Laparoscopic repair of various types of biliary-enteric fistula: three cases

Biliary-enteric fistula is one of the reasons for converting from laparoscopic cholecystectomy (LC) to open surgery. Here we present three cases of various types of biliary-enteric fistula treated successfully by laparoscopic surgery. Two cases were diagnosed preoperatively, and the remaining case intraoperatively. The first patient had a cholecystoduodenal fistula with a common bile duct stone. The second patient had cholecystocolic and choledochoduodenal fistulas with a common bile duct stone, and the third patient had a cholecystogastric fistula. The fistulas were repaired laparoscopically by intracorporeal suturing or with an endoscopic linear stapling device. All the patients had good postoperative courses without any postoperative complication. Our experience has shown us that with advances in surgical skills and instruments, laparoscopic surgery for biliary-enteric fistula can be adopted as the first treatment choice regardless of the preoperative diagnosis.

Mild hypothermia inhibits inflammation after experimental stroke and brain inflammation

BACKGROUND AND PURPOSE

We previously showed that mild hypothermia protects against experimental stroke, even when cooling was delayed by 2 hours. Protection may be due in part to inhibiting inflammation. To clarify, we examined leukocyte infiltration, microglial activation, and adhesion molecule expression in models of stroke and pure brain inflammation.

METHODS

Rats underwent 2-hour middle cerebral artery occlusion (MCAO; n=36) or intravenous injection with 5 mg/kg lipopolysaccharide (LPS; n=22). Temperature was lowered to 33 degrees C for 2 hours or kept at 37 degrees C. In MCAO, cooling was applied intraischemically or on reperfusion (delayed). In the LPS model, cooling began after injection. One and 3 days later, brains were assessed for neutrophils, monocytes/microglia, major histocompatibility complex class II antigen, and intercellular adhesion molecule-1 (ICAM-1).

RESULTS

One day after MCAO, both intraischemic and delayed hypothermia decreased ICAM-1 (51% and 60%, respectively, versus normothermia; P<0.001), monocytes (63% and 57%; P<0.01), and microglia (55% and 53%; P<0.001). Similar decreases were seen at 3 days for ICAM-1 (91% and 93%; P<0.001), monocytes (62% and 54%; P<0.01), and microglia (55% and 53%; P<0.001). In the LPS model, ED-1-positive cells were not observed in the brain, but hypothermia decreased ICAM-1 (26%; P<0.05), OX6 (56%; P<0.01), and microglia (47%; P<0.01) at 1 day.

CONCLUSIONS

Mild hypothermia decreases inflammatory responses in both brain inflammation and stroke, implicating a direct anti-inflammatory effect of cooling. This suggests that hypothermia can attenuate factors contributing to delayed ischemic injury.

Attenuation of nitric oxide synthase isoform expression by mild hypothermia after focal cerebral ischemia: variations depending on timing of cooling

OBJECT

In this study the authors examined the influence of mild hypothermia on early expression of nitric oxide synthase (NOS) isoforms and peroxynitrite generation after experimental stroke.

METHODS

In 82 male Sprague-Dawley rats, middle cerebral artery occlusion was performed for 2 hours by using the intraluminal suture model. The rats were maintained at their normal body temperature or exposed to 2 hours of intraischemic or postischemic (2-hour delay) mild hypothermia. Brains were collected 2, 6, and 24 hours after onset of ischemia for immunohistochemical and Western blot analysis of neuronal (n)NOS and inducible (i)NOS expression and peroxynitrite generation.

CONCLUSIONS

Western blots showed significantly increased nNOS and iNOS expression in the ischemic cortex at 2, 6, and 24 hours compared with sham-operated animals. The NOS expression was highest at 24 hours. Postischemic hypothermia attenuated nNOS expression at 6 and 24 hours to a greater extent than intraischemic hypothermia. Intraischemic hypothermia reduced iNOS expression at both 2 and 24 hours, whereas postischemic hypothermia decreased iNOS expression at 24 hours. Results of immunohistochemical studies showed that nNOS colocalized with the neuronal marker MAP-2 at all time points, whereas iNOS was initially localized to vessels, and then localized to activated microglia by 24 hours. Intraischemic but not postischemic hypothermia decreased the number of nitrotyrosine-positive cells in the ischemic cortex at 24 hours. Mild hypothermia significantly but differentially attenuates increases in NOS isoforms, with more robust nNOS suppression when cooling is delayed. This may have important implications for understanding the mechanism of hypothermic neuroprotection and for stroke therapy.

Cellular targets of brain inflammation in stroke

Ischemia elicits an inflammatory response in the injured brain that is mediated by various factors, leading to the accumulation of inflammatory cells. These cells, in turn, generate both toxic and reparative substances. The inflammatory reaction, which has a rapid onset and continues after the stroke, is thought to acutely contribute to the evolution of tissue injury. Knowledge of these signaling pathways has led to the identification of a variety of therapeutic targets for stroke treatment, particularly during the reperfusion phase. Whether these targets will be useful in the development of therapies for the treatment of stroke in humans is far from clear, but they provide fertile ground for scientific investigation.

