Fetus in fetu: a case report and review of the literature

A cystic tumor was first found in the abdomen of a Taiwanese girl at the age of 9 months. The tumor gradually increased in size and caused no symptoms until the girl was 7 years of age, when surgical removal was carried out. Pathological examination disclosed two "fetuses" within the fibrous sac. The pathogenesis of fetus in fetu and its differentiation from retroperitoneal teratoma are still controversial issues. Further work needs to be done to elucidate whether it is a natural progression of the twinning process to teratoma or the inclusion of a monozygotic diamniotic twin within the bearer.

Prenatal diagnosis and postnatal management of surgically correctable fetal malformations

Twenty newborns, prenatally diagnosed to have congenital malformations, received surgical correction postnatally in recent 7 years. Using serial ultrasound examinations, the following lesions were found: multicystic dysplastic kidney (3 cases), ureteropelvic and ureterovesical junction stenosis (1 case), Mullerian duct cyst (1 case), sarococcygeal teratoma (3 cases), adenomatoid malformation of lung (1 case), omphalocele (1 case), gastroschisis (1 case), duodenal atresia (1 case), ileal atresia (1 case), meconium peritonitis (2 cases), imperforate anus (1 case), adrenal cyst (1 case), congenital diaphragmatic hernia (1 case) and a pair of xipho-omphalopagus twin. The results of surgical corrections were good in all except one baby with omphalocele who died of respiratory distress syndrome.

Relationship between coronary artery size and ventricular hypertrophy

The relationship between coronary blood flow and ventricular hypertrophy has been studied in animal models. But, this relationship in the human body is scarcely evaluated. In this study we measured coronary arterial sizes by coronary arteriograms and correlated them with ventricular hypertrophy. Patients who underwent cardiac catheterization and coronary arteriography and showed no significant coronary arterial lesions were included in this study. There were 131 patients, 75 men and 56 women, with a mean age of 53 +/- 10 years (S.D.). After evaluation with electrocardiograms, echocardiograms and left ventriculograms these patients were divided into 4 groups: (1) the non-hypertrophy (NVH) group, 50 cases; (2) the left ventricular hypertrophy (LVH) group, 38 cases; (3) the right ventricular hypertrophy (RVH) group, 23 cases; and (4) the biventricular hypertrophy (BVH) group, 20 cases. The proximal portion of the 3 major coronary arteries and the left main stem were measured from coronary arteriograms with the catheter tip as a size reference. The results showed that the left main stem was larger than the 3 major coronary arteries in the NVH, LVH and BVH groups. But in the RVH group, the left main stem was not significantly larger than the right coronary artery. In all 4 groups the left circumflex coronary artery was the smallest while the left anterior descending coronary artery and the right coronary artery were similar in size. Patients with LVH showed dilatation of all 3 left coronary measurements (left main stem, left anterior descending coronary artery and left circumflex coronary artery) as compared with the NVH patients and the RVH patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Serological and virological diagnosis for dengue infection]

For many years dengue fever has been one of the most serious diseases in southeast Asia. A dengue type 2 epidemic occurred in Liuchiu, Pingtung in 1981. A recent epidemic, primarily of dengue type 1 has been in progress in southern Taiwan since 1987. In clinical aspects, dengue infection may be confused with measles, rubella, influenza, acute mumps, enteric viral infection and food allergies. Only definite confirmation is possible through serological and virological methods. All four serotypes of the dengue virus, however, are antigenically similar, and their antibodies are also cross-reactive with other flaviviruses. This phenomenom renders the specificity of many serological tests to be less accurate than they should be. Thus, improved virus isolation and identification becomes a necessary tool in proving the dengue infection. This article offers a brief review of some serological tests including the hemagglutination inhibition test, IgG- and MAC-ELISA, the plaque reduction neutralization test, and virological tests including antigen capture ELISA and indirect immunofluorescence antibody assay, with emphasis on their application to the diagnosis of dengue infection.

Meckel's diverticulum and related umbilical abnormalities: review of 26 cases

Twenty-six surgically documented cases of Meckel's diverticulum and related abnormalities at the National Taiwan University Hospital during a 7-year period (1980 through 1987) are reviewed. According to clinical presentation, they were classified into five groups: (1) hemorrhage in 10 cases, (2) inflammation in 4 cases, (3) intestinal obstruction in 4 cases, (4) umbilical abnormalities in 6 cases, and (5) incidental finding on laparotomy in 2 cases. The percentage of umbilical abnormalities was 23%. In contrast, the 2 cases found incidentally represented 8% of 26 cases in this series. The diagnosis of umbilical abnormalities is obvious. For cases with Meckel's diverticuli, however, we detected their complications (hemorrhage, inflammation and intestinal obstruction) only preoperatively except for the hemorrhagic group in whom 6 among 10 cases were proved to have ectopic gastric mucosa by Meckel's scan. Other aspects about the clinical presentation, method of diagnosis, strategy for management are reviewed and discussed.

