CT findings of extramedullary hematopoiesis in the thorax, liver and kidneys, in a patient with idiopathic myelofibrosis

Extramedullary hematopoiesis occurring in multiple organs such as thorax, liver and both kidneys is an unusual condition. We report the CT findings of this condition with review of literature. The lesions consisted of intrathoracic paravertebral masses, focal intrahepatic mass and masses of both pelvocalyceal systems on CT scans.

Integrating the Internet into health administration education: a report from AUPHA's Faculty Internet integration task force

HRSA funded a survey to determine what Internet resources would be most useful to AUPHA membership. This manuscript describes the Internet-intensive survey methodology, reports the survey results, and lists the task force recommendations. The task force used sequential questionnaires posted on the Web to gather both potentially useful Internet resource ideas and membership perceptions of the importance of each idea. Resources recommended by survey participants and the Task Force members emphasized potential improvements to the AUPHA and AUPHA-member Web pages.

Laser removal of oxides and particles from copper surfaces for microelectronic fabrication

Laser removal of surface oxides and small particles from copper surfaces was carried out using a Q-switched Nd:YAG laser. Oxide layers and small particles on copper surfaces should be removed for the improvement of solder quality on printed circuit boards (PCBs) and for the prevention of circuit failure or loss of production yield during the fabrication of microelectronic devices. A selective removal of surface oxides from a copper surface was achieved by the laser treatment, which was confirmed by on-line acoustic monitoring of the process. An angular laser cleaning technique in which the laser irradiates the surface at a glancing angle was used for effective removal of the particles from the surface. The unique characteristics of this technique and the cleaning mechanism are discussed.

Differential effects of ovariectomy on the mechanical properties of cortical and cancellous bone in rat femora and vertebrae

The purpose of this study was to evaluate the effects of ovariectomy on the mechanical properties of bone in the aged Sprague-Dawley rat model of osteoporosis. Eight female rats were sacrificed at the start of the study, at the age of four months. Twenty-four remaining rats were then bilaterally ovariectomized (OVX), and another twenty-four served as controls. Eight rats from each group were sacrificed at five, ten or fifteen weeks. The mean density of L1 vertebral bodies from OVX rats was lower than in their control counterparts, as was the compressive modulus, the ultimate compressive stress and the toughness. The second lumbar vertebra from each rat was cored to remove the bulk of the cancellous bone and tested in compression to failure. Ovariectomy did not affect the mechanical properties of the cored vertebrae, suggesting that the mechanically relevant changes take place in the cancellous bone. The gravimetric density and bone mineral density (measured by dual-energy x-ray absorptiometry) of whole femora were lower in OVX rats than control rats. However, the gravimetric density of the cortical bone was unchanged, and when femora were tested to fracture in three-point bending, the mechanical properties of the midshaft were found to be unaffected. This study suggests some limitations to the mature ovariectomized rat model of osteoporosis: mechanically significant loss of cancellous bone occurs in vertebrae much more rapidly than suggested by other studies. Further, there is little evidence of mechanically important bone loss in cortical bone within four months of ovariectomy.

Validation of serological tests forHelicobacter pylori infection in an Irish population

BACKGROUND

Serological tests for Helicobacter pylori using laboratory and 'office' formats are commonly used, easy to perform, inexpensive and widely available. Local validation of test performance is required.

AIMS

This study examined the performance of a laboratory and 'office' ELISA in a population of Irish dyspeptics presenting for endoscopy.

METHODS

Consecutive patients presenting for endoscopy had blood drawn at sedation. Samples were analysed using two ELISA formats; a standard laboratory format and an 'office' ELISA test card. H. pylori infection was diagnosed by analysis of antral and corpus biopsies using the rapid urease test, culture and histology. A combination of two positive invasive tests was considered indicative of infection.

