Breast cancer vascularity: color Doppler sonography and histopathology study

In this prospective study, the authors examined 50 patients with breast tumors (malignant, n = 32; benign, n = 18) to investigate the correlation between color Doppler flow mapping and histopathological findings and to evaluate the clinical significance of color Doppler mapping. Among the 32 patients with breast cancer, color Doppler signals were detected in 24 patients (75%). The maximum flow velocities varied from 5 to 34 cm/sec, with 16 (67%) of them above 15 cm/sec. Among the 18 patients with benign tumors, color Doppler signals could be detected in 7 (39%). The maximum flow velocity varied from 3 to 30 cm/sec but was over 15 cm/sec in only two patients (28%). Histological studies revealed that color Doppler signals detected by Doppler sonography correlated with disordered neovascularization penetrating the lesion from its periphery, consisting of thin-walled blood vessels and large arteriovenous shunts. Although large tumors tend to have high Doppler flow, there is no significant correlation between the maximum flow velocity and tumor size. There is also no significant correlation between the detection of high flow color Doppler signals and the age, receptor status, tumor size, lymph node metastases, or clinical stage of patients with breast cancer. However, there is a positive association (p < 0.05) between nodal metastases and higher tumor flow velocity in T1 (< or = 2 cm) breast tumors, but not in larger tumors. It is concluded that color Doppler is useful in the assessment of tumor vascularity but is of limited value in the differentiation of benign from malignant lesions. However, the presence of color Doppler signals in T1 breast cancer suggesting early dissemination of the cancer might be of important clinical significance in detecting those small, apparently early, but aggressive tumors with poor prognosis.

Occult breast carcinoma--use of color Doppler in localization

Occult breast carcinoma presenting with axillary metastases is a difficult clinical problem. Mammography is recommended as the diagnostic tool for detecting breast masses, but is very insensitive. In two consecutive patients with nonpalpable carcinoma of the breast, the detection of breast lesions was made by color Doppler sonography. The sensitivity of the technique makes it a useful diagnostic aid in patients with negative mammograms.

Genetic analysis of the glucose-6-phosphatase mutation of type 1a glycogen storage disease in a Chinese family

Type 1a glycogen storage disease (GSD) is an autosomal recessive metabolic disorder caused by a deficiency in glucose-6-phosphatase (G6Pase). Polymerase chain reaction (PCR) and nucleotide sequence analysis were used to identify the location and nature of mutations at the G6Pase locus in two siblings affected with type 1a GSD. Both patients are compound heterozygotes with two different single nucleotide substitutions in the two G6Pase alleles. A guanine to adenine transition was identified at base position 327 in the exon 2, converting an arginine to a histidine at codon 83. The second substitution was a thymine to adenine transversion at base position 1101 in the exon 5, converting an isoleucine to an asparagine at codon 341. Family study reveals that both parents are heterozygous carriers: the father with a mutant G6Pase allele at exon 2, the mother with another mutant G6Pase allele at exon 5. This is the first family study in Taiwan on type 1a GSD identified by molecular analysis. The mutations identified herein are novel substitutions in the G6Pase gene. In addition, an adenine to guanine substitution was observed at base position 653 in the exon 5 of G6Pase gene in both sibling patients and their parents, as well as in 15 normal Chinese subjects and three normal Caucasian subjects.

Appendicitis: usefulness of color Doppler US

PURPOSE

To assess whether color Doppler ultrasonography (US) can help diagnose early acute appendicitis in appendices of equivocal size at gray-scale US.

MATERIALS AND METHODS

In a retrospective study, color Doppler US findings were evaluated in 20 individuals with proved normal appendix at barium enema examination and in 50 patients in whom pathologic findings confirmed acute appendicitis. In a prospective study, the diagnostic value of hyperemia in the wall of the appendix in differentiating a normal from an inflamed appendix was evaluated in 26 patients with appendices of equivocal size (5-7 mm in maximal outer diameter) at grayscale US.

RESULTS

In the retrospective study, 44 of the 50 patients had hyperemia at color Doppler US. The remaining six patients had no hyperemia, and pathologic findings confirmed gangrenous appendices. The 20 patients with proved normal appendix at barium enema examination had no detectable blood flow in the wall. In the prospective study, 10 of 26 patients had hyperemia at color Doppler US, and pathologic findings confirmed early acute appendicitis. Results of barium enema examination (n = 12) or clinical follow-up (n = 4) confirmed no appendicitis in the remaining 16 patients.

