Bilateral emphysematous pyelonephritis with perirenal abscess cured by conservative therapy

Emphysematous pyelonephritis is a rare life-threatening infection of the renal parenchyma. It usually affects unilateral kidney and occurs mostly in diabetic patients. It is characterized by the presence of gas within the renal parenchyma and requires prompt diagnosis and early aggressive therapy. Bilateral emphysematous pyelonephritis is even more rare and is associated with high mortality. We describe a case of a 62-year-old diabetic woman who presented with nonketotic hyperosmolar coma and bilateral emphysematous pyelonephritis caused by Klebsiella pneumoniae. Diagnosis of bilateral emphysematous pyelonephritis was confirmed by an abdominal computed tomographic scan and microbiologic studies. Our patient was successfully treated using percutaneous catheter drainage and long-term antibiotic therapy.

Fusion of coregistered cross-modality images using a temporally alternating display method

As an aid to the interpretation of functional images, cross-modality coregistration of functional and anatomical images has grown rapidly. Various ways of easily interpreting and visualising coregistered images have previously been investigated; for their display, an intensity-weighted temporally alternating method is used. For brain images, geometric registration involves the automatic alignment method, using the head scalp boundary extracted from the sinogram of a PET emission scan and a surface-matching algorithm; images of the chest or abdomen are registered semi-automatically using a paired point matching algorithm. For the simultaneous display of geometrically registered images, rapid image switching is applied; both images are written with independent colour scales. The rapidly alternating display of two images, synchronised with monitor scanning, induces the fusion of images in the human visual perception system. The accuracy of registration of PET and MRI images is within 2 mm for two point sets. A resulting image is intensified by weighting the display time and/or controlling the intensity map of each image with the degree of interest. This method may be useful for the interpretation and visualisation of coregistered images.

The management of superior sulcus tumors

Lung cancers arising from the extreme apex of the lung-superior sulcus tumors (SST)-have distinct symptoms and signs at presentation and a characteristic appearance on imaging. However, in their early stages, these tumors are often missed by traditional anterior/posterior chest X-rays. Recent advances in computed tomography (CT) and magnetic resonance imaging (MRI) have made selection of patients with potentially resectable of SST more accurate. If mediastinoscopy reveals no mediastinal lymph nodes involved, the patient can be treated with surgery followed by radiation therapy with or without chemotherapy. If mediastinoscopy reveals microscopic mediastinal lymph node involvement, the patient can be treated with induction radiation therapy and concurrent chemotherapy followed by surgery. If mediastinoscopy reveals gross mediastinal lymph node involvement (N2), or if CT reveals N3 or T4 lesions, the patient can be treated with concurrent chemotherapy and radiation therapy to relieve symptoms; the outcome of such treatment appears to be better than that of sequential chemotherapy followed by radiation therapy. Whenever possible, to enhance the patient's quality of life, surgery should be considered to improve function and relieve pain.

Transtubular potassium concentration gradient (TTKG) and urine ammonium in differential diagnosis of hypokalemia

BACKGROUND

Hypokalemia is a common and sometimes serious clinical problem, whose etiological diagnosis can frequently be based on the patient's history and the clinical setting. Measurement of urinary indices such as excretory rate of K+, random urine K+ concentrations and blood acid-base parameters have been employed in the pathophysiological diagnosis, though with some pitfalls.

METHODS

To investigate the diagnostic usefulness of the transtubular potassium concentration gradient (TTKG) and urine ammonium in the differentiation of hypokalemia, we measured serum K+ and osmolality, random urine electrolytes, osmolality and ammonium, the urinary [Na]/[K] ratio (U(Na)/K), plasma aldosterone and TTKG in 7 patients with diarrhea, 6 with vomiting, 7 with mineralocorticoid excess, 6 with diuretic usage, and compared them with those of 7 overnight fasted and acid-loaded healthy volunteers.