RESULTS

The sensitivity and specificity of laboratory ELISA was 82.4% and 85% respectively while the values for the 'office' ELISA were 87.7% and 85.7% respectively. In patients under 45 years sensitivities and specificities of the 'office' test exceeded 90%. The two serological tests agreed in 87.5% of subjects.

CONCLUSIONS

Both tests performed satisfactorily. However, indeterminate results impaired the usefulness of the laboratory ELISA particularly when using a new cut-off. The 'office' ELISA performed particularly well in young patients. A simpler test using antigens from locally prevalent strains to optimise accuracy is awaited.

Pseudotumorous hyperplasia of the caudate lobe in the non-cirrhotic liver: MR and CT arterial portography appearance

We describe the magnetic resonance image and computed tomographic arterial portography appearance of pseudotumorous hyperplasia in the caudate process of the caudate lobe in a non-cirrhotic patient. A prominent portal vein branch directly arising from the right main portal branch was seen in the center of the lesion on magnetic resonance imaging and computed tomographic arterial portography. We think that portal flow change of the caudate lobe by an anomalous portal branch may be correlated to pseudotumorous hyperplasia.

Use of esophagectomy to treat recurrent hyperplastic tissue obstruction caused by multiple metallic stent insertion for corrosive stricture

We report a case of a 75-year-old woman who received repeated metallic stent insertion for corrosive esophageal injury. She underwent esophagectomy and gastric tube reconstruction about 3 years after injury because both stents were occluded in turn by overgrowth of granulation tissue. The gross and microscopic changes of the esophagus secondary to prolonged stent insertion are described. In the literature, no reports of similar cases have been recorded. Our limited experience revealed that using metallic stents to treat benign esophageal stricture should be handled very cautiously because of the complications which can commonly occur and are difficult to manage. Repeated stent insertion, although effective for temporarily relieving dysphagia, is ineffective in the long run and can create complications. We suggest that the feasibility of esophagectomy should be evaluated after the improvement of the general condition of the patient.

Modulation of EWS/WT1 activity by the v-Src protein tyrosine kinase

Desmoplastic small round cell tumor (DSRCT) is a malignant human cancer that is associated with a specific t(11;22) chromosome translocation, where 265 amino acids from the EWS amino-terminus are fused to the DNA binding domain of the WT1 tumor suppressor gene. We have noticed the presence of several SH3 interacting domains within the amino-terminus of EWS and have assessed the potential of EWS/WT1 to interact with such motifs. We find that EWS/WT1 can associate with the SH3 domain of several proteins, including v-Src. Ectopic expression of v-Src phosphorylates EWS/WT1 in vivo, as well as enhances the transactivation ability of the EWS amino-terminal domain. Structural alteration of the v-Src SH2 or SH3 domains produced mutants that could not interact with EWS/WT1 nor augment the transcriptional properties of EWS. Taken together, our results suggest the possibility that some transcriptional properties of EWS/WT1 may be regulated by a cytoplasmic signaling pathway.

Comparing MR imaging and CT in the staging of gastric carcinoma

OBJECTIVE

The purpose of this study was to assess the usefulness of breath-hold two-dimensional (2D) fast low-angle shot (FLASH) and T2-weighted turbo spin-echo fast MR imaging compared with helical CT in the staging of gastric carcinoma.

SUBJECTS AND METHODS

Thirty patients with gastric carcinoma underwent preoperative MR imaging and helical CT. MR imaging at 1.5 T was performed immediately after the intramuscular injection of scopolamine and the oral administration of water or effervescent granules. Breath-hold 2D FLASH T1-weighted images in all three planes, turbo spin-echo T2-weighted axial images, and gadolinium-enhanced fat-suppressed 2D FLASH axial images were included. Helical CT was performed 60 sec after initiation of i.v. contrast medium injection (2.5-3 ml/sec). Two groups of two radiologists each independently analyzed the MR and helical CT findings, and these results were compared with the pathologic findings.