CONCLUSION

Hyperemia in the wall of the appendix at color Doppler US is a sensitive indicator for inflammation. A simple additional color Doppler US examination may be helpful in the diagnosis of early acute appendicitis when an appendix is well depicted and is equivocal in size at gray-scale US.

Intragenic homozygous deletions of MTS1 gene in gastric cancer in Taiwan

The multiple tumor suppressor 1 (MTS1) and 2 (MTS2) genes, located on chromosome 9p21, have been reported to be deleted or mutated in many malignant cell lines and in a high percentage of some primary carcinomas. To determine whether these genes are altered, and if so, what is the nature of the alterations, in human gastric adenocarcinoma, we investigated their frequency of mutation by Southern blotting, polymerase chain reaction (PCR) and direct sequencing in 55 patients. Furthermore, loss of heterozygosity (LOH) of chromosome 9p21 at the IFNA locus and D9S171 was assessed. Homozygous deletions of exon 1 of the MTS1 gene were identified in 5 of 55 (9.1%) primary tumors. No deletion of MTS2 gene was noted. LOH was observed in 7 (14.3%) of 49 informative cases (5 cases at IFNA locus, 2 cases at D9S171 and one case with combined LOH at D9S171 and homozygous deletion at exon 1 of MTS1). Direct sequencing of PCR products of the MTS1 and MTS2 gene did not reveal any point mutation in these 55 patients. These data indicate that alterations of the MTS1 and MTS2 genes are infrequently encountered. Additional studies of LOH with more microsatellite markers near 9p21 are mandatory to elucidate whether another tumor suppressor gene exists in the vicinity of MTS1 in primary gastric adenocarcinoma.

[A patient with myotonic dystrophy who presented with chest roentgenographic abnormalities and alveolar hypoventilation]

A 52-year-old man had been asymptomatic except for nasal speech since his third decade of life. A chest roentgenogram obtained during a health screening one year before admission revealed elevation of the right hemidiaphragm and infiltrates in the right lower lung field. Because the pulmonary shadows had gradually increased, he was admitted to the hospital, for further examination. Based on physiological findings and on the results of electromyography, myotonic dystrophy was diagnosed. The chest roentgenographic abnormalities were regarded as resulting from complications of this disease. Arterial blood gas analysis showed hypercapnic hypoxia and a spirogram showed that the vital capacity and maximum voluntary ventilation were about half of their respective predicted values. The hypercapnic ventilatory response was also abnormally low. An overnight study of oxygen saturation showed episodes of marked desaturation, and polysomnography revealed central sleep apnea. Inhalation of capsaicin showed an abnormally high cough threshold. Patients with undiagnosed myotonic dystrophy rarely present with chest roentgenographic abnormalities.

Surgical treatment of peptic ulcer disease: changing patterns in the past 40 years

During the past 40 years (1951-1990), 7,663 patients with peptic ulcer disease underwent surgical treatment at the National Taiwan University Hospital. A great change in patient characteristics and operative procedures was noted between the last 10 years and the previous three decades. There were 7,105 patients (92.7%) between 1951 and 1980, an average of 237 patients per year. However, only 558 patients received surgery in the last 10 years, an average of 56 patients per year. The proportion of female patients increased from 9.5% in the earlier period to 20.4% in the last 10 years; the average age of patients also increased. In the earlier period, the indications for surgery were hemorrhage (38.4%), perforation (36.1%), intractable pain (16.4%) and stenosis (9.1%). Perforation (89.2%) was the most common indication for surgical treatment in the last 10 years. Hemorrhage (4.9%), pain (4.1%) and stenosis (1.8%) were less common. There was no significant difference in surgical morbidity between the two periods. Primary subtotal gastrectomy (SG) accounted for 75.4% of operations in the earlier period, but vagotomy became the main treatment in the last 10 years, including highly selective vagotomy (HSV) (31.9%), and truncal vagotomy with drainage procedure (TV + D) (31.0%). The surgical mortality in the earlier period was 1.3% for SG, 1.8% for TV + D and 16.1% for simple closure. There was no significant change in ulcer location between the two periods. The overall mortality rate was higher in the last 10 years (5.2%) than in the earlier 30 years (2.7%) (p < 0.001). In follow-up studies, the satisfactory rate after operation was similar among patients receiving SG (89.8%), HSV (90.3%) and TV + D (91.1%) between 1977 and 1990.

