Species heterogeneity between gerbils and rats: quinolinate production by microglia and astrocytes and accumulations in response to ischemic brain injury and systemic immune activation

Quinolinic acid is an excitotoxic kynurenine pathway metabolite, the concentration of which increases in human brain during immune activation. The present study compared quinolinate responses to systemic and brain immune activation in gerbils and rats. Global cerebral ischemia in gerbils, but not rats, increased hippocampus indoleamine-2,3-dioxygenase activity and quinolinate levels 4 days postinjury. In a rat focal ischemia model, small increases in quinolinate concentrations occurred in infarcted regions on days 1, 3, and 7, although concentrations remained below serum values. In gerbils, systemic immune activation by an intraperitoneal injection of endotoxin (1 mg/kg of body weight) increased quinolinate levels in brain, blood, lung, liver, and spleen, with proportional increases in lung indoleamine-2,3-dioxygenase activity at 24 h postinjection. In rats, however, no significant quinolinate content changes occurred, whereas lung indoleamine-2,3-dioxygenase activity increased slightly. Gerbil, but not rat, brain microglia and peritoneal monocytes produced large quantities of [13C(6)]-quinolinate from L-[13C(6)]tryptophan. Gerbil astrocytes produced relatively small quantities of quinolinate, whereas rat astrocytes produced no detectable amounts. These results demonstrate that the limited capacity of rats to replicate elevations in brain and blood quinolinic acid levels in response to immune activation is attributable to blunted increases in local indoleamine-2,3-dioxygenase activity and a low capacity of microglia, astrocytes, and macrophages to convert L-tryptophan to quinolinate.

Clinical experience in radical lymphadenectomy for adenocarcinoma of the gastric cardia

OBJECTIVES

We evaluated the pattern of nodal metastasis and its prognosis after radical lymphadenectomy in adenocarcinoma of the gastric cardia.

METHODS

We conducted a retrospective cohort study of 70 patients (52 men and 18 women; mean age 63.6 years) with adenocarcinomas of the gastric cardia who underwent extended gastrectomy (65 total gastrectomies and 5 proximal gastrectomies) and radical lymphadenectomy (D2 to D4) at Taichung Veterans General Hospital between 1989 and 1995.

RESULTS

Twenty-four complications developed in 22 (31.4%) patients, and seven (10.0%) hospital deaths occurred. An overall 5-year cumulative survival of 37.6% was obtained. Lymph node metastases were identified in 53 (75.7%) patients. Nodal involvement was closely related to the depth of tumor invasion (p = 0.005). When the gastric wall invasion was limited to the subserosal layer (T1 and T2, n = 15), no patient had N4 group nodal metastasis. Once the serosal layer had been involved (beyond T3), N4 group nodal metastasis was frequently seen (30.9%, 17 of 55 patients). A multivariable analysis revealed that the level of nodal involvement, the depth of tumor invasion, and the presence of complications were independent prognostic factors. Cumulative 5-year survivals of curability A (n = 12), B (n = 19), and C (n = 32) resections were 100%, 21.2%, and 27.5%, respectively (p = 0.0001). The long-term survival of the patients after resection was also closely related to their pTNM stages (p = 0.0004).

CONCLUSIONS

We conclude that gastrectomy accompanied by radical lymphadenectomy provides a reasonable long-term survival expectancy that is closely related to the stage of the disease and the curability of resection.

SlyA, a transcriptional regulator of Salmonella typhimurium, is required for resistance to oxidative stress and is expressed in the intracellular environment of macrophages

Appropriate regulation of genes enables Salmonella typhimurium to adapt to the intracellular environment of the host. The Salmonella slyA gene is in a family of transcriptional regulators that may play an important role in this adaptation. We have previously shown that slyA mutant Salmonella strains are profoundly attenuated for virulence and do not survive in macrophages. In this study, we demonstrate that the expression of multiple Salmonella proteins is regulated by SlyA during stationary phase and during infection of macrophages. Both of these conditions also induced the expression of a slyA::lacZ transcriptional fusion. Expression of the slyA::lacZ transcriptional fusion increased 15-fold in stationary phase and was not dependent on the stationary-phase sigma factor, RpoS. slyA mutant Salmonella strains were sensitive to oxidative products of the respiratory burst, including hydrogen peroxide and the products of the redox cycling compound paraquat, but not to nitric oxide donors. These results suggest that the SlyA regulon is activated during infection of the host and is required for resistance to toxic oxidative products of the reticuloendothelial system.

