Clinicopathologic features of early rectal carcinoma and indications for endoscopic treatment

PURPOSE

This study was undertaken to clarify the indications for endoscopic treatment.

METHODS

Clinical and pathologic features of 191 lesions in 180 patients with early rectal carcinoma were examined, including 110 intramucosal carcinomas and 81 carcinomas with submucosal invasion (submucosal carcinomas). All lesions had been endoscopically or surgically resected at the National Cancer Center Hospital between 1976 and 1990.

RESULTS

Metastasis to regional lymph nodes (LN metastasis) was seen in 0 percent (0/39) of intramucosal carcinomas and 9.2 percent (6/65) of submucosal carcinomas in the surgically treated patients. The incidence of LN metastasis was higher for lesions larger than 10 mm in diameter, for those showing massive submucosal invasion, and for moderately differentiated adenocarcinomas. LN metastases were associated significantly with lymphatic invasion.

CONCLUSIONS

These results suggest that early rectal carcinomas should be resected surgically if they 1) show massive submucosal invasion, 2) are classified as moderately differentiated adenocarcinomas, and 3) are larger than 10 mm in diameter. In patients with both scanty submucosal invasion and features of well-differentiated adenocarcinoma or intramucosal carcinoma and if no other risk factors for LN metastasis are present, such as lymphatic invasion by the primary lesion, surveillance may suffice after endoscopic resection.

The interaction of RepC initiator with iterons in the replication of the broad host-range plasmid RSF1010

The replication origin of the broad host-range plasmid RSF1010 contains 3.5 copies of a 20mer iteron sequence that bind specifically to the plasmid-encoded initiator, RepC. Here we demonstrated that even a single iteron was bent upon binding of RepC. Moreover, the bending angle seems to become larger along with the increment of the number of iterons. In a mutational analysis of the iteron sequence, we isolated seven kinds of base-substitution mutants of iterons, and estimated the replication activity of these mutants in vivo. We found that each of the subsections in the 20mer iteron sequence made a distinct contribution to the initiation of RSF1010 DNA replication. With the binding assay of RepC and mutated iterons in vitro, we found that the formation of a productive RepC-iteron complex was required for the initiation of plasmid DNA replication.

Design of noncovalent trypsin inhibitor based on the X-ray crystal structure of the complex

The inhibitory mechanism of trans-4-aminomethylcyclohexanecarbonyl-L-phenyl-alanine-4-carbo xymethylanilide (1), a noncovalent serine protease inhibitor synthesized based on previous structure-activity studies, was clarified based on the X-ray crystal structure of the complex (2.2 A resolution, R = 0.175), where the amino group of the aminomethylcyclohexane moiety was bifurcately hydrogen-bonded to the carboxyl oxygens of Asp 189 side group (specificity pocket), and the hydrogen bonds of the cyclohexanecarbonyl oxygen to NHs of Gly 193 and Ser 195 residues (oxyanion hole) and of Phe NH to Ser 195 O gamma atom (catalytic triad) were observed. In contrast, the Phe benzene moiety and terminal carboxymethylanilide of 1 were not well located on the electron density map, suggesting the conformational freedom of these P1' and P2' sites at the binding pocket. Based on these insights, trans-4-aminomethylcyclohexanecarbonyl-4-nitro-L-phenylalanine-4-+ ++benzoylanilide (2) was designed, in which the P1' and P2' sites were modified so as to effectively interact with the amino acid residues of trypsin binding pocket via hydrogen bonding and van der Waals interactions, respectively. Consequently, 2 showed 40 times higher inhibitory activity against trypsin than 1.

Effect of Helicobacter pylori eradication on the healing and recurrence of peptic ulcer: combination therapy with low-dose omeprazole and clarithromycin

AIM

To investigate the effect of eradication of Helicobacter pylori using combination therapy with low-dose omeprazole and clarithromycin on the healing and recurrence of peptide ulcers.