RESULTS

The urine K+ concentrations did not reflect urinary loss of potassium according to the subjects' hydration status. U(Na)/k in the hypokalemic patients with mineralocorticoid excess (1.4 +/- 0.5) was lower than in normal subjects (2.3 +/- 0.4) (p<0.05). TTKG was higher in hypokalemic patients with mineralocorticoid excess (13.3 +/- 4.4) and diuretic usage (8.6 +/- 1.3) and lower in those with diarrhea (1.6 +/- 0.3) than in the normal controls (5.0 +/- 0.7) (p<0.5). TTKG in the patients with vomiting (3.5 +/- 0.6) was the same as in normal controls. TTKG was stronger correlated with the plasma aldosterone levels in the hypokalemic patients due to renal potassium loss. Urine ammonium concentrations of the acid-loaded normal subjects (73.3 +/- 5.0 mEq/L), patients with diarrhea (74.4 +/- 2.0 mEq/L) and patients with mineralocorticoid excess (68.7 +/- 6.9 mEq/L) were higher than in overnight-fasted normal subjects (31.3 +/- 4.9 mEq/L).

CONCLUSION

TTKG and random urine ammonium were useful in the pathophysiological differential diagnosis of hypokalemia.

Detection of Hantaan and Seoul viruses by reverse transcriptase-polymerase chain reaction (RT-PCR) and restriction fragment length polymorphism (RFLP) in renal syndrome patients with hemorrhagic fever

BACKGROUND

Hemorrhagic fever with renal syndrome (HFRS), also called Korean hemorrhagic fever (KHF), is the most common cause of acute renal failure in the Far East. Two serotypes of hantavirus, Hantaan and Seoul viruses are known pathogens for HFRS in Korea.

PURPOSE

To elucidate the diagnostic applicability for the serotype diagnosis in HFRS patients, we used nested reverse transcriptase-PCR and restriction fragment length polymorphism (nRT-PCR/RFLP) to screen 2 prototype viruses, 11 virus isolates from HFRS patients, and 69 specimens obtained from 31 HFRS patients.

METHODS

The nRT-PCR was performed using primers specific for the G1 segments of the Hantaan (HF3 1140-1163, HB14 1363-1342) and Seoul (SF2 809-832, SB3 1200-1177) viruses. The initial PCR products were then further amplified using nested primers for the Hantaan (HF4 1141-1164, HB13 1360-1339) and Seoul (SF7 863-884, SB1 1165-1142 ) viruses. Amplified segments were then digested with restriction enzymes specific for either Hantaan (C1a I) or Seoul (Sac I) virus sequences.

RESULTS

In all cultured viruses, the serotypes identified by nRT-PCR/RFLP were consistent with those of PRNT. nRT-PCR/RFLP results indicated the presence of Hantaan virus in 10 patients and of Seoul virus in 15 patients. In 3 patients, both Hantaan- and Seoul-specific amplified bands were visualized in serially collected samples, and in 4 patients no amplicon was detected. Among 69 specimens, 55 were positive; these positive specimens were obtained between days 3 and days 33 of illness. The positive rate was not affected by the clinical phase, day of illness, or severity of HFRS.

CONCLUSIONS

nRT-PCR/RFLP is a rapid and convenient method for serotype diagnosis in most HFRS patients. It could also allow detection of genetic variation of hantavirus within the same serotype.

The possible cost effectiveness of peripheral blood stem cell mobilization with cyclophosphamide and the late addition of G-CSF

The purpose of this study was to develop a cost-effective protocol for the mobilization of peripheral blood stem cells (PBSC) in patients with malignancy. Thirty consecutive patients were randomized to mobilize PBSC with the late addition of a standard 250 microg dose of G-CSF (Neutrogen) from day 8 or early addition of the same dose of G-CSF from day 2, following cyclophosphamide (CY) 4 g/m2. The median yield of CD34+ cells from evaluated patients was 7.87 x 10(6)/kg (range, 2.06-27.25), collected in a median of four apheresis (range, 2-9). Target CD34 + cell doses > or = 2.0 x 10(6)/kg were achieved in all patients able to be evaluated. There were no statistically significant differences in CD34+ cell yields or toxicities. Overall engraftment occurred with median days to neutrophils > or = 0.5 x 10(9)/L or platelets > 20 x 10(9)/L of 11 and 17 days, respectively. However, the duration of G-CSF administration was markedly shorter in the late use of G-CSF group than in the early use of G-CSF group, with a median of 9 days compared with 15 days (p<0.001). PBSC harvesting after priming with CY plus delayed use of G-CSF made it a safe and cost-effective procedure.

