[Head injuries in children and adolescents: treatment and outcome]

We conducted a retrospective study to investigate the treatment and outcome of head injuries in children and adolescents in Taiwan. The study group consisted of 820 children and adolescents with head injuries admitted to Chang Gung Memorial Hospital from January 1985 to December 1989. The data were obtained from chart review and questionnaire. The cases were divided into four age-groups: group A (0-4 years old), group B (5-9 years old), group C (10-14 years old) and group D (15-17 years old). Computed tomogram of the brain was performed in 92% of the cases and most had abnormal findings. The frontal, temporal and parietal regions in that order accounted for the most focal sites of injuries on computed tomogram. Brain and other major surgery were necessary in 23.7% and 11.3% of the cases, respectively. Of the 15.3% of cases with seizures, most had early-onset seizures. A questionnaire of 398 survivors, showed that most patients achieved a good recovery level (94.2%) on the Glasgow outcome scale, a normal recovery (83.8%) of motor function and independent walking (96.0%) in locomotion. Vision and hearing were impaired in only 9.3% and 6.0% of cases, respectively. Approximately 97% of the patients aged 5 years or over recovered to be independent in their daily living activities and in normal communication. There were no significant differences in their above outcome-analyses among the different age-groups.

Pharmacokinetics and plasma protein binding of the new potent class III antiarrhythmic agent 3-[4-(1H-imidazol-1-yl)benzoyl]-7-isopropyl-3, 7-diazabicyclo[3.3.1]nonane dihydroperchlorate

GLG-V-13 (3-[4-(1H-imidazol-1-yl)benzoyl]-7-isopropyl-3,7-diazabicyclo [3.3.1] nonane dihydroperchlorate, CAS 155029-33-7) has been shown to be a potent class III antiarrhythmic agent. The oral and intravenous pharmacokinetics and plasma protein binding of GLG-V-13 in dogs and in rabbits have now been investigated. Plasma GLG-V-13 concentration-time profiles, following an i.v. bolus dose of 6 mg/kg, were fitted to a 2-compartment model. The volume of distribution at steady state (Vd(ss)), the total systemic (ClB), and the elimination half-life (t1/2 beta) were 4.441 l/kg, 1.113 l/h/kg, and 2.485 h in dogs and 3.723 l/kg, 1.548 l/h/kg, and 1.401 h in rabbits. Following i.v. dosing, approximately 9.38% of the parent compound was excreted in dogs urine (0-72 h). Changes in plasma GLG-V-13 concentrations, after oral administration of GLG-V-13 (6 mg/kg), were best described by the 1-compartment pharmacokinetic model. The tmax and Cmax were 1.69 h, 0.54 mg/l in dogs and 1.44 h, 0.35 mg/l in rabbits. On oral administration, GLG-V-13 was moderately eliminated (t1/2kel' 1.867 h-1 in dogs and 3.961 h-1 in rabbits, respectively). Oral bioavailability was estimated to be 53.2% +/- 11.3% in dogs and 66.7% +/- 7.7% in rabbits. About 8.74% of the oral dose (6 mg/kg) was excreted via the dog urine (0-72 h). In vitro binding of GLG-V-13 to dog plasma protein was 29.4 +/- 9.90% (from 0.5 to 4 mg/l). Ex vivo binding of GLG-V-13 to dog plasma protein was 10.4 +/- 7.20%.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical significance of intratumoral blood flow in cervical carcinoma assessed by color Doppler ultrasound

BACKGROUND

Much evidence has suggested that vascular density reflects the clinical behavior of cancer. In this study, the intratumoral blood flow in cervical carcinomas was assessed by transvaginal color Doppler ultrasound, and its clinical significance was evaluated.

