Nitrate Reductases from Wild-Type and nr(1)-Mutant Soybean (Glycine max [L.] Merr.) Leaves : II. Partial Activity, Inhibitor, and Complementation Analyses

Soybean (Glycine max [L.] Merr.) leaves have been shown to contain three forms of nitrate reductase (NR). Two of the forms, which are present in leaves of wild-type (cv. Williams) plants grown in the absence of NO(3) (-), are termed constitutive and designated c(1)NR and c(2)NR. The third form, which is present in NO(3) (-)-grown mutant (nr(1)) plants lacking the constitutive forms, is termed inducible and designated iNR. Samples of c(1)NR, c(2)NR, and iNR obtained from appropriately treated plants were analyzed for the presence of partial activities, response to inhibitors, and ability to complement a barley NR which lacks the molybdenum cofactor (MoCo) but is otherwise active.The three forms were similar to most assimilatory NR enzymes in that they (a) exhibited NADH-cytochrome c reductase, reduced flavin mononucleotide-NR, and reduced methyl viologen-NR partial activities; (b) were inhibited by p-hydroxymercuribenzoate at the site of initial electron transport through each enzyme; (c) were more inhibited by CN(-) in their reduced enzyme state as compared with their oxidized state; and (d) complemented a MoCo-defective NR (e.g. contained cofactors with characteristics similar to the MoCo found in barley NR and commercial xanthine oxidase). However, among themselves, they showed dissimilarities in their response to treatment with HCO(3) (-) and CN(-), and in their absolute ability to complement the barley NR. The site of effect for these treatments was the terminal cofactor-containing portion of each enzyme. This indicated that, although a terminal cofactor (presumably a MoCo) was present in each form, structural or conformational differences existed in the terminal cofactor-protein complex of each form.

Ethanol, aspirin, ibuprofen, and the gastroduodenal mucosa: an endoscopic assessment

The effect on the gastroduodenal mucosa of alcohol combined either with aspirin or ibuprofen was studied in 60 normal volunteers. The volunteers were divided into six groups comprised of 10 subjects receiving ibuprofen, placebo, or aspirin with or without alcohol. Medications consisted of 1) three 325-mg aspirin tablets, or three identical placebo tablets, 2) one 600-mg ibuprofen tablet, and 3), three ounces of 100 proof vodka diluted in 6 ounces of orange juice, or alcohol placebo made by diluting 3 ounces of water in orange juice. All subjects received 4 doses over a 24-hr period and underwent endoscopic examination the following morning. The gastroduodenal mucosa was graded according to a 0 to 4 + scale. Aspirin caused considerably greater duodenal and gastric damage than did either ibuprofen or placebo. The addition of alcohol to all drugs increased the damage seen in the stomach but not to a significant degree; this effect was slightly more pronounced with ibuprofen than with placebo or aspirin and approached significance (0.1 greater than p greater than 0.05). These results are compatible with alcohol being a mild damaging agent or a potentiating agent for damage from other drugs.

Mouse peritoneal macrophages plated on mannan- and horseradish peroxidase-coated substrates lose the ability to phagocytose by their Fc receptors

Ligand-conjugated substrates were used to study mouse macrophage receptor-ligand interactions. Both resident and thioglycollate-elicited macrophages plated on substrates conjugated with mannans and horseradish peroxidase (HRP), ligands for the Man/GlcNAc receptor, lost their ability to phagocytose zymosan. In addition, these macrophages also lost their ability to phagocytose IgG-coated erythrocytes (E(IgG] via their Fc receptors (FcR). The abrogation of Fc receptor-mediated phagocytosis occurred as early as 4 hr after macrophage plating on HRP-coated substrates and was dependent on the amount of HRP conjugated to the substrate. Macrophages plated on those substrates showed a 70% reduction in E(IgG) binding and the same decrease (approximately 35%) in binding of 125I-labeled Fab fragment of monoclonal anti-IgG2b FcR antibody as macrophages plated on dinitrophenyl-anti-dinitrophenyl IgG immune complexes. We interpret these results as showing that modulation of macrophage mannose/GlcNAc receptors induces modulation of FcR.