Adenovirus-mediated p53 gene transfer in sequence with cisplatin to tumors of patients with non-small-cell lung cancer

PURPOSE

To determine the safety and tolerability of adenovirus-mediated p53 (Adp53) gene transfer in sequence with cisplatin when given by intratumor injection in patients with non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Patients with advanced NSCLC and abnormal p53 function were enrolled onto cohorts receiving escalating dose levels of Adp53 (1 x 10(6) to 1 x 10(11) plaque-forming units [PFU]). Patients were administered intravenous cisplatin 80 mg/m(2) on day 1 and study vector on day 4 for a total of up to six courses (28 days per course). Apoptosis was determined by the terminal deoxynucleotidyl- transferase-dUTP nick-end labeling assay. Evidence of vector-specific sequences were determined using reverse-transcriptase polymerase chain reaction. Vector dissemination and biodistribution was monitored using a series of assays (cytopathic effects assay, Ad5 hexon enzyme-linked immunosorbent assay, vector-specific polymerase chain reaction assay, and antibody response assay).

RESULTS

Twenty-four patients (median age, 64 years) received a total of 83 intratumor injections with Adp53. The maximum dose administered was 1 x 10(11) PFU per dose. Transient fever related to Adp53 injection developed in eight of 24 patients. Seventeen patients achieved a best clinical response of stable disease, two patients achieved a partial response, four patients had progressive disease, and one patient was not assessable. A mean apoptotic index between baseline and follow-up measurements increased from 0.010 to 0.044 (P =.011). Intratumor transgene mRNA was identified in 43% of assessable patients.

CONCLUSION

Intratumoral injection with Adp53 in combination with cisplatin is well tolerated, and there is evidence of clinical activity.

Introduction of human immunodeficiency virus 2 infection into South Korea

Although human immunodeficiency viruses 1 and 2 (HIV-1 and HIV-2) share mode of transmission, their epidemiologic characteristics differ and international spread of HIV-2 has been limited. To investigate the extent of HIV-2 infection in South Korea and to clarify the characteristic of HIV-2 isolates, we describe epidemiological, serological and genetic analyses of five HIV-2 isolates from South Korea. Five of 964 HIV antibody-positive serum specimens showed positive reactivity by HIV1/2 enzyme immunoassay (EIA), HIV-2 Western blot analysis, HIV-2 particle agglutination (PA) test and line immunoassay (LIA) but negative or indeterminate one by HIV-1 PA test and HIV-1 Western blot analysis. To confirm HIV-2 infection by genetic analysis, reverse transcription-polymerase chain reaction (RT-PCR) was performed on five HIV-2 seropositive samples. PCR products from gag (197 bp) and env gene regions (137 bp) were obtained with three of the five samples with HIV-2 specific gag primers and with all the five samples with env primers. To obtain larger sequences for a more comprehensive phylogenetic analysis, we performed PCR for a 1191 bp env region of HIV-2 but only two such products were obtained. For the phylogenetic analysis, three 197 bp gag and two 1191 bp env PCR products were cloned and sequenced. Based on the gag and env sequences alignments, three isolates (KR4063, KR7051 and KR8091) were clustered phylogenetically within HIV-2 subtype A. In conclusion, HIV-2 virus is present in South Korea and was detected in five subjects. Furthermore, the prevalence of HIV-2 infection should be monitored continuously in South Korea to assess the spread of this virus and to assist in the diagnosis of HIV infection.

Value of morphometric nuclear image analysis using the Feulgen reaction in renal cell carcinoma

OBJECTIVE

To evaluate retrospectively the ability of morphometric nuclear image analysis to predict survival in patients with renal cell carcinoma.