Different kynurenine pathway enzymes limit quinolinic acid formation by various human cell types

Substantial increases in the tryptophan-kynurenine pathway metabolites, l-kynurenine and the neurotoxin quinolinic acid, occur in human brain, blood and systemic tissues during immune activation. Studies in vitro have shown that not all human cells are capable of synthesizing quinolinate. To investigate further the mechanisms that limit l-kynurenine and quinolinate production, the activities of kynurenine pathway enzymes and the ability of different human cells to convert pathway intermediates into quinolinate were compared. Stimulation with interferon gamma substantially increased indoleamine 2,3-dioxygenase activity and L-kynurenine production in primary peripheral blood macrophages and fetal brains (astrocytes and neurons), as well as cell lines derived from macrophage/monocytes (THP-1), U373MG astrocytoma, SKHEP1 liver and lung (MRC-9). High activities of kynurenine 3-hydroxylase, kynureninase or 3-hydroxyanthranilate 3,4-dioxygenase were found in interferon-gamma-stimulated macrophages, THP-1 cells and SKHEP1 cells, and these cells made large amounts of quinolinate when supplied with L-tryptophan, L-kynurenine, 3-hydroxykynurenine or 3-hydroxyanthranilate. Quinolinate production by human fetal brain cultures and U373MG cells was restricted by the low activities of kynurenine 3-hydroxylase, kynureninase and 3-hydroxyanthranilate 3,4-dioxygenase, and only small amounts of quinolinate were synthesized when cultures were supplied with L-tryptophan or 3-hydroxyanthranilate. In MRC-9 cells, quinolinate was produced only from 3-hydroxykynurenine and 3-hydroxyanthranilate, consistent with their low kynurenine 3-hydroxylase activity. The results are consistent with the notion that indoleamine 2,3-dioxygenase is an important regulatory enzyme in the production of L-kynurenine and quinolinate. Kynurenine 3-hydroxylase and, in some cells, kynureninase and 3-hydroxyanthranilate 3,4-dioxygenase are important determinants of whether a cell can make quinolinate.

Identification and differentiation of bear bile used in medicinal products in Taiwan

One hundred eighty-three suspect bear bile used in medicinal products, collected in Taiwan as gall bladders or dried powder forms, were analyzed using FTIR, HPTLC, and HPLC techniques to identify whether they are indeed bear bile. Those confirmed were further examined to determine whether the observed analytical parameters can be reliably used for source inference, i.e., differentiating products among North American black bear, farmed Asiatic black bear, polar bear, etc. Our data suggested that North American and polar bears contain a higher concentration of TC (relative to TUDC and TCDC), whereas the relative concentration of TC in Asiatic bears (wild or farmed) is much lower. Thus, the relative concentration of TC can potentially be used for differentiating Asiatic bear bile from North American and polar bear products, but it cannot be used for the differentiation of wild and farmed bear bile as suggested in an earlier report by Espinoza et al. The origin of the 183 samples analyzed were found to be as follows: 118 (64%), bile salts, or gall bladders were of domestic pig; 56 (31%), bile products of Asiatic bear; 4 (2.2%), Asiatic bear mixed with pig bile salts; 3 (1.6%) goat gall bladders; 1 (0.55%) water buffalo bile salts; and 1 (0.55%), pig bile salts mixed with water buffalo bile salts.