Mouse peritoneal macrophages plated on mannan- and horseradish peroxidase-coated substrates lose the ability to phagocytose by their Fc receptors

Ligand-conjugated substrates were used to study mouse macrophage receptor-ligand interactions. Both resident and thioglycollate-elicited macrophages plated on substrates conjugated with mannans and horseradish peroxidase (HRP), ligands for the Man/GlcNAc receptor, lost their ability to phagocytose zymosan. In addition, these macrophages also lost their ability to phagocytose IgG-coated erythrocytes (E(IgG] via their Fc receptors (FcR). The abrogation of Fc receptor-mediated phagocytosis occurred as early as 4 hr after macrophage plating on HRP-coated substrates and was dependent on the amount of HRP conjugated to the substrate. Macrophages plated on those substrates showed a 70% reduction in E(IgG) binding and the same decrease (approximately 35%) in binding of 125I-labeled Fab fragment of monoclonal anti-IgG2b FcR antibody as macrophages plated on dinitrophenyl-anti-dinitrophenyl IgG immune complexes. We interpret these results as showing that modulation of macrophage mannose/GlcNAc receptors induces modulation of FcR.

Nitrate Reductases from Wild-Type and nr(1)-Mutant Soybean (Glycine max [L.] Merr.) Leaves : I. Purification, Kinetics, and Physical Properties

NADH:nitrate reductase (EC 1.6.6.1) and NAD(P)H:nitrate reductase (EC 1.6.6.2) were purified from wild-type soybean (Glycine max [L.] Merr., cv Williams) and nr(1)-mutant soybean plants. Purification included Blue Sepharose- and hydroxylapatite-column chromatography using acetone powders from fully expanded unifoliolate leaves as the enzyme source.Two forms of constitutive nitrate reductase were sequentially eluted with NADPH and NADH from Blue Sepharose loaded with extract from wild-type plants grown on urea as sole nitrogen source. The form eluted with NADPH was designated c(1)NR, and the form eluted with NADH was designated c(2)NR. Nitrate-grown nr(1) mutant soybean plants yielded a NADH:nitrate reductase (designated iNR) when Blue Sepharose columns were eluted with NADH; NADPH failed to elute any NR form from Blue Sepharose loaded with this extract. Both c(1)NR and c(2)NR had similar pH optima of 6.5, sedimentation behavior (s(20,w) of 5.5-6.0), and electrophoretic mobility. However, c(1)NR was more active with NADPH than with NADH, while c(2)NR preferred NADH as electron donor. Apparent Michaelis constants for nitrate were 5 millimolar (c(1)NR) and 0.19 millimolar (c(2)NR). The iNR from the mutant had a pH optimum of 7.5, s(20,w) of 7.6, and was less mobile on polyacrylamide gels than c(1)NR and c(2)NR. The iNR preferred NADH over NADPH and had an apparent Michaelis constant of 0.13 millimolar for nitrate.Thus, wild-type soybean contains two forms of constitutive nitrate reductase, both differing in their physical properties from nitrate reductases common in higher plants. The inducible nitrate reductase form present in soybeans, however, appears to be similar to most substrateinduced nitrate reductases found in higher plants.

Stages IE and IIE non-Hodgkin's lymphomas of the stomach. Comparison of treatment modalities

Seventy-nine patients with Stages IE and IIE non-Hodgkin's lymphomas of the stomach were treated between 1953 and 1980. The histopathologic classification was as follows: diffuse large cell, 61 (of which 23 were immunoblastic sarcomas [plasmacytoid]); diffuse well-differentiated lymphocytic, 6; diffuse mixed, 1; undifferentiated non-Burkitt's, 1; nodular, 9; and unclassifiable, 1. Thirty-five patients had Stage IE disease and 44 had Stage IIE. Treatment modalities included surgery, radiotherapy, chemotherapy, and combinations thereof. Sixty-six patients had a laparotomy for diagnosis and/or management. Of these, only 42 had a gastrectomy. The stomach was considered to be unresectable in the other 24 patients. There were 5 postoperative deaths among 31 patients who had a laparotomy or gastrectomy at our institution. The overall 5-year actuarial survival was 56%; the disease-free survival was 54%. For patients with Stage IE disease the survival was 76%, and for those with Stage IIE, 42%. Promising results were obtained in 13 patients who were treated on a multimodality program consisting of four cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus bleomycin (Bleo), which was alternated with involved field radiotherapy. All 13 patients had no evidence of disease as of this report. Only one patient had a relapse (Waldeyer's ring), and he was salvaged with radiotherapy. Six of these 13 were diagnosed by endoscopic biopsy and did not have a laparotomy, 3 were found to have unresectable disease at laparotomy, and 4 had a resection. Biopsy with the flexible fiberscope and treatment with CHOP-Bleo and radiotherapy can avoid the morbidity and mortality of gastrectomy.