RESULTS

For T staging, MR imaging accuracy was higher than that of helical CT (73.3% and 66.7%, respectively); however, the accuracies of the two methods were not significantly different from each other (McNemar test, p > 0.05). Overstaging was noted in 6.7% of cases with MR imaging and 10% with helical CT. Understaging was noted in 20% of cases with MR imaging and 23.3% with helical CT. For N staging, the accuracies of MR imaging and helical CT were 55% and 58.6%, respectively, with no statistical significance (overstaging, 10% and 6.9%; understaging, 34.5% and 34.5%, respectively).

CONCLUSION

MR imaging was comparable to helical CT in the T and N staging of gastric cancer.

Production and characterization of biologically active human GM-CSF secreted by genetically modified plant cells

Human granulocyte-macrophage colony-stimulating factor (GM-CSF), a hemopoietic growth factor, was produced and secreted from tobacco cell suspensions. The GM-CSF cDNA was carried by a binary vector under the control of the CaMV 35S promoter and the T7 terminator. In addition, a 5'-nontranslated region from the tobacco etch virus (TEV leader sequence) was fused to the N-terminal end of the GM-CSF transgene. For ease of purification, a 6-His tag was added to the 3' end of the GM-CSF cDNA. Addition of the TEV leader sequence increased protein production more than twofold compared to non-TEV controls. Initial batch cultivation studies indicated a maximum of 250 microg/L extracellular and 150 microg/L intracellular GM-CSF. Western blot analysis detected multiple peptides with masses from 14 to 30 kDa in the extracellular medium. The plant-produced GM-CSF was biologically active and could be bound to a nickel affinity matrix, indicating that both the receptor-binding region and the 6-His tag were functional. The batch production of GM-CSF was compared with the production of other recombinant proteins secreted by transformed tobacco cells. The recovery of secreted GM-CSF was increased by the addition of stabilizing proteins and by increasing salt in the growth medium to physiological levels.

Combined analysis of germline polymorphisms of p53, GSTM1, GSTT1, CYP1A1, and CYP2E1: relation to the incidence rate of cervical carcinoma

BACKGROUND

The authors established the genotype frequencies of cytochrome P450 (CYP1A1/MspI, CYP2E1/PstI, and CYP2E1/DraI), glutathione-S-transferase (GSTM1 and GSTT1), and p53 (exon 4/AcclI and intron 3/16-base pair duplication) gene polymorphisms in cervical carcinoma patients and controls and evaluated the association between the specific genotype or genotype combinations of these polymorphisms and the risk of cervical carcinoma.

METHODS

In this case-control study, the genotypes of 181 human papillomavirus (HPV)-16 or HPV-18 positive cervical carcinoma patients and 1-to-1 age-matched controls were determined using a polymerase chain reaction-based technique.

RESULTS

Among these polymorphisms, the individuals carrying arginine/proline genotypes of p53 showed a 9.5-fold increase of cervical carcinoma risk (95% confidence interval [CI], 4.9-18.6) compared with those individuals carrying arginine/arginine genotypes. The frequency of overall GSTT1 null genotypes also was significantly higher in cervical carcinoma patients compared with that of GSTT1 positive genotypes (P = 0.003; odds ratio [OR] = 1.9; 95% CI, 1.2-2.9). The genotype combination of p53 and GST played a more important role in describing the relative risk of cervical carcinoma. The individuals carrying both the arginine/proline genotype of p53 and the null genotype of GSTT1 showed a 3.5-fold increase of cervical carcinoma risk (95% CI, 1.8-7.1) compared with those individuals carrying both the arginine/arginine genotype of p53 and the GSTT1 positive genotype. In the patients who were stratified into the two age groups, the null genotypes of GSTT1 (69.1% vs. 45.5%; P = 0.016) and GSTM1 (61.8% vs. 40.0%; P = 0.028) in cervical carcinoma were significantly overrepresented in the younger age subgroup (age 40 years or younger) compared with those of controls. Especially in this age group, the individuals carrying both null genotypes of GSTT1 and GSTM1 showed a 17.8-fold increase of cervical carcinoma risk (95% CI, 2.2-141.0) compared with the individuals carrying both positive genotypes of GSTT1 and GSTM1.