Mild hypothermia inhibits nuclear factor-kappaB translocation in experimental stroke

Nuclear factor-kappaB (NFkappaB) is a transcription factor that is activated after cerebral ischemia. NFkappaB activation leads to the expression of many inflammatory genes involved in the pathogenesis of stroke. The authors previously showed that mild hypothermia is protective even when cooling begins 2 h after stroke onset. In the present study, they examined the influence of hypothermia on NFkappaB activation. Rats underwent 2 h of transient middle cerebral artery occlusion. Brains were cooled to 33 degrees C immediately after or 2 h after occlusion, and maintained for 2 h. After normothermic ischemia (brain temperature at 38 degrees C), NFkappaB cytoplasmic expression, nuclear translocation, and binding activity were observed as early as 2 h in the ischemic hemisphere and persisted at 24 h. Hypothermia decreased NFkappaB translocation and binding activity but did not alter overall expression. Hypothermia also affected the levels of NFkappaB regulatory proteins by suppressing phosphorylation of NFkappaB's inhibitory protein (IkappaB-alpha) and IkappaB kinase (IKK-gamma) and decreasing IKK activity, but did not alter overall IKK levels. Hypothermia suppressed the expression of two NFkappaB target genes: inducible nitric oxide synthase and TNF-alpha. These data suggest that the protective effect of hypothermia on cerebral injury is, in part, related to NFkappaB inhibition due to decreased activity of IKK.

Gene expression profile analysis in human hepatocellular carcinoma by cDNA microarray

We performed gene expression profiling of normal and hepatocellular carcinoma (HCC) liver tissues using a high-density microarray that contained 3,063 human cDNA. The results of a microarray hybridization experiment from eight different HCC tissues were analyzed and classified by the Cluster program. Among these differentially-expressed genes, the galectin-3, serine/threonine kinase SGK, translation factor eIF-4A, -4B, -3, fibroblast growth factor receptor, and ribosomal protein L35A were up-regulated; the mRNAs of Nip3, decorin, and the insulin-like growth factor binding protein-3 were down-regulated in HCC. The differential expression of these genes was further confirmed by an RT-PCR analysis. In addition, our data suggest that the gene expression profile of HCC varies according to the histological types.

Studies of a novel human thrombomodulin immobilized substrate: surface characterization and anticoagulation activity evaluation

Immobilization of the anticoagulative or antithrombogenic biomolecule has been considered as one of the important methods to improve the blood compatibility of artificial biomaterials. In this study, a novel immobilization reaction scheme was utilized to incorporate the human thrombomodulin, an endothelial cell associated glycoprotein, onto the cover glass surface with an aim to develop an anticoagulative substrate. Trichlorotriazine and amino-terminated silane were employed as the coupling agents, while the polyethylene glycol with a molecular weight of 1500 was used as the spacer in this reaction scheme. Protein C activation assay indicated the immobilized human thrombomodulin still has this coenzymatic activity but is lower, possibly due to the conformation variation by the coupling agents. In vitro platelet adhesion assay has demonstrated the surface with immobilized human thrombomodulin is much less platelet-activating than others. Therefore, the novel reaction scheme proposed here is very promising for future development of an anticoagulative silicon or cover glass substrate (e.g. implantable sensor or biochip) by the immobilization of antithrombogenic protein, such as the human thrombomodulin in this study.

Antiproliferative mechanism of retinoid derivatives in ovarian cancer cells

Retinoid derivatives have been implicated for the growth regulation of ovarian cancer cells. However, the molecular mechanisms are not yet fully defined. To dissect detailed mechanisms of each derivative, four ovarian cancer cells (A2774, PA-1, OVCAR-3, SKOV-3) were treated with all-trans retinoic acid (ATRA), 9-cis retinoic acid (9-cis RA), 13-cis RA, or 4-hydroxyphenyl retinamide (4-HPR). When treated with 1 microm, HPR inhibits most effectively the growth of all four cells. Depending on cell types treated, IC(50) values were 0.7-2.7 microm for 4-HPR, and 2.7-9.0 microm for other retinoid derivatives. DNA fragmentation assay indicated that the antiproliferative effect of HPR could be mediated by apoptosis. Transcription assays coupled with transient transfection in OVCAR-3 cells indicated that ATRA, 9-cis RA, and 13-cis RA were active for all RAR/RXR subtypes, whereas 4-HPR was only active for RARgamma. However, 4-HPR exerted the strongest suppression on AP-1 (c-Jun) activity. As expected from AP-1 data, in vitro invasion assays showed that HPR blocked effectively the migration of OVCAR-3 cells. Thus, 4-HPR showed not only more potent antiproliferative activity than any other retinoid derivatives used, but also effectively inhibited the invasion, probably through the suppression of AP-1 activity. Taken together coupled with its selective activity only for RARgamma, these results suggest that 4-HPR could be less toxic, and very effective anticancer drugs for late stage ovarian cancer.

Endoscopic transsphenoidal approach through a widened nasal cavity for pituitary lesions

We operated upon 12 patients with macroadenoma and two with Rathke's cleft cyst using an endoscope through a nasal speculum. Pure endoscopic endonasal transsphenoiolal approach (TSA) was performed in nine patients and endoscope-assisted microscopic endo nasal TSA in five. A thin-bladed nasal speculum was used to achieve a wide, almost midline, pathway without an incision at the septal mucosa. This made it possible to convert from the endoscopic to the microscopic approach and vice versa at any time during operation as the occasion demanded. In 10 of the 12 patients with macroadenoma, adenomas were removed totally and did not recur during the mean follow-up period of 24 months. Two adenomas could not be removed totally due to their invasiveness. In two of five patients who underwent endoscope-assisted microscopic TSA for macroadenoma, the endoscope could visualise residual tumour at blind corners after microscopic tumor removal. Two patients with Rathke's cleft cyst did not show recurrence. No patient showed sinonasal or endocrinological complications. Versatile use of the endoscope through a widened nasal cavity using a nasal speculum is a promising tool for the treatment of pituitary lesions.