A controlled endoscopic study comparing the toxic effects of sulindac, naproxen, aspirin, and placebo on the gastric mucosa of health volunteers

Sixty volunteers were endoscopically evaluated to compare gastric mucosal injury following oral administration of sulindac, naproxen, aspirin, or placebo for two consecutive seven-day periods. A single-blind technique was utilized wherein the endoscopist was unaware which drug each volunteer had received. The following dosages were employed for the two study periods: sulindac, 150 and 200 mg, b.i.d., naproxen, 250 and 375 mg, b.i.d., and aspirin, 650 and 975 mg, q.i.d. The only subject who developed a frank ulcer with mucosal bleeding was in the sulindac group, however volunteers taking sulindac demonstrated statistically less significant mucosal injury on endoscopic examination than those receiving naproxen or aspirin.

Digital subtraction angiography with an Isocon camera system: clinical applications

A new imaging system for digital subtraction angiography (DSA) was evaluated in 30 clinical studies. The image receptor is a 25 X 25 cm, 12 par gadolinium oxysulfate rare-earth screen whose light output is focused to a low-light-level Isocon camera. The video signal is digitized and processed by an image-array processor containing 31 512 X 512 memories 8 bits deep. In most patients, intraarterial DSA studies were done in conjunction with conventional arteriography. In these arterial studies, images adequate to make a specific diagnosis were obtained using half the radiation dose and half the amount of contrast material needed for conventional angiography. In eight intravenous studies performed either to identify renal artery stenosis or for evaluation of congenital heart anomalies, the images were diagnostic but objectionably noisy.

Thrombocytopenia and gastrointestinal hemorrhage in the cancer patient: prevalence of unmasked lesions

Some coagulation deficiencies are known to cause bleeding by unmasking existing gastrointestinal pathology, as opposed to directly causing mucosal blood loss. Characteristics and etiology of gastrointestinal hemorrhage associated with thrombocytopenia have not been analyzed. Our objectives were to correlate the distribution and cause of gastrointestinal bleeding, as diagnosed by fiberoptic endoscopy, with the severity of thrombocytopenia. One hundred thirty-three patients were divided into three groups, determined by platelet count at the time of bleeding (group A: less than 20,000/mm3; group B: 20,000 to 40,000/mm3; group C greater than 40,000/mm3). Results of 187 endoscopies revealed unifocal sources of blood loss in over 50% of each group, and diffuse mucosal oozing independent of gastrointestinal pathology was seen in only 1% of group C. The only significant difference (p = 0.04) comparing unifocal, multifocal, and diffuse sources of bleeding was observed between groups A and C, where in the distribution of multifocal or diffuse sources of bleeding was more common in group A. Esophagitis was more common and gastric ulceration less common in group A. No endoscopic complications occurred. Gastrointestinal bleeding associated with thrombocytopenia is most commonly due to co-existent gastrointestinal pathology as opposed to diffuse mucosal bleeding. Even when an inflammatory process, such as esophagitis or gastritis, affects a particular organ, bleeding is usually unifocal or multifocal as opposed to diffuse even in the presence of moderately severe thrombocytopenia.

Gastrointestinal hemorrhage in the cancer patient

The usefulness of fiberoptic endoscopy, performed to identify the cause(s) of gastrointestinal bleeding in cancer patients was assessed by (1) identifying the clinical presentation of bleeding, (2) evaluating the safety and diagnostic yield of fiberoptic endoscopy, (3) determining the frequency distribution of causes of bleeding, and (4) evaluating the clinical course following acute gastrointestinal bleeding in a cancer patient population. Hematemesis, melena, and hematochezia were observed in decreasing order of frequency as manifestations of bleeding. Of 187 endoscopic procedures performed on 133 patients, 75% were bleeding from benign lesions with the majority due to gastric ulceration, gastritis, or duodenal ulceration. One third of patients with tumors involving the gastrointestinal tract were bleeding from another source. Mortality from major hemorrhage was 8%; 55% of patients were alive at the end of 2 years. Endoscopy was performed without complications and contributed to medical management, angiographic therapy, and surgical planning.

Effects of fenbufen, indomethacin, naproxen, and placebo on gastric mucosa of normal volunteers. A comparative endoscopic and photographic evaluation

The effects of fenbufen (1,000 mg a day), indomethacin (150 mg a day), naproxen (750 mg a day), and placebo on gastric mucosa were determined by endoscopy and recorded photographically. One hundred normal subjects, randomly divided into equal, parallel-treatment groups, were given the drugs in divided daily doses for seven consecutive days. The results revealed that the effects of fenbufen on gastric mucosa were significantly (p less than or equal to 0.05) less than those of either naproxen or indomethacin and not statistically different from those observed with placebo.

Collagenous colitis

Collagenous colitis is a newly described entity that clinically manifests itself as watery diarrhea of long-standing duration. The main histopathologic characteristic is the presence of a collagen band immediately beneath the colonic surface epithelium. Ultrastructurally, the collagen is deposited beneath the basement membrane, which is intact. Pathogenetically, an aberrant function of the pericryptal fibroblastic sheath may be involved.