CONCLUSIONS

The results of the current study suggested that the arginine/proline genotype of p53, independently or in conjunction with the GSTT1 null genotype, could affect the genetic susceptibility for cervical carcinoma, and HPV positive women carrying both null genotypes of GSTT1 and GSTM1 have an increased risk of cervical carcinoma developing before age 40 years.

A linkage map of the turnip sawfly Athalia rosae (Hymenoptera: Symphyta) based on random amplified polymorphic DNAs

A linkage map was constructed for the sawfly, Athalia rosae (Hymenoptera), based on the segregation of random amplified polymorphic DNA (RAPD) markers and a visible mutation, yellow fat body (yfb). Forty haploid male progeny (20 yfb and 20+) from a single diploid female parent (yfb/+) were examined. Sixty-one of the 180 arbitrary primers tested by polymerase chain reaction (PCR) produced one or more RAPD bands. A total of 79 RAPD markers were detected. Of these, seven showed significant deviation from the expected 1:1 ratio, and were therefore excluded from further analysis. The remaining 72 RAPD markers and the marker mutation, yfb, were subjected to linkage analysis. Sixty RAPD markers and the yfb marker were organized into 16 linkage groups, spanning a distance of 517.2 cM. Twelve RAPD markers showed no linkage relationship to any group. Thirteen gel-purified RAPD bands were cloned and sequenced to generate the sequence-tagged sites (STSs). A single locus was represented by two markers, with one of them having a short internal deletion.

Increased beta-carboline 9N-methyltransferase activity in the frontal cortex in Parkinson's disease

Enzymatic beta-carboline N-methyltransferase activities generate N-methylated beta-carbolinium cations that are analogs of the parkinsonian-producing neurotoxin MPP+. We measured beta-carboline-2N-methyltransferase and beta-carboline-9N-methyltransferase activities in the supernatant and particulate fractions from postmortem human brains. These N-methyltransferase activities were assessed in the substantia nigra, putamen, and frontal cortex from control and Parkinson's disease cases. No significant differences were measured in any brain region in particulate and supernatant fraction beta-carboline 2N-methyltransferase activity or particulate fraction beta-carboline 9N-methyltransferase activity. Likewise, supernatant fraction beta-carboline 9N-methyltransferase activity was similar in the putamen and substantia nigra from Parkinson's disease and control cases. Unexpectedly, supernatant fraction beta-carboline 9N-methyltransferase activity was increased fourfold in Parkinson's disease frontal cortex (P < 0.05), suggesting that beta-carboline N-methylation may play a role in Parkinson's disease.

Rosai-Dorfman disease mimicking parasagittal meningioma: case presentation and review of literature

BACKGROUND

Sinus histiocytosis with massive lymphadenopathy was originally described by Rosai and Dorfman in 1969. It usually presents with bilateral painless cervical lymphadenopathy. In extremely rare circumstances, the CNS can be affected. Only 21 prior cases of intracranial involvement have been reported.

CASE REPORT

A 33-year-old white male presented with a 2-week history of progressive cephalgia. The patient underwent MRI testing that revealed an enhancing mass in the right parasagittal region with associated edema. Preoperative diagnosis was right parasagittal meningioma. The patient underwent craniotomy with complete resection of the mass. Histopathology was compatible with Rosai-Dorfman disease (RDD).

CONCLUSION

Rosai-Dorfman disease is rarely found intracranially; however, its ability to mimic meningioma as well as other pathologies underlines its importance. With so few reported cases of intracranial involvement, more experience will be necessary before this clinical presentation and prognosis can be clearly outlined.