Intra and postischemic mild hypothermia : Effects on inducible nitric oxide synthase and peroxynitrite in experimental stroke

P86

Background: Mild hypothermia is protective even when delayed hours after stroke onset. Because metabolic depletion and glutamate release occur early after ischemia onset, other mechanisms may underlie the protection, particularly when cooling is delayed. Inflammation and free radicals mediate delayed ischemic injury. We examined whether mild hypothermia alters induction and activity of inducible nitric oxide synthase (iNOS, found primarily in inflammatory cells) and peroxynitrite generation. Methods: Rats were subjected to transient middle cerebral artery occlusion for 2 hours. Mild hypothermia began immediately (intraischemic, 33 O C-I, n=8) or 2 h (delayed, 33 O C-D, n=8) after ischemia onset during the reperfusion phase. Hypothermia was maintained for 2 h. Normothermic animals were maintained at 37 O C (n=8). Brains were examined 1 and 3 days later for infarction, NOS activity (NADPH diaphorase), iNOS induction and peroxynitrite (nitrotyrosine) production. Results: Mild hypothermia attenuated infarct size in both groups compared to normothermia (33 O C-I: 26.8±7.7%, 33 O C-D: 30.4±4.8%, 37 O C: 70.8±3.3%, P<0.001). iNOS-positive cells appeared 1 d after ischemia in the infarct area and increased in number by 3 d, but NOS activity was only seen at 3 d. Nitrotyrosine-positive cells also increased by 3 d. Positive cells in all cases appeared microglia/monocyte/macrophage-like with ameboid morphology. Mild hypothermia significantly decreased NADPH diaphorase, iNOS and peroxynitrite densities at 3 d, but not 1 d. NADPH diaphorase-positive cells per hemisphere were: 37 O C: 1028±68, 33 O C-I: 152±12, 33 O C-D: 101±1 (P<0.001). Densities of iNOS-positive cells were: 37 O C: 1265±83/mm 2 , 33 O C-I: 435±93/mm 2 , 33 O C-D: 688±59/mm2 (P<0.001). Densities of nitrotyrosine-positive cells were: 37 O C: 585±14/mm 2 , 33 O C-I: 214±23/mm 2 , 33 O C-D: 106±12mm 2 (P<0.001). No differences in any of the parameters were seen at 1 d. Conclusion: Mild hypothermic neuroprotection is related to attenuation of iNOS and peroxynitrite in inflammatory cells at 3 d but not earlier. This is evident even when cooling is delayed by 2 h.

Squamous cell lung cancer with solitary subungual metastasis

Subungual metastasis resulting from internal malignancies is an extremely rare event. A few cases of subungual metastasis from lung cancer have been reported. However, subungual metastasis arising from lung cancer without any other form of distant metastases has not been reported. The misdiagnosis of a solitary subungual metastases as a benign inflammatory lesion is an important problem as it may cause the misdiagnosis of a lower stage of lung cancer. We may be reporting the first case of a subungual metastasis from lung cancer without any other distant metastases.

Metastatic renal cell carcinoma in a meningioma: a case report

Tumor-to-tumor metastasis is rare. We report a case of metastatic renal cell carcinoma in meningioma. A 67-year-old woman presented a two-week history of motor dysphagia and decreased short-term memory. She had undergone a left radical nephrectomy for a renal cell carcinoma 7 years ago, and had not received any adjuvant therapy. MRI disclosed a 3.0 x 3.0 x 3.0-cm sized round tentorial-based extraaxial mass with peritumoral edema in the left posterior temporal lobe. During operation, the tumor was found to be an encapsulated mass firmly attached to the tentorium. Histologically, the tumor was a meningotheliomatous meningioma extensively infiltrated by metastatic renal cell carcinoma, accompanying widespread coagulative necrosis. Immunohistochemical staining for cytokeratin revealed strong positivity only in the renal cell carcinoma component. The patient's postoperative course was uneventful. Post-operative radiation therapy was applied to the whole brain. Three months after operation, the patient developed right hemiparesis and dysphagia. Brain MRI at that time did not reveal recurrence or any other causative lesions, although the whole body scan disclosed uptake at the second lumbar vertebra and rib. The patient refused further treatment.

Cellular electrophysiology of fast pathway ablation of rabbit atrioventricular node

Discrete radiofrequency lesion at the atrial insertion site of the tendon of Todaro in the perfused rabbit preparation lengthens A-H interval, mimicking fast pathway input ablation. This study attempts to define the cellular electrophysiology of the ablation region prior to and after the elimination of fast AV node conduction. In six superfused rabbit AV node preparations, the cellular electrophysiology around the region of the atrial insertion to the tendon of Todaro was recorded using standard microelectrode technique prior to and after ablation. Before ablation, the action potentials recorded in the area of proposed lesion were exclusively from atrial or AN cells. At postablation, the superior margin of the lesion was populated with atrial or AN cells. AN, N, or NH cells bordered the lower part of the lesion. Electrophysiology of surviving cells at the edges of the lesion showed no significant changes in their Vmax, APD50 or APD90 and MDP from preablation values. Fast AV node pathway input ablation in the rabbit heart can be accomplished with a singular lesion around the atrial insertion site of the tendon of Todaro, involving atrial or AN cells. The results of the studies imply that inputs to the compact node may act as a substrate for successful ablation of AV node reentry tachycardia.

