Helicobacter pylori induces mono-(adenosine 5'-diphosphate)-ribosylation in human gastric adenocarcinoma

Mono-(adenosine 5'-diphosphate) (ADP)-ribosylation, which transfers an ADP-ribose from nicotinamide adenine dinucleotide (NAD) to an acceptor protein, is an important post-translational modification of cellular proteins. Several bacterial toxins are known to possess the mono-ADP-ribosyltransferase activity to catalyze this reaction as a possible pathogenic factor. Therefore, the aim of this study was to examine whether H. pylori may also induce mono-ADP-ribosylation in a human gastric mucosal protein in association with gastric cancer development. Tumorous and adjacent non-tumorous mucosal tissue specimens were obtained from the surgically removed stomachs of 5 patients with gastric adenocarcinoma, and then were homogenized into cytosolic and membranous fractions. Each homogenate or an H. pylori extract was assayed for mono-ADP-ribosylation with [adenylate-(32)P]-NAD and 3-aminobenzamide, a potent inhibitor of poly-ADP-ribosylation. The radiolabeled proteins were separated by sodium dodecylsulfate-polyacrylamide gel electrophoresis followed by radio-image analysis. In the extracts from H. pylori, a strain-dependent, endogenous radiolabeling of 70-kDa protein was detected. An assay of the membranous fractions from 5 gastric adenocarcinomas with the extract of OMH4, a clinical H. pylori isolate, revealed notable radiolabelings of 55- and 45-kDa proteins, which were not found without the OMH4 extract. In contrast, the radiolabelings were minimal in the membranous fractions from respective non-tumorous mucosae, and they were not detected in any of the examined cytosolic fractions. All three radiolabelings of 70-, 55-, and 45-kDa proteins were dependent on NAD, but not on ADP-ribose. Snake venom phosphodiesterase digestion of the 3 radiolabeled proteins released only AMP. We thus found that H. pylori had an enzymatic mono-ADP-ribosyltransferase activity which enabled it to modify the 55- and 45-kDa membranous proteins of human gastric adenocarcinoma, as well as the 70-kDa protein of H. pylori itself. The possible roles underlying our observations on carcinogenesis or development of human gastric carcinoma are yet to be elucidated.

High en bloc resection rate achieved by endoscopic mucosal resection with IT knife for early gastric cancer

BACKGROUND/AIMS

Circumferential endoscopic mucosal resection (EMR) around lesions performed by an insulation-tipped diathermic knife (IT knife) increases en bloc resection rates, suggesting the possibility of expanding indications for EMR.

METHODOLOGY

Clinical outcome of EMR performed by IT knife under general anesthesia was evaluated for 26 patients with 29 early gastric cancer.

RESULTS

Successful en bloc resection rates obtained by the IT knife were 100, 87.5, 90.0 and 100% for lesions < or =10 mm in size, 11-20 mm, 21-30 mm, and > or =31 mm, respectively. They were significantly higher with the IT knife than those obtained by the conventional method (IT knife method: 93.1% vs. conventional method: 28.5%, p<0.0001). Two lesions were lateral margin positive, and in three cases invasion of lesions was observed as deep as the submucosa. Distal, total, and proximal gastrectomy with D2 lymphadenectomy, respectively, was provided in 3 cases; however, no lymph node involvement was found in any of the resected specimens. Bleeding and perforation were observed in 3 cases, respectively, however, no additional surgical treatment was required for these patients.

CONCLUSIONS

EMR by means of the IT knife under general anesthesia can be performed safely and adequately. It is a useful treatment modality for early gastric cancer.

Treatments of hamartoma with neuroendoscopic surgery and stereotactic radiosurgery: a case report

Hypothalamic hamartoma is a non-neoplastic tumor manifesting as gelastic seizure, precocious puberty, and abnormal behavior. Treatment of it is very complicated due to its location. We report a case of hypothalamic hamartoma treated by neuroendoscopic surgery and stereotactic radiosurgery. A 5-year-old girl presented with violent behavior, precocious puberty, gelastic seizure and atonic seizure. She was diagnosed with hypothalamic hamartoma by CT and magnetic resonance imaging at 11 months of age. Tumor size did not change, but tumor intensity had changed on the MR image at 5 years of age. Magnetic resonance spectroscopy revealed decreased N-acetylaspartate and increased choline and creatine in the tumor. After neuroendoscopic biopsy, she underwent linear accelerator stereotactic radiosurgery. But her symptoms remained unchanged for 6 months. She then underwent partial resection and laser coagulation of the tumor by a neuroendoscopic approach. After the procedure, the frequency of her seizures was remarkably decreased, and her violent behavior improved. The transventricular neuroendoscopic approach to the hypothalamus is less invasive than the radical surgery. Neuroendoscopic surgery can be one of the treatments of choice for hypothalamic hamartoma.