Endoscopically-assisted duodenal feeding tube placement using a nasogastric tube: preliminary two-year experience

Our initial 2-year experience using a new technique of nasoduodenal feeding tube placement with a soft nasogastric tube is presented. This technique was used for patients with major burns to initiate early, safe enteral feeding. With the use of double loops in the tube and endoscopic assistance, the placement of the nasogastric tube beyond the second portion of the duodenum was accomplished in approximately 20 minutes. A method of transpyloric duodenal intubation using a soft, unstented nasogastric tube that allowed rapid bedside nasoduodenal intubation, with the patient in the supine position, was used. The tube placement technique minimizes the suffering of critically ill patients and the labor of clinicians performing the tube placement.

Extensive intra-abdominal-retroperitoneal fat necrosis in a patient with renal cell carcinoma

Extensive intra-abdominal-retroperitoneal fat necrosis is rare, especially its occurrence in cases of renal cell carcinoma (RCC). We report a patient who presented with a palpable left lower abdominal mass. The RCC was an incidental radiographic finding. The fat necrosis exhibited properties similar to a liposarcoma at laparotomy and on histologic examination of frozen tissue sections. Debulking surgery with left hemicolectomy, transverse colostomy and a midrectal Hartmann pouch was performed. In subsequent surgery, radical right nephrectomy and closure of the colostomy were performed. There were no discernible factors predisposing this patient to fat necrosis. To our knowledge, such extensive intra-abdominal-retroperitoneal fat necrosis is extremely rare. A literature search failed to find a similar case of intra-abdominal or retroperitoneal fat necrosis in association with RCC.

Focal appendicitis confined to the tip: diagnosis at US

PURPOSE

To evaluate the diagnostic value of graded-compression ultrasonography (US) for the diagnosis of focal appendicitis confined to the tip.

MATERIALS AND METHODS

During a 4-year period, US was performed in 1,450 patients with clinically suspected acute appendicitis. Of these patients, 443 had appendicitis at pathologic examination, 20 of whom had focal appendicitis confined to the tip. Focal appendicitis confined to the tip was defined as occurring when the resected specimen had inflammation only at the distal third of the appendix.

RESULTS

Of 20 patients with focal appendicitis confirmed at pathologic examination, 17 patients (85%) had focal appendicitis that was correctly diagnosed at US. The remaining three patients' appendices were diagnosed at US as normal (false-negative cases). Five patients had perforation at the tip, and one patient had an appendicolith.

CONCLUSION

Although US appears to be fairly accurate in the diagnosis of focal appendicitis confined to the tip, the entire length of the appendix should be evaluated in order to avoid a false-negative diagnosis.

Enhancement of porcine natural killer cell activity by recombinant human and murine IL-12

These studies describe the effects of recombinant human (rHu) and recombinant murine (rMu) interleukin 12 (IL-12) in the porcine system. To examine the effects of rHu and rMu IL-12, porcine PBL were cultured with rHu and rMu IL-12, and then used for a NK assay. Significant enhancement of porcine NK cell cytotoxicity was observed, and maximal enhancement was reached after 26 hr culture in nanogram quantities (5 ng/ml = 10 units/ml) of rHu and rMu IL-12. Monoclonal antibody (mAb) specific for human IL-12, C8.6, blocked rHu IL-12 enhanced porcine natural killer (NK) cytotoxicity. It was also shown that rHu IL-12 had additive effects on enhancement of NK cell cytotoxicity with PNK-E/G7 mAbs which react with cytolytic trigger molecules on porcine NK cells. By using purified NK cells, porcine tumor necrosis factor-alpha (TNF-alpha) secretion was measured on rHu IL-12 and PNK-E/G7 mAb-activated NK cells. rHu IL-12 and PNK-E/G7 mAbs synergize to induce TNF-alpha secretion. These data indicate that rHu and rMu IL-12 are cross-reactive in the porcine system and suggest the potential use of the porcine system as an important animal model for further study of rHu IL-12.