Spinal clear cell meningioma presented with progressive paraparesis in infancy

Clear cell meningioma, about 20 cases of which have been reported in the literature, is a morphological variant of meningioma. The authors report a case of spinal clear cell meningioma that occurred in a child. A 14-month-old girl showed gradually progressive paraparesis 1 month after she started to walk. Magnetic resonance image showed an intradural extramedullary mass compressing the conus medullaris and cauda equina. Complete excision of the tumor was done, and the patient gradually recovered from motor weakness and neurogenic bladder. Histological examinations along with immunohistochemical and ultrastructural investigations allowed a diagnosis of clear cell meningioma. During the follow-up period, a recurrent mass lesion was detected on the 8-month follow-up MR image in the same region. Because clear cell meningioma might be biologically aggressive, postoperative adjuvant therapy and close follow-up investigation should be considered.

Loss of heterozygosity in gastric neuroendocrine tumor

The MEN1 gene locus is known to be partly responsible for the tumorigenesis of sporadic gastric neuroendocrine tumors, but the genetic events that drive the neoplastic process of this tumor remain largely unknown. In order to screen the tumor suppressor genes associated with the tumorigenesis of gastric neuroendocrine tumors, 15 neuroendocrine carcinomas and three carcinoid tumors in the stomach were analyzed for loss of heterozygosity (LOH) using 22 microsatellite markers. In our study, the gastric neuroendocrine tumors showed a high rate of LOH in chromosomes 8p (82%), 15q (58%), 17p (57%), llp (50%), 12p (50%) and 13q (50%). The mean fractional allelic loss (FAL) was higher in the neuroendocrine carcinoma components than in the adenocarcinoma components (0.42 versus 0.33, respectively). In four cases, the adenocarcinoma components showed discordant LOH patterns from those of the neuroendocrine counterparts in half of the informative chromosomes analyzed. Comparably, the gastric neuroendocrine carcinomas exhibited a higher LOH frequency on 8p and a lower LOH on 7q than did the gastric adenocarcinomas. It is suggested that chromosome 8p is the possible location of the tumor suppressor genes associated with the tumorigenesis of gastric neuroendocrine tumors.

Long-term results of laser in situ keratomileusis for high myopia

The objective of this study was to evaluate the results of laser in situ keratomileusis (LASIK) for high myopia after a follow-up of two years. A total of 42 eyes from 33 patients with high myopia (range: -9.00 D to -25.50 D) were studied. LASIK was performed using an automated microkeratome (Steinway, USA) and OmniMed II excimer laser with the standard MKM program (Summit Technology, Inc., Waltham, MA) in all patients. The patients were followed up at one, three, six, 12 and 24 months. During follow-up manifest refraction and best corrected and uncorrected visual acuity were measured. Any complications were also analyzed. The two-year follow-up results were as follows. The mean postoperative manifest spherical equivalents (MSE) were -0.51 D at one month, -1.09 D at three months, -1.78 D at six months, -2.17 D at 12 months and -2.61 D at 24 months. Myopic regression continued during the two-year follow-up (p < 0.05). The accuracy of the intended postoperative correction within +/- 2.00 D was 73.8% at one month, 69.1% at three months, 52.4% at six months, 52.4% at 12 months, and 45.2% at 24 months. The best corrected visual acuity (BCVA) was unchanged or increased in 35 eyes (83.3%). Only three eyes (7.2%) lost two or more lines of BCVA. This was due to irregular astigmatism in one eye, macular degeneration in one eye, and rhegmatogenous retinal detachment in one eye. In this study, LASIK was effective and safe in the correction of high myopia, however continuous myopic regression was seen over the two-year follow-up. Refining the nomogram to adjust for progressive myopic regression will be necessary in order to obtain better results.

Pulmonary fibrosis in a steel mill worker

We report a case of pulmonary fibrosis in a 32-year-old man, who had worked at a steel mill and who died of respiratory failure due to interstitial fibrosis despite vigorous treatment. He showed SLE-associated symptoms, such as pleural effusion, malar rashes, discoid rashes, arthritis, leukopenia, and positive antinuclear antibody and anti-histone antibody. However, he did not present anti-DNA antibody. A thoracoscopic lung biopsy showed interstitial fibrosis, chronic inflammation and a small non-caseating granuloma in lung tissues, which could be induced by external agents such as metals. The manganese concentration in the lung tissue was 4.64 microg/g compared to 0.42-0.7 microg/g in the controls. The levels of other metals, such as iron, nickel, cobalt and zinc in patient's lung tissue were higher than those in the controls. The patient was probably exposed to Si and various metal dusts, and the lung fibrosis was related to these exposures. Exposure to Si and metal dusts should be sought in the history of any patient with SLE, especially in a male with pulmonary signs, and if present, exposure should be stopped. In the meantime, steps should be taken to ensure that workers exposure to Si and metal dusts in all environments have adequate protection.

Unusual association of pulmonary artery sling with right aortic arch and aberrant left subclavian artery

We present an unusual case of vascular sling, tracheal stenosis by complete cartilaginous ring, and aberrant left subclavian artery with right aortic arch that underwent successful surgical repair for the sling. These abnormalities were suspected from unusual multiple indentations found on esophagogram. Complete preoperative diagnosis was established with chest computerized tomogram combined with angiography.