A silver-containing halogen-free inorganic photochromic glass

A halogen-free inorganic photochromic soda-lime silicate glass containing silver ions has been developed; reversible change between colorless and yellow color in this glass is achieved through combined 193 nm excimer laser irradiation and heat treatment.

Report of changing signal intensity on follow-up MRI in a case of hypothalamic hamartoma

We present a case of hypothalamic hamartoma in which the signal intensity of the lesion significantly changed during the course of follow-up. To date, stability of the lesion morphology over time has been considered an important diagnostic criterion of hypothalamic hamartoma. Radiologists should be aware that in hypothalamic hamartoma, signal intensity can change during its natural course.

Chordoid glioma of the third ventricle: CT and MR findings

We present a case of chordoid glioma involving the third ventricle in a 42-year-old woman. CT and MR showed a homogeneously enhancing mass occupying the third ventricle, with a cystic component. Chordoid glioma should be included in the differential diagnosis of uncommon masses of the third ventricle in middle-aged women.

Transformation of fibrolamellar carcinoma to common hepatocellular carcinoma in the recurrent lesions of the rectum and the residual liver: a case report

A 21-year-old man had undergone central bisegmentectomy of the liver due to fibrolamellar carcinoma (FLC). Twice, 24 and 30 months after the first operation, lymph node metastases were removed. We have reported this case previously and this is the second report of the same case. Forty-two months after the second operation to remove lymph node metastases, a recurrence occurred in the rectum and was excised. However, the tumor also recurred in the residual liver. The patient underwent hepatectomy for a palliative purpose but died 16 months after the last operation. Histopathologically, the primary tumor was diagnosed as pure FLC, but the lymph node metastases had foci of the common hepatocellular carcinoma (HCC) mixed with FLC. In contrast, the recurrent tumors in the rectum and the residual liver showed the histopathological features of common HCC. Thus, during repeated recurrences, histopathological features changed from pure FLC to common HCC.

Migrated disc in the lumbar spinal canal--case report

A 49-year-old man who had complained of back pain for 20 years presented with numbness and pain in his left leg persisting for 6 weeks. Magnetic resonance imaging demonstrated a peripherally enhanced intraspinal mass at the L-3 level. The mass was completely removed. The operative and histological findings revealed degenerated disc fragments surrounded by granulation tissue. His symptoms were completely relieved. Migrated disc should be included in the differential diagnosis of patients with a long history of back pain and an intraspinal mass.

Post-stroke treatment with imidapril reduces learning deficits with less formation of brain oedema in a stroke-prone substrain of spontaneously hypertensive rats

The present study was undertaken to examine the effects of the ACE (angiotensin converting enzyme) inhibitor imidapril, on the brain, when administered after the onset of stroke in a stroke-prone substrain of spontaneously hypertensive rats (SHRSP). Learning deficits and induced lesions in the brain as well as in the kidneys and heart were investigated in detail. SHRSP were divided into two groups with or without salt loading at the age of 4 weeks. The salt loading was performed for 7-9 weeks to increase the incidence of stroke. Within 24 h after the first observation of stroke, animals were subsequently treated with 5 mg/kg imidapril orally once a day or the vehicle for up to the age of 27 weeks. Imidapril attenuated progression of neurological abnormalities such as irritability, hyperkinesia and motor dysfunction, and increased survival rate. In three-panel runway testing, learning deficits did not develop significantly in the imidapril-treated group, and was comparable to that in the non-salt-loaded/non-stroke group. Imidapril reduced oedema formation in the cortex, hippocampus and striatum, and also suppressed lesion formation in the kidneys and heart. Imidapril thus suppressed progression of neurological deficits with loss of learning ability following onset of stroke, and also suppressed formation of oedema in the brain and decreased the number of lesions in other organs. Imidapril-induced reduction of cerebrovascular damage, which presumably occurs in the brain after stroke, may account for the inhibitory effects of imidapril on lesion formation and learning impairment.