PATIENTS AND METHODS

We studied 60 patients with active duodenal ulcers and 60 with gastric ulcers who were H. pylori-positive by the rapid urease test and a histological examination of antral biopsy specimens. The eradication method used was a combination of omeprazole (20 mg a day) and clarithromycin (400 mg twice a day). The patients were followed up for 24 months after the end of the treatment. H. pylori infection and the ulcer stage were investigated by endoscopy every 6 months. We assessed the relationship between H. pylori infection, ulcer healing to a white scar and ulcer recurrence after combination therapy.

RESULTS

H. pylori was eradicated in 23 out of 120 patients (22%), with suppression in 101 out of 120 patients (84%). The rate of ulcer healing to a white scar 6 months after treatment was significantly higher and the ulcer recurrence rate within 2 years after treatment was significantly lower in patients with H. pylori suppression or eradication than in those continuously positive for the organism.

CONCLUSIONS

These results suggest that not only the eradication but also the suppression of H. pylori may improve ulcer healing and reduce the rate of relapse.

Application of a unique automated synthesis system for solution-phase peptide synthesis

An automated synthesis system, which is suitable for repetitive syntheses using similar reaction procedures, was used to synthesize systematically a library of all possible dipeptides (25) and tripeptides (125) from 5 protected amino acids. The apparatus has also been applied to the automated synthesis of 10 fragment tripeptide derivatives that are constituents of the hormone PACAP-27. The measured molecular optical rotation values of the library of 125 tripeptides were found to correlate well with calculated values obtained by summation of the molecular optical rotation values for the constituent amino acids.

Carcinoma of the ampulla of Vater synchronously associated with early gastric cancer--a report of two cases

We report two cases of carcinoma of the ampulla of Vater synchronously associated with early gastric cancers. The gastric lesions were diagnosed pre-operatively in one patient and at the time of examination of the resected specimen following pancreatoduodenectomy in the other. Specific problems in the diagnosis and management of these multiple primary carcinomas are discussed. Careful evaluation of the stomach prior to the surgical treatment for ampullary carcinoma is recommended.

The S-locus of Nicotiana alata: genomic organization and sequence analysis of two S-RNase alleles

Genomic clones encoding the S2- and S6-RNases of Nicotiana alata Link and Otto, which are the allelic stylar products of the self-incompatibility (S) locus, were isolated and sequenced. Analysis of genomic DNA by pulsed-field gel electrophoresis and Southern blotting indicates the presence of only a single S-RNase gene in the N. alata genome. The sequences of the open-reading frames in the genomic and corresponding cDNA clones were identical. The organization of the genes was similar to that of other S-RNase genes from solanaceous plants. No sequence similarity was found between the DNA flanking the S2- and S6-RNase genes, despite extensive similarities between the coding regions. The DNA flanking the S6-RNase gene contained sequences that were moderately abundant in the genome. These repeat sequences are also present in other members of the Nicotianae.

Pernicious anemia and Helicobacter pylori infection in Japan: evaluation in a country with a high prevalence of infection

OBJECTIVES

To evaluate the degree of gastritis and the prevalence of Helicobacter pylori in Japanese patients with pernicious anemia (PA).

METHODS

Histological assessment for mucosal atrophy and inflammation was performed in gastric biopsy specimens taken from 24 Japanese patients with PA and from 24 age- and sex-matched controls. The prevalence of H. pylori was evaluated by Giemsa staining and serum IgG antibodies. Serum gastrin and pepsinogens were determined by radioimmunoassay.

RESULTS

All patients with PA had severe fundic atrophic gastritis, and 17 (71%) also had antral atrophic gastritis. Thirteen (54%) of 24 age- and sex-matched controls had fundic atrophic gastritis, and 15 (62%) also had antral atrophic gastritis. Mucosal inflammation was identified in the fundus of all 24 patients and in 15 (62%) controls and in the antrum of 22 (92%) patients and 16 (67%) controls. H. pylori was not detected by Giemsa staining or serum IgG antibodies to H. pylori in any patient with PA but was present in 16 (67%) controls. Serum gastrin levels were significantly higher, and serum pepsinogen I, II, and the I/II ratio were significantly lower in patients than in controls (p < 0.001).

CONCLUSIONS

Our results confirm that H. pylori infection is infrequent in PA and is unlikely to be a factor in producing type A gastritis in PA.

Does dopamine act on myocardial cells?