The role of the mannose/N-acetylglucosamine receptor in the pinocytosis of horseradish peroxidase by mouse peritoneal macrophages

Saccharomyces cerevisiae mannan inhibits the pinocytosis of horseradish peroxidase (HRP) by resident, thioglycollate-,proteose peptone-, and Corynebacterium parvum-elicited macrophages from 30 to 70% when 1 mg/ml HRP is used, and 65 to 87% when 250 micrograms/ml HRP is used. In contrast, HRP uptake by J774 cells, a macrophage cell line reported to have little mannose receptor activity, is inhibited only about 25% by mannan. HRP uptake by resident and thioglycollate-elicited (thio) macrophages is also inhibited 34 and 66% by addition of EGTA to the medium and 55 and 79% by trypsin treatment of the macrophages, respectively. The inhibitory effect of EGTA can be reversed by 1 mM excess Ca2+. High extracellular concentrations of Ca2+, in the range of 10-20 mM, however, inhibit pinocytosis in resident macrophages by about 50%. Sucrose uptake by resident macrophages is not appreciably affected by mannan. These results support the hypothesis that HRP uptake is mediated by the macrophage mannose/N-acetylglucosamine receptor. PMA stimulates fluid-phase pinocytosis of HRP by thio macrophages but does not affect receptor-mediated uptake of HRP, while the combination of adenosine, homocysteine, and erythro-9-(2-hydroxy-3-nonyl) adenine (EHNA) selectively inhibits bulk-phase uptake by thio macrophages.

Soybean mutants lacking constitutive nitrate reductase activity : I. Selection and initial plant characterization

The objectives of this study were to select and initially characterize mutants of soybean (Glycine max L. Merr. cv Williams) with decreased ability to reduce nitrate. Selection involved a chlorate screen of approximately 12,000 seedlings (progeny of mutagenized seed) and subsequent analyses for low nitrate reductase (LNR) activity. Three lines, designated LNR-2, LNR-3, and LNR-4, were selected by this procedure.In growth chamber studies, the fully expanded first trifoliolate leaf from NO(3) (-)-grown LNR-2, LNR-3, and LNR-4 plants had approximately 50% of the wild-type NR activity. Leaves from urea-grown LNR-2, LNR-3, and LNR-4 plants had no NR activity while leaves from comparable wild-type plants had considerable activity; the latter activity does not require the presence of NO(3) (-) in the nutrient solution for induction and on this basis is tentatively considered as a constitutive enzyme. Summation of constitutive (urea-grown wild-type plants) and inducible (NO(3) (-)-grown LNR-2, LNR-3, or LNR-4 plants) leaf NR activities approximated activity in leaves of NO(3) (-)-grown wild-type plants. Root NR activities were comparable in wild-type and mutant plants grown on NO(3) (-), and roots of both plant types lacked constitutive NR activity when grown on urea. In both growth chamber- and field-grown plants, oxides of nitrogen [NO((x))] were evolved from young leaves of wild-type plants, but not from leaves of LNR-2 plants, during in vivo NR assays. Analysis of leaves from different canopy locations showed that constitutive NR activity was confined to the youngest three fully expanded leaves of the wild-type plant and, therefore, on a total plant canopy basis, the NR activity of LNR-2 plants was approximately 75% that of wild-type plants. It is concluded that: (a) the NR activity in leaves of NO(3) (-)-grown wild-type plants includes both constitutive and inducible activity; (b) the missing NR activity in LNR-2, LNR-3, and LNR-4 leaves is the constitutive component; and (c) the constitutive NR activity is associated with NO((x)) evolution and occurs only in physiologically young leaves.

Soybean Mutants Lacking Constitutive Nitrate Reductase Activity : II. Nitrogen Assimilation, Chlorate Resistance, and Inheritance