Primary malignant tumor of liver in infants and children in Taiwan

During the years 1976 through 1985, 55 cases of primary malignant tumor of liver in infants and children were treated. Of the 55, 30 were histologically proved to have hepatocellular carcinoma (HCC), and ten to have hepatoblastoma (HB). HCC was diagnosed in another 14 children based on clinical findings. There was one case of liposarcoma. Distinguishing features of primary malignant tumor of the liver of children in Taiwan include: (1) a significantly greater number of HCC than HB (4.4:1); (2) a 100% (25/25) positive rate of hepatitis B surface antigen (HBsAg) with family clustering for HCC; (3) 71% of the HCC patients also suffered from liver cirrhosis; (4) male preponderance in incidence of HCC. All of these results strongly supported the idea that vertical transmission of hepatitis B virus infection from the mother plays an important role in the development of HCC in this area. A 60% resectable rate and 40% survival rate were observed in HB, but for HCC, the resectability was less than 10%. Only two children were cured of HCC. Among those without tumor resection, all, except two, children died within 1 year. No difference in survival time was observed between those who had chemotherapy and those who did not. Early diagnosis and complete excision of the tumor remains the only way to long-term survival. Monitoring of alpha-fetoprotein in high-risk children, followed by more intensive investigation for those with elevation, is mandatory for early detection of the tumor.

An F1-ATPase beta-subunit precursor lacking an internal tetramer-forming domain is imported into mitochondria in the absence of ATP

Post-translational import of the F1-ATPase beta-subunit precursor into isolated mitochondria requires both an energized inner membrane and nucleoside triphosphate hydrolysis on the organelle surface. Nested internal deletions of the F1 beta-precursor which progressively move a 128-residue carboxyl-terminal domain of the protein closer to the amino terminus reveal an abrupt transition between residues 122 and 144 to a form of the protein which is imported in the absence of added ATP. This transition region of the F1 beta-precursor is the same sequence which we have defined in earlier studies is required for formation of a tetramer following in vitro translation of the F1 beta-precursor. These data indicate that part of the requirement for ATP in the import of mitochondrial precursors may be involved in the reorganization of oligomeric species on the membrane surface which are formed following their translation.

Dissection of the catalytic mechanism of isozyme 4-4 of glutathione S-transferase with alternative substrates

The kinetic and chemical mechanism of isozyme 4-4 of rat liver glutathione (GSH) S-transferase was investigated by using several alternative peptide substrates including N-acetyl-GSH, gamma-L-glutamyl-L-cysteine (gamma-GluCys), N4-(malonyl-D-cysteinyl)-L-2,4-diaminobutyrate (retro-GSH), and N4-(N-acetyl-D-cysteinyl)-L-2,4-diaminobutyrate (decarboxylated retro-GSH). The enzyme, which is normally stereospecific in the addition of GSH to the oxirane carbon of R absolute configuration in arene oxide substrates, loses its stereospecificity toward phenanthrene 9,10-oxide with the retro peptide analogues, giving a 2:1 mixture of the S,S and R,R stereoisomeric 9,10-dihydro-9-(S-peptidyl)-10-hydroxyphenanthrenes. The analogues with normal peptide bonds (N-acetyl-GSH and gamma-GluCys) show normal stereospecific addition. The kinetic mechanism of the enzyme was investigated by using the alternative substrate diagnostic with several 4-substituted 1-chloro-2-nitrobenzenes and GSH, N-acetyl-GSH, and gamma-GluCys. Varying the concentration of electrophile vs the identity of the GSH analogue and the concentration of GSH vs the identity of the electrophile gave two sets of intersecting reciprocal plots, a result consistent with a random sequential kinetic mechanism. The pH profiles of kc and kc/Ksm [saturating GSH, variable 1-chloro-2,4-dinitrobenzene (1)] exhibit a dependence on a deprotonation in the enzyme-GSH-1 and enzyme-GSH complexes with molecular pKa's of 6.1 and 6.6, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of protein structure in the mitochondrial import pathway. Analysis of the soluble F1-ATPase beta-subunit precursor