We examined the electrophysiological effects of dopamine on the single myocardial cells isolated from the rat and rabbit heart. Dopamine at a concentration of 1 or 10 microM did not affect the L-type Ca2+ current (ICa) or the transient outward current (ITO) in rat ventricular, rabbit atrial, ventricular, and sinoatrial node cells. It did not induce any detectable change in the action potential configuration of the rabbit ventricular cells either. We conclude that dopamine does not directly act on myocardial cells at least in terms of the electrophysiological properties.

Implications of host pancreatic hormones in the restart of grafted liver

Regulatory roles of insulin and glucagon in hepatic metabolism and function are well described. However, little is known about implications of host pancreatic hormones in primary function of grafted liver. This study aimed to investigate it in relation to hepatic mitochondrial function. Insulin, c-peptide, and glucagon in peripheral blood were monitored for 2 days in clinical liver transplantation by a continuous sampling technique to avoid influences of hormonal oscillation. In grafts with immediate function (n = 10), smooth increase of arterial ketone body ratio reflecting hepatic intramitochondrial redox state was accompanied by increased c-peptide and decreased glucagon, resulting in the increase of c-peptide/glucagon ratio. In other functioning grafts (n = 20), where ketone body ratio was rather lower, increased glucagon level, observed also during anhepatic phase, resulted in the slower increase of c-peptide/glucagon ratio. There were accompanied by increased free fatty acid and ketone body levels. In primary nonfunction (n = 4), rapid increase of c-peptide accompanied by hyperglycemia resulted in the accelerated increase of c-peptide/glucagon ratio, but ketone body ratio did not show any increase. Insulin/c-peptide ratio also showed a rapid increase. These findings suggest that the increase of insulin/glucagon ratio in portal blood, potentially influenced by recipient condition, is associated with the recovery of mitochondrial energy metabolism in survived hepatic grafts. However, this relationship does not work in failed grafts, where irreversible impairment of energy metabolism is attributed to graft itself.

Inversion(10)(q11q24) in a case of adult T-cell leukemia

We report a case of adult T-cell leukemia (ATL) with complex chromosome abnormalities including an inversion (10)(q11q24) in a 64-year-old man. Although some abnormalities of chromosome 10 have been seen in ATL and other lymphoid neoplasias, inv(10)(q11q24) has previously been reported only in a case of T-cell chronic lymphocytic leukemia. Recent studies have revealed a rearrangement of a novel homeobox-containing gene called TCL-3 or HOX11 on 10q24 in T-cell acute lymphoblastic leukemia with the specific chromosome translocation t(10;14)(q24;q11), and thus the significance of 10q24 aberrations in leukemogenesis is indicated. We suggest that, despite the rarity of this anomaly, inv(10) (q11q24) may be a new chromosome inversion related to T-cell neoplasia and that the 10q24 anomaly may be an important cytogenetic clue for the elucidation of the pathogenesis of some peripheral T-cell neoplasias.

Helicobacter pylori infection is associated with low antral somatostatin content in young adults. Implications for the pathogenesis of hypergastrinemia

BACKGROUND

Recent studies on the role of Helicobacter pylori in the pathogenesis of duodenal ulcers have focused on the mechanism by which H. pylori infections cause exaggerated gastrin release.

METHODS

We determined meal-stimulated serum gastrin concentrations and antral somatostatin content in 24 asymptomatic volunteers (6 H. pylori-infected, 18 H. pylori-uninfected). Somatostatin content was determined by radioimmunoassay in biopsy specimens obtained from the antrum.

RESULTS

Fasting and integrated 2-h gastrin concentrations were significantly higher in H. pylori-positive volunteers than in H. pylori-negative volunteers (fasting, 111 +/- 16.3 pmol/l versus 53.4 +/- 3.5 pmol/l; p < 0.05; integrated 2-h, 267 +/- 41.2 pmol/l versus 70.1 +/- 2.1 pmol/l; p < 0.01). Antral somatostatin content was 0.764 +/- 0.173 ng/mg and 2.931 +/- 0.414 ng/mg in H. pylori-positive and -negative volunteers, respectively (p < 0.01).