METHODS

Sixty-five patients with Stage Ib-IIb cervical carcinoma exhibiting visible cervical tumor by transvaginal ultrasound were enrolled. All patients were scheduled for radical hysterectomy and pelvic lymph node dissection. Transvaginal color Doppler ultrasound was performed before surgery to search for blood flow signals from the tumor and the main uterine artery. The corresponding arterial resistance index (RI) was calculated. Clinical and pathologic data were recorded. A cytokinetic study was performed by propidium iodide staining and flow cytometry. The human papillomavirus (HPV) status was assessed by polymerase chain reaction.

RESULTS

Intratumoral blood flow was detected by color Doppler ultrasound in 46.2% (30/65) of the tumors. Patients with detectable intratumoral blood flow exhibited significantly more pelvic lymph node metastasis (10/30 vs. 2/35, P = 0.005), a higher percentage of cancer cells in the S- + G2M-phase (30.02 +/- 18.54% vs. 19.35 +/- 11.21%, P < 0.005), and a higher prevalence of HPV infection (30/30 vs. 25/35, P = 0.001) when compared with those without intratumoral blood flow. No significant difference was observed concerning the patient's age, tumor size, clinical staging, histologic type, and DNA ploidy status between these two groups. Regression analysis of the intratumoral RI value on the S- + G2M-phase fraction showed linear regression (n = 30, r2 = 0.501, P < 0.01). The RI values of the main uterine artery showed no significant difference between these two groups.

CONCLUSION

The intratumoral blood flow by transvaginal color Doppler ultrasound correlated well with a higher proliferation index, higher incidence of HPV infection, and pelvic lymph node metastasis in cervical carcinoma.

Nodular amyloidosis of the lung and the breast mimicking breast carcinoma with pulmonary metastasis

Nodular amyloidosis of the breast and lung is a rare condition of unknown aetiology. The disease runs a benign course, but offers a diagnostic problem due to nonspecific histological features. We describe the case of a 56 year old woman with a 5 year history of multiple nodules of both lungs and left breast, clinically mimicking breast carcinoma with pulmonary metastasis. To our knowledge, this is the first case of cytologically proven amyloidosis diagnosed by ultrasound-guided percutaneous transthoracic fine-needle aspiration of pulmonary nodules.

Nodular amyloidosis of the lung and the breast mimicking breast carcinoma with pulmonary metastasis

Nodular amyloidosis of the breast and lung is a rare condition of unknown aetiology. The disease runs a benign course, but offers a diagnostic problem due to nonspecific histological features. We describe the case of a 56 year old woman with a 5 year history of multiple nodules of both lungs and left breast, clinically mimicking breast carcinoma with pulmonary metastasis. To our knowledge, this is the first case of cytologically proven amyloidosis diagnosed by ultrasound-guided percutaneous transthoracic fine-needle aspiration of pulmonary nodules.

Identification and analysis of the expression of CD8 alpha beta and CD8 alpha alpha isoforms in chickens reveals a major TCR-gamma delta CD8 alpha beta subset of intestinal intraepithelial lymphocytes

Expression screening has been used to clone cDNAs encoding the alpha- and beta-chains of chicken CD8. Amino acid sequence similarities with the mammalian sequences were about 30%. Many amino acid residues of structural or functional importance were more highly conserved, as were the overall structures of both chains. Like human CD8 alpha, the chicken alpha-chain lacked sites for N-linked glycosylation, but the beta-chain contained three such sites. In COS cells transfected with CD8 beta cDNA, surface expression of the beta-chain was dependent on co-transfection of the alpha-chain cDNA, indicating that, as in mammals, chicken CD8 can be expressed as a CD8 alpha alpha homodimer or as a CD8 alpha beta heterodimer. Immunofluorescence analysis with mAbs that were shown to identify the CD8 alpha- and CD8 beta-chains revealed that the vast majority of the CD8+ cells in the thymus, spleen, and blood of adult chickens express both CD8 alpha- and CD8 beta-chains. However, a relatively large proportion of the CD8+ TCR-gamma delta cells in the spleens of embryos and young chicks express only the alpha-chain of CD8. Among intestinal epithelial lymphocytes the major CD8+ T cell populations present in mice are conserved, but there is a population of TCR-gamma delta CD8 alpha beta cells that is not found in rodents. This observation is important in interpretation of experiments examining the pathways of development of intestinal intraepithelial lymphocytes in chickens.

