A prospective study of Tc-99m MIBI in the differential diagnosis of pelvic masses in female patients

PURPOSE

This study evaluated the feasibility of Tc-99m MIBI scintigraphy in the differential diagnosis of pelvic masses in female patients before operation.

METHODS

Seventy-one patients with pelvic masses were studied with planar imaging over the abdomen and pelvis 5, 15, 30, and 60 minutes after injection of 740 MBq (20 mCi) Tc-99m MIBI. The uptake of the masses was graded, and other abnormal signs, such as intestinal involvement, lymph node involvement, or peritoneal fluid collection, were also considered in image interpretation. An exploratory laparotomy was performed 3 days to 2 weeks after imaging. The scintigraphic diagnosis was compared with that of computed tomography (CT), CA-125 measurement, and pathologic analysis.

RESULTS

Forty-one of 46 pelvic masses with no activity were proved benign. Eighteen of 25 with a fixed, focal uptake were malignant. In 19 of 23 masses, intestinal activity noted within 30 minutes was caused by metastases. All three cases with lymph node involvement and six cases with ascites were confirmed malignant. Combining focal uptake with intestinal involvement correctly indicated 22 of 23 malignant conditions before operation, whereas negative scans identified 41 of 48 benign lesions. Four of seven false-positive lesions had a higher cellular component. The diagnostic performance of Tc-99m MIBI is better than that of CT and CA-125 tests, because CT had eight false-positive and three false-negative results, whereas CA-125 had 12 false-positive and 3 false-negative results, respectively.

CONCLUSIONS

Tc-99m MIBI is useful for differentiating benign and malignant pelvic masses in female patients. A fixed focal uptake or intestinal uptake of the radiotracer suggests malignancy, with diagnostic sensitivity, specificity, accuracy, and positive and negative predictive values of 95.6%, 85.4%, 88.7%, 75.9%, and 97.6%, respectively, in the current prospective study.

Cerebral arteriovenous malformations associated with aneurysms--a report of 10 cases and literature review

We analysed 10 cases of arteriovenous malformations (AVMs) associated with aneurysms and reviewed the literature in order to confirm the clinical characteristics of AVMs associated with aneurysms. The mean incidence of aneurysms in our AVM population was 9.1% and the average age was 38 years. The ratio of male to female was 1.3 to 1. The aneurysms (40-96%) were often located on a feeding artery and seldom (23%) at an arterial bifurcation. The mortality rate was 0-26% in surgically managed patients and 38-60% in conservatively treated patients. The combination of intracranial vascular lesions is not rare. Most patients presented with symptoms referable to their AVMs. Treating both lesions in a single operation is the best option. The prognoses for most patients was good.

[Molecular epidemiology of respiratory syncytial virus infection in infants]

OBJECTIVE

To search for the molecular epidemiology of respiratory syncytial virus (RSV) infection in infants.

METHODS

The randomly amplified polymorphism DNA (RAPD) technology was used to study 96 RSV strains isolated and identified from the patients in Changchun State Hospital of Pediatrics during 1992-1994 and 1 reference strain of M type.

RESULTS

All strains were typable, four RAPD patterns were observed, different diseases have different types. 87.14% of the patients' RSV strains had the same RAPD pattern(R1).

CONCLUSION

RAPD method is a rapid, easy and high resolution technique, with which we can know on the molecular level the microbial infection state. There was epidemic of R1 type infection during the period surveyed.

[Effects of smoking on interleukin-2 and its receptor system in human peripheral blood]

42 healthy male smokers and 42 healthy male nonsmokers matched in age and life style were strictly chosen into the study from Beijing urban and rural areas. Peripheral blood mononuclear cells(PBMCs) were separated and then stimulated by PHA under 37 degrees C, 5% CO2 condition. Immunochemical methods were applied in testing the synthesis of interleukin 2(IL-2) and the expression of its membrane receptor (mIL-2R) and the level of soluble receptor (sIL-2R) in serum. The results showed that when compared with nonsmokers, stimulated PBMC from smokers had significant higher percentage of mIL-2R positive cells (P < 0.05) in vitro. Levels of sIL-2R in serum of smokers were also significantly higher than those of nonsmokers (P < 0.05). The percentage of IL-2 secrete cells of smokers had higher tendency (P = 0.08). These data indicated that the immune function of smokers and nonsmokers are different concerning the IL-2 and its receptor system.

[Histological study of uterine cervix during termination of early pregnancy by mifepristone and prostaglandins]

OBJECTIVE

To study the histological changes of uterine cervix during termination of early pregnancy by mifepristone and prostaglandins (PG).

METHODS

A total of 24 women who requested medical abortion was recruited. For each woman, 3 cervical biopsies were taken: before mifepristone treatment; 48 hours after mifepristone 150 mg single dose treatment (i.e. immediately before PG administration); and 1 hour after gestational sac expulsion. Specimens were studied by optical and electron microscopy.