CONCLUSIONS

Low antral somatostatin content may cause hypergastrinemia in asymptomatic healthy volunteers, and H. pylori may contribute to the pathogenesis of duodenal ulcer, through this mechanism.

[A preliminary analysis of unrelated marrow transplantations facilitated by the Japan Marrow Donor Program (JMDP)]

Between January 1993 and June 1994, the JMDP facilitated marrow donations from unrelated donors for 171 patients with malignant and non-malignant disorders. The median age of the patients was 21 years. All patients received marrow from phenotypically HLA -A, -B, -DR identical donors. About half of the patients wrer treated with total body irradiation (TBI)-containing regimens and about 80% of the patients received short-courses methotrexate and cyclosporine for graft-versus-host disease (GVHD) prophylaxis. Eight out of 171 patients, (4.7%) had graft failure and 63 out of 144 patients (44%), who survived for more than 30 days posttransplant, developed grade II to IV acute GVHD. The incidence of chronic GVHD was 47% (extensive form; 27%); most of them were progressive/quiscent type. The incidence of moderate to severe acute GVHD was higher than that observed in sibling transplants. On the other hand, the incidence of chronic GVHD was similar to that observed in sibling transplants. Overall survival at 1.5 years posttransplant was about 50% with no significant differences between diseases. The age correlated significantly with the survival in standard risk leukemia but not in high-risk leukemia. Despite the risk of graft failure and acute GVHD, this preliminary analysis demonstrates that transplantation of marrow from unrelated donors can be an effective treatment for certain hematologic disorders.

Systemic lupus erythematosus and anticardiolipin antibodies in Klinefelter's syndrome

A case report of Klinefelter's syndrome is presented that shows features of systemic lupus erythematosus, arteriographically-proven peripheral artery occlusion with leg ulcers, multiple cerebral infarcts and persistent elevations of anticardiolipin antibodies.

Virginiae butanolide binding protein from Streptomyces virginiae. Evidence that VbrA is not the virginiae butanolide binding protein and reidentification of the true binding protein

Virginiae butanolides (VBs) A-E are butyrolactone autoregulators that control virginiamycin production in Streptomyces virginiae. We have previously reported the purification and molecular cloning of VbrA, a putative VB binding protein (Okamoto, S., Nihira, T., Kataoka, H., Suzuki, A., and Yamada, Y. (1992) J. Biol. Chem. 267, 1093-1098). However, VbrA protein overexpressed in Escherichia coli did not show any detectable VB binding activity nor did the immunoprecipitation of native VbrA from a cell-free extract of S. virginiae cause any decrease in such activity, indicating that VbrA is not the true VB binding protein. This finding prompted us to seek the true VB binding protein by repurification. After successive purification by anion exchange, gel filtration, heparin, and hydrophobic interaction chromatography, a 26-kDa protein (p26k) was identified as the true VB binding protein. Partial amino acid sequences of p26k were determined, and the gene (barA) that encodes this protein was isolated and cloned using degenerate oligonucleotide probes. When the barA gene was expressed in Streptomyces lividans and E. coli, strong VB binding activity appeared, demonstrating unambiguously that the S. virginiae p26k protein is the true VB binding protein.

Helicobacter pylori infection, serum gastrin, and gastric acid secretion in teen-age subjects with duodenal ulcer, gastritis, or normal mucosa

BACKGROUND

Many studies have confirmed the close association of Helicobacter pylori with duodenal ulcer (DU) in adults. However, in the subtype of DU known as 'childhood' or 'early onset DU' genetic factors seem to play a prominent role in the pathogenesis. The aim of this study was to investigate the prevalence of H. pylori in teen-age subjects with DU, gastritis, and normal mucosa and to examine the relationship of H. pylori to serum gastrin levels and gastric acid secretion.

METHODS

Sixty-one teen-age subjects (24 with DU, 14 with gastritis, and 23 normal subjects) were investigated for the presence of H. pylori, antral histology, gastrin levels, basal acid output (BAO), and maximal acid output (MAO).