Prevention of encephalomyocarditis virus-induced diabetes in mice by inhibition of the tyrosine kinase signalling pathway and subsequent suppression of nitric oxide production in macrophages

Macrophages comprise the major population of cells infiltrating pancreatic islets during the early stages of infection in DBA/2 mice by the D variant of encephalomyocarditis virus (EMC-D virus). Inactivation of macrophages prior to viral infection almost completely prevents EMC-D virus-induced diabetes. This investigation was initiated to determine whether a tyrosine kinase signalling pathway might be involved in the activation of macrophages by EMC-D virus infection and whether tyrosine kinase inhibitors might, therefore, abrogate EMC-D virus-induced diabetes in vivo. When isolated macrophages were infected with EMC-D virus, inducible nitric oxide synthase mRNA was expressed and nitric oxide was subsequently produced. Treatment of macrophages with the tyrosine kinase inhibitor tyrphostin AG126, but not tyrphostin AG556, prior to EMC-D virus infection blocked the production of nitric oxide. The infection of macrophages with EMC-D virus also resulted in the activation of the mitogen-activated protein kinases (MAPKs) p42(MAPK/ERK2)/p44(MAPK/ERK1), p38(MAPK), and p46/p54(JNK). In accord with the greater potency of AG126 than of AG556 in blocking EMC-D virus-mediated macrophage activation, the incidence of diabetes in EMC-D virus-infected mice treated with AG126 (25%) was much lower than that in AG556-treated (75%) or vehicle-treated (88%) control mice. We conclude that EMC-D virus-induced activation of macrophages resulting in macrophage-mediated beta-cell destruction can be prevented by the inhibition of a tyrosine kinase signalling pathway involved in macrophage activation.

A radioimmunoassay method for detection of DNA based on chemical immobilization of anti-DNA antibody

High selectivity provided by biomolecules such as antibodies and enzymes has been exploited during the last two decades for development of biosensors. Of particular importance are efficient immobilization methods for biomolecules in order to preserve their biological activities. In this study, we have evaluated immobilization strategies for an anti-DNA antibody on a self-assembled monolayer of omega-functionalized thiols. The antibody was immobilized via peptide bond formation between the primary amines in the antibody and the carboxyl groups on the self-assembled monolayer. The peptide bond coupling was achieved by activating COOH groups on the surface through N-Hydroxysuccimide (NHS)-ester formation, followed by acylation of NH2 group in the antibody. DNA binding activity of the immobilized antibody was examined by counting beta emission from 35S-labeled DNA.

Streptococcal keratitis after myopic laser in situ keratomileusis

A 24-year-old healthy male underwent uncomplicated laser in situ keratomileusis (LASIK) in left eye. One day after the surgery, he complained of ocular pain and multiple corneal stromal infiltrates had developed in left eye. Immediately, the corneal interface and stromal bed were cleared, and maximal antibiotic treatments with fortified tobramycin (1.2%) and cefazolin (5%) were given topically. The causative organism was identified as 'Streptococcus viridans' both on smear and culture. Two days after antibiotic therapy was initiated, the ocular inflammation and corneal infiltrates had regressed and ocular pain was relieved. One month later, the patient's best corrected visual acuity had returned to 20/20 with -0.75 -1.00 x 10 degrees, however minimal stromal scarring still remained. This case demonstrates that microbial keratitis after LASIK, if treated promptly, does not lead to a permanent reduction in visual acuity.

The clear cell variant of epithelioid intravenous leiomyomatosis of the uterus: report of a case

A case of very rare uterine clear cell epithelioid leiomyomatosis is reported. The patient presented with a recurrent pelvic mass after hysterectomy 2 years earlier. The recurrent tumor was located mainly in the vessels of the broad ligament as worm-like plugs. The reviewed hysterectomy specimen showed a typical multi-lobulated intramural mass together with worm-like plugs within the myometrial vessels. Computer tomography exhibited metastatic nodules in both lungs. According to an histological examination, all the tumor cells were of epithelioid type and contained abundant clear cytoplasm. Characteristic large, thick-walled blood vessels were observed. Immunohistochemical staining and ultrastructural examination supported smooth-muscle origin in this case. Electron microscopic study revealed that the clear cytoplasm was attributed to the presence of numerous dilated mitochondria that had lost their cristae. The patient is still alive with the disease 28 months after surgery.

Interaction of glucagon with dimyristoylphosphatidylcholine in vesicular and discoidal complexes

Glucagon fragments dimyristoylphosphatidylcholine liposomes into discoidal complex under appropriate conditions. The concentration of glucagon required to fragment the vesicles increases with increasing pH, which appears to be related to the glucagon binding. It was also observed that the fragmentation is facilitated by NaCl, which is also due to increased glucagon binding. From the quenching of Trp fluorescence by doxyl group located at various positions of the acyl chain of the lipid, Trp of glucagon was found to be located close to the bilayer surface in the vesicular complex. However, the Trp fluorescence was quenched by the doxyl group in the discoidal complex to an equal extent regardless of the position of this spin label in the acyl chain. This and the results of second derivative UV spectroscopy of Tyr suggested that segments including Tyr-13 and Trp-25 are involved in the discoidal complex formation and that the orientation of glucagon is not normal to the bilayer surface.

Different effects of flecainide on atrioventricular conduction properties in the adult and immature rabbit heart

The influence of flecainide (0.1, 0.5, 1.0, and 2.0 micrograms/mL) on atrioventricular (AV) conduction was studied in neonatal and adult perfused rabbit hearts using extracellular bipolar surface electrograms and premature atrial and ventricular pacing. Flecainide produced a concentration and rate-related increase in the steady-state nodal conduction (AHmin) and an increase in slow AH conduction (AHmax) in both age groups. The drug produced significant increases in the refractory periods of the atrium, AV node, His-Purkinje system, and ventricular myocardium. The neonatal refractory periods were significantly greater at lower or the same drug concentrations than those of the adult. The neonatal Wenckebach cycle length was significantly greater with a lower concentration of drug (0.5 microgram/mL) than was the adult Wenckebach cycle length. The His-Purkinje system steady-state conduction time (HVmin) was increased by a lower concentration of drug in the neonate (0.5 microgram/mL) as compared with 2.0 micrograms/mL in the adult. These data show that across a wide range of AV conduction parameters, the neonatal preparations responded to a lower concentration of flecainide than did the adult preparations. These findings may, in part, be the basis for the reported greater efficacy of the drug in children than in adults.