Role of oxoproline in the regulation of neutral amino acid transport across the blood-brain barrier

Regulation of neutral amino acid transport was studied using isolated plasma membrane vesicles derived from the bovine blood-brain barrier. Neutral amino acids cross the blood-brain barrier by facilitative transport system L1, which may allow both desirable and undesirable amino acids to enter the brain. The sodium-dependent amino acid systems A and Bo,+ are located exclusively on abluminal membranes, in a position to pump unwanted amino acids out. gamma-Glutamyl transpeptidase, the first enzyme of the gamma-glutamyl cycle, is an integral protein of the luminal membrane of the blood-brain barrier. We demonstrate that oxoproline, an intracellular product of the gamma-glutamyl cycle, stimulates the sodium-dependent systems A and Bo,+ by 70 and 20%, respectively. Study of system A showed that 2 mM oxoproline increased the affinity for its specific substrate N-methylaminoisobutyrate by 50%. This relationship between the activity of the gamma-glutamyl cycle and system A transport may provide a short term regulatory mechanism by which the entry of potentially deleterious amino acids (i.e. neurotransmitters or their precursors) may be retarded and their removal from brain accelerated.

Purification and molecular cloning of an inducible gram-negative bacteria-binding protein from the silkworm, Bombyx mori

A 50-kDa hemolymph protein, having strong affinity to the cell wall of Gram(-) bacteria, was purified from the hemolymph of the silkworm, Bombyx mori. The cDNA encoding this Gram(-) bacteria-binding protein (GNBP) was isolated from an immunized silkworm fat body cDNA library and sequenced. Comparison of the deduced amino acid sequence with known sequences revealed that GNBP contained a region displaying significant homology to the putative catalytic region of a group of bacterial beta-1,3 glucanases and beta-1,3-1,4 glucanases. Silkworm GNBP was also shown to have amino acid sequence similarity to the vertebrate lipopolysaccharide receptor CD14 and was recognized specifically by a polygonal anti-CD14 antibody. Northern blot analysis showed that GNBP was constitutively expressed in fat body, as well as in cuticular epithelial cells of naive silkworms. Intense transcription was, however, rapidly induced following a cuticular or hemoceolien bacterial challenge. An mRNA that hybridized with GNBP cDNA was also found in the l(2)mbn immunocompetent Drosophila cell line. These observations suggest that GNBP is an inducible acute phase protein implicated in the immune response of the silkworm and perhaps other insects.

Large-scale selection of CD34+ peripheral blood progenitors and expansion of neutrophil precursors for clinical applications

Hematopoietic recovery after high-dose chemotherapy is characterized by an obligate period of neutropenia of approximately 8-10 days. It is postulated that if a pool of neutrophil precursors and progenitors were expanded in vitro and reinfused, the duration of neutropenia may be substantially shortened by these cells capable of providing mature neutrophils within days of reinfusion. In this study, peripheral blood progenitor cell products were obtained from six normal donors mobilized with rhG-CSF and two patients mobilized with cyclophosphamide and rhG-CSF. CD34+ cells were isolated using the Isolex immunomagnetic bead method. A mean of 8.26 x 10(7) CD34+ cells with a mean purity of 74.5% were seeded at a concentration of 1 x 10(5)/ml into a 12 day stroma-free liquid culture using gas-permeable bags. A serum-free growth medium supplemented with PIXY321 was used. On day 7, there was a mean cellular expansion of fourfold, at which time the cells were resuspended at the initial concentration, yielding a mean culture volume of 3L (1-6 L). On day 12, there was an additional mean fold cellular expansion of 10 x, achieving an overall mean fold expansion of 41 +/- 16. Cellular characterization of the expanded cells revealed predominantly neutrophil precursors by morphology (mean 70.1%) and flow cytometric analysis. A mean of 52.3% of the expanded cells expressed CD15. Immunohistochemical staining revealed a mean of 7.1% CD41a+ megakaryocytic progenitors in the final cultured cell product. Detectable CD34+ cells were maintained only in those cultures initiated with greater than 90% CD34+ cells. Colony-forming units-granulocyte-macrophage (CFU-GM) were maintained in the 12 day culture at a level similar to the preculture number, whereas CFU mixed were depleted in all samples. On day 0, there were few CFU clusters (colonies containing fewer than 50 cells) identified, but by day 12, a mean total of 8.3 x 10(6) CFU clusters were identified. On day 12, the expanded cells were harvested and pooled using the Fenwal CS3000 Plus blood cell separator and resuspended in Plasma-Lyte-A with 1% human serum albumin. The mean harvest recovery of expanded progenitors was 91%, with a mean viability of 86%.