Rapid urease tests lack sensitivity in Helicobacter pylori diagnosis when peptic ulcer disease presents with bleeding

OBJECTIVE

The eradication of Helicobacter pylori (H. pylori) in patients with bleeding peptic ulcer disease (PUD) decreases the rate of ulcer rebleeding. Although all methods for H. pylori diagnosis have been extensively evaluated in uncomplicated PUD the efficacy of the commonly used rapid urease test (RUT) has not been established in patients with bleeding peptic ulcer disease. The aim of this study was to evaluate the efficacy of the RUT (CLOtest) in patients with bleeding duodenal ulcers (DUs).

METHODS

Consecutive patients with symptoms of upper GI tract hemorrhage and a DU at the time of endoscopy were evaluated. The presence of H. pylori infection was determined by RUT, microbiology, and histology. Consecutive patients with uncomplicated DUs were similarly evaluated. The prevalence of H. pylori as determined by the RUT alone was compared to that determined by a combination of all tests in both patient groups.

RESULTS

Fifty-five patients with bleeding DUs and 69 with nonbleeding DUs were evaluated. The prevalence of H. pylori in patients presenting with bleeding was 72.7% (95% confidence interval [CI] 61.0-84.5%) and lower than the prevalence rate of 92.8% (95% CI 86.6-98.8%) in patients with uncomplicated PUD (p < 0.05). The prevalence of H. pylori in the bleeding DU group as determined by RUT alone (54.5%) was less than that determined by a combination of all tests (73%) with a false-negative rate of 10 of 40 (25%; 95% CI 11.6-38.4%) (p < 0.05). This false-negative rate was significantly greater than that observed in the group presenting with dyspepsia (1 of 64 [1.6%; 95% CI 0-4.6%]) (p < 0.01).

CONCLUSIONS

The prevalence of H. pylori is lower in patients with bleeding DUs when compared to patients with uncomplicated DUs. In addition, the sensitivity and negative predictive value of the RUT is lower in patients presenting with bleeding, and other methods of H. pylori diagnosis should be used in this patient group.

Increased numbers of both airway basophils and mast cells in sputum after allergen inhalation challenge of atopic asthmatics

Mast cells and basophils are metachromatic cells that participate in allergic inflammation. Allergen challenge to the airways of atopic asthmatic individuals increases levels of metachromatic cells, which may reflect an increase in mast cells, basophils, or both. We conducted a study to characterize the kinetics of basophil and mast cell recruitment to the airways of atopic asthmatic subjects after allergen inhalation challenge, using monoclonal antibodies specific for each type of cell. Of 19 subjects, 14 developed both early- and late-phase asthmatic responses (dual responders [DRs]), whereas five developed only early asthmatic responses (early responders [ERs]) after allergen inhalation. There was a significant increase in the number of sputum eosinophils (p < 0.002) and basophils (p < 0.002) at 7 h and 24 h after challenge in both ERs and DRs. There was also a significant increase in the number of activated eosinophils (p = 0. 00002) and mast cells (p = 0.009) in sputum at 7 h and 24 h after challenge in DRs, but not in ERs (p > 0.4). DRs had a significantly higher number of allergen-induced sputum basophils than did ERs (p < 0.01), and sputum basophils correlated significantly with airway hyperresponsiveness (AHR) to methacholine at 24 h after challenge (r = 0.66, p = 0.002). DRs tended to have higher allergen-induced basophil levels than did ERs, which may contribute to the observed AHR.

Combined analysis of germline polymorphisms of p53, GSTM1, GSTT1, CYP1A1, and CYP2E1: relation to the incidence rate of cervical carcinoma

BACKGROUND

The authors established the genotype frequencies of cytochrome P450 (CYP1A1/MspI, CYP2E1/PstI, and CYP2E1/DraI), glutathione-S-transferase (GSTM1 and GSTT1), and p53 (exon 4/AcclI and intron 3/16-base pair duplication) gene polymorphisms in cervical carcinoma patients and controls and evaluated the association between the specific genotype or genotype combinations of these polymorphisms and the risk of cervical carcinoma.