RESULTS

All 24 patients with DU and 8 of 14 with gastritis were infected with H. pylori; none of the normal subjects were infected. Mean gastritis scores and fasting serum gastrin levels were significantly higher in patients with DU or H. pylori-positive gastritis than in subjects with H. pylori-negative gastritis or normal mucosa (p < 0.05). The difference in serum gastrin levels was also significant when patients with DU were compared with those with H. pylori-positive gastritis (p < 0.05). BAO and MAO were significantly higher in patients with DU than in subjects with H. pylori-positive gastritis or normal mucosa (p < 0.05), but there was no difference between subjects with H. pylori-positive gastritis and those with normal mucosa.

CONCLUSION

H. pylori infection is associated closely with teen-age DU and gastritis and with hypergastrinemia but does not affect BAO and MAO in most infected teen-age subjects.

[MRI of traumatic anosmia]

On MRI, the authors were able to demonstrate the contused lesions of bilateral rectal gyri near the crista galli in all of five cases of traumatic anosmia. Thin slice coronal and sagittal images of MRI were very useful for detecting the lesions. Conventional CT scans failed to demonstrate the lesions in 3 out of the 5 cases, but, even in these cases, MRI was able to clearly depict the contused lesions of bilateral rectal gyri. Therefore, the depicted lesions of bilateral rectal gyri on MRI can be evidence of traumatic anosmia and this may be very significant in medico-legal cases.

Establishment of lipopolysaccharide-dependent nuclear factor kappa B activation in a cell-free system

Nuclear factor kappa B (NF-kappa B), consisting of p50 and p65, is bound to a cytoplasmic retention protein, I kappa B, in a resting state, and the stimulation of cells with a variety of inflammatory stimuli induces the dissociation of NF-kappa B from I kappa B and the nuclear translocation of NF-kappa B, thereby activating several genes involved in inflammatory responses, such as interleukin (IL)-6, IL-8, and tumor necrosis factor alpha. In order to elucidate the precise mechanism of NF-kappa B activation, we have established lipopolysaccharide (LPS)-dependent NF-kappa B activation in a cell-free system using plasma membrane-enriched, cytosol, and nuclear fractions extracted from a human monocytic cell line, THP-1, by disruption with sonication followed by a differential centrifugation. The combination of plasma membrane-enriched fraction and cytosol was sufficient to activate NF-kappa B in a LPS/CD14-dependent manner only in the presence of ATP as judged by the binding of NF-kappa B to the IL-8 gene kappa B site on an electrophoretic mobility shift assay. LPS-dependent NF-kappa B activation was inhibited by protein kinase inhibitors, such as staurosporine, herbimycin A, tyrphostin, and genistein, but not mitogen-activated protein kinase substrate, cGMP-dependent protein kinase, cAMP-dependent protein kinase, protein kinase C, and calmodulin-dependent protein kinase II inhibitory peptides, suggesting that staurosporine-sensitive kinase(s) as well as tyrosine kinase(s) are involved in LPS-mediated NF-kappa B activation. In addition, LPS induced the phosphorylation of I kappa B-alpha, starting at 5 min after the stimulation in a cell-free system. Moreover, the phosphorylation was inhibited by herbimycin A and tyrphostin, but not staurosporine, suggesting that these protein kinase inhibitors act at distinct steps of signal transmission. Establishment of ligand-dependent activation of NF-kappa B in a cell-free system will facilitate identification of protein kinase(s) and its substrate(s) involved in LPS-mediated NF-kappa B activation.

Induction of anterior chamber-associated immune deviation with lymphoreticular allogeneic cells

Immune privilege in the anterior chamber of the eye results in part from a selective deficit in delayed hypersensitivity that is elicited by antigenic materials placed in this unique tissue site. This stereo-typical systemic immune response (anterior chamber-associated immune deviation [ACAID]) to intraocular antigen can also be evoked in naive mice by the intravenous injection of syngeneic peritoneal exudate cells (PEC) that have been incubated overnight with a soluble antigen in the presence of supernatants of cultured iris and ciliary body (I/CB) cells or with transforming growth factor (TGF)-beta. To determine whether a similar protocol could be used to induce ACAID to transplantation antigens expressed on allogeneic PEC, we conducted experiments with allodisparate PEC donors and recipients selected to differ at loci dictating MHC and/or minor histocompatibility antigen. Recipients of I/CB supernatant-treated PEC from donors disparate for class I and/or class II antigens, as well as donors disparate only for minor H antigens, were specifically unable to display donor-specific delayed hypersensitivity, whereas recipients of PBS-treated allogeneic PEC developed intense donor-specific delayed hypersensitivity. We conclude that allogeneic PEC that have been cultured with I/CB supernatant overnight create an alloantigen-specific ACAID-inducing signal that confers ACAID on naive recipient mice.