Establishment and characterization of cell lines derived from uterine malignant mixed Müllerian tumor

OBJECTIVE

We report the establishment and characterization of three new cell lines derived from uterine malignant mixed müllerian tumor (MMMT).

METHODS

Three uterine MMMT cell lines from primary tumors of Korean patients were cultured and the involved cell morphology, growth properties, DNA profiles, immunohistochemical properties, tumor-associated antigen secretion, and genetic alterations of related oncogenes and tumor suppressor genes were studied as well.

RESULTS

Three MMMT cell lines were successfully established including one homologous tumor SNU-539 and two heterologous tumors SNU-685 and SNU-1077. All lines showed substrate adherence and high viability and were proven by DNA fingerprinting analysis to be unique. Contamination by mycoplasma and bacteria was excluded. SNU-539 and SNU-1077 cells stained positively for both epithelial and mesenchymal antigens, while SNU-685 cells only stained positively for mesenchymal antigens. The level of secretion of tumor-associated antigens, CA125 and CEA, was shown to be undetectable in all three lines. One missense mutation from AAC to GAC at codon 239 of exon 7 in the p53 gene was identified in SNU-539.

CONCLUSIONS

These newly established and characterized permanent uterine MMMT cell lines might be regarded as valuable resources for a multitude of in vitro investigations, which should be used for clarifying the obscure histogenetic origin and understanding the biological behavior of this aggressive tumor.

Establishment and characterization of human ovarian carcinoma cell lines

Five human ovarian carcinoma cell lines cultured from primary and metastatic tumors of Korean patients were characterized. These lines were isolated from two papillary serous cystadenocarcinomas, two endometrioid carcinomas, and one malignant Brenner tumor. It was shown that the growth of these cell lines was stable when cultured after at least 20 passages. Population doubling times varied from 40 to 67 hr. All lines showed high viability and were proven by DNA fingerprinting analysis to be unique. Contamination by mycoplasma or bacteria was excluded. In two lines, SNU-8 and SNU-840, an elevated level of CA125 antigen secretion could be detected, whereas CEA was undetectable in all five lines. Four different mutations in functional and highly conserved regions of the p53 gene were identified in three of our five lines (60%), namely in SNU-119, SNU-251, and SNU-563. Included were two missense mutations, one in-frame 3-base-pair deletion, and one out-of-frame 1-base-pair deletion. It is interesting to note that one of these three lines, SNU-251, presented an additional simultaneous nonsense mutation of the BRCA1 gene and missense mutation of the hMLH1 gene. In its lacking both wild-type alleles of the BRCA1 gene, SNU-251 might serve as an unusual and important in vitro model for studies related to ovarian carcinoma and the BRCA1 gene. It is thus likely that the establishment and characterization of these permanent human ovarian carcinoma cell lines in continuous cultures can provide useful tools for in vitro studies related to human ovarian carcinomas.

Molecular role of TGF-beta, secreted from a new type of CD4+ suppressor T cell, NY4.2, in the prevention of autoimmune IDDM in NOD mice

A new type of CD4+ T cell clone (NY4.2) isolated from pancreatic islet-infiltrated lymphocytes of acutely diabetic non-obese diabetic (NOD) mice prevents the development of insulin-dependent diabetes mellitus (IDDM) in NOD mice, as well as the recurrence of autoimmune diabetes in syngeneic islet-transplanted NOD mice. It has been demonstrated that the cytokine TGF-beta, secreted from the cells of this clone, is the substance which prevents autoimmune IDDM. This investigation was initiated to determine the molecular role TGF-beta plays in the prevention of autoimmune IDDM by determining its effect on IL-2-induced signal transduction in Con A-activated NOD mouse splenocytes and HT-2 cells. First, we determined whether TGF-beta, secreted from NY4.2 T cells, inhibits IL-2-dependent T cell proliferation in HT-2 cells (IL-2-dependent T cell line) and NOD splenocytes. We found that TGF-beta suppresses IL-2-dependent T cell proliferation. Second, we determined whether TGF-beta inhibits the activation of Janus kinases (JAKs), as well as signal transducers and activators of transcription (STAT) proteins, involved in an IL-2-induced signalling pathway that normally leads to the proliferation of T cells. We found that TGF-beta inhibited tyrosine phosphorylation of JAK1, JAK3, STAT3 and STAT5 in Con A blasts from NOD splenocytes and HT-2 cells. Third, we examined whether TGF-beta inhibits the cooperation between STAT proteins and mitogen-activated protein kinase (MAPK), especially extracellular signal-regulated kinase 2 (ERK2). We found that TGF-beta inhibited the association of STAT3 and STAT5 with ERK2 in Con A blasts from NOD splenocytes and HT-2 cells. On the basis of these observations, we conclude that TGF-beta may interfere with signal transduction via inhibition of the IL-2-induced JAK/STAT pathway and inhibition of the association of STAT proteins with ERK2 in T cells from NOD splenocytes, resulting in the inhibition of IL-2-dependent T cell proliferation. TGF-beta-mediated suppression of T cell activation may be responsible for the prevention of effector T cell-mediated autoimmune IDDM in NOD mice by TGF-beta-producing CD4+ suppressor T cells.