Identification and analysis of the expression of CD8 alpha beta and CD8 alpha alpha isoforms in chickens reveals a major TCR-gamma delta CD8 alpha beta subset of intestinal intraepithelial lymphocytes

Expression screening has been used to clone cDNAs encoding the alpha- and beta-chains of chicken CD8. Amino acid sequence similarities with the mammalian sequences were about 30%. Many amino acid residues of structural or functional importance were more highly conserved, as were the overall structures of both chains. Like human CD8 alpha, the chicken alpha-chain lacked sites for N-linked glycosylation, but the beta-chain contained three such sites. In COS cells transfected with CD8 beta cDNA, surface expression of the beta-chain was dependent on co-transfection of the alpha-chain cDNA, indicating that, as in mammals, chicken CD8 can be expressed as a CD8 alpha alpha homodimer or as a CD8 alpha beta heterodimer. Immunofluorescence analysis with mAbs that were shown to identify the CD8 alpha- and CD8 beta-chains revealed that the vast majority of the CD8+ cells in the thymus, spleen, and blood of adult chickens express both CD8 alpha- and CD8 beta-chains. However, a relatively large proportion of the CD8+ TCR-gamma delta cells in the spleens of embryos and young chicks express only the alpha-chain of CD8. Among intestinal epithelial lymphocytes the major CD8+ T cell populations present in mice are conserved, but there is a population of TCR-gamma delta CD8 alpha beta cells that is not found in rodents. This observation is important in interpretation of experiments examining the pathways of development of intestinal intraepithelial lymphocytes in chickens.

Prognostic factors of resectable intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma is a rare disease. The prognostic factors of resectable cholangiocarcinoma have not been previously reported. Nineteen patients (10M, 9F) with resectable cholangiocarcinoma were investigated to find factors that might influence prognosis. The cumulative survival rate was measured using the Kaplan-Meier method. The log-rank test was used to compare two survivals. Age, sex, tumor size, and positive tissue carcinoembryonic antigen were factors that had no influence on prognosis. Patients with a positive HLA-DR, a well-differentiated carcinoma, and a clear resective margin had better prognoses but were statistically undifferentiatable from the other patients. Patients with positive hilar lymph nodes had poor prognoses (P < 0.01), whereas patients with positive mucobilia had good prognoses (P < 0.05). Positive staining for HLA-DR on tumor cells was observed in nine of 19 cases of intrahepatic cholangiocarcinoma. The positive HLA-DR staining correlated with a better prognosis, but no significant difference was noted between the positive and negative HLA-DR staining group. A positive hilar lymph node was a grave sign, as almost all patients of positive lymph node died within 9 months after operation. Positive mucobilia was a good prognostic sign that correlated with the long-term survival.

Metabolism and metabolite pharmacokinetics of BRB-I-28, a class Ib antiarrhythmic agent

The metabolism of BRB-I-28 (7-benzyl-3-thia-7-azabicyclo[3.3.1]nonane), a novel class Ib antiarrhythmic agent, was characterized in vivo in dogs and rats and in vitro with rat liver microsomal preparations containing a NADPH-generating system. In dogs, rats and the in vitro hepatic microsomal oxidation system, BRB-I-28 was extensively metabolized to form 7-benzyl-3-thia-7-azabicyclo [3.3.1]nonane-3-oxide (I), a major metabolite. The metabolite I was produced via S-oxidation, presumably by the hepatic P-450 system. Formation of minor metabolite, 7-benzyl-3-thia-7-azabicyclo[3.3.1]nonane (II) via the oxidation of the benzylic site was also identified in rats. Following intravenous and oral administration of BRB-I-28 to dogs, the plasma concentration of major metabolite I could be test described by a 1-compartmental model. The plasma AUC of metabolite I was 20% (i.v.) and 179.4% (oral) of that of the parent BRB-I-28, respectively, suggesting that BRB-I-28 was metabolized significantly by the first pass effect following oral administration. Extensive metabolism of BRB-I-28 to form metabolites I and II, which have demonstrated much lower antiarrhythmic activities, further supports previously observed pharmacodynamic and pharmacokinetic findings.