Supernumerary impactions of the mandibular cuspids and bicuspids. Case report

A case involving the presence of supernumerary cuspids and bicuspids is described. The condition was probably an inherited one because of the family history and the bilateral incidence. The supernumerary teeth erupted because of alveolar resorption in which inflammatory factors probably played a role. Radiographic follow-up of the site of supernumerary impacted teeth and alveolar resorption should be undertaken.

Down-regulation of the cyclin A promoter in differentiating human embryonal carcinoma cells is mediated by depletion of ATF-1 and ATF-2 in the complex at the ATF/CRE site

The human embryonal carcinoma cell line NEC14 can be induced to differentiate by the addition of N,N'-hexamethylene-bis-acetamide (HMBA). After treatment with HMBA, the level of cyclin A transcript decreased steeply, reaching less than one-tenth of the original level by 48 h. The promoter elements concerned with this down-regulation were studied by using reporter genes and by analyzing DNA-protein complexes. The deletion of the sequence between -608 and -259 containing three GC boxes decreased the promoter activity to about a half, and further deletion up to -194, eliminating the ATF/CRE site, resulted in a decrease to about a tenth of the original level in undifferentiated NEC14 cells. These sequences were involved in down-regulation of the promoter activity in differentiation-induced NEC14 cells. DNA-protein complexes formed at the ATF/CRE site with extracts prepared from undifferentiated and differentiation-induced cells gave the same footprint, but showed different electrophoretic mobilities. The supershift assay with specific antibodies against ATF-1 and ATF-2 indicated that both factors were depleted in the complex after induction of NEC14 cell differentiation. Both the ATF/CRE site and GC boxes seemed to be also involved in up-regulation of the cyclin A promoter in growth-stimulated human fibroblasts at the G1/S boundary.

Hepatic cholesterol 7 alpha-hydroxylase activity and serum 7 alpha-hydroxy-cholesterol level during liver regeneration after partial hepatectomy in rats

Hepatic cholesterol 7 alpha-hydroxylase is a rate-limiting enzyme for bile acid synthesis, and we have previously shown that the serum 7 alpha-hydroxycholesterol level reflects the enzyme activity in patients with an intact liver. The purpose of this study was to evaluate the alterations in hepatic cholesterol 7 alpha-hydroxylase activity and the serum 7 alpha-hydroxycholesterol level after hepatectomy and the correlations between these parameters and liver mass. Hepatic cholesterol 7 alpha-hydroxylase activity, the serum 7 alpha-hydroxycholesterol level and the remaining liver weight were determined after 70% hepatectomy in rats. Cholesterol 7 alpha-hydroxylase activity was decreased on days 1 and 2 (from 28.3 +/- 3.7 to 8.5 +/- 2.8 and 13.3 +/- 3.6 pmol/min/mg protein, respectively), returned to the preoperative level on day 3 (24.7 +/- 2.6 pmol/min/mg protein) and further elevated thereafter (71.4 +/- 10.9 on day 7 and 51.3 +/- 6.6 pmol/min/mg protein on day 14). The serum level of 7 alpha-hydroxycholesterol changed simultaneously with the enzyme activity, and a significant correlation between the two parameters was observed (r = 0.915, p < 0.0001). The correlations between the liver weight and hepatic cholesterol 7 alpha-hydroxylase activity and serum 7 alpha-hydroxycholesterol level were significant (p < 0.01), but the significances disappeared for the period of days 3-14 (r = 0.424, p = 0.08; r = 0.299, p = 0.228, respectively). In conclusion, hepatic cholesterol 7 alpha-hydroxylase activity is suppressed by hepatectomy and then activated as the liver regenerates. The serum 7 alpha-hydroxycholesterol level is a good parameter of this enzyme activity after partial hepatectomy.