Solid and papillary neoplasms of the pancreas

Solid and papillary neoplasms of the pancreas, a rare tumor usually found in young female patients, seldom presents with metastasis since it is a tumor with low potential for malignancy. The prognosis for this lesion is much more favorable than that for other pancreatic neoplasms. In an attempt to understand the characteristics and prognosis of this lesion, we reviewed twenty cases treated at the Department of Surgery, Severance Hospital, Yonsei University from 1985 to 1994. The mean age of the patients was 25.6 years (range: 13 to 39 years), and 19 (95%) were women. Chief complaints were palpable mass (50%), pain (45%), and indigestion (5%). In laboratory studies, tumor markers, including CEA, CA125, CA19-9, and aFP were studied in eight patients, and found negative. Other laboratory findings were also nonspecific. These tumors may occur anywhere in the pancreas. In our studies, the tumor was most often located in the tail (45%), and the head (40%) of the pancreas. These were treated by distal pancreatectomy and splenectomy (55%), Whipple's operation (20%), pylorus preserving pancreatoduodenectomy (10%), enucleation (10%) or excision (5%). Significant morbidity or mortality was not observed during hospitalization, and no recurrence or malignant degeneration occurred during the mean follow-up period of 4 years (range: 1 month to 9 years). In conclusion, this study has suggested that the patients with a solid and papillary neoplasm of the pancreas have a good prognosis for successful treatment, if the disease is diagnosed early and the tumor is completely resected. A higher index of suspicion, and more aggressive diagnostic workups are needed in dealing with this disease entity.

A case of paraesophageal hernia repaired by laparoscopic approach

Paraesophageal hernia comprises only 2 approximately 5% of all hiatal hernias but is prone to incarceration and strangulation. For this reason they must be recognized and repaired as expeditiously as possible. The laparoscopic approach has already been successfully applied to the repair of the more common sliding hiatal hernia and it seems reasonable to propose that the paraesophageal hernia, provided it is not complicated, might also be repaired by the laparoscopic technique. We present here a case of paraesophageal hernia which has been successfully repaired by the laparoscopic approach. A 73-year-old female suffering from postprandial fullness in the retrosternal area was diagnosed preoperatively with paraesophageal hiatal hernia with gastroesophageal acid reflux and was submitted for laparoscopic repair. The procedure entailed reduction of the hernia, mobilization of the esophagogastric junction with crural repair and partial fundoplication. At the 9th-month follow-up, the patient had remained asymptomatic and follow-up studies revealed no evidence of hernia or acid reflux. As a result of this favorable experience with minimal morbidity, early hospital discharge, and effective control of symptoms without adverse sequalae, laparoscopic repair can be considered as the curative and minimal invasive method in the management of paraesophageal hernia.

Selection and expansion of peripheral blood CD34+ cells in autologous stem cell transplantation for breast cancer

Cytopenia after high-dose chemotherapy and autologous stem cell reinfusion is a major cause of morbidity. Ex vivo cultured expansion and differentiation of CD34+ peripheral blood progenitor cells (PBPC) to neutrophil precursors may shorten the neutropenic period further. We explored the use of these ex vivo cultured PBPCs in nine patients with metastatic breast cancer. All underwent PBPC mobilization with cyclophosphamide, VP-16, and G-CSF. Subsequently, they underwent four to five apheresis procedures. One apheresis product from each patient was prepared using the Isolex 300 Magnetic Cell Separation System (Baxter Immunotherapy, Irvine, CA) to obtain CD34+ cells. These cells were then cultured in gas permeable bags containing serum-free X-VIVO 10 (BioWhittaker, Walkersville, MD) medium supplemented with 1% human serum albumin and 100 ng/mL PIXY321. At day 12 of culture the mean fold expansion was 26x with a range of 6 to 64x. One patient's cells did not expand because of a technical difficulty. The final cell product contained an average of 29.3% CD15+ neutrophil precursors with a range of 18.5% to 48.1%. The patients underwent high-dose chemotherapy with cyclophosphamide, carboplatin, and thiotepa. On day 0, the cryopreserved PBPCs were reinfused and on day +1 the 12-day cultured cells were washed, resuspended, and reinfused into eight of nine patients. One patient was not infused with cultured cells. The mean number of cultured cells reinfused was 44.6 x 10(6) cells/kg with a range of 0.8 to 156.6 x 10(6) cells/kg. No toxicity was observed after reinfusion. The eight patients have recovered absolute neutrophil counts > 500/microL on a median of 8 days (range 8 to 10 days); the median platelet transfusion independence occurred on day 10 (range 8 to 12 days) and platelet counts > 50,000/microL were achieved by day 12 (range 9 to 14) for the seven patients whose platelet counts could be determined. Expanded CD34+ selected PBPC can be obtained and safely reinfused into patients.

