperatively without being staged. Two patients refused surgery, and the remaining patient died of progressive disease prior to surgery. Thirty-one of the 40 patients who underwent curative surgery completed both cycles of postoperative IP therapy; 4 patients received only 1 cycle. Three patients (5%) died secondary to treatment complications. There were two operative deaths, and one patient died of peritonitis associated with Grade 4 granulocytopenia. Nine of the 40 patients (23%) whose carcinomas were resected for cure had recurrent carcinoma. With a median follow-up period now exceeding 45 months, the calculated median survival for the 59 patients entered into the trial is >4 years.

CONCLUSIONS

This program of preoperative systemic and postoperative IP chemotherapy has been found to be safe and appears to decrease gastric carcinoma recurrence rates and increase survival compared with historic controls.

Overexpression of the c-erbB-2 gene enhanced intrinsic metastasis potential in human breast cancer cells without increasing their transformation abilities

Overexpression of the c-erbB-2 gene-encoded p185 has been reported in approximately 30% of human breast cancers and has been correlated with lymph node metastasis and poor prognosis in breast cancer patients. To investigate whether overexpression of p185 can enhance the metastatic potential of human breast cancer cells, we have introduced the human c-erbB-2 gene into the very low p185-expressing MDA-MB-435 human breast cancer cells and established 435.eB transfectants that express higher levels of p185. In this study, we compared the metastatic phenotypes of the parental MDA-MB-435 cells and the 435.eB transfectants. In vivo experimental metastasis assays in which we injected MDA-MB-435 parental cells or 435.eB transfectants into the tail veins of ICR-SCID mice demonstrated that mice injected with p185-overexpressing 435.eB transfectants formed significantly more metastatic tumors than the mice injected with parental and control cells. The changes in experimental metastatic potential in vivo were accompanied by increased invasiveness in vitro. In addition, the secretion of basement membrane-degradative enzymes, which is an important step in the invasion and metastasis process, was also increased in the p185-overexpressing 435.eB transfectants. These results indicated that p185 overexpression can enhance the metastatic potential of MDA-MB-435 human breast cancer cells. To investigate whether enhanced metastatic potential in the p185-overexpressing 435.eB transfectants was the result of increased cancer cell growth and transformation potential, we compared the growth rate, anchorage-independent growth ability, and tumorigenicity of the 435.eB transfectants with that of the parental cells. The transfectants and the parental cells all had similar growth rates and anchorage-independent growth abilities and demonstrated similar tumorigenic potential. These findings suggest that c-erbB-2 is a metastasis-promoting gene for breast cancers that is distinct from other tumor-promoting genes in that the c-erbB-2 gene can enhance the intrinsic metastatic potentials of MDA-MB-435 cells without increasing their transformation abilities.

Phase II study of liposomal doxorubicin in refractory ovarian cancer: antitumor activity and toxicity modification by liposomal encapsulation

PURPOSE

A phase II study of liposomal doxorubicin was conducted in patients with ovarian cancer who failed to respond to platinum- and paclitaxel-based regimens. Liposomal doxorubicin was selected as a result of its superior activity against ovarian cancer xenografts relative to free doxorubicin and activity in refractory ovarian cancer patients that was noted during the phase I study.

PATIENTS AND METHODS

Thirty-five consecutive patients were accrued in two institutions (22 in one and 13 in the other). All had progressive disease after either cisplatin or carboplatin and paclitaxel, or at least one platinum-based and one paclitaxel-based regimen. Patients received intravenous (I.V.) liposomal doxorubicin 50 mg/m2 every 3 weeks with a dose reduction to 40 mg/m2 in the event of grade 3 or 4 toxicities, or a lengthening of the interval to 4 weeks (and occasionally to 5 weeks) with persistence of grade 1 or 2 toxicities beyond 3 weeks.

RESULTS

Nine clinical responses (one complete response [CR], eight partial responses [PRs]) were observed in 35 patients (25.7%), with seven of these having been confirmed by two consecutive computed tomographic (CT) measurements. The median progression-free survival was 5.7 months with an overall survival of 1.5 to 24+ months (median, 11 months). Although 13 patients experienced grade 3 or 4 nonhematologic skin and mucosal toxicities (either hand-foot syndrome or stomatitis), with dose modifications, the treatment was very well tolerated. Nausea that was clearly attributable to the drug, hair loss, extravasation necrosis, or decreases in ejection fraction did not occur.