METHODS

In this case-control study, the genotypes of 181 human papillomavirus (HPV)-16 or HPV-18 positive cervical carcinoma patients and 1-to-1 age-matched controls were determined using a polymerase chain reaction-based technique.

RESULTS

Among these polymorphisms, the individuals carrying arginine/proline genotypes of p53 showed a 9.5-fold increase of cervical carcinoma risk (95% confidence interval [CI], 4.9-18.6) compared with those individuals carrying arginine/arginine genotypes. The frequency of overall GSTT1 null genotypes also was significantly higher in cervical carcinoma patients compared with that of GSTT1 positive genotypes (P = 0.003; odds ratio [OR] = 1.9; 95% CI, 1.2-2.9). The genotype combination of p53 and GST played a more important role in describing the relative risk of cervical carcinoma. The individuals carrying both the arginine/proline genotype of p53 and the null genotype of GSTT1 showed a 3.5-fold increase of cervical carcinoma risk (95% CI, 1.8-7.1) compared with those individuals carrying both the arginine/arginine genotype of p53 and the GSTT1 positive genotype. In the patients who were stratified into the two age groups, the null genotypes of GSTT1 (69.1% vs. 45.5%; P = 0.016) and GSTM1 (61.8% vs. 40.0%; P = 0.028) in cervical carcinoma were significantly overrepresented in the younger age subgroup (age 40 years or younger) compared with those of controls. Especially in this age group, the individuals carrying both null genotypes of GSTT1 and GSTM1 showed a 17.8-fold increase of cervical carcinoma risk (95% CI, 2.2-141.0) compared with the individuals carrying both positive genotypes of GSTT1 and GSTM1.

CONCLUSIONS

The results of the current study suggested that the arginine/proline genotype of p53, independently or in conjunction with the GSTT1 null genotype, could affect the genetic susceptibility for cervical carcinoma, and HPV positive women carrying both null genotypes of GSTT1 and GSTM1 have an increased risk of cervical carcinoma developing before age 40 years.

Abundance of cyclin B1 regulates gamma-radiation-induced apoptosis

gamma-Radiation is a potent inducer of apoptosis. There are multiple pathways regulating DNA damage-induced apoptosis, and we set out to identify novel mechanisms regulating gamma-radiation-induced apoptosis in hematopoietic cells. In this report, we present data implicating the cyclin B1 protein as a regulator of apoptotic fate following DNA damage. Cyclin B1 is the regulatory subunit of the cdc2 serine/threonine kinase, and accumulation of cyclin B1 in late G2 phase of the cell cycle is a prerequisite for mitotic initiation in mammalian cells. We find that abundance of the cyclin B1 protein rapidly increases in several mouse and human hematopoietic cells (Ramos, DP16, HL60, thymocytes) undergoing gamma-radiation-induced apoptosis. Cyclin B1 accumulation occurs in all phases of the cell cycle. Antisense inhibition of cyclin B1 accumulation decreases apoptosis, and ectopic cyclin B1 expression is sufficient to induce apoptosis. These observations are consistent with the idea that cyclin B1 is both necessary and sufficient for gamma-radiation-induced apoptosis. (Blood. 2000;95:2645-2650)

CT-guided celiac plexus block for intractable abdominal pain

Treatment of intractable abdominal pain due to inoperable intraabdominal malignancy is important, and the ineffectiveness of pharmacological agents has led many investigators to recommend chemical neurolysis of the celiac ganglions as a treatment. The author describes the technique and results of celiac plexus neurolysis under CT-guidance with various approach routes, including anterior, posterior and transaortic routes. Twenty-eight patients, ranging in age from 36 to 82 years, have been treated with this procedure. All had inoperable or recurred intraabdominal malignancies and suffered from intractable upper abdominal pain and/or back pain. The author performed the procedure using absolute alcohol by an anterior approach (n=18), posterior approach (n=6) and transaortic approach (n=4). Pain was rated according to a visual analog scale before and after the procedure to gauge treatment success. No major complications occurred. Mild hypotension occurred in five patients (18%) and transient diarrhea in six patients (21%). Twenty-one (75%) of the 28 patients had some relief of pain and 17 of these patients (61%) had good relief of pain after the procedure. The results support that CT-guided celiac plexus block with alcohol is a safe and effective means of pain control in patients with intraabdominal malignancy.