A series of proteins containing defined internal and presequence deletions in the F1-ATPase beta-subunit precursor have been synthesized in vitro using a linked transcription-translation system. These different forms of the protein have been analyzed by the combination of gel filtration and in vitro mitochondrial import studies. These studies reveal that the soluble F1 beta-subunit precursor (55 kDa) forms a homooligomeric assembly of apparent molecular weight 230,000 on gel filtration analysis. The formation of this tetrameric beta-protein was dependent on the sequence between residues 122 and 144 of the precursor and was independent of the presence of a mitochondrial presequence within the first 19 residues of the precursor. When the tetrameric F1 beta-precursor was partially purified from the translation reaction it was incompetent for import into mitochondria. However, import of the partially purified beta-subunit could be restored by addition of reticulocyte lysate protein. In the absence of the tetramer-forming sequence, the protein behaved as an aggregate complex approximately 400 kDa in size. Formation of the high molecular weight aggregate and import into mitochondria was dependent upon a functional presequence at the amino terminus of the precursor. These studies are discussed in terms of the maintenance of an import competent structure for mitochondrial precursors and role of soluble factors in this process.

The role of protein structure in the mitochondrial import pathway. Unfolding of mitochondrially bound precursors is required for membrane translocation

In order to examine the influence of protein structure on the post-translational import of a protein into mitochondria, the carboxyl-terminal 129 residues of F1-ATPase beta-subunit precursor (511aa) have been replaced with 61 residues of yeast copper metallothionein. Import of the F1 beta-copper metallothionein (beta CuMT) hybrid into mitochondria was as efficient as that of the F1 beta precursor in the absence of copper. Addition of copper to mitochondrial import reactions, which had no significant effect on import of the F1 beta-subunit precursor, blocked import of the beta CuMT protein. This copper-dependent transport block for the beta CuMT precursor occurred after the precursor was bound to mitochondria. Expression of the beta CuMT protein in vivo revealed that beta CuMT would bind copper and allow growth of a copper-sensitive yeast host on an otherwise inhibitory level of the cation as long as it was localized in the cytoplasm. These data indicate that the binding of copper by beta CuMT renders it refractile for partial unfolding which is necessary for its translocation into mitochondria. These observations provide an alternative scheme for the selection of mutants defective in mitochondrial import.

[Brain metastasis from lung cancer--analysis of 53 patients]

From 1976 to 1985, 53 patients with brain metastasis from lung cancer were treated. The most common histologic type was adenocarcinoma (47.4%). All patients presented neurologic symptoms, and 29 were first admitted into the Department of Neurology. CT scan and angiography were most valuable for diagnosis. Metastasis occurred most frequently in frontal, temporal and parietal lobes. In this series, chemotherapy alone was ineffective but resection of the brain foci prolonged the survival in 90.9% of the patients. The authors believe that in order to facilitate radiotherapy or/and chemotherapy, resection of the brain foci should be given more consideration.

Effects of exogenous fat emulsion on lymphocyte function in septic rats

Effects of exogenous fat emulsion (Intralipid) on lymphocyte function were studied, in vivo, with rats. Abdominal sepsis was induced in Sprague Dawley rats by cecal ligation and puncture. Following a bolus infusion of the fat emulsion or normal saline, lymphocyte proliferations after stimulation with bacto-concanavalin A (Con A), phytohemagglutinin (PHA), and pokeweed mitogen (PWM) were evaluated in animals divided into the following groups: group I, non-septic rats receiving saline infusion (NS-S); group II, non-septic rats receiving the fat emulsion (NS-F); group III, septic rats receiving saline (S-S); group IV, septic rats receiving the fat emulsion (S-F). Results of the study demonstrated that lymphocyte function was not suppressed by the presence of sepsis, and infusion of the exogenous fat emulsion also did not lead to a suppression of the lymphocyte function in either the septic or the non-septic rats. The results obtained from a previous, as well as this present, study suggest that although infusion of exogenous fat emulsion may suppress the function of monocyte and polymorphonuclear cells, lymphocyte function is not affected.

Phosphodiester bond cleavage outside mitochondria is required for the completion of protein import into the mitochondrial matrix

The present studies show that hydrolysis of a phosphodiester bond, most likely ATP, is a distinct, second step required to complete import of the F1-ATPase beta-subunit into the mitochondria. This step follows a membrane potential-dependent first step. We show, using an inhibitor of adenine nucleotide transport and the analogue beta,gamma-AMP-PCP, that the activity required for this phosphodiester hydrolysis-dependent completion of protein import resides outside the mitochondrial inner membrane. This activity is proposed to act on the precursor at the site of translocation either to render it competent or to catalyze its vectorial movement directly through the import apparatus. This activity shares properties ascribed to proteins of the heat-shock family, which are proposed to participate in the ATP-dependent refolding of partially denatured proteins and nascent peptides.