STUDY DESIGN

The subjects were 40 patients with previously untreated renal cell carcinoma. Pathologic stage was determined using Robson's stage system. Nuclear grade was assigned according to the criteria of Fuhrman et al. We used the Feulgen staining technique, which has been widely used for the histochemical assessment of nuclear DNA content. A minimum of 300 nuclei were analyzed from each subject. Five variables in morphometric nuclear image analysis were measured: nuclear area, nuclear perimeter, nuclear ellipticity, nuclear regularity and DNA content. Cox's proportional hazard model was applied to identify prognostic usefulness with respect to survival time.

RESULTS

All nuclear morphometric variables but nuclear regularity correlated with tumor grade. According to univariate survival analyses, Robson stage and nuclear ellipticity revealed a prognosis on survival with statistical significance. After adjustments for age and sex, nuclear ellipticity remained the only significant prognostic factor related to survival (P < .01). The survival rates were relatively high for patients with nuclear ellipticity > 773 as compared to those with nuclear ellipticity < 773 (P < .05).

CONCLUSION

These findings indicate that morphometric nuclear image analysis using the Feulgen reaction is a reliable and efficient technique and that nuclear ellipticity is the most discriminating morphometric variable for predicting the prognosis of renal cell carcinoma patients.

Early expression of IFN-alpha/beta and iNOS in the brains of Venezuelan equine encephalitis virus-infected mice

To investigate the roles of type I interferon (IFN-alpha/beta) and other mediators of innate immune responses (e.g., inducible nitric oxide synthase [iNOS]) in early dissemination of Venezuelan equine encephalitis virus (VEE) infection, we used mice with targeted deletions in either their IFN-alpha/beta-receptor (IFNAR-1-/-) or interferon regulatory factor 2 (IRF-2-/-) genes. Following footpad infection, both IFNAR-1-/- and IRF-2-/- mice were more susceptible than control mice to VEE. The IFNAR-1-/- mice also exhibit accelerated VEE dissemination to serum, spleen, and brain, and compared with control mice, they evidenced faster kinetics in the upregulation of proinflammatory genes. In contrast, in IRF-2-/- mice, iNOS gene induction was completely absent following peripheral virulent VEE infection. In evaluating the role of cells involved in iNOS production, primary microglial cell cultures were found to be highly permissive to VEE infection. Moreover, VEE infection increased levels of nitric oxide (NO) in resting microglial cultures but decreased NO production in IFN-gamma-stimulated microglia. Thus, these findings suggest that reactive nitrogen species play an important contributory role in VEE dissemination and survival of the host. Our results further suggest the necessity for a carefully balanced host response that follows a middle course between immunopathology and insufficient inflammatory response to VEE infection.

Fracture toughness of resin-based luting cements

STATEMENT OF PROBLEM

The introduction of resin-modified glass ionomer cements has expanded the choices of luting cements available to the clinician; however, few independent studies are available on the fracture toughness of the currently available resin-modified glass ionomer luting agents compared with the composite cements.

PURPOSE

This investigation evaluated the relative fracture toughness (K(IC)) of 3 composite luting cements (Panavia 21, Enforce, and C&B Metabond), 3 resin-modified glass ionomer luting cements (Advance, Vitremer Luting, and Fuji Duet), and a conventional glass ionomer luting cement (Ketac-Cem) at 24-hour and 7-day storage times.

MATERIAL AND METHODS

K(IC) was determined by preparing minicompact test specimens (n = 8) with introduced precracks. Specimens were stored in distilled water at 37 degrees C + 2 degrees C until testing. Testing was performed on an Instron testing machine at a displacement rate of 0.5 mm/min.

RESULTS

ANOVA (P <.001) and REGW Multiple Range Test (P <.05) demonstrated significant differences among several of the cements tested. The mean fracture toughness values of C&B Metabond at 24 hours and Enforce at both 24 hours and 7 days were significantly greater than use any of the other cements tested.

CONCLUSION

The resin-modified glass ionomer cements exhibited improved fracture toughness when compared with the conventional glass ionomer; however, they were still inferior to Enforce and C&B Metabond composite cements.