Primary biliary cirrhosis associated with mixed type autoimmune hemolytic anemia and sicca syndrome: a case report and review of literature

A case presenting with an unusual association of primary biliary cirrhosis and mixed type autoimmune hemolytic anemia plus sicca syndrome is described. The 49-yr-old female primary biliary cirrhosis patient had a confirmed sicca syndrome and presented with jaundice and life-threatening anemia. Laboratory tests revealed positive Coombs' test with coexisting cold and warm autoantibodies. She was successfully treated by blood transfusion with packed red cells lacking any red cell antigens corresponding to serum alloantibodies and pulse methylprednisolone therapy. The patient remained stable under maintenance treatment using oral steroids and ursodeoxycholic acid. This case is probably the first reported showing an association between primary biliary cirrhosis and mixed type autoimmune hemolytic anemia plus sicca syndrome and was probably induced by heterogenous and complicated autoimmune reactions.

Paraganglioma of the cauda equina with associated intramedullary cyst: MR findings

The MR imaging features of a paraganglioma of the cauda equina with associated spinal cord cysts are presented. MR imaging showed the tumor to be isointense with the spinal cord on all pulse sequences and to enhance homogeneously. The intramedullary cysts had increased signal intensity on proton density- and T2-weighted images, and involved the cervical and thoracic regions.

Synthesis and structure-opioid activity relationships of trans-(+/-)-3,4-dichloro-N-methyl-N-[4- or 5-hydroxy-2-(1-pyrrolidiny)cyclohexyl]benzeneacetamides

To explore the effects of attaching a hydroxy function to the cyclohexane ring of kappa-selective opioid N-[2-(1-pyrrolidinyl)cyclohexyl]benzeneacetamides, trans-(+/-)-3,4-dichloro-N-methyl-N-[4- or 5-hydroxy-2-(1-pyrrolidiny)cyclohexyl]benzeneacetamides (1-4) and their benzoates (5-8) have been synthesized in a divergent and stereoselective manner. When compared with the parent compound U-50488, hydroxy derivatives 1-4 maintained high selectivity towards the kappa-opioid receptor (mu/kappa ratio = 24 to > 91); while displaying significant reduction in binding affinity (Ki,kappa = 75-218 nM). The lowest kappa-affinity was observed with compound 4, where the hydroxy group is attached at the 5-axial or 5-beta position. Further reduction in kappa-affinity was observed when the hydroxy function was benzoylated. However, the 4 beta, 5 alpha, and 5 beta isomers (6-8) maintained varying degrees of kappa-selectivity; the 4 alpha-isomer compound 5, with its benzoate moiety situated at the 4-axial position is now a moderately potent mu-selective opioid (Ki,mu = 168 nM, mu/kappa = 0.076). The result suggest the importance of lipophilicity in binding to opioid receptors and the presence of a specific lipophilic binding site on the mu-opioid receptor.

Chicken Nkx-2.8: a novel homeobox gene expressed in early heart progenitor cells and pharyngeal pouch-2 and -3 endoderm

Members of the NK family of homeobox transcription factors regulate critical steps of organogenesis during vertebrate development. In the studies described in this report, we have isolated and functionally characterized the chicken Nkx-2.8 (cNkx-2.8) cDNA and protein and defined the temporal and spatial pattern of cNkx-2.8 gene expression during chicken development. cNkx-2.8 transcripts are first detectable at HH stage 7 in the splanchnopleura. At stage 10(+), the cNkx-2.8 gene is expressed in the linear heart tube and the dorsal half of the vitelline vein. However, after looping, HH stage 13, cNkx-2.8 is no longer expressed in the looped heart tube, but is expressed in the ventral pharyngeal endoderm. At stage 15, in addition to the pharyngeal expression pattern, cNkx-2.8 is expressed in the ectoderm of the pharyngeal arches and the aortic sac. By HH Stage 17, cNkx-2.8 expression is detectable in lateral endoderm of the second and third pharyngeal pouches, the posterior portion of the aortic sac, and the sinus venosus. cNkx-2.8 binds to previously characterized Nkx2-1 and Nkx2-5 DNA-binding sites and overexpression of cNkx-2.8 transactivates a minimal promoter which contains multimerized Nkx-2 DNA-binding sites. In addition, cNkx-2.8 and serum response factor can coactivate a minimal cardiac alpha-actin promoter. These data are consistent with a model in which cNkx-2.8 performs a unique temporally and spatially restricted function in the developing embryonic heart and pharyngeal region. Moreover, the coexpression of cNkx-2.5 and -2.8 raises the possibility that cNkx-2. 8 may have a redundant role with cNkx-2.5 in the coalescing heart tube and may play an important role in the transcriptional program(s) that underlies thymus formation. The existence of multiple NK-2 family members and their partially overlapping patterns of expression are discussed within the framework of a "Nkx code."