Nitrogen assimilation in three nitrate reductase (NR) mutants of soybean (Glycine max L. Merr. cv Williams) was studied in the growth chamber and in the field. These mutants, LNR-2, LNR-3, and LNR-4, lack the non-NO(3) (-)-inducible or constitutive fraction of leaf NR activity found in wild-type plants, but this had no effect on the concentration of nitrogen accumulated when grown on NO(3) (-) in the growth chamber. Dry weight accumulation of two of the mutants (LNR-3 and LNR-4) was decreased relative to LNR-2 and wild type. In the field, LNR-2 had dry weights and nitrogen concentrations similar to the wild type at 34 and 61 days after planting, and at maturity. Acetylene reduction activities were also similar at 61 days.Urea-grown LNR-2 seedlings lack both inducible and constitutive NR activity, and were resistant to four days of treatment with 0.5 mm ClO(3) (-). Urea-grown wild-type seedlings, having only constitutive NR activity, developed ClO(3) (-) toxicity symptoms and suffered decreases in unifoliolate leaf NR activity and chlorophyll concentration. This suggests that (a) the reduction of ClO(3) (-) to ClO(2) (-) by NR is the major cause of ClO(3) (-) toxicity in soybeans and (b) the constitutive NR is active in situ.Segregation of the F(2) of reciprocal crosses between the wild type and the mutants indicated that absence of constitutive NR activity was controlled by a single recessive nuclear gene. Evolution of NO((x)) gas was also absent in these mutants, and this was found to be inherited jointly with constitutive NR activity: in 346 segregants, no recombinants were found. Allelism tests between LNR-2 and LNR-3, and LNR-2 and LNR-4, indicated that the constitutive NR mutation was at the same locus in each mutant.

Yeast mannans inhibit binding and phagocytosis of zymosan by mouse peritoneal macrophages

We have examined the effects of various mannans, glycoproteins, oligosaccharides, monosaccharides, and sugar phosphates on the binding and phagocytosis of yeast cell walls (zymosan) by mouse peritoneal macrophages. A phosphonomannan (PO(4):mannose ratio = 1:8:6) from kloeckera brevis was the most potent inhibitor tested; it inhibited binding and phagocytosis by 50 percent at concentrations of approximately 3-5 mug/ml and 10 mug/ml, respectively. Removal of the phosphate from this mannan by mild acid and alkaline phosphatase treatment did not appreciably reduce its capacity to inhibit zymosan phagocytosis. The mannan from saccharomyces cerevisiae mutant LB301 inhibits phagocytosis by 50 percent at 0.3 mg/ml, and a neutral exocellular glucomannan from pichia pinus inhibited phagocytosis by 50 percent at 1 mg/ml. Cell wall mannans from wild type S. cervisiae X2180, its mnn2 mutant which contains mannan with predominantly 1(arrow)6- linked mannose residues, yeast exocellular mannans and O-phosphonomannans were less efficient inhibitors requiring concentrations of 1-5 mg/ml to achieve 50 percent reduction in phagocytosis. Horseradish peroxidase, which contains high-mannose type oligosaccharides, was also inhibitory. Mannan is a specific inhibitor of zymosan binding and phagocytosis. The binding and ingestion of zymosan but not of IgG- or complement-coated erythrocytes can be obliterated by plating macrophages on substrates coated with poly-L-lysin (PLL)-mannan. Zymosan uptake was completely abolished by trypsin treatment of the macrophages and reduced by 50-60 percent in the presence of 10 mM EGTA. Pretreatment of the macrophages with chloroquine inhibited zymosan binding and ingestion. These results support the proposal that the macrophage mannose/N-acetylglucosamine receptor (P. Stahl, J.S. Rodman, M.J. Miller, and P.H. Schlesinger, 1978, Proc. Natl. Acad. Sci. U.S.A. 75:1399-1403, mediates the phagocytosis of zymosan particles.

Chromosome variation in protoplast-derived potato plants

Chromosomes have been studied in protoplast-derived potato plants of the tetraploid cultivars Maris Bard and Fortyfold. A high degree of aneuploidy was found amongst the regenerants of both cultivars but the nature of the chromosome variation differed. The Maris Bard regenerants were characterised by high chromosome numbers, a wide range of aneuploidy (46-92) and a low percentage of plants with the normal chromosome number (2n = 48), whereas a much higher proportion of the Fortyfold regenerants had 48 chromosomes and the variants were within a more limited aneuploid range. In both cultivars chromosome variation was found between calluses, within calluses and even within shoot cultures. The origin of the chromosome variation and the differences found between the two cultivars are discussed.

An evaluation of a fluorescent screen-isocon camera system for x-ray imaging in radiology

A large field format imaging system which utilizes a flat fluorescent screen rather than the traditional image intensifier as the primary x-ray detector is discussed in this paper. A low light level image isocon camera is optically coupled to a rare-earth screen. An overview of the isocon camera and its return beam mode of operation is included. Theoretical limitations to this approach to real time radiographic imaging are discussed in terms of system efficiency and signal-to-noise ratio (SNR) requirements. The viability of this concept for radiographic imaging is considered with respect to the image intensifier-camera unit. The merits of employing a CsI:Na screen as the primary detector and an isocon tube with an improved SNR are presented as potential areas for further investigation.