Influences of dietary uptake and reactive sulfides on metal bioavailability from aquatic sediments

Understanding how animals are exposed to the large repository of metal pollutants in aquatic sediments is complicated and is important in regulatory decisions. Experiments with four types of invertebrates showed that feeding behavior and dietary uptake control bioaccumulation of cadmium, silver, nickel, and zinc. Metal concentrations in animal tissue correlated with metal concentrations extracted from sediments, but not with metal in porewater, across a range of reactive sulfide concentrations, from 0.5 to 30 micromoles per gram. These results contradict the notion that metal bioavailability in sediments is controlled by geochemical equilibration of metals between porewater and reactive sulfides, a proposed basis for regulatory criteria for metals.

Anti-A isoagglutinin as a risk factor for the development of pure red cell aplasia after major ABO-incompatible allogeneic bone marrow transplantation

Delayed erythropoiesis and pure red cell aplasia (PRCA) have been reported after major ABO-incompatible BMT. We attempted to find risk factors for the development of PRCA in 27 patients who underwent major ABO-incompatible BMT. In all patients, the donor marrow was depleted of RBCs before infusion. In 22 patients, isoagglutinins were determined until they disappeared. In eight (29.6%) out of 27 patients, bone marrow examination following BMT showed the findings of PRCA. We analyzed various clinico-pathologic risk factors and isoagglutinin type was the only significant risk factor. Patients with anti-A isoagglutinins against donor RBC developed PRCA more frequently than patients with anti-B (8/17 vs 0/9). Median days to the disappearance of isoagglutinins tended to be longer in patients with PRCA (PRCA vsnon-PRCA, 200 vs 66 days) and in cases with anti-A isoagglutinins (anti-A vsanti-B, 160 vs 51 days). Times to disappearance of isoagglutinins correlated with times to reticulocytes over 1% and initial appearance of donor type RBC (R2 = 0.708 and 0.711). In conclusion, RBC engraftment following major ABO-incompatible BMT was dependent on the disappearance of isoagglutinins against donor RBC, and anti-A isoagglutinin was a risk factor for the development of PRCA after major ABO-incompatible allogeneic BMT. Bone Marrow Transplantation (2000) 25, 179-184.

Clinical implications of antineutrophil cytoplasmic antibody test in lupus nephritis

To elucidate the prevalence and clinical implications of antineutrophil cytoplasmic antibody (ANCA) in lupus nephritis (LN), we examined ANCA by indirect immunofluorescence and by ELISA against antilactoferrin (anti-LF) and antimyeloperoxidase (anti-MPO) antibody. To discriminate perinuclear ANCA (pANCA) with antinuclear antibody (ANA), all the ANCA-positive sera were tested again after incubating patients' sera with single-stranded (SS) and double-stranded (ds) DNA. These results were compared with clinicopathologic manifestations and clinical courses of LN. ANCA was positive in 19 (37.3%) of 51 LN patients. Among these LN patients, 3 had cytoplasmic ANCA (cANCA) and 16 had pANCA. ANCA was not found in 8 SLE patients without nephritis and 30 normal controls. The presence of ANCA, particularly pANCA, was associated with the presence of nephritis (18/51 cases vs. 0/8 cases, p < 0.05), especially with diffuse proliferative lupus nephritis, WHO class IV (17/18 cases vs. 21/31 cases, p < 0.05) as well as the presence of anti-dsDNA antibody (17/19 cases vs. 18/30 cases, p < 0.05). Patients with ANCA frequently had deterioration of renal function (3/16 vs. 0/26 cases). Anti-LF antibody was positive in 13 patients. Among those, 12 patients had nephritis. Five patients with anti-LF antibody did not have ANCA, but 7 had pANCA, and 1 had cANCA. Patients with anti-LF antibody had lower initial creatinine levels than those without it [serum creatinine (mg/dl): 0.78 (0.6-1.0) vs. 1.43 (0.5-5.0), p < 0.05]. Anti-MPO antibody was positive in only 1 patient, suggesting that MPO is a rare antigen for ANCA in LN.

B-cell lymphoma of bronchus-associated lymphoid tissue (BALT): CT features in 10 patients

PURPOSE

The purpose of this work was to describe the CT findings of pathologically confirmed bronchus-associated lymphoid tissue (BALT) lymphoma in 10 patients.