Ultrasonic dissection in resection of hepatocellular carcinoma

An ultrasonic dissector has been used in the resection of liver tumors and was found to be safe and efficient in noncirrhotic patients. Thirty-one (cirrhosis, 61%) liver resections for hepatoma treated with ultrasonic dissector were compared to 39 (cirrhosis, 74%) resections treated with finger fracture. We found that patients treated with an ultrasonic dissector versus those treated by finger fracture, had less blood loss (especially in cirrhotic liver), 836 +/- 593 cc vs 1348 +/- 1226 cc, more operative time, 337.6 +/- 100.5 min vs 197 +/- 92.8 min, more days of hospital stay 19.1 +/- 12.8 days vs 11.5 +/- 5.6 days and more days of removal of drains, 14.9 +/- 11.7 days vs 10.2 +/- 6.4 days. The morbidity, mortality, amount of blood transfusion and amount of drainage were quite similar between two groups.

Cloning and identification of amino acid residues of human phospholipase C delta 1 essential for catalysis

In vitro single point mutagenesis, inositol phospholipid hydrolysis, and substrate protection experiments were used to identify catalytic residues of human phosphatidylinositide-specific phospholipase C delta 1 (PLC delta 1) isolated from a human aorta cDNA library. Invariant amino acid residues containing a functional side chain in the highly conserved X region were changed by in vitro mutagenesis. Most of the mutant enzymes were still able to hydrolyze inositol phospholipid with activity ranging from 10 to 100% of levels in the wild type enzyme. Exceptions were mutants with the conversion of Arg338 to Leu (R338L), Glu341 to Gly (E341G), or His356 to Leu (H356L), which made the enzyme severely defective in hydrolyzing inositol phospholipid. Phospholipid vesicle binding experiments showed that these three cleavage-defective mutant forms of PLC delta 1 could specifically bind to phosphatidylinositol 4,5-bisphosphate (PIP2) with an affinity similar to that of wild type enzyme. Western blotting analysis of trypsin-treated enzyme-PIP2 complexes revealed that a 67-kDa major protein fragment survived trypsin digestion if the wild type enzyme, E341G, or H356L mutant PLC delta 1 was preincubated with 7.5 microM PIP2, whereas if it was preincubated with 80 microM PIP2, the size of major protein surviving was comparable to that of intact enzyme. However, mutant enzyme R338L was not protected from trypsin degradation by PIP2 binding. These observations suggest that PLC delta 1 can recognize PIP2 through a high affinity and a low affinity binding site and that residues Glu341 and His356 are not involved in either high affinity or low affinity PIP2 binding but rather are essential for the Ca(2+)-dependent cleavage activity of PLC.

Characterization and regulation of two testicular inhibin/activin beta B-subunit messenger ribonucleic acids that are transcribed from alternate initiation sites