CONCLUSION

Liposomal doxorubicin has substantial activity against ovarian cancer refractory to platinum and paclitaxel. The responses achieved with liposomal doxorubicin were durable and maintained with minimal toxicity. This liposomal formulation should be evaluated further in combination with other drugs in less refractory patients.

Randomized controlled trial of trimebutine (anal sphincter relaxant) for pain after haemorrhoidectomy

BACKGROUND

Anal sphincter spasm may aggravate pain after haemorrhoidectomy. The aims of this study were to investigate whether a trimebutine suppository (Proctolog) reduced anal resting pressure and, subsequently, to test its efficacy in relieving pain after haemorrhoidectomy.

METHODS

Ten patients underwent anal manometry before and 4 h after Proctolog application. A controlled randomized trial was then conducted on 160 consecutive patients. A standard haemorrhoidectomy was performed. Eighty patients were then randomized to receive an application of Proctolog immediately after the procedure (group 1). The remaining 80 did not receive a suppository (controls, group 2). An independent, blinded observer determined the pain scores.

RESULTS

Proctolog resulted in a mean 35 per cent reduction in resting anal pressure (P < 0.001). However, there were no differences in the pain score at 4 h after haemorrhoidectomy, maximum pain during the first 24 h, maximum pain during the second postoperative day, ketoprofen requirement or need for intramuscular pethidine injections between groups 1 and 2.

CONCLUSION

Although Proctolog reduced mean resting anal pressure at 4 h after application, this did not affect pain after haemorrhoidectomy.

Heart rate, heart rate variability, and blood pressure during perioperative stressor events in abdominal surgery

STUDY OBJECTIVE

To define the behavior of power spectral heart rate variability (PSHR) during potentially stressful events in the perioperative period, and relate it to changes in blood pressure (BP) and heart rate (HR).

DESIGN

Longitudinal clinical study.

SETTING

Operating room and recovery suites of a large tertiary care referral center.

PATIENTS

26 ASA physical status I, II, and III patients undergoing elective abdominal surgery.

INTERVENTIONS

Anesthesia was induced with thiopental sodium and fentanyl, and maintained with isoflurane/nitrous oxide (N2O)/relaxant or enflurane/N2O/relaxant. The trachea was intubated and intraabdominal surgery was performed.

MEASUREMENTS AND MAIN RESULTS

Observations consisted of HR, noninvasive blood pressure, and PSHR. They were made before and after induction of anesthesia, tracheal intubation, and surgical incision, and during maximal surgical stimulation and skin closure. HR and mean arterial pressure (MAP) maxima were also recorded for one hour before and after emergence from anesthesia. PSHR was obtained using a special algorithm and data acquisition system for real time spectral analysis of the instantaneous HRversus time function. The HR power spectrum parameters analyzed were low-frequency (LFA; powerband = 0.04 to 0.10 Hz), respiratory-induced frequency (RFA; powerband = respiratory frequency +/- 0.06 Hz), and the ratio of LFA to RFA. With induction of anesthesia, only RFA power decreased significantly. LFA power reduction became significant only after intubation and continued so until after incision. Immediately after induction, the decline in RFA power (vs. preinduction) was more pronounced when compared with the decline in LFA power (76% vs. 34%; p = 0.01). Hence, the ratio LFA/RFA increased significantly after induction of anesthesia. It was significantly higher than at postintubation, preincision, or skin closure. A significant elevation in LFA, LFA/RFA ratio, and BP occurred with maximal abdominal surgical stimulation. Only preinduction LFA, RFA, and LFA/ RFA ratio were predictive of MAP changes with induction of anesthesia (p = 0.006). In 8 of the 15 patients who had MAP changes of at least 10 mmHg with induction, PSHR indices correctly predicted a change of this magnitude. Late intraoperative HR maxima were positively correlated with the change in HR and incision (r2 = 0.58; p < 0.01). The change in BP with incision was positively correlated with early postoperative HR maxima (r2 = 0.60; p < 0.01).

CONCLUSIONS

On anesthetic induction, preoperative, but not intraoperative, spectral indices were predictive of BP changes. Power spectral analysis of HR may provide information about the autonomic state that is not evident from BP or HR. The HR power spectrum, in particular, indicated a striking autonomic imbalance immediately after the induction of anesthesia despite stable HR and BP. LFA and LFA/RFA ratio appeared to track sympathetic autonomic activation during abdominal surgical stimulation, but not during other perioperative stressor events.

Biofeedback is effective treatment for levator ani syndrome

PURPOSE

The effects of biofeedback (BF) on pain relief and anorectal physiology in patients with levator ani syndrome (LAS) were prospectively studied.