METHOD

The CT examinations of 10 patients with pathologically proven BALT lymphoma were reviewed retrospectively by two radiologists. Evaluated findings included number and distribution of lesions. We also assessed other CT findings such as presence of airspace consolidation, nodules, ground-glass attenuation, bubble-like radiolucencies, air bronchogram, bronchial dilatation, and lymphadenopathy.

RESULTS

Pulmonary lesions were revealed as airspace consolidation in six patients (60%) and nodule(s) in six (60%). Multiplicity of disease was seen in seven patients (70%) and bilateral lung lesions in six (60%). Areas of ground-glass attenuation were seen in seven patients (70%). Bubble-like radiolucencies were present in five patients (50%) and air bronchogram in nine (90%). Findings of bronchial dilatation and lymphadenopathy were seen in three patients (30%).

CONCLUSION

BALT lymphomas usually appear as airspace consolidation or nodules with air bronchogram or adjacent ground-glass attenuation at CT. These findings are similar to previous descriptions of pseudolymphomas. Multiple bilateral lesions are common in BALT lymphoma. Bubble-like radiolucencies have not been described previously and can be an additional finding of BALT lymphoma.

Restriction primers as short as 6-mers for PCR amplification of bacterial and plant genomic DNA and plant viral RNA

Amplification of DNA or RNA sequences using the polymerase chain reaction (PCR) or reverse transcriptase PCR (RT-PCR) requires primers of an appropriate length to be designed. Two hexamer restriction primers, denoted as E101 and H301, which correspond to sequences of EcoRI and HindIII recognition sites, respectively, were selected and used as primers in PCR and RT-PCR. We first applied the restriction primers to the plasmid DNA and bacterial (Pseudomonas) and plant (Cymbidium) genomic DNAs. We observed positive DNA amplifications with the recombinant plasmid DNA and bacterial and plant genomic DNAs. Purified viral RNA was used for template in the RT-PCR with the primers and successful DNA amplification was obtained. These results suggest that the 6-mer restriction primers can be useful for new applications in PCR.

Myocardial injury-induced fibroblast proliferation facilitates retroviral-mediated gene transfer to the rat heart in vivo

BACKGROUND

Efficient and stable transfer of therapeutic DNA into injured myocardium would be an initial step towards a genetic treatment aimed at myocardial repair after myocardial infarction. Proliferating cardiac fibroblasts in the healing myocardium could be a compelling target for retroviral infection. We evaluated the feasibility of direct in vivo gene transfer into injured myocardium using a high-titer, stable retroviral vector.

METHODS

Using the TE-FLY-A-based MFG retroviral vector harboring nlsLacZ reporter, the gene transfer efficiency was assessed first in vitro in rat cardiac fibroblasts, followed by in vivo evaluation in healing rat myocardium after local freeze-thaw injury. A total of 2.5 x 10(7) infectious units of retrovirus were injected into the injured region of a beating rat heart. The transduced cells were identified by X-gal staining and immunohistochemistry.

RESULTS

Highly efficient transduction of cardiac fibroblasts was observed in vitro with 98% of the cells transduced with single infection. The cell proliferation index in the cardiac granulation tissue appeared maximal 3 days after cryoinjury. Retroviral injection into the injured beating heart induced gene expression localized to the wound repair region. One week after retrovirus injection, 14% of the cells in the reparative tissue were beta-gal-positive, while 4% were beta-gal-positive after 4 weeks. The transduced cells were mostly myofibroblasts.

CONCLUSIONS

Local gene transfer to the healing rat heart is feasible by retrovirus in vivo. This observation may serve as a useful guide for the development of gene therapy aimed at myocardial repair after myocardial infarction.