Suppressive effects of Aspergillus fumigatus culture filtrates on human alveolar macrophages and polymorphonuclear leucocytes

Aspergillus spp., especially A. fumigatus (Af) can colonize the airways and the lungs with localized underlying conditions and further invade the surrounding lung tissues, even in subjects without systemic predisposing factors, presumably by escaping the local host defences. To clarify the mechanisms of colonization and invasion of Af, we investigated the in vitro effects of Af culture filtrates (ACFs) on the functions of human alveolar macrophages (AMs), and polymorphonuclear leucocytes (PMNs). ACFs were obtained by culturing clinically isolated Af in Medium-199 at 37 degrees C for 5 days. In the study of phagocytosis of Af conidia by human AMs, 52% of AMs ingested conidia during a 60 min incubation period in Medium-199. However, the percentage decreased to 24% when incubated with a final concentration of 30% ACF in Medium-199. With respect to the antichemotactic activity on human PMNs, 3% ACF was sufficient for significant suppression, and 30% ACF completely inhibited the migration of PMNs. In addition, phorbol myristate acetate (PMA)-induced O2- release from PMNs was significantly suppressed in Medium-199 which included 12.5% ACF or more. The antichemotactic activity of ACF was partially abolished by trypsin or chicken egg ovomacroglobulin. When ACF was separated into two fractions (molecular weight > 10 and < 10 kDa) by dialysis and centrifugation through CL-LGC filters, both fractions retained the antichemotactic activity. We conclude that Af produce several antiphagocytic factors, which can be responsible for the colonization of Af in the bronchopulmonary tissues and allow this species to invade surrounding lung tissues in pulmonary aspergillosis by suppressing local host defences.

Genetic analysis of the HPRT mutation of Lesch-Nyhan syndrome in a Chinese family

BACKGROUND

The Lesch-Nyhan syndrome is an X-linked recessive inherited disease caused by a complete deficiency of hypoxanthine guanine phosphoribosyl-transferase (HPRT) activity. Many different mutations throughout the HPRT coding region of Lesch-Nyhan patients have been described, including single base substitutions, partial or entire gene deletions, gene insertions or endoduplication of exons. However, study of gene mutation in Chinese patients has rarely been reported in Taiwan.

METHODS

Polymerase chain reaction (PCR) and nucleotide sequence analysis were used to identify the location and the nature of the mutation at the HPRT locus in two brothers affected with Lesch-Nyhan syndrome. The HPRT cDNA, amplified from total RNA of patient's peripheral blood by reverse transcription-polymerase chain reaction, was cloned into a pGEM-3Zf(-) vector and then sequenced. Family study involved initial screening using single-strand conformation polymorphism, and further confirmation by direct sequencing of the exon encompassing the mutation.

RESULTS

The mutation identified in these two affected siblings was a single nucleotide substitution, from cytosine to guanine, in exon 3 of the HPRT coding region. This transversion putatively caused a single amino acid substitution from phenylalanine to leucine at codon 74 in the translated protein. This base change was further confirmed by direct sequencing of both the HPRT cDNA fragment and the exon 3 of HPRT gene amplified from genomic DNA. The family study revealed that the patient's mother was a heterozygous carrier, and the mutation seemed to have occurred de novo in a germinal cell from one of the maternal grandparents.

CONCLUSIONS

This is the first family study on Chinese patients with Lesch-Nyhan syndrome identified by molecular analysis in Taiwan. The mutation described herein is a novel substitution which occurs in a suggested "hotspot" of mutation (exon 3) of the HPRT gene. The application of molecular analysis of HPRT-gene allows not only DNA diagnosis by directly detecting the mutant alleles, but also prenatal diagnosis and carrier identification within individual families affected by Lesch-Nyhan syndrome.

Clinical use of selected and expanded peripheral blood CD34+ cells: a preliminary report of feasibility and safety

In this report, we describe the preliminary results from a feasibility and safety study on the clinical use of CD34-positive cells cultured from mobilized peripheral blood. Separation and cell expansion were successfully performed, and the patients tolerated the infusions without problems and achieved engraftment.