We and others have shown that the inhibin/activin beta B-subunit gene is expressed differently in the gonads. Two species of 4.8- and 3.7-kilobase (kb) beta B-subunit messenger RNA (mRNA) with equal concentrations were identified in the testis, whereas 1 predominant 4.8-kb and a minor 3.7-kb mRNA were observed in the ovary. In this study, we analyzed the structures of these 2 mRNAs in rat testis and showed that both 4.8- and 3.7-kb beta B-subunit mRNAs were terminated at the region proximal to 2.2 kb down-stream from the translation stop codon. However, only 4.8-kb mRNA could be detected when RNA probes prepared from the 5'-region 1 kb up-stream from the translation start site were used for Northern blot analysis. Our observations suggested that the 2 heterogeneously sized beta B-subunit mRNAs are transcribed from different initiation sites. Transcription of the 4.8-kb mRNA was initiated at 3 adjacent nucleotides, GGA, 1.1 kb up-stream from the translation start codon ATG, whereas multiple transcription initiation sites spreading over 150 nucleotides upstream from the ATG codon were previously identified for 3.7-kb mRNA. Neither of the 2 transcripts contained TATA and CAAT boxes in their promoters. The 5'-flanking DNAs required for transcription of the 4.8- and 3.7-kb mRNA were examined by their ability to induce transient expression of the chloramphenicol acetyltransferase (CAT) gene in MA-10 Leydig tumor cells. A marked increase in CAT activity was detected when the 5'-flanking DNA for the 4.8- or 3.7-kb transcript was progressively shortened from its 5'-end. Maximal CAT activity was observed when -409 and -139 basepair beta B-subunit DNA up-stream from the 4.8- and 3.7-kb transcription initiation site, respectively, were fused to the CAT gene, suggesting the presence of a negative regulatory element(s) at the up-stream regions of these promoters. Although putative AP-2 sites were identified, treatment of the transfected cells with cAMP and/or phorbol 12-myristate 13-acetate did not apparently change CAT activity driven by either the 4.8- or 3.7-kb promoter. Our results concluded that 1) the two inhibin/activin beta B-subunit mRNAs were transcribed from different initiation sites; 2) both promoters may be controlled by up-stream negative regulatory elements; and 3) neither of these promoters is responsive to cAMP and/or phorbol esters under the conditions employed.

Increased expressions of CD69 and HLA-DR but not of CD25 or CD71 on endometrial T lymphocytes of nonpregnant women

To investigate lymphocyte subpopulations and the status of T-cell activation at different phases of the menstrual cycle, lymphocytes in endometrial tissue were analyzed by dual-color flow cytometry in 39 patients. Compared with peripheral blood, the lymphocytes in the endometrium had a higher CD3-/(CD56+ or CD16+) ratio (25.2% +/- 6.8% vs 11.1% +/- 7.0%), but an inverted CD3+ CD8-/CD3+ CD8+ ratio (0.5 vs 1.8) and a minimal amount of B cells (3.3% +/- 3.1%). TcR gamma delta + T cells accounted for a minor proportion (7.8% +/- 5.1%) in endometrium. The proportions of TcR alpha beta + (85.0% +/- 6.6%) and CD3+ CD56+ (7.4% +/- 4.4%) endometrial T lymphocytes were found significantly different from those in peripheral blood (89.1% +/- 5.6% and 3.8% +/- 3.4%, respectively). As the endometrium proceeded from proliferative phase to luteal phase, the proportion of CD3+ CD8+ T cells in peripheral blood increased from 35.6% +/- 6.9% to 41.3% +/- 8.4% and CD3+ CD8- T cells decreased from 64.4% +/- 6.9% to 58.7% +/- 8.4%. The endometrial T cells expressed high levels of CD69 (84.1% +/- 18.9%) and DR (75.9% +/- 9.7%), but rarely expressed CD25 (7.0% +/- 5.4%) and CD71 (2.8% +/- 1.8%). The patterns of expression of these activation markers were similar in both proliferative and luteal phases. Our observations suggest that endometrial T lymphocytes are in a state of recent and persistent activation. Lymphocytes expressing the NK cell markers (CD56 or CD16) and CD8+ accounted for a significant proportion, suggesting that they may play important roles in local defense.

Is total abdominal hysterectomy with bilateral salpingo-oophorectomy adequate for new FIGO stage I endometrial carcinoma?