RESULTS

Significant collagenolysis as demonstrated by marked reduction and irregularity of collagen fibers, abundant accumulation of an amorphorous material of ground substance, and infiltration of neutrophilic polymorphonuclear leukocytes were shown in stroma as well as in the deep portion of cervix after mifepristone as compared to the samples of early pregnant cervix before treatment. These changes presented to a further extent after the expulsion of gestational sac.

CONCLUSION

The changes observed were similar to previous reports during cervical dilatation in term delivery. The present study confirmed the histological cervical ripening effect by mifepristone and suggested it may be used as cervical ripening agent before induction of labor as well.

Suppression of H-ras-mediated transformation in NIH3T3 cells by a ras ribozyme

Murine NIH3T3 cells were used to study the effect of ribozymes on H-ras-mediated transformation. Parental 3T3 cells were transfected with the activated H-ras gene. H-ras-transformed cells had altered morphology and increased colony formation in soft agar in contrast to untransfected 3T3 cells. A hammerhead ribozyme (site-specific ribonuclease) designed to cleave codon 12 (GUC) of the activated H-ras RNA was expressed in transformed cells. 3T3 clones expressing the ras ribozyme displayed decreased expression of activated H-ras RNA. The ras ribozyme reversed the transformed phenotype to resemble that of untransfected 3T3 cells. Furthermore, 3T3 cells containing the ras ribozyme were shown to suppress transformation when they were subsequently transfected with activated H-ras. Insertion of a mutant ribozyme largely devoid of cleaving capacity into H-ras-transformed cells resulted in smaller reductions in H-ras gene expression and colony formation in soft agar when compared with the ras ribozyme. Finally, the ras ribozyme alone did not perturb normal 3T3 cell growth. This study suggests the possible utility of anti-oncogene ribozymes as suppressors of tumor cell growth as well as inhibitors of cellular transformation.

Protective effect of gypenosides against oxidative stress in phagocytes, vascular endothelial cells and liver microsomes

The action of gypenosides (GP, saponins of Gynostemma pentaphyllum, a Chinese medicinal herb) as an antioxidant was studied using various models of oxidant stress in phagocytes, liver microsomes and vascular endothelial cells. The results show that GP decreased superoxide anion and hydrogen peroxide content in human neutrophils and diminished chemiluminescent oxidative burst triggered by zymosan in human monocytes and murine macrophages. An increase of lipid peroxidation induced by Fe2+/cysteine, ascorbate/NADPH or hydrogen peroxide in liver microsomes and vascular endothelial cells was inhibited by GP. It was also found that GP protected biomembranes from oxidative injury by reversing the decreased membrane fluidity of liver microsomes and mitochondria, increasing mitochondrial enzyme activity in vascular endothelial cells and decreasing intracellular lactate dehydrogenase leakage from these cells. The extensive antioxidant effect of GP may be valuable to the prevention and treatment of various diseases such as atherosclerosis, liver disease and inflammation.

Collateral sensitivity to azidothymidine in methotrexate resistant human leukemia cells

Resistance to methotrexate (MTX) is a well established clinical problem and strategies to circumvent this would obviously be beneficial. The human leukemia cell line, CCRF-CEM, was grown in folinic acid to study MTX resistance-reflecting more in vivo conditions. A 15.8-fold resistant subline, CEM/MTX, was evolved by stepwise increases in MTX exposure. The MTX resistant cell line exhibited both increased dihydrofolate reductase (DHFR) activity due to gene amplification as well as impaired MTX uptake. An additional mechanism of resistance to MTX was a 2-fold increase in thymidine kinase (TK). As a result of this increased TK activity, the CEM/MTX cells were collaterally sensitive to the nucleoside analogue, azidothymidine (AZT). CEM cells resistant to MTX possess properties that can be exploited by AZT and these studies may have clinical implications.

Reversal of the malignant phenotype by an anti-ras ribozyme

In this study a ribozyme (catalytic RNA) was designed to site specifically cleave the mRNA of the activated H-ras gene expressed in human bladder carcinoma EJ cells. The optimal conditions for catalytic cleavage by the ribozyme were demonstrated in vitro. A synthetic DNA encoding the ribozyme was cloned into a mammalian expression vector (pH beta APr-1) and transfected into EJ cells. The expressed ribozyme significantly altered the morphology and suppressed the growth of EJ cells in vitro. These cell lines were examined for their malignant potential in athymic (nude) mice by an orthotopic (transurethral) implantation model, which recapitulates the invasive potential of various bladder carcinomas. EJ tumors expressing the H-ras ribozyme were characterized by a marked reduction in tumor take and invasion compared to those formed by control EJ cells. These differences resulted in almost a twofold increase in survival of mice implanted with ribozyme-containing EJ cells. These results further elucidate the role of ras genes in tumorigenicity and invasion, as well as introduce ribozymes as a new class of anticancer agents.