The Isocon camera system in digital subtraction imaging

A new system for digital vascular subtraction imaging is presented. The image receptor consists of a rare-earth screen with light output optically focused onto the photocathode of a low-light-level image Isocon camera. This system represents a departure from the conventional use of the image intensifier for digital subtraction imaging. Our initial results suggest that this system could be competitive with traditional image intensifier systems and that it deserves clinical trial.

A double-blind randomized placebo controlled gastroscopic study to compare the effects of indomethacin capsules and indomethacin suppositories on the gastric mucosa of human volunteers

Forty-five normal volunteers were divided into 3 equal groups, each receiving indomethacin or placebo once daily in he evening as a capsule or suppository for 10 days. The dose of indomethacin was 50 mg for the first 5 days and 100 mg for the second 5 days. Endoscopic evaluation of the gastric mucosa was carried out on days 1, 6 and 11. It was found that indomethacin capsules caused significantly more gastric irritation than indomethacin suppositories (p less than .01) or placebo (p less than .0001). No significant difference was found in the incidence of gastric injury observed in the indomethacin suppository and placebo groups.

Color television in gastrointestinal endoscopy

Endoscopic color television is a practical method of recording gastrointestinal pathology and procedures. Nevertheless, a careful MEDLARS review of the medical literature failed to reveal a mention of this method during the past ten years. The endoscopic procedure can be recorded to illustrate many features not possible with still pictures. While particularly useful in teaching endoscopy, it is also useful for demonstrating pathologic findings to interested physicians, patients, and relatives. Television recording requires meticulous attention to details of lighting, focus, and cleansing of areas to be photographed and of the instrument objective, but results may well be superior to other means of photography in gastrointestinal endoscopy.

Colorectal cancer in young adults

The clinical and pathologic characteristics of colorectal cancer in patients younger than 30 years are compared with those in patients 30 to 39 years of age. Patients in the two age groups had similar symptoms, predominantly undifferentiated neoplasms, and poor prognoses. However, when the characteristics of these patients were compared with those described for a general patient population with colorectal cancer there was a gradual decrease in the incidence of mucin-producing tumors, poorly differentiated carcinomas, and primary lesions in the right colon, with increasing age at diagnosis. The highest incidences were found in patients less than 30 years old. The degree of tumor anaplasia and stage of tumor at diagnosis significantly influenced the duration of disease-free interval after curative resection of the primary and the duration of survival. Ninety-six percent of patients younger than 40 years had carcinomas extending beyond the colonic wall at diagnosis, adversely affecting long-term survival. The five-year survival of only 25% to 30% in these patients emphasizes the need for early diagnosis and aggressive treatment.

Endoscopic upper gastrointestinal polypectomy. Report of 73 polypectomies in 63 patients

Seventy-three upper gastrointestinal endoscopic polypectomies were performed in 63 patients over a period of five years. Thiry-eight patients (52%) had adenomatous polyps, two of which contained carcinoma in situ and 26 (36%) were inflammatory in nature. Four lesions were removed from the duodenum. Hemodynamically significant hemorrhage occurred in five cases and persistent symptomatic ulcer in three cases. All complications occurred early in the series and responded to conservative measures. There was no mortality or need for surgical intervention in any case. It was concluded that: 1. upper gastrointestinal tract endoscopic polypectomy is a safe and relatively simple procedure; 2. postprocedural complications can be markedly reduced by prophylactic conservative antiulcer therapy and 3. especially in the area of adenomatous polyps, excision of the entire lesion is superior to biopsy in the detection of early malignancy.

A comparative endoscopic evaluation of the damaging effects of nonsteroidal anti-inflammatory agents on the gastric and duodenal mucosa

Twenty-five normal volunteers were randomized into five equal parallel groups. Groups I received ibuprofen (2,400 mg./day); group II received tolmetin (2,000 mg./day); group III received indomethacin (150 mg./day); group IV received naproxen (750 mg./day) and group V received placebo (four tablets daily). All drugs were given on a q.i.d. basis except naproxen which was given b.i.d. The doses selected represented the manufacturer's highest recommended dosage for the treatment of arthritic disorders. A single-blind technic was used in which the investigators were unaware of which drug each volunteer was taking. Upper gastrointestinal endoscopy and photography were carried out before and after seven days of administration of each medication. Gastric and duodenal mucosal injury was graded on a 0-4 + scale. Three of the four drugs studied produced essentially equal gastric and duodenal mucosal injury with tolmetin producing the most damage followed by naproxen and indomethacin. Ibuprofen produced gastric mucosal injury equivalent to that seen with naproxen and indomethacin but no duodenal mucosal injury was seen with this drug. Extremely poor correlation was found between subjective symptomatology and endoscopic findings.