Neonatal adenoviral pneumonia--report of three autopsy cases

Adenovirus pneumonia, while common in infancy and childhood, is rarely documented but may be fatal in the neonatal period. In regard to the serious outcome and no responsiveness to common anti-viral agents, adenovirus infection should be considered in the differential diagnosis of pneumonia in neonates. We report three cases of fatal neonatal adenovirus pneumonia, all of which were diagnosed by postmortem examination. Two patients were born by cesarean section at 35 or 36 weeks of gestation, and the other was a 5100 gm postmature baby born by vaginal delivery at 43 weeks of gestation. Respiratory insufficiency was detected just after birth or in the immediate postnatal period, and was associated with lethargy and chest X-ray findings of pneumonic infiltration. The postmortem findings of these patients were remarkably consistent and characterized by predominant lung involvement. The lungs showed diffuse massive consolidation with scattered patchy hemorrhage, and histologically revealed multifocal necrotizing alveolitis and/or bronchiolitis, often with hemorrhage. Alveolar lining cells and desquamated cells contained numerous smudge ells and many cells with characteristic inclusion bodies. Electron microscopy revealed that these inclusion bodies consisted of arrays of icosahedral particles of adenovirus. It is unusual that one of the patients, who was born by cesarean section without any evidence of prenatal infection, developed adenoviral pneumonia; this indicates that infection may occur in the immediate postnatal period as well as during passage of the birth canal.

A new type of CD4+ suppressor T cell completely prevents spontaneous autoimmune diabetes and recurrent diabetes in syngeneic islet-transplanted NOD mice

Insulin-dependent diabetes mellitus (IDDM) in the non-obese diabetic (NOD) mouse results from effector T cell-mediated autoimmune processes directed against pancreatic beta cells. These effector T cell-mediated beta cell-specific autoimmune processes can be blocked by transfusion with supressor T cells. The CD4+ autoreactive T cell clone, NY4.2, isolated from lymphocytes infiltrating the pancreatic islets of NOD mice was transfused into young NOD mice and none of the animals became diabetic. Similarly, when NY4.2 cells were transfused into acutely diabetic NOD mice prior to syngeneic islet transplantation, the grafted islets were not destroyed and the animals maintained normoglycaemia. This investigation was initiated to determine how our cloned CD4+ autoreactive suppressor T cells are able to inhibit effector T cell-mediated beta cell destruction in NOD mice. We found that NY4.2 cells, which responded to self MHC class II determinants, had a significant immunosuppressive effect on proliferative responses of splenic effector T cells from NOD mice. This suppressive activity of the NY4.2 cells was a result of soluble factors secreted by them. The clone was found to produce substantial amounts of transforming growth factor beta (TGF-beta), IL-10, and IFN-gamma, but not IL-2 or IL-4, indicating that this T cell clone is not a member of either the classic Th1 or Th2 cell type. The suppressive activity of NY4.2 cells was abrogated by treatment with anti-TGF-beta antibodies, but not by treatment with anti-IL-10 or anti-IFN-gamma antibodies. On the basis of these observations, we suggest that a new type of CD4+ suppressor T cell, NY4.2, by secreting TGF-beta, can prevent effector T cell-mediated beta cell destruction.

Effects of rebamipide on gastric cell damage by Helicobacter pylori-stimulated human neutrophils

Helicobacter pylori stimulated human neutrophils to produce oxygen radicals as evidenced by the production of chemiluminescence in the presence of luminol. The capacity of H. pylori to produce oxygen radicals from neutrophils was much higher than that of Escherichia coli and Staphylococcus aureus and is almost as strong as that of PMA. Rebamipide (2-(4-chlorobenzoylamino)-3-[2-(1H)-quinolinon-4-yl] propionic acid) suppressed the chemiluminescence produced by H. pylori-stimulated neutrophils and also suppressed the chemiluminescence produced by a cell-free xanthine/xanthine oxidase reaction with luminol. Thus, it is indicated that this drug has the action of scavenging oxygen radicals. Gastric mucosal cells labelled with a fluorescent dye were damaged by the incubation of the cells with neutrophils and H. pylori, and this damage was protected by rebamipide. The protection of cell damage was ascertained as a decrease in the release of fluorescent dye into the incubation medium and a reduction in the distortion of cell geometry. The data suggest that H. pylori induce human neutrophils to produce oxygen radicals which are responsible for gastric mucosal cell damage and that rebamipide removes the oxygen radicals produced from H. pylori-activated neutrophils and thus reduces the gastric mucosal cell damage. These effects may account for the ulcerogenesis action of H. pylori and for part of the mechanism of the anti-ulcer action of rebamipide.

[A study on menopausal symptoms and health needs among middle aged women]

During the middle age of a woman's life cycle, several health changes and problems occur. Therefore, middle aged women must manage their health and maintain quality life by coping with bodily changes. However, today there is not enough research and health programs for middle aged women. Data from the study will be used for health promotion program development of middle aged women. Data was collected from January 21 to 24, 1995 by telephone interview. Four hundred middle aged women between 40 and 59 years old and living in Chon Ju City were interviewed. The results of this study were as follow: 1. Frequency rate of menopausal symptoms was 38.4%. The most serious menopausal symptom was psychosomatic symptom. Mean score orders of experienced symptoms were back pain, joint pain (1.80), nervousness (1.80), general weakness (1.67). 2. The most important problems as perceived by the clients were children (45.8%), health (24.0%) and economics (7.8%). The most serious health problems were concerning the muscle-skeletal system (45%) such as arthritis, spinal disk problems and osteoporosis. Adult diseases (14.5%) such as hypertension and diabetes were also health concerns. Health management activities reported were exercise (22.5%), social activity (12%) and inactivity (53%). 33% of clients were interested in health groups and they wanted a program of health education, exercise and social activity to be provided. 3. General characteristic variables were significantly related to the level of menopausal symptoms as follows: age (t = -2.06, p = 0.040), status of marriage (t = -3.56, p = 0.000), educational level (F = 4.35, p = 0.05) and menopausal status (t = 4.37, p = 0.000).