METHOD

Sixteen consecutive patients (9 men, 7 women; mean age, 50.1 (range, 39-66) years) with LAS were treated with BF from July 1993 to October 1995. Mean duration of pain was 32.5 (standard error of the mean, 6.7) months. All underwent a full course of BF using a manometric balloon technique. Mean follow-up was 12.8 (standard error of the mean, 2.6) months. Pain score and anorectal physiology tests were administered prospectively by an independent observer before and after BF.

RESULTS

After BF, the pain score was significantly improved (before BF: median, 8 (range, 6-10); after BF: median, 2 (range, 1-4); P < 0.02). Analgesic requirements were also significantly reduced (all 16 patients needed nonsteroidal anti-inflammatory drugs (NSAID) before BF; only two patients needed NSAID after BF; P < 0.03). There were no significant changes to the anorectal physiology parameters after BF. To date, there have been no side effects or regressions.

CONCLUSION

Although BF had a negligible effect on anorectal physiologic measurements in LAS, it was effective in pain relief, with no side effects.

[Distribution of 70kDa heat shock protein in rabbit brains after heat stress and heat stroke]

OBJECTIVE

Evaluation of the relationship between the induction of 70kDa heat shock protein in rabbit brains and heat stress.

METHODS

HSP70 was detected using monoclonal antibody by ABC method in rabbit hypothalamus, hippocampus and cerberal cortex.

RESULTS

Intense HSP70 staining was displayed in rabbit brains of the heat stroke group (rectal temperature 43 degrees C to death). Positive cells were distributed mainly in the CA1, CA2 regions of the hippocampus; granular cell layer I and pyramidal layer (II) of the cerebral cortex; and the periventricular area of hypothalamus. HSP70-psoitive substances were localized in the cytoplasm and neuronal processes, a few neurons exhibited dark staining nucle. Hosever, the rabbit brains of the general heat stress group (rectal temperature 42.0 degrees C, 30 minutes) had much weaker staining.

CONCLUSION

Hyperthermia causes neuronal expression of HSP70, particularly under strong heat stress, and may be sustained till death.

Reflection filter with high reflectivity and narrow bandwidth

A kind of reflection filter with a narrow bandwidth and high reflectivity is designed as being composed of an all-dielectric Fabry-Perot filter, a high-reflectivity Ag film, and especially an ultrathin metallic film, n approximately = k. Exemplary structures and some formulas concerning spectral-reflection performances, such as general reflectivity, maximum reflectivity, and the halfwidth of the reflection band, are given. Experiments show the validity of this design.

[Resources survey of medicinal species from genus Aralia]

This paper deals with the distribution area, growing environment and medicinal parts of 19 species and 1 variety, including 2 new species of genus Aralia. An index for identification of these medicinal species is presented.

Transcriptional organization and regulation of the dnaK and groE operons of Chlamydia trachomatis

The transcriptional organization and regulation of the dnaK and groE heat shock operons of Chlamydia trachomatis were studied and found to resemble those of the cognate operons of Bacillus subtilis and Clostridium acetobutylicum. The gene order is conserved (hrcA-grpE-dnaK), but no dnaJ homolog could be identified in this region. The dnaK operon was transcribed as a low-abundance polycistronic mRNA whose levels did not increase upon exposure to heat shock. In contrast, a more abundant 2.3-kb mRNA encoding only the dnaK sequence was detectable, and its steady-state level increased upon heat shock. The transcription initiation sites of the dnaK and groE operons were found to be preceded by sequences that resemble an Escherichia coli sigma70 consensus promoter. Upstream of each putative promoter is an inverted repeat sequence which resembles a similar element (CIRCE [controlling inverted repeat of chaperone expression]) found upstream of the dnaK and groE operons in at least 27 eubacterial species. In vitro transcription studies utilizing partially purified C. trachomatis RNA polymerase demonstrated that the regions containing the putative promoter elements of the dnaK and groE operons are functional, although heat shock-regulated expression could not be demonstrated.

Identification of sequences necessary for transcription in vitro from the Chlamydia trachomatis rRNA P1 promoter

Chlamydia trachomatis RNA polymerase was partially purified by heparin-agarose chromatography and used in conjunction with a plasmid-borne G-less cassette template to characterize the C. trachomatis rRNA P1 promoter in vitro. Stepwise mutational analysis revealed that sequences in the -10, -25, and -35 regions are necessary for promoter activity, but no sequence upstream of position -40 is required. Partially purified C. trachomatis RNA polymerase and purified Escherichia coli holoenzyme exhibited some differences in promoter specificity.