1998 Distinguished Lecture: biomechanics of the microcirculation, an integrative and therapeutic perspective

The microcirculation, integratively speaking, is distensible and contains 40%-50% of the total blood volume. Other than the mission of mass transport, the microcirculation and its endothelial cells have the role of regulation, signal transduction, proliferation, and repair. In this article, the emphasis is on the integrative role of the microcirculation on circulatory control and its therapeutic role on blood volume compensation. To introduce this topic, I first summarize the morphometry data on the blood volume distribution in the coronary, pulmonary, and mesentery circulation and then review the methodology developed in my laboratory to assess the microvascular volume change or shift of blood volume from microcirculation to macrocirculation. Evidence obtained through these studies indicates that the microcirculation can play a more important role as a reservoir to compensate for blood volume loss than the venous system. Reanalysis of published data also indicates that microvascular pooling, not hypovolemia, is the likely factor causing endotoxin shock or hypotension for hemodialysis patients. Understanding of the role of the microcirculation could lead to more effective diagnosis of cardiovascular deficiency and therapy for hypotension or low cardiac output with intervention through the microcirculation.

Nmethyl-N-nitrosourea (MNU) induces papillary thyroid tumours which lack ras gene mutations in the hermaphroditic fish Rivulus marmoratus

To investigate the patterns of alkylating agent-induced tumour formation, 40 fish (Rivulus marmoratus) were exposed to N-methyl-N-nitrosourea (MNU) at 50 ppm in 10 mM Hepes-buffered synthetic seawater for 2 h. Tumour incidence 4 months after exposure was approximately 95%, and mainly papillary thyroid tumours were induced. For elucidating the molecular event in Rivulus papillary thyroid carcinogenesis, we first analysed for ras gene mutations based on the known ability of MNU to induce point mutations. The amplified R. Marmoratus Ha-and Ki-ras gene exon 1 and 2 regions were checked along with confirming the presence and expression patterns of the DNA repair gene O(6)-methylguanine alkyltransferase (O(6)-MT) and other oncogenes (c-src, c-fos, and c-myc). Ha- and Ki-ras genes from 38 tumour samples were tested for point mutations with direct sequencing but were not found to contain mutations. In this report, based on the lack of Ha- and Ki-ras gene mutations in papillary thyroid tumour induction in R. Marmoratus, we suggest that Ha- and Ki-ras gene-independent pathways such as ret/PTC rearrangements and other activations are involved in Rivulus papillary thyroid carcinogenesis. Teratogenesis Carcinog. Mutagen. 20:1-9, 2000.

Molecular genetic relationships between Bombycidae and Saturniidae based on the mitochondria DNA encoding of large and small rRNA

The phylogenetic relationships between Bombycidae (Bombyx mori and Bombyx mandarina) and Saturniidae (Antheraea yamamai and Antheraea pernyi) were investigated based on large and small mitochondiral rRNA genes. About 430 bp of four kinds of PCR-amplified fragments were sequenced and aligned. For the 16S rRNA gene, B. mori shared a 98, 87 and 86% sequence homology with B. mandarina, A. yamamai and A. pernyi, and for the 12S rRNA gene, B. mori shared a 99, 89 and 88% sequence homology with B. mandarina, A. yamamai and A. pernyi, respectively. DNA sequence data were also used for a phylogenetic analysis. All of the trees showed monophyly for both Bombycidae and Saturniidae. The monophyly confidence limits of these trees were estimated using bootstrapping tests and measured more than 99% for all trees for both Bombycidae and Saturniidae.

Orbitocranial injury caused by wood

A rare case of a patient with orbitocranial injury by a wooden foreign body is reported. Penetrating periorbital wound by a wooden stick with entry site at the right upper eyelid was related to the invasion into the temporal lobe. Fortunately, the anterior and posterior segments of eye were unharmed, but right ocular motility was markedly restricted mechanically in all directions. Forced duction test was strong positive, especially the dextroversion of the right eye. Computed tomography scan showed a well-delineated low density from the orbital wall into the temporal lobe. The wooden foreign body was subsequently removed from the orbit and the temporal lobe, through the neurosurgical frontotemporal approach. After the wooden foreign body was removed, the ocular movement of the right eye fully recovered without any intracranial or ocular complications.