Neisseria gonorrhoeae: vaginal clearance and its correlation with resistance to infection in subcutaneous chambers in orally immunized estradiol-primed mice

The rate of clearance of Neisseria gonorrhoeae in vaginal specimens harvested from inbred Balb/c and outbred (Institute of Cancer Research [ICR]) white mice, previously primed with saline or beta-estradiol and then challenged with live gonococci, was determined. Survival of gonococci was significantly (P < 0.05) better in estradiol-primed mice from both inbred and outbred lines at 24 h after challenge. Vaginal clearance of gonococci from ICR mice parenterally primed with a gonococcal PI-B synthetic peptide and then orally immunized with gamma irradiated, protein-III deficient gonococcal cells was significantly (P < 0.001) faster than in corresponding nonimmunized, estradiol-primed controls. The more rapid vaginal clearance in the orally immunized mice was correlated with an elevated subcutaneous chamber ID50% (> 100,000 colony forming units) determined for the same groups of mice. Peptide-primed mice orally immunized with irradiated Escherichia coli cells demonstrated a chamber ID50% of < 100 CFU and were significantly (P < 0.01) slower to clear gonococci following vaginal challenge. High levels of specific IgA and IgG antibodies to gonococci were detected by an enzyme-linked immunosorbent assay in vaginal wash specimens from orally immunized mice. However, high antibody titers were not always predictive of an increased resistance to vaginal challenge. These models may be helpful in providing more economical and accessible in vivo methods for screening certain gonococcal vaccine candidates before more expensive testing in chimpanzees or humans.

The relation between thickened aortic valve and coronary artery disease

BACKGROUND

The relationship between the site of aortic valve thickening and ipsilateral coronary artery stenosis has not been reported previously. This study was undertaken to test the hypothesis that left-sided coronary cusp thickening may be associated with a left-sided coronary artery stenosis, and also as would be in the right-sided relationship.

METHODS

Two-dimensional echocardiography and cardiac catheterization were used to evaluate 420 consecutive patients. One hundred and six patients who had echocardiographic evidence of a single aortic valve thickening were studied to determine whether there was a relation between the coronary artery stenosis and the aortic valve thickening at the same side. Thickened aortic valve was defined as an aortic valve thickness to aortic wall thickness ratio > or = 1.0. Coronary artery disease (CAD) was defined as a > 50% luminal diameter narrowing of the left main coronary artery or a > 70% luminal diameter narrowing of the coronary artery other than the left main coronary artery.

RESULTS

Patients with a thickened aortic valve had a greater incidence of CAD (89/132, 67.4%) than those without (141/288, 49.0%) (p < 0.05). In patients with thickened aortic valves, the incidence of CAD was 45.5% in the fifth decade, 60% in the sixth decade, 69.6% in the seventh decade and 74.1% in the eighth decade. Progressive increase of the incidence of CAD was not found in patients without a thickened aortic valve. In the 106 cases with a single aortic valve thickening, 30 patients (28.3%) had a left coronary cusp thickening; 12 of them (40%) had a left-sided coronary artery stenosis, 3 patients (10%) had right coronary artery stenosis and 7 patients (23.3%) had no coronary artery stenosis. In the 34 patients with right coronary cusp thickening, the stenosis occurred at the left coronary artery in 13 patients (38.2%), at the right coronary artery in 3 patients (8.8%) and with normal coronary artery in 5 patients (14.7%). This finding did not support the relationship between thickened aortic valve and coronary artery disease at the same side (chi 2 = 0.06, p = 0.96).

CONCLUSIONS

There was a significantly greater incidence of CAD in patients with a thickened aortic valve than in those without. The incidence of CAD in patients with thickened aortic valves increased with age. There was no direct relationship observed between the site of aortic valve thickening and ipsilateral coronary artery stenosis.