MR characteristics of progressive massive fibrosis

This study was performed to evaluate the static and dynamic magnetic resonance imaging (MRI) contrast enhancement pattern of progressive massive fibrosis (PMF) in coal workers' pneumoconiosis. Eighteen lesions in 12 patients were evaluated using a 1.5-T MR unit. T1-weighted FLASH images were obtained before and 0.5, 1, 2, 3, 4, 5, 7.5, 10, 12.5, and 15 minutes after injection of gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA; 0.1 mmol/kg). Imaging findings, the contrast enhancing pattern, enhancement time curve, and the contrast uptake equivalent (CE; mmol/L) were evaluated. On T1-weighted images, 14 lesions showed high signal intensity, and four showed low signal intensity. On T2-weighted images, all lesions were of low signal intensity and were indistinguishable from aerated lung parenchyma. After contrast infusion, all lesions except two enhanced markedly. The time enhancement curve showed a marked, gradual increase in signal intensity up to 3 minutes, a subtle increase in signal intensity up to 7.5 minutes, and then a plateau until 15 minutes after Gd-DTPA injection. Characteristic MR findings of PMF in coal workers' pneumoconiosis include T1 high signal intensity, T2 low signal intensity, and marked postinfusion enhancement. The time enhancement curve shows a marked, gradual increase of signal intensity up to 3 minutes and plateau up to 15 minutes.

Helicobacter pylori eradication therapy: a discrepancy between current guidelines and clinical practice

BACKGROUND

Consensus guidelines recommend that patients with peptic ulcer disease, and other causes of dyspepsia, should be treated with Helicobacter pylori eradication regimens. However, it has not been firmly established whether physicians have adapted their practice accordingly.

OBJECTIVES

(1) To establish the proportion of ulcer-healing prescriptions that H. pylori eradication regimens accounted for, (2) to evaluate the composition of the eradication regimens used, and (3) to compare the prescribing patterns of specialist and primary care practitioners.

METHODS

Seven community pharmacy practices were identified, and all prescriptions for individual acid-suppressing agents and eradication regimens were prospectively evaluated over an initial one-month period. Prospective documentation and evaluation of eradication regimens only was then continued for a further three-month period.

RESULTS

The prescriptions for 585 patients were evaluated. Proton-pump inhibitors and H2-receptor antagonists accounted for 261 (44.5%) and 307 (52.5%) of prescriptions respectively. H. pylori eradication therapy was prescribed for 17 (2.9%) patients in this initial period. Sixty-six eradication regimens were evaluated over four months: 48/66 (73%) of these were initiated by primary care practitioners and 18/66 (27%) by specialists. Thirteen different combinations of antibiotics and acid-suppressing agents were identified - many of undocumented efficacy. Dual, triple and quadruple regimens accounted for 15 (23%), 48 (72.5%) and 3 (4.5%) of patient prescriptions respectively.

CONCLUSION

H. pylori eradication therapy currently accounts for a very small proportion of ulcer-healing medication in clinical practice. Most eradication regimens are initiated by primary care practitioners. In comparison with specialist practices, prescriptions from this source are more likely to be of undocumented efficacy.