The utility of an anti-fos ribozyme in reversing cisplatin resistance in human carcinomas

The results presented here demonstrate that expression of a fos ribozyme limits Fos protein synthesis and enhances sensitivity of A2780DDP cells to antineoplastic agents, including cisplatin. Moreover, the reversal of this resistance is associated with down-regulation of dTMP synthase, DNA polymerase beta, topoisomerase I and hMTII-A, genes previously linked to DNA synthesis and repair. Thus these studies further implicate the role of the c-fos gene in DNA synthesis through modulation of expression of dTMP syntase, DNA polymerase beta and topoisomerase I. Finally, the use of ribozymes to circumvent drug resistance suggests their potential utility as agents to inhibit tumor cell growth.

Ribozyme-mediated cleavage of c-fos mRNA reduces gene expression of DNA synthesis enzymes and metallothionein

The c-fos gene product Fos has been implicated in many cellular processes, including signal transduction, DNA synthesis, and resistance to antineoplastic agents. A fos ribozyme (catalytic RNA) was designed to evaluate the effects of suppressing Fos protein synthesis on expression of enzymes involved in DNA synthesis, DNA repair, and drug resistance. DNA encoding the fos ribozyme (fosRb) was cloned into the pMAMneo expression plasmid, and the resultant vector was transfected into A2780DDP cells resistant to the chemotherapeutic agent cisplatin. The parental drug-sensitive A2780S cells were transfected with the pMMV vector containing the c-fos gene. Morphological alterations were accompanied by significant changes in pharmacological sensitivity in both c-fos- and fosRb-transfected cells. pMAMneo fosRb transfectants revealed decreased c-fos gene expression, concomitant with reduced thymidylate (dTMP) synthase, DNA polymerase beta, topoisomerase I, and metallothionein IIA mRNAs. In contrast, c-myc expression was elevated after fos ribozyme action. Insertion of a mutant ribozyme, mainly capable of antisense activity, into A2780DDP cells resulted in smaller reductions in c-fos gene expression and in cisplatin resistance than the active ribozyme. These studies establish a role for c-fos in drug resistance and in mediating DNA synthesis and repair processes by modulating expression of genes such as dTMP synthase, DNA polymerase beta, and topoisomerase I. These studies also suggest the utility of ribozymes in the analysis of cellular gene expression.

In vitro staining of islets of Langerhans for fluorescence-activated cell sorting

A previously described technique from the author's laboratories for purification of pancreatic islets by fluorescence-activated cell sorting used the dye neutral red (NR) to obtain specific fluorescence of islets sufficient to give a sorting signal. A major drawback with this technique was the need to inject the dye intravascularly before excision of the pancreas. Preliminary investigations showed that NR would produce selective staining of islets by topical application in vitro but only at low concentrations that were insufficient to give fluorescence strong enough for sorting. The chelating agent dithizone (DTZ) produces bright red staining of islets by topical application in vitro. Further studies showed that dithizone-stained islets exhibited moderately strong fluorescence that faded too quickly for reliable sorting. By combining both NR and DTZ staining in vitro, selective fluorescence of islets was obtained that was sufficient to allow efficient sorting. Using the combined DTZ/NR stain the yield of islets obtained by sorting from a single rat pancreas was 569 +/- 72 (n = 16), corresponding to 83% of the islets present in the digest. The mean purity of the preparation, confirmed by histologic examination, was 80%. The viability of the islets was shown to be good both by supravital staining and by the successful correction of streptozotocin diabetes in syngeneic rats following transplantation of sorted islets.

Evaluation of N-4-(hydroxycarbophenyl) retinamide as a cancer prevention agent and as a cancer chemotherapeutic agent

In this review, a retinoid analogue (N-4-hydroxycarbophenyl) retinamide (R11) has been evaluated for its pharmacological and clinical properties. R11 has been studied both as a cancer prevention agent, as well as, a cancer chemotherapeutic agent. R11 alone and in combination with other agents can be used for the treatment of cervical dysplasia or leukemia. This review will examine novel strategies and mechanisms of action for retinoids in the treatment and prevention of cancer.

[Induction of differentiation of human promyelocytic leukemia (HL-60) cells by new retinoid R-81001]

By using soft agar colony-forming assay, a monoclonal subline of human promyelocytic leukemia HL-60 cells was isolated and inducing activity of differentiation of a new retinoid R-81001 on the cells was studied. Phenotypic changes, such as biologic behavior, morphological and biochemical characteristics, show that R-81001 can induce HL-60 cells to differentiate along the myeloid pathway.