Esophageal reflux after total or proximal gastrectomy in patients with adenocarcinoma of the gastric cardia

OBJECTIVES

To demonstrate gastroesophageal reflux induced by proximal gastrectomy and to report preventive measures, such as total gastrectomy followed by Roux-en-Y esophagojejunostomy.

METHODS

Thirteen patients underwent proximal gastrectomy (PG), and six patients underwent total gastrectomy (TG). Two of the 13 patients who received PG later underwent completion total gastrectomy. All patients were followed with endoscopy, radionuclide scintigraphy, and 24-h pH monitoring.

RESULTS

Endoscopic examination revealed evidence of esophagitis in all PG group patients; however, none of the TG group had esophagitis. Prolonged esophageal transit was observed in 11 patients (10 in the PG group, one in the TG group). Increased residual fraction was found in 10 patients (nine in the PG group, one in the TG group). An increase in the retrograde index was found in 14 cases (11 in the PG group, three in the TG group). Positive enterogastroesophageal reflux was identified in 11 patients (eight in the PG group, three in the TG group). Twenty-four hour pH monitoring resulted in 10 positives (10 in the PG group, none in the TG group).

CONCLUSIONS

Frequently, proximal gastrectomy will lead to significant gastroesophageal reflux and, subsequently, to varying degrees of esophagitis. The clinical symptoms are usually characteristic. However, the severity of esophagitis and the mechanism of reflux can be determined only by integrated interpretation of a reflux study. The study should include endoscopy, radionuclide scintigraphy, and 24-h pH monitoring. Although a total gastrectomy with Roux-en-Y diversion can reduce the incidence of acid reflux, neutral enteroesophageal reflux may be observed during a radioactive isotope study. Fortunately, neutral refluxes rarely cause esophagitis. A proximal gastrectomy should be avoided in adenocarcinoma of the gastric cardia, except in early cancer. Symptomatic palliation can be relieved by medication. However, completion total gastrectomy is the only effective method for eradicating unrelenting symptoms.

Modulation of the fate of cytoplasmic mRNA by AU-rich elements: key sequence features controlling mRNA deadenylation and decay

Regulation of cytoplasmic deadenylation has a direct impact on the fate of mRNA and, consequently, its expression in the cytoplasm. AU-rich elements (AREs) found in the 3' untranslated regions of many labile mRNAs are the most common RNA-destabilizing elements known in mammalian cells. AREs direct accelerated deadenylation as the first step in mRNA turnover. Recently we have proposed that AREs can be divided into three different classes. mRNAs bearing either the class I AUUUA-containing ARE or the class III non-AUUUA ARE display synchronous poly(A) shortening, whereas class II ARE-containing mRNAs are deadenylated asynchronously, with the formation of poly(A)- intermediates. In this study, we have systematically characterized the deadenylation kinetics displayed by various AREs and their mutant derivatives. We find that a cluster of five or six copies of AUUUA motifs in close proximity forming various degrees of reiteration is the key feature that dictates the choice between processive versus distributive deadenylation. An AU-rich region 20 to 30 nucleotides long immediately 5' to this cluster of AUUUA motifs can greatly enhance the destabilizing ability of the AUUUA cluster and is, therefore, an integral part of the class I and class II AREs. These two features are the defining characteristics of class II AREs. Our results are consistent with the interpretation that the pentanucleotide AUUUA, rather than the nonamer UUAUUUA(U/A)(U/A), is both an essential and the minimal sequence motif of AREs. Our study provides the groundwork for future characterization of ARE-binding proteins identified by in vitro gel shift assays in order to stringently define their potential role in the ARE-mediated decay pathway. Moreover, transformation of deadenylation kinetics from one type to the other by mutations of AREs implies the existence of cross talk between the ARE and 3' poly(A) tail, which dictates the decay kinetics.