OBJECTIVE

The new FIGO staging for endometrial cancer cases complies with other forms of surgical staging and correlates better with clinical outcomes because it includes prognostic factors. This study was done to investigate whether total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH+BSO) is adequate for new FIGO Stage I endometrial carcinoma.

SUBJECTS

Sixty-five cases of endometrial carcinoma defined according to the new FIGO Stage Ia (n = 26), Ib (n = 24) and Ic (n = 15) were analysed. They all received TAH+BSO only and were followed up for at least two years.

METHODS

The histologic type, grade, depth of myometrial invasion, lympho-vascular tumour emboli and tumour size were analysed by t-test to correlate the risk factors for treatment failure.

RESULTS

There were no recurrences after TAH+BSO in Ia and Ib cases. However, recurrences occurred in five cases (33%) of Stage Ic with deep myometrial invasion, high histologic grade, large tumour size and tumour emboli.

CONCLUSIONS

TAH+BSO is inadequate in some Ic cases with a high histologic grade, deep myometrial invasion and tumour emboli. Thus, thorough pre-operative and intra-operative staging, adequate operation method and prompt post-operative adjuvant therapy are indispensable for successful treatment.

Beef tallow, but not corn bran or soybean polysaccharide, reduces large intestinal and fecal bile acid concentrations in rats

Diets high in fat and low in dietary fiber have been associated with a higher incidence of colon cancer, possibly by increasing bile acid concentration in the colon. Therefore changes in bile acid metabolism due to beef tallow, corn bran (CB), and soy polysaccharide (SP) feeding were studied. Rats were fed one of four diets for six weeks: 5% beef tallow fiber-free (LF), 20% beef tallow fiber-free (HF), 20% beef tallow with CB (HFCB), and 20% beef tallow with SP (HFSP). HF increased fecal output compared with LF, and HFCB and HFSP increased fecal output compared with HF. HF reduced fecal bile acid concentration by two-thirds compared with LF, although daily bile acid excretion was similar. There was a tendency toward a smaller bile acid quantity in the small intestine with HF than with LF. Neither fiber altered total fecal bile acid concentration or small intestinal bile acid quantity compared with HF. However, 7 alpha-dehydroxylase activity in the colon was lower with HFSP than with HFCB. Increasing dietary beef tallow from 5% to 20% in animals fed a fiber-free diet greatly reduced the concentration of bile acids in the large intestine and feces, an effect associated with a reduced risk of colon cancer.

Construction of Tn917ac1, a transposon useful for mutagenesis and cloning of Bacillus subtilis genes

A Tn917 derivative was constructed for the purposes of mutagenesis and cloning of Bacillus subtilis genes. This transposon, Tn917ac1 (4.6 kb), consisted of terminal inverted repeats of Tn917, the res sequence, a ColE1 origin of replication (ori) and two drug-resistance genes. The plasmid carrying this transposon, named pD917, contained the erm-tnpR-tnpA gene cluster of Tn917 and a temperature-sensitive ori of pE194. For the purpose of mutagenesis, transposition of Tn917ac1 was induced by culturing strains harboring pD917 in a medium containing a low concentration of erythromycin. Cells with a Tn917ac1 insertion in the chromosome were selected on agar containing chloramphenicol after heat treatment to eliminate the plasmidic form of pD917. DNA fragments adjacent to Tn917ac1 could be cloned by restriction digestion of the chromosomal DNA and by transforming the self-ligated restriction fragments into Escherichia coli. Sequence analysis revealed that Tn917ac1 was integrated into the chromosome of B. subtilis by transposition in a recE strain and by transposition or integration of pD917 in a wild-type strain. Tn917ac1 has been demonstrated to be useful for mutating and cloning of the genes involved in the biosynthesis of fengycin in B. subtilis F29-3.