Echocardiographic evaluation of hearts with twisted atrioventricular connections (criss-cross heart)

An echocardiographic study was performed on seven patients with twisted atrioventricular connections (criss-cross heart) relative to the usual atrial arrangement. The atrioventricular connections were concordant in five patients and discordant in two. The ventriculoarterial junction was either double-outlet right ventricle (n = 6) or discordant connections (n = 1). Associated cardiac defects were ventricular septal defect (n = 7), pulmonary stenosis (n = 5), straddling tricuspid valve (n = 2), and straddling mitral valve (n = 1). Malalignment between the atrial and ventricular septum was the most important feature of this disease and resulted in altered spatial orientation of the trabecular ventricular septum, and recesses in the ventricles and the right atrium. When assessed by echocardiography, these anatomical features were not invariably recognized in every case, but they were dependent upon the type of atrioventricular connections and the presence of straddling of the atrioventricular valves. Left ventricular recess was the most consistent feature and was present in every patient, regardless of the atrioventricular connections. Right atrial recess was found in four of five patients with concordant atrioventricular connections but was not present in patients with discordant atrioventricular connections. Right ventricular recess was recognized as such in a single patient with concordant atrioventricular connection and straddling mitral valve. The trabecular septum was oriented in a horizontal plane in hearts with concordant atrioventricular connections and without atrioventricular valve straddling. The trabecular septum was oriented semivertically in all other hearts.(ABSTRACT TRUNCATED AT 250 WORDS)

Spontaneous fragmentation of dimyristoylphosphatidylcholine vesicles into a discoidal form at low pH

Upon prolonged incubation at low pH, the turbidity of a dimyristoylphosphatidylcholine (DMPC) small unilamellar vesicle (SUV) suspension underwent an initial increase followed by a decrease to below the starting value. Electron microscopic observation of the vesicle suspension, after the turbidity minimum was reached, revealed the formation of discoidal particles which were smaller than the original vesicles. NMR studies indicated that all the choline groups in the discoids are accessible to added chemical shift agent, corroborating the fragmentation of the vesicles. Formation of the discoids from DMPC multilamellar vesicle (MLV) was also observed but without going through the initial increase in turbidity. The DMPC was subsequently found to be hydrolyzed into lysophosphatidylcholine (lysoPC) and myristic acid under the same conditions that caused the fragmentation. That the discoidal fragment consisted of DMPC and its hydrolysis products, lysoPC and myristic acid, was verified by electron microscopic observation of discoids when these components were mixed at neutral pH. A 50% cholesterol content prevented the fragmentation of DMPC vesicles. A model for this discoidal complex, in which a patch of DMPC bilayer is surrounded at its periphery by lysoPC and myristic acid, is proposed.

pH-sensitive liposomes containing polymerized phosphatidylethanolamine and fatty acid

With the ultimate aim of targeting cancer drugs to malignant tissues, liposomes containing polymeric phosphatidylethanolamine and a fatty acid were prepared. For this purpose diacetylenic phosphatidylethanolamine (DAPE), a phosphatidylethanolamine containing diacetylene, was synthesized. Liposomes containing DAPE, fatty acid, and either phosphatidylethanolamine (PE) or phosphatidylethanolamine-beta-oleoyl-gamma-palmitoyl (POPE) were then prepared. Polymerization of DAPE was effected by UV illumination. The polymeric liposomes so obtained were stable at physiological pH but became leaky below pH 6.5. Of various compositions studied, the greatest pH-sensitivity was found with liposomes composed of 35 mol% DAPE, 35 mol% POPE, and 30 mol% saturated fatty acid. The presence of blood plasma albumin decreased vesicle stability while apolipoprotein A-I (apo A-I) had the opposite effect and plasma as a whole had a slightly stabilizing effect.

A study on nesidioblastosis in hyperinsulinemic hypoglycemia--diagnosis, treatment, and neurologic sequelae

The medical records of six cases of nesidioblastosis were examined to determine the diagnostic approach, treatment, and neurologic sequelae. All six patients were male, and their ages at the onset of the disease ranged from one day to six months (mean 3.36 +/- 2.5 mo.). Initial clinical features were seizure, cyanosis, poor feeding, and apnea. Other subsequent symptoms were developmental delay, hyperactivity, and cold sweating. The Birth weight of the neonatal onset group was heavier than the postneonatal onset group (4.4 +/- 0.3 vs 3.26 +/- 0.04 kg). Before the diagnosis of hyperinsulinism, steroids of ACTH proved effective for seizure control. Initially, hyperinsulinemia (serum insulin greater than 10 microU/ml) was detected in four cases, but another two cases also showed hyperinsulinism by insulin/glucose(I/G) ratio greater than 0.3 during the fasting test. The glucagon response performed in 2 cases, showed normal and partial responses. Euglycemia was obtained by near total pancreatectomy (95% pancreatic resection)without malabsorption or persistent diabetes. In one case, nesidioblastoma coexisted with nesidioblastosis. Developmental delay was noted in three cases. In this group, the mean duration between symptom onset and operation was longer than the group without developmental delay (1.25 +/- 0.47 vs 0.38 +/- 0.19 yr).