A novel pancreas-specific serpin (ZG-46p) localizes to the soluble and membrane fraction of the Golgi complex and the zymogen granules of acinar cells

By immunoscreening a cDNA expression library of rat pancreas using a polyspecific antiserum raised against purified pancreatic zymogen granule membranes, we have identified a cDNA clone coding for a novel protein, named ZG-46p. The cDNA contains an ORF of 1215 bp coding for a protein of 405 amino acids with a calculated molecular mass of 46 kDa. Sequence analysis revealed high homologies to known serine protease inhibitors (serpins), e.g. human anti-thrombin III (47.2%) or human and rat anti-trypsin (44%). The highest homology is present in the serpin signature, a consensus sequence common to all serpins, as well as its flanking hinge region. Northern blot analysis reveals the exclusive expression of the novel serpin mRNA in the pancreas, both during embryonic development and in the adult gland but not in the acinar carcinoma cell line AR4-2J. In vitro translation experiments demonstrate that the protein is N-glycosylated, but in vivo and in vitro phosphorylation was not found in spite of multiple phosphorylation sites. By immunofluorescence studies pancreatic serpin was localized predominantly to the Golgi complex in a similar distribution as the marker protein TGN38. Western blot analysis of various subcellular fractions showed ZG-46p mainly as soluble protein in the Golgi but also in zymogen granule content. A minor but significant portion of the protein was firmly attached to both the zymogen granule and Golgi membranes as Triton X-114 extraction indicates. The cellular localization, the distribution in the soluble and membrane fraction of Golgi complex and zymogen granules, and the finding that pancreatic serpin is associated with aggregated secretory proteins suggest a role in the sorting of pancreatic enzymes during granule formation.

Utilization of Chinese medicine in Taiwan

This article examines the use of Chinese medicine in Taiwan. Based on a national sample survey, the authors investigated how Chinese medicine is being used and factors that are associated with its use among the Taiwanese. Results of the study suggest that Chinese medicine use among this population depends on health conditions, and that having a regular source of care for Chinese medicine as well as a preference for Chinese medicine are two predictors for its use. Policies on the integration of Chinese medicine or other traditional medicine into the modern healthcare system are recommended.

Distribution of codeine, morphine, and 6-acetylmorphine in vitreous humor

Two hundred and twenty-three vitreous humor specimens, which were obtained from a medical examiner's office, were found to be opiate positive (cutoff, 50 ng/mL) by fluorescence polarization immunoassay. All samples were analyzed for their free codeine, morphine, and 6-acetylmorphine contents by a gas chromatography-mass spectrometry protocol. 6-Acetylmorphine was found (cutoff, 10 ng/mL) in 41 specimens in the concentration range of 10-125 ng/mL. Twenty specimens had a free codeine-free morphine concentration ratio > or = 1. Eighty-five samples that were found to contain 50 ng/mL free morphine were further analyzed for their total codeine and total morphine contents. Total codeine-total morphine concentration ratios in 8 (of the 85 samples) were > or = 1, whereas this ratio in the others (only those with a codeine concentration high than 15 ng/mL were included) was significantly lower than 1. The codeine-morphine concentration ratio in vitreous humor appears to resemble that reported for blood and urine and can be used as the basis for differentiating between codeine- and morphine- (heroin-) induced fatalities.

Lower gastrointestinal bleeding from a hepatocellular carcinoma invading the colon

Bleeding from the gastrointestinal tract due to hepatocellular carcinoma invasion is unusual. We describe a 71-year-old man who had bloody stools caused by a hepatocellular carcinoma that directly invaded the transverse colon. The diagnosis was confirmed by colonoscopy and tissue examination. Our patient is the first with lower gastrointestinal bleeding from a hepatocellular carcinoma during the natural course of the tumor.