Aspergillus culture filtrates and sputum sols from patients with pulmonary aspergillosis cause damage to human respiratory ciliated epithelium in vitro

Aspergillus species frequently colonize lower respiratory tracts and lungs with localized underlying conditions (healed tuberculous cavity, cystic fibrosis, bronchiectasis, etc.) even in subjects without systemic predisposing factors. We investigated the in vitro effects of culture filtrates of Aspergillus species and sputum sols from patients with pulmonary aspergillosis on ciliary beat frequency (CBF) and epithelial integrity of human respiratory ciliated epithelium. Culture filtrates of 25 clinically isolated fungi (16 Aspergillus fumigatus, three Aspergillus niger, one Aspergillus flavus, three Candida albicans, and two Cryptococcus neoformans) were obtained by culturing the fungi in Medium-199 at 37 degrees C for 7 days, and five sputum sols were obtained from patients with pulmonary aspergillosis infected by A. fumigatus. During 6 h experiments using a photometric technique, 14 out of 16 A. fumigatus culture filtrates caused progressive and significant reduction in CBF associated with marked epithelial disruption, whilst the culture filtrates of A. niger and A. flavus caused minor epithelial damage without slowing of CBF, and Medium-199 alone (Control) showed neither epithelial damage nor slowing of CBF. All of the sputum sols also caused significant slowing of CBF as well as epithelial disruption. Culture filtrates of C. albicans and Cr. neoformans had no effects on human respiratory epithelium. We conclude that Aspergillus species, especially A. fumigatus release a factor (or factors) which causes damage to respiratory epithelium and slows CBF, and that these factors may contribute to the colonization of the lower respiratory tracts by the Aspergillus species and may possibly contribute to the further proliferation and spread of the lesions in pulmonary aspergillosis.

Microsatellite instability in gastric carcinoma with special references to histopathology and cancer stages

To study the molecular mechanism of gastric carcinogenesis, the frequencies of microsatellite instability were evaluated with seven dinucleotide repeat loci in 59 patients with gastric carcinoma. Microsatellite instability at two or more loci was found in 41.5% (17/41) of advanced gastric carcinoma, 21.4% (3/14) of early gastric carcinoma, but not in remnant gastric carcinoma (0/4), with an overall frequency of 33.9% (20/59). Diffuse gastric carcinoma had a similar prevalence (32.1%, 9/28) to intestinal gastric carcinoma (40.7%, 11/27). The frequency of microsatellite instability in gastric carcinoma was not significantly different with respect to age, sex and Helicobacter pylori infection. Microsatellite instability tended to occur more frequently in cancers of the cardia (62.5%, 5/8) compared with cancers of other stomach regions (31.9%, 15/47), but the difference was not statistically significant. These data suggest that microsatellite instability occurs in early gastric carcinoma and its occurrence increases during tumour progression. Furthermore, its frequency was independent of age, gender, histological types and Helicobacter pylori infection.

Clinicopathologic characteristics of Helicobacter pyloric seropositive gastric adenocarcinomas

To compare and characterize retrospectively the clinicopathologic features of gastric cancers with and without previous Helicobacter pylori infection, we determined the preoperative seropositivity of H. pylori in 151 patients who had undergone gastric resection for primary gastric adenocarcinoma between 1988 and 1993. The overall seroprevalence of H. pylori was 60.9%. H. pylori-positive gastric cancers were frequently associated (p<0.05) with macroscopic localized types (Borrmann I and II) in which negative cancer associated with infiltrative types (Borrmann III and IV) and cancer invasion of the duodenum. Multivariate analysis showed that H. pylori seropositivity was not an independent prognostic factor. Pathologic tumor-node-metastases (TNM) stage remained the only prognostic indicator. Our study suggests that H. pylori has a significant impact on the clinically relevant tumor biology of gastric cancer. Investigation along this line is warranted.

Infestation rate of head lice in primary school children in Inchon, Korea

The survey of the head louse infestation of primary school children in Inchon city was carried out in May 26-27, 1995. Total number of the children surveyed were 1,530. Four (0.5%) out of 768 boys were infested with nits or adults/nymphs of lice and 72 (9.4%) out of 762 girls were positive with those of lice. The infestation rate of lice for girls was 19 times higher than that of boys.