Weber-Christian disease presenting with proptosis: a case report

Weber-Christian disease (WCD) is a rare inflammatory disease of adipose tissue, which is characterized by painful cutaneous nodules and constitutional symptoms. Although any area of the body containing fat can be affected by WCD, the involvement of retrobulbar fat is uncommon and proptosis is a rare presenting manifestation. We report a case who presented with proptosis of the right eye which is accompanied by painful subcutaneous nodules, high fever and myalgia. Biopsies of retrobulbar tissue and suprapubic nodule showed lobular panniculitis with mixed cellular infiltration, mainly composed of histiocytes and lymphocytes. He responded well to high-dose glucocorticoid.

AAC-11 overexpression induces invasion and protects cervical cancer cells from apoptosis

To identify the genes involved in cervical carcinogenesis, we applied the mRNA differential display (DD) method to analyze normal cervical tissue, cervical cancer, metastatic lymph node, and cervical cancer cell line. We cloned a 491-bp cDNA fragment, CC231, which was present in metastatic tissue and cervical cancer cell line, but absent in normal cervical and cervical cancer tissues. The 491 bp cDNA fragment has 98% homology to the previously published sequence, AAC-11 (antiapoptosis clone 11). The levels of AAC-11 mRNA expressions in nine normal cervical and nine primary cervical cancer tissues were low. Its expression was higher in three metastatic tissues and five cervical cancer cell lines (HeLa, CaSki, SiHa, CUMC-3, and CUMC-6). Invasion of matrigel and adhesion to laminin by AAC-11 transfected CUMC-6 cells were increased by approximately 2-fold and 4-fold, respectively. Northern blot analysis showed that matrix metalloproteinase (MMP)-2 and membrane type 1 MMP (MT1-MMP) genes were found to be expressed in high levels in AAC-11-transfected cancer cells. But MMP-2 and MT1-MMP were not expressed in cells transfected with vector alone or wild-type cells. AAC-11-transfected cells expressed an elevated level of MMP-2 protein as assessed by immunoblotting. On the contrary, tissue inhibitor of MMP (TIMP-2) expression was detectable in cells transfected with vector alone or wild-type cells, respectively. Its expression was undetectable in AAC-11 transfected cells. In cervical cancer cells transfected with AAC-11, the expression of beta-catenin was up-regulated. These suggest that overexpressions of MMP-2 and MT1-MMP, loss of TIMP-2 expression, and up-regulation of beta-catenin by AAC-11 transfection may contribute to the development of cervical cancer invasion. AAC-11 gene transfection increased cervical cancer cell colonization. The effect of AAC-11 on cultured cervical cancer cells was associated with antiapoptotic process. Approximately 50% of the AAC-11 transfected cells in serum-free medium died after 2 weeks, compared to 1 week for vector alone or wild-type cells. These results suggest that AAC-11 may serve as a candidate metastasis-related and apoptosis-inhibiting gene in human cervical cancer.

Antioxidant and anti-tumor promoting activities of the methanol extract of heat-processed ginseng

Heat treatment of Panax ginseng C.A. Meyer at a temperature higher than that applied to the conventional preparation of red ginseng yielded a mixture of saponins with potent antioxidative properties. Thus, the methanol extract of heat-processed neoginseng (designated as 'NGMe') attenuated lipid peroxidation in rat brain homogenates induced by ferric ion or ferric ion plus ascorbic acid. Furthermore, the extract protected against strand scission in phiX174 supercoiled DNA induced by UV photolysis of H2O2, and was also capable of scavenging superoxide generated by xanthine-xanthine oxidase or by 12-O-tetradecanoylphorbol-13-acetate (TPA) in differentiated human promyelocytic leukemia (HL-60) cells. Topical application of NGMe onto shaven backs of female ICR mice 10 min prior to TPA, significantly ameliorated skin papillomagenesis initiated by 7,12-dimethylbenz[a]anthracene. Moreover, TPA-induced enhancement of epidermal ornithine decarboxylase (ODC) activity and ODC mRNA expression was abolished by a topical dose (0.68 mg) of NGMe. Likewise, TPA-induced production of tumor necrosis factor- in mouse skin was inhibited by NGMe pretreatment.