Competition between negative acting YY1 versus positive acting serum response factor and tinman homologue Nkx-2.5 regulates cardiac alpha-actin promoter activity

Transcription of sarcomeric alpha-actin genes is developmentally regulated during skeletal and cardiac muscle development through fine-tuned control mechanisms involving multiple cooperative and antagonistic transcription factors. Among the cis-acting DNA elements recognized by these factors is the sequence CC(A/T)6GG of the serum response element (SRE), which is present in a number of growth factor-inducible and myogenic specified genes. We recently showed that the cardiogenic homeodomain factor, Nkx-2.5, served as a positive acting accessory factor for serum response factor (SRF) and together provided strong transcriptional activation of the cardiac alpha-actin promoter. In addition, Nkx-2.5 and SRF collaborated to activate the endogenous murine cardiac alpha-actin gene in 10T1/2 fibroblasts, by a mechanism that involved coassociation of SRF and Nkx-2.5 on intact SREs of the alpha-actin promoter. Here, we show that the second SRE of the avian cardiac alpha-actin promoter served as a binding site for Nkx-2.5, SRF, and zinc finger containing GLI-Kruppel-like factor, YY1. Expression of YY1 inhibited cardiac alpha-actin promoter activity, whereas coexpression of Nkx-2.5 and SRF was able to partially reverse YY1 repression. Displacement of YY1 binding by Nkx-2.5/SRF complex occurs through mutually exclusive binding across the CaSRE2. The interplay and functional antagonism between YY1 and Nkx-2.5/SRF might constitute a developmental as well as a physiologically regulated mechanism that modulates cardiac alpha-actin gene expression during cardiogenesis.

Optimal surgical strategy for potentially curable serosa-involved gastric carcinoma with intraperitoneal free cancer cells

BACKGROUND

Radical gastrectomy with systematic lymphadenectomy (RG) remains controversial in the treatment of gastric carcinoma. On the other hand, the prognosis of gastric carcinoma, in the presence of intraperitoneal free cancer cells, is poor. The optimal surgical strategy for serosa-involved gastric carcinoma with intraperitoneal free cancer cells remains undefined.

STUDY DESIGN

A prospective study of intraperitoneal cytologic washing was conducted on 134 patients with potentially curable serosa-involved gastric carcinoma who underwent RG. During the same period, 28 patients with resectable tumors who received palliative simple gastrectomies because of the presence of gross incurable conditions (eg, multiple hepatic metastases, peritoneal carcinomatosis, or extra-abdominal metastasis) were used as controls.

RESULTS

Intraperitoneal free cancer cells were found in 26 patients (19.4 percent). Compared with the remaining 108 patients without free cancer cells, there were no significant differences in the clinicopathologic characteristics and pathologic stages. No patients died after palliative resection, but five patients died after RG. The patients with free intraperitoneal free cancer cells had a poorer long-term prognosis after RG than those without free cancer cells (p < 0.0001). The prognosis for such patients was similar to the prognosis of those who underwent palliative resection.

CONCLUSIONS

A peritoneal washing cytologic examination is mandatory before resection for potentially curable serosa-involved gastric carcinoma. When free cancer cells appear in the washing fluid, the cancer is incurable. Simply gastrectomy without additional lymphadenectomy is the optimal strategy for treatment.

Comparison of enzyme immunoassays for antibodies to Haemophilus ducreyi in a community outbreak of chancroid in the United States

The performance of two EIAs (adsorption EIA and lipooligosaccharide [LOS] EIA) that detect antibodies to Haemophilus ducreyi was evaluated with serum specimens obtained from 163 patients (96 with genital ulcer disease [GUD]). Paired serum specimens (initial and follow-up) were obtained from 52 of the GUD patients. By use of initial serum specimens from 82 GUD patients whose etiologic agents for their ulcers had been identified, the adsorption EIA had a sensitivity and specificity for chancroid of 53% and 71%, while the LOS EIA had a sensitivity and specificity of 48% and 89%, respectively. Sensitivity and specificity of the adsorption EIA increased to 78% and 84%, respectively, when the results of follow-up serum specimens were used to calculate optimal performance. The proportion of patients testing positive for H. ducreyi who had anti-H. ducreyi IgG antibodies, as determined by adsorption EIA, increased with the duration of infection, thus limiting the role of EIAs in the diagnosis of chancroid.

Primary uncemented Osteonics total hip arthroplasty: preliminary results of 2-6 year follow-up

BACKGROUND

Cemented total hip arthroplasty (THA) bears the inherent disadvantages of cement complications. A research toward the improvement of uncemented prosthesis design continues to evolve. The purpose of this report is to present the preliminary results and to identify common problems in uncemented THA.