Nonoperative management of persimmon bezoar. A successful modification of traditional papain therapy

The soft phytobezoars occurring in the postoperative stomach may be readily removed by enzyme digestion and manipulation. In contrast, the persimmon bezoar (diospyrobezoar) has been persistently to such treatment and has required surgical removal. Experience with unsuccessful attempts at enzyme digestion in a number of such patients led to the experimental use of a "soaking" technic which satisfactorily dissolved two of three large persimmon bezoars and shrank the remaining foreign body sufficiently so that it could be removed endoscopically by way of the esophagus. A concomitant gastric ulcer healed uneventfully on medical therapy.

Sarcoma of the stomach: clinicopathologic study of 43 cases

The records of 43 patients with histologically proved primary gastric sarcoma treated at M. D. Anderson Hospital and Tumor Institute between 1945 and 1975 were reviewed. Weight loss, abdominal pain, and hematemesis or melena were the most common symptoms, and palpable epigastric mass was the most common physical sign. Ninety-five percent of the gastric tumors were leiomyosarcomas. The median survival time and the five-year survival for the 29 patients who had curative gastrectomy were 33 months and 38%, respectively. Morphologic and histologic factors that adversely influenced the length of disease-free interval and survival following curative surgery included 1) primary tumor 8 cm or greater in diameter, 2) tumor extension to serosa of the stomach, and 3) low grade of differentiation of the primary tumor. Seventy-seven percent of recurrences in patients with curative tumor resection occurred within two years of resection of the primary. Of the 17 patients with advanced disease who received chemotherapy, two (15%) had objective tumor regression of greater a median survival time of eight months for patients who failed to respond. New approaches that may improve the results of treatment of gastric sarcoma are discussed.

The effects of ibuprofen, indomethacin, aspirin, naproxen, and placebo on the gastric mucosa of normal volunteers: a gastroscopic and photographic study

The effects of various nonsteroidal antiinflammatory drugs on the gastric mucosa were endoscopically evaluated in 40 normal volunteers. Eight groups, each containing five subjects were designed: aspirin (3600 mg/d); placebo; ibuprofen (1600 mg/d); ibuprofen (2400 mg/d); indomethacin (100 mg/d); indomethacin (150 mg/d); naproxen (500 mg/d); and naproxen (750 mg/d). All volunteers took medication for seven days and gastroscopy was carried out on day one and day eight. All findings were documented by photography. Severe gastric mucosal injury occurred with aspirin (P less than 0.05), both doses of indomethacin, and the higher dose of naproxen. Lesser changes were seen with the lower dose of naproxen, both doses of ibuprofen and placebo. The higher doses of ibuprofen, indomethacin, and naproxen caused a greater degree of gastric mucosal injury, but statistical significance was achieved only with naproxen (P less than 0.01). Subjective gastrointestinal complaints generally correlated with endoscopic pathology; however, nine volunteers had evidence of severe injury to the gastric mucosa with no symptomatology. This was confined to the patients on indomethacin, naproxen, and ibuprofen. Aspirin patients all had some degree of symptomatology but to a lesser degree than expected in view of the endoscopic findings.

Effects of ibuprofen, tolmetin and placebo on the gastric mucosa of aspirin-sensitive volunteers

Patients who have demonstrated a gastric mucosal sensitivity to aspirin often react to other nonsteroidal, anti-inflammatory drugs to a similar or lesser degree. In a single-blind crossover study, five healthy volunteers who had previously developed erosive gastritis secondary to one week of aspirin therapy were randomly assigned to seven-day courses of treatment with ibuprofen, tolmetin and placebo. Treatment schedules were separated by washout periods to eliminate residual drug effects. Ibuprofen produced less gastric mucosal injury than tolmetin and, over all, appeared to be better tolerated. It was also noted that clinical symptoms often do not reflect the severity of gastroscopic findings, which may explain silent hemorrhaging in patients treated with agents of this type.

Distribution of Lyb-4.1 and other membrane antigens on murine lymphoid tumors

The distribution of membrane antigens on 6 DBA/2-derived tumors (L1210, L5178Y, P815, ABLS 11, ABLS 12, and ABLS 13) was studied by direct cytotoxicity and quantitative absorption assays. Lyb-4.1 antigen was found solely on the L1210 tumor. Iad antigens were absent from all tumors, and H-2Kd and H-2Dd antigens were present on all tumors. Immunoglobulin was adsorbed to the ascites tumors and lost after 3 days or more in tissue culture. These studies were performed to characterize the distribution of DBA/2 membrane antigens on DBA/2-derived tumors as a base line for functional and chemical studies with these tumors and with their solubilized proteins.