Prediction of probability of pneumonectomy for lung cancer using Tc-99m MAA perfusion lung imaging

Pulmonary perfusion scintigraphy with Tc-99m MAA was performed on 182 patients, on whom either pneumonectomy or lobectomy was performed, because of primary nonsmall-cell lung carcinoma. Among them, 76 underwent pneumonectomy, and 106 underwent lobectomy. The mean value of the perfusion fraction (PF) of the affected lung of the patients undergoing pneumonectomy was 32.3 +/- 13.6% (range, 4%-50%) and was less than that of the patients undergoing lobectomy, 43.5 +/- 4.5% (range, 27%-50%). The difference was statistically significant (t-test, t = 6.82; P < 0.001). Among the 28 patients whose PF of the affected lung was equal to or less than 30%, 26 underwent pneumonectomy and only 2 had a lobectomy. Among the 154 patients whose PF of the affected lung was more than 30%, 50 underwent pneumonectomy and 104 had a lobectomy. These result suggest that "30%" can be a cutoff value (Yates correction X(2) test, X2 = 33.09; P < 0.001).

Regulation of RAG-2 protein expression in avian thymocytes

The recombinase-activating genes, RAG-1 and RAG-2, have been shown to be necessary to initiate the process of V(D)J recombination during the ontogeny of lymphocytes. While much is known about the end products of this rearrangement process, little is known about the function or regulation of the components of the recombinase system. To this end, we have generated a monoclonal antibody to the chicken RAG-2 protein. Chicken thymocytes were found to express high levels of RAG-2, part of which is phosphorylated. Within thymocytes, RAG-2 is expressed primarily within the nucleus. RAG-2 protein levels are high in the CD4- CD8- and CD4+ CD8+ immature thymocytes but absent at the single-positive CD4+ CD8- or CD4- CD8+ stage of thymocyte development. Mitogenic stimulation of thymocytes with phorbol myristate acetate and ionomycin results in down-regulation of RAG-2 expression. Consistent with these data, in vivo levels of RAG-2 are markedly lower in proliferating thymocytes than in smaller, G0/G1 cells. Down-regulation of RAG-2 expression appears to occur before cells enter S phase, suggesting that RAG-2 function may be limited to noncycling cells.

Vascular patterns of gestational trophoblastic tumors by color Doppler ultrasound

BACKGROUND

Destruction of uterine vasculature is a common phenomenon in gestational trophoblastic tumors. The authors categorized such uterine vasculature by color Doppler ultrasound and studied its clinical significance.

METHODS

Color Doppler ultrasound was performed in 28 patients with gestational trophoblastic tumors. The vascular morphologic manifestations were recorded, and the peak systolic velocity and resistance index of uterine artery were calculated. Serum beta-human chorionic gonadotropin (hCG) levels were measured periodically to monitor chemotherapy response. Seventeen uneventful postmole uteri were used as controls. Two-tailed Student's t-test and Fisher's exact test were used for statistical analysis.

RESULTS

The gestational trophoblastic tumors were categorized as diffuse type (N = 7), lacunar type (N = 16), and compact type (n = 5) according to their vascular patterns. The mean serum beta-hCG level at diagnosis in diffuse type lesions (6608 +/- 6320 mIU/mL) was significantly lower than in the lacunar type (40462 +/- 39735 mIU/mL; P = 0.04) and compact type (212114 +/- 205126 mIU/mL; P = 0.02), whereas the level in compact type lesions was significantly higher than in the lacunar type (P = 0.003). Lacunar type lesions exhibited a significantly lower uterine artery resistance index (0.51 +/- 0.13) than diffuse type (0.66 +/- 0.10; P = 0.03) or compact type lesions (0.70 +/- 0.06; P = 0.02). All lesions exhibited significantly higher peak systolic velocity than control subjects (P < 0.001); however, no significant difference was observed among them. Brief courses (< 5 cycles) of chemotherapy cured more diffuse type (6 of 7) than lacunar type (3 of 15, P = 0.006) or compact type lesions (0 of 5, P = 0.008). Histopathologic diagnosis was available for 11 lesions. They were invasive mole in seven lacunar type lesions and choriocarcinoma in four compact type lesions.