Extraneural metastasis of intracranial germinoma with syncytiotrophoblastic giant cells--case report

A 14-year-old boy presented with an extraneural metastasis of germinoma with syncytiotrophoblastic giant cells (STGC). The tumor was located in the pineal area, suprasellar cistern, and frontal base, and associated with the slight elevation of the beta-human chorionic gonadotropin (HCG) serum level. Following radiation therapy, the tumor completely disappeared, and the beta-HCG level decreased to normal. Two years after the initial treatment, metastasis of the tumor to the left femur was observed without recurrence of the primary lesion. The biopsy specimen revealed germinoma, the diagnosis was germinoma with STGC because of the associated elevation of HCG level. The metastatic tumor was treated by chemotherapy with cisplatin and etoposide, and the tumor completely disappeared. With adjuvant chemotherapy, he has been recurrence-free for 3 years. Extraneural metastasis occurs more frequently from germinoma with STGC than germinoma. Aggressive chemotherapy combined with radiation therapy in the initial treatment might have to be tried to avoid metastasis from germinoma with STGC.

Treatment of chronic subdural hematoma by closed-system drainage without irrigation

BACKGROUND

Recurrence of chronic subdural hematoma after surgery has not been eliminated. We sought to determine whether irrigation influences recurrence rate.

METHODS

Patients who had undergone surgery for chronic subdural hematoma were reviewed retrospectively.

RESULTS

Between 1986 and 1993, 186 cases of chronic subdural hematoma were treated surgically at Mito National Hospital. Recurrence was limited to six cases (3.2%). A closed drainage system without irrigation has been used since 1988 in 119 patients. Before 1988, 67 cases were treated with single burr hole irrigation and drainage. The rate of recurrence with the closed drainage system was 3.4% (four cases), compared with 3.0% (two cases) for irrigation and drainage.

CONCLUSION

Compared with irrigation and drainage, the closed drainage system without irrigation was safe and effective, and recurrence of chronic subdural hematoma is not influenced by irrigation.

Primitive neuroectodermal tumor in the spinal epidural space--case report

A 4-year-old boy presented with a rare case of an epidural tumor causing compression of the thoracic spinal cord manifesting as rapid worsening of gait disturbance. The tumor was grossly totally resected, and radiotherapy and chemotherapy were subsequently administered. The histological diagnosis was primitive neuroectodermal tumor. He has been free of recurrence for more than 6 years. Early tumor resection followed by chemotherapy and irradiation is recommended for patients with primitive neuroectodermal tumor and unstable symptoms.

Nontraumatic convexity intradiploic arachnoid cyst

A 63-year-old male presented with an unusual case of nontraumatic intradiploic arachnoid cyst in the frontotemporal convexity area. Skull radiography showed a circular osteolytic lesion of the right parietal bone. Computed tomography revealed a defect of the inner table, widened diploic space, and thinned outer table. Magnetic resonance imaging showed a cyst containing cerebrospinal fluid. Bone scintigraphy showed no abnormal uptakes. Intraoperative observation confirmed the neuroimaging findings. Histological examination found no abnormal findings in specimens of skull bone or arachnoid membrane. Intradiploic arachnoid cyst is characterized by parasagittal, multiple, well-demarcated osteolytic lesions on radiographs in the elderly. However, the clinical features of this disease remain unclear and diagnosis without an exploratory surgical procedure may not be possible.

Pseudo-cerebrospinal fluid rhinorrhea after skull base surgery

A 41-year-old female underwent complete resection of a left petroclival meningioma via an anterior transpetrosal approach, during which the greater superficial petrosal nerve was divided. On the 14th day after the operation, she first noticed leakage of clear fluid from her right nostril whenever the ambient room temperature rose. This pseudo-cerebrospinal fluid rhinorrhea may have developed because of parasympathetic hypersensitivity due to division of the greater superficial petrosal nerve.

Superior sagittal sinus thrombosis associated with primary antiphospholipid syndrome--case report

A 36-year-old female with a history of recurrent pregnancy loss experienced sudden onset of disturbance in consciousness, with right hemiparesis and total aphasia. Computed tomography revealed a massive hemorrhage in the left frontal lobe, and angiography showed occlusion of the anterior two-thirds of the superior sagittal sinus. Laboratory investigations detected the presence of lupus anticoagulant, elevation of the anticardiolipin beta 2-glycoprotein I complex antibody level, and a decreased protein S activity level. There were no underlying conditions, such as connective tissue disorders, malignancies, infectious diseases, and drug-induced disorders, so the diagnosis was primary antiphospholipid syndrome. Primary antiphospholipid syndrome should be considered in the evaluation of patients with "idiopathic" or "primary" sinus and cerebral venous thrombosis.