Relative stabilities of dinucleotide and tetranucleotide repeats in cultured mammalian cells

The differences in rates of frameshift mutations between a dinucleotide repeat sequence [(CA)(17)] and a tetranucleotide repeat sequence [(GAAA)(17)] have been determined in immortalized, non-tumorigenic, mismatch repair-proficient mouse cells and in mismatch repair-defective human colorectal cancer cells. Clones with mutations were selected on the basis of restoration of activity of a bacterial neomycin resistance gene whose reading frame was disrupted by insertion of the microsatellite upstream of the translation initiation codon. This gene was introduced into the cells on a plasmid, which integrated into the genome of the host cells. Mutation rates of the tetra-nucleotide repeat were much lower than those of the dinucleotide repeat in both cell types. In addition, independent subclones of the colorectal cancer cell line were assayed by PCR for instability of endo-gen-ous tetranucleotide and dinucleotide repeat sequen-ces. In all cases, the mutation frequencies of the dinucleotide repeats were higher than those of the tetranucleotide repeats.

Spectrum of opportunistic infections and malignancies in patients with human immunodeficiency virus infection in South Korea

To determine the frequency and types of major opportunistic diseases in patients with HIV infection in South Korea, we reviewed the medical records of 173 HIV-infected patients. The patients were seen from 1985 to 1998 at a referral hospital for AIDS in South Korea. Most patients (85%) were male, and 107 (62%) were infected by heterosexual contacts. CD4+ lymphocyte counts at presentation were <200/microL in 27% of the patients. Tuberculosis was the most frequent opportunistic infection (25% of patients), followed by candidiasis (21%), herpes zoster (20%), Pneumocystis carinii pneumonia (10%), cytomegalovirus disease (9.8%). There were no cases of toxoplasmosis. Kaposi's sarcoma developed in 3 patients (1.7%), and non-Hodgkin's lymphoma, in 2 (1.2%). Eleven patients (6.4%) developed peripheral neuropathy, and 8 (4.6%) had HIV encephalopathy. Tuberculosis was the single most important HIV-related infection in South Korean patients.

The benefit of treatment intensification is age and histology-dependent in patients with locally advanced non-small cell lung cancer (NSCLC): a quality-adjusted survival analysis of radiation therapy oncology group (RTOG) chemoradiation studies

PURPOSE

Currently, chemoradiation treatment strategies in locally advanced NSCLC are essentially the same irrespective of tumor histology or patient age. The purpose of this study is to analyze the impact of age, histology, Karnofsky performance status (KPS), and specific toxicities on the median survival time (MST) and quality-adjusted survival (QTime) for each treatment strategy.

METHODS AND MATERIALS

Nine hundred seventy-nine patients with Stage II-IIIB inoperable NSCLC were enrolled on 6 prospective Phase II and III studies from 1983 to 1995. Treatment regimens ranged from standard RT (SRT) to 60 Gy, hyperfractionated RT (HRT) to 69.6 Gy, induction chemotherapy (ICT) of cisplatin (CIS) and vinblastine (VBL) followed by SRT, ICT + concurrent CT (CCT) + SRT, and CCT + HRT; CCT consisted of etoposide or VBL + CIS. Toxicities assessed were skin, mucous membrane, lung, esophagus, neurologic, hematologic, and upper GI. QTime was calculated by weighting the time spent with a specific toxicity, as well as local or distant tumor progression. Each toxicity was weighted with increasing severity as the toxicity increased in grade.

RESULTS

As expected, patients with the worst KPS (50-70) had the lowest MST (7.8 months) and QTime (6.7 months). Patients <70 years had improved survival with more aggressive therapy (i.e., ICT + SRT or CCT + HRT), while patients > 70 years achieved the best QTime with standard RT (SRT) alone. In patients with squamous cell carcinoma, those treated with ICT + CCT + SRT had dramatically improved MST (25.7 months) and QTime (21.8 months) compared to the other treatment regimens (11.7-12.8 and 10.7-12 months, respectively). Patients with adenocarcinoma, however, generally manifested incrementally better MST and QTime as the therapies intensified. Within the concurrent chemoradiation arms, the upper GI and lung toxicities had the greatest impact on QTime.

CONCLUSION

This quality-adjusted survival analysis suggests that there is a critical relationship between the type of histology and its optimal treatment, age and the ability to tolerate intensive therapy, and the need to reduce lung and upper GI toxicities.