Development and progression of renal disease in Pima Indians with non-insulin-dependent diabetes mellitus. Diabetic Renal Disease Study Group

BACKGROUND

Non-insulin-dependent diabetes mellitus (NIDDM) is a major cause of end-stage renal disease. However, the course and determinants of renal failure in this type of diabetes have not been clearly defined.

METHODS

We studied glomerular function at intervals of 6 to 12 months for 4 years in 194 Pima Indians selected to represent different stages in the development and progression of diabetic renal disease. Initially, 31 subjects had normal glucose tolerance, 29 had impaired glucose tolerance, 30 had newly diagnosed diabetes, and 104 had had diabetes for five years or more; of these 104, 20 had normal albumin excretion, 50 had microalbuminuria, and 34 had macroalbuminuria. The glomerular filtration rate, renal plasma flow, urinary albumin excretion, and blood pressure were measured at each examination.

RESULTS

Initially, the mean (+/-SE) glomerular filtration rate was 143+/-7 ml per minute in subjects with newly diagnosed diabetes, 155+/-7 ml per minute in those with microalbuminuria, and 124+/-7 ml per minute in those with macroalbuminuria; these values were 16 percent, 26 percent, and 1 percent higher, respectively, than in the subjects with normal glucose tolerance (123+/-4 ml per minute). During four years of follow-up, the glomerular filtration rate increased by 18 percent in the subjects who initially had newly diagnosed diabetes (P=0.008); the rate declined by 3 percent in those with microalbuminuria at base line (P=0.29) and by 35 percent in those with macroalbuminuria (P<0.001). Higher base-line blood pressure predicted increasing urinary albumin excretion (P=0.006), and higher base-line urinary albumin excretion predicted a decline in the glomerular filtration rate (P<0.001). The initial glomerular filtration rate did not predict worsening albuminuria.

CONCLUSIONS

The glomerular filtration rate is elevated at the onset of NIDDM and remains so while normal albumin excretion or microalbuminuria persists. It declines progressively after the development of macroalbuminuria.

Biofeedback therapy for excessive stool frequency and incontinence following anterior resection or total colectomy

PURPOSE

Excessive stool frequency and incontinence after anterior resection (AR) or total colectomy (TC) can be refractory to expectancy and antidiarrheal agents. We prospectively assessed efficacy of anorectal biofeedback therapy (BF) in this clinical situation.

METHODS

Thirteen patients (10 men and 3 women; mean age, 62.1 (standard error of the mean (SEM), 4.6) years) had more than six bowel movements per day and/or episodes of incontinence, which did not abate after antidiarrheal agents were given for at least six (mean, 27.9 (SEM, 6.3)) months after surgery. All underwent four sessions of outpatient BF. Assessment was by continence questionnaire and anorectal physiology tests, which were administered before and after BF.

RESULTS

In seven AR patients, daily stool frequency was decreased (8.7 (SEM, 2.1) before and 4.6 (SEM, 1.2) after, P < 0.05), and daily incontinence episodes were reduced (2.7 (SEM, 0.9) before and 0.4 (SEM, 0.2) after, P < 0.05) after BF. Six TC patients also had decreased daily stool frequency (6.2 (SEM, 2.1) before, 3.3 (SEM, 1.6) after; P < 0.05) and incontinence episodes (2.4 (SEM, 0.9) before, 0.5 (SEM, 1) after; P < 0.05) after BF. There were no significant changes in anorectal physiology parameters after BF. At a mean follow-up of 10.6 (SEM, 2.5) months after BF, there were no regressions or complications.

CONCLUSIONS

BF is a safe and effective option for refractory excessive stool frequency and/or incontinence following AR or TC.

Subtle translocation (18;21) confirmed by FISH in a patient with Down syndrome

The patient presented with the typical features of Down syndrome; hypotonia, brachycephaly, flattened occiput, bilateral prominent medical epicanthic folds, flat nasal bridge, protruding tongue, low-set dysplastic ears, short broad hands, bilateral clinodactyly and simian crease. The karyotype of this child was originally reported as normal. High-resolution chromosomes revealed extra material on the long arm of chromosome 18. The mother's karyotype showed a reciprocal translocation between the long arm of 18 and the long arm of 21 at band q23 and q22.1, respectively. FISH performed separately with two different 21q cosmid probes gave two signals on the mother's metaphases and three signals on the proband. These findings confirmed that the proband is trisomic for the long arm of chromosome 21 at loci D21S65 and D21S19.