METHODS

The results of 402 primary Osteonics total hip prostheses were reviewed with an average follow-up period of 3.1 years. The postoperative rating according to the modified D' Aubigne & Postel hip score included functional and radiographic analysis.

RESULTS

The results were rated as good or excellent in 95% of hips. Stable fixation of the prosthesis was shown in 97% of radiographs. The most common zone of focal osteolysis was in the periarticular area.

CONCLUSION

The clinical results in a 2 to 6 year follow-up was encouraging. A relatively high incidence of thigh pain did not correlate with femoral canal filling of prosthesis. Periarticular osteolysis is still an unsettled problem in uncemented prostheses and needs further investigation.

Case report: life-threatening haematochezia from a jejunal leiomyoma

Leiomyoma is a common benign intestinal tumour. Melaena is not rare in this tumour. Recently, rectal haematochezia has been considered as one of the very rare manifestations of leiomyoma. We report a case of jejunal leiomyoma showing life-threatening rectal bleeding. This 76-year-old man was admitted to hospital because of continuous rectal bleeding for 2 days. Haemorrhagic shock occurred and transfusion of 27 units of packed red blood cells failed to correct the shock. Emergent superior mesenteric angiography revealed a distal jejunal tumour showing evidence of active oozing. Segmental intestinal resection was performed to remove this jejunal tumour. Final pathological examination disclosed a jejunal leiomyoma with a ruptured artery responsible for the life-threatening bleeding. The patient recovered after tumour resection. Our presenting case was probably the second case of jejunal leiomyoma showing haematochezia. The diagnostic priority is discussed.

Bacterial meningitis and lumbar epidural hematoma due to lumbar acupunctures: a case report

A 48-year-old female expressed signs of meningeal irritation after having received several lumbar acupunctures within one week for back pain. Bacterial meningitis was diagnosed from cerebrospinal fluid examinations. Magnetic resonance image (MRI) of spine at admission demonstrated a fusiform lesion with characters of subacute hematoma in the epidural space of the first and second lumbar level. She received antibiotics treatment only and recovered from her central nervous system infection completely. The epidural lesion disappeared spontaneously in the MRI follow up three weeks later. We report the diagnosis and follow-up of epidural hematoma of the lumbar spine by MRI which aided the medical physician to treat meningitis attentively.

Surgical treatment and its long-term result for caustic-induced prepyloric obstruction

OBJECTIVE

To present our long-term results of the treatment of caustic-induced prepyloric obstruction, and to set out guidelines for the management of such patients.

DESIGN

Retrospective study.

SETTING

General hospital (medical centre), Taiwan.

SUBJECTS

30 patients (8 male and 22 female, mean age 34 years, range 13-62) who developed prepyloric obstruction out of 271 treated for caustic injuries of the upper gastrointestinal tract.

INTERVENTIONS

Gastrojejunostomy (n = 24), antrectomy and Billroth I reconstruction (n = 4), and antrectomy and Billroth II reconstruction (n = 2). Four patients required second operations: oesophageal reconstruction for stricture (n = 3), and gastrojejunostomy for restenosis of Billroth I anastomosis (n = 1).

MAIN OUTCOME MEASURES

Morbidity and mortality.

RESULTS

No patient died postoperatively, and there were three complications--wound infection, internal bleeding, and stenosis of the Billroth I anastomosis. 21 patients were able to enjoy their normal diet postoperatively, 5 required periodic dilatation of oesophageal strictures, and 4 required further operations.

CONCLUSIONS

Gastrojejunostomy gives good long term results as long as there is no oesophageal stricturing, and morbidity and mortality are low. The long term outcome is dependent on the degree of oesophageal involvement.

Rapid spongiform degeneration of the cerebrum and cerebellum in Creutzfeldt-Jakob encephalitis: serial MR findings

We report the cerebral MR imaging findings in a patient with pathologically proved Creutzfeldt-Jakob disease in whom predominant gray and white matter degeneration was seen within 1 year of symptom onset. The initial MR signal abnormalities in the basal ganglia were subtle. A follow-up MR examination revealed diffuse cerebral and cerebellar atrophy and demyelination.