CONCLUSION

Vascular morphologic patterns of gestational trophoblastic tumors by color Doppler ultrasound correlated well with beta-hCG levels, uterine hemodynamics, chemotherapy response, and possibly the histopathologic diagnosis.

Successful resection of a minute icteric hepatocellular carcinoma--case report

A 38-year-old male was admitted to our department with jaundice. Imaging studies including ultrasonography, ERCP, PTC and computed tomography (CT) revealed a hilar lesion. Right hepatic lobectomy, caudate lobectomy, excision of CBD and restoration of biloenteric continuity was performed. Pathological examination showed an icteric hepatoma (1.2 x 0.8 x 0.8 cm in size) originating in the caudate lobe. The tumor thrombus occupied the common hepatic duct and the right intrahepatic duct. The postoperative course was fairly unremarkable, and the patient has remained in good health for four years after surgery without any sign of recurrence.

Prognostic factors after hepatectomy for hepatocellular carcinoma

During a seven and a half year period from 1985 through June 1992, hepatic resection was carried out on 84 patients with hepatocellular carcinoma. Their ages ranged from 10 to 79, with an average of 55 years. Hepatitis B surface antigen (HbsAg) was positive in 83%, an alfafetoprotein level of more than 20 ng/dl was found in 71%, and cirrhosis was noted in 64%. Surgical mortality was 3.6% and hospital mortality 1.2%. The 1-, 3- and 5-year actuarial survival rates, excluding in-hospital deaths, were 74%, 56% and 49%, respectively. The large number of patients operated on in the early stage (52%), and Child's class A (61%) might account for the low surgical mortality and high survival rate. The favorable conditions were identified as follows; no cirrhosis, surgery in the early stage, tumor size less than 5 cm, negative HbsAg and freedom from vascular involvement. Multivariate analysis showed that only negative HbsAg had better survival.

Characterization of two promoters of a rat pregnancy-specific glycoprotein gene

Pregnancy-specific glycoproteins (PSGs) are the major placental glycoproteins, that together with the carcinoembryonic antigens comprise a subfamily within the immunoglobulin superfamily. In order to develop an animal model for understanding the molecular mechanisms underlying the control of PSG expression, we isolated and characterized cDNA and genomic clones encoding a rodent PSG, rnCGM3. The rnCGM3 cDNA is 2761 bp in length and contains an open reading frame that encodes a 475 amino acid polypeptide with a domain arrangement of L1N1-L2N2-L3N3-A. The sequence in 5'-untranslated and L1 regions of rnCGM3 is identical to a previously identified cDNA, rnCGM6. The transcription initiation sites of both genes are located at nucleotide -197 upstream of the translation start site. In transient transfection assays using a chloramphenicol acetyltransferase (CAT) reporter gene, we demonstrated that DNA elements at nucleotides -326 to -185 (PI) and -147 and -86 (PII) relative to the translation start site of rnCGM3 could both function as promoters. The downstream promoter, PII, which is located within the first exon, shares high sequence identity with the minimal promoters of human PSG genes. Electrophoretic mobility shift assays (EMSAs) showed that protein factors in placental cell extracts formed three complexes (PIICI, PIICII, and PIICIII) with the PII promoter element. The PIICIII complex was also observed by DNase I footprinting analysis. Unlike PII, the upstream promoter, PI, contains a TATA box. DNase I footprinting analysis revealed two nuclear protein binding sites at nucleotides -311 to -290 (PISI) and -257 to -239 (PISII) in PI. EMSAs showed that protein factors in placental cell extracts bound to both sites and deletion of either site markedly reduced CAT expression. PISII contains a palindromic motif, TGTTGCTCAACA, and protein cross-linking and Southwestern hybridization analyses demonstrated that the protein factor binding to PISII had an apparent molecular mass of 40 kDa.