Results of urgent thrombolysis in patients with major stroke and atherothrombotic occlusion of the cervical internal carotid artery

PURPOSE

Atherothrombotic occlusion of the cervical internal carotid artery (ICA) without collateral flow is one of the most critical forms of acute ischemia. We report the results of urgent thrombolytic treatment of patients with major stroke in this clinical category.

METHODS

Clinical findings and outcome in 33 patients were investigated. All patients had suffered a major stroke, with a score of 24 or higher on the NIH Stroke Scale on admission. Ischemic abnormalities were not detected on initial CT studies. Diagnoses were made at angiography, and patients were treated by intravenous or intraarterial local thrombolysis within 6 hours of stroke onset.

RESULTS

Recanalization was accomplished in eight patients with intraarterial local thrombolysis; four of these patients had a good clinical outcome. Two factors characteristic of those whose treatment was successful were dramatic improvement of symptoms after partial recanalization achieved within 3 hours of onset and stabilized improvement after subsequent percutaneous transluminal angioplasty or carotid endarterectomy for residual atherosclerotic stenosis at the ICA origin.

CONCLUSION

The results of this study suggest that urgent intraarterial local thrombolysis may be a successful treatment method for some patients in this critical clinical category if the treatment can be accomplished within 3 hours of ictus and followed by either angioplasty or endarterectomy for residual stenosis.

Pitfalls in endovascular treatment of dural arteriovenous fistulas involving the cavernous sinus

SUMMARY

Angiographic changes of the sylvian veins, superior ophthalmic vein (SOV), and superior petrosal sinus (SPS) before and after endovascular treatment were determined for 18 patients with dural arteriovenous fistulas (AVFs) involving the cavernous sinus, and pitfalls of endovascular treatment, especially regarding venous drainage routes, for 3 of the patients were reported. Case 1: 57-year-old woman who presented with right abducens nerve palsy had a Barrow type D fistula in the right cavernous sinus draining into the bilateral inferior petrosal sinuses (IPS). One of the ipsilateral sylvian veins that had drained antegradely before treatment was occluded, and a small lacunar infarction in the corona radiata developed after transvenous embolization (TVE) of the right cavernous sinus. Case 2: 72-year-old woman who presented with symptoms of right ocular hypertension had a type D fistula in the right cavernous sinus draining into only the ipsilateral SOV. Conjunctival hyperemia persisted and was aggravated after angioanatomical obliteration of the fistula by transarterial embolization. Case 3: 55-year-old man who presented with left abducens nerve palsy had a type D fistula in the left cavernous sinus draining into the ipsilateral IPS and sylvian vein. The dural AVF was obliterated once with TVE, but recurred 1 week later with retrograde drainage into the ipsilateral SPS and mesencephalic veins. A second TVE resulted in complete obliteration of the fistula. In conclusion, detailed analysis of drainage routes is necessary for planning of treatment of patients with dural AVF, and prompt treatment is needed when redistribution of drainage routes develops during or after TVE.

Thrombin reduces large heparan sulfate proteoglycan molecules in cultured vascular endothelial cell layers through inhibition of core protein synthesis

We investigated the alteration of heparan sulfate proteoglycans induced by thrombin in cultured vascular endothelial cells. Heparan sulfate proteoglycans, which were metabolically labeled with [3H] glucosamine and [35S] sulfate, were isolated by DEAE-Sephacel ion-exchange chromatography and characterized by molecular sieve gel filtration. Core proteins were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of [35S] amino acids-labeled heparan sulfate proteoglycans after digestion with hepartinase. It was revealed that the high molecular weight subclass of heparan sulfate proteoglycans in the cell layer was markedly decreased by thrombin without changes of the hydrodynamic size of the molecules and the molecular weight of heparan sulfate chains. In addition, thrombin decreased the amount of large heparan sulfate proteoglycan core protein with a molecular weight of approximately 400 kDa, probably perlecan core, in the cell layer and the conditioned medium. The present data suggest that thrombin-induced decrease in the amount of heparan sulfate in vascular endothelial cell layer includes a reduction of the number of large heparan sulfate proteoglycan perlecan molecules through a suppression of the core protein synthesis.