Clearing of psoriasis after cardiac surgery requiring cardiopulmonary bypass oxygenation: a corollary to clearance after dialysis?

A 54-year-old man had severe psoriasis with associated arthritis for 10 years. Attempts at therapy with tars, topical steroids and a short course of ultraviolet light were unsuccessful. His psoriasis cleared 6 weeks after cardiac surgery requiring cadiopulmonary bypass oxygenation.

Clearing of psoriasis after cardiac surgery requiring cardiopulmonary bypass oxygenation: a corollary to clearance after dialysis?

A 54-year-old man had severe psoriasis with associated arthritis for 10 years. Attempts at therapy with tars, topical steroids and a short course of ultraviolet light were unsuccessful. His psoriasis cleared 6 weeks after cardiac surgery requiring cadiopulmonary bypass oxygenation.

Chemotherapy for metastatic carcinoid tumors: experiences with 32 patients and a review of the literature

An analysis of results of chemotherapy in 32 patients with metastatic carcinoid tumors was carried out. The most frequently used chemotherapeutic agent was 5-fluorouracil (5-FU) followed by nitrosoureas in combination with 5-FU or with cyclophosphamide. Adriamycin (used as adriamycin-DNA complex) alone or in combination with other drugs was used in seven patients. Seven partial responses were observed, five of them occurring in the patients receiving adriamycin-containing regimens. Based on these findings, adriamycin deserves further evaluation in metastatic carcinoid tumors.

Treatment of symptomatic hepatic cyst by percutaneous instillation of Pantopaque

A large, symptomatic, simple hepatic cysts was managed by the percutaneous instillation of Pantopaque. The method was based on reports of similar percutaneous treatment of renal cysts. In 6 months the patient was asymptomatic and radiographs demonstrated evidence of a fibrous reaction within the cyst. The patient remains asymptomatic 16 months after puncture. These results suggest that percutaneous instillation of sclerosing agents may provide an alternative to operative procedures.

Gastrointestinal carcinoma: diagnosis, staging, and follow-up

When cancer of the gastrointestinal tract is suspected, thorough studies should be made to determine the presence, type, and severity of the primary tumor and whether it has spread. Besides routine x-ray studies, angiography, scanning, and sonography may furnish valuable information. Endoscopy, which has revolutionized diagnosis of these tumors, not only makes it possible to obtain a specimen for histologic analysis without laparotomy but also reveals gross involvement as a guide to surgery. Staging of the lesion helps the physician select which patients would benefit from surgery and which instead should be treated with palliative chemotherapy or irradiation, or both. The patient's quality of life during treatment also must be considered. The side effects of multiple-agent chemotherapy, for example, may take too great a toll on the patient's ability to function. Continuous, long-term follow-up is essential. Metastases may develop after three to five years in particularly indolent tumors, and new primary lesions are far from rare.

Evaluation of gastric ulcerations

All gastric ulcers diagnosed during the period November, 1969-May, 1974, were prospectively evaluated by roentgenography, fiberoptic gastroscopy, directed biopsy, and brush cytology. Gastroscopy was performed routinely in patients with radiologic diagnosis of gastric ulcer or questionable findings, and in symptomatic individuals with negative roentgenograms. A total of 123/142 ulcers, 109 benign, 14 malignant, were available for complete follow-up. Gastroscopy was correct in 106 of 109 benign ulcers visualized. Roentgenoscopy demonstrated 91 of 109, of which 7 were incorrectly called carcinoma. Gross diagnosis was correct by gastroscopy in 11 of 14 malignant ulcers. Radiology visualized 6 of 14; gross diagnosis was correct in 1 of 6 (5 called benign). Directed gastroscopic biopsy was negative for malignant changes in all 109 benign and 3 of 14 malignant ulcers. Total complete gastroscopic diagnostic failures were 4 of 123, for an overall accuracy of 96.7%. Overall roentgenographic accuracy was 70.8%.

Carcinoma of the esophagus and cardia: diagnostic evaluation in 113 cases

Fiberoptic endoscopy with directed biopsy and brush cytology was used to diagnose 73 patients with squamous carcinoma of the esophagus and 40 adenocarcinomas of the gastric fundus invading the lower esophagus. Over-all accuracy of histologic diagnosis in the esophagus was 95.8 per cent and in the cardia, 97.5 per cent. Multiple biopsies (6 to 8) and brush cytology complemented one another in providing a high index of reliable histologic diagnoses. There were no complications. Endoscopy with the fiberoptic scope as now performed is well tolerated and accurate. It appears to be the most reliable means of diagnosis in cancer of the esophagus and cardia and should be performed routinely in all patients with symptoms referable to the esophagus.