Peripheral cholangiocarcinoma and clonorchiasis: CT findings

Sixteen patients with peripheral cholangiocarcinoma of the liver were examined with computed tomography (CT). None of the 16 patients presented with jaundice or had documented cirrhosis. On scans obtained both before and after the injection of contrast material, the tumors were depicted as low-attenuation masses in all cases, with wide variations in homogeneity. The tumor margin was irregular in 12 cases, and there was minimal contrast enhancement of the tumor in 14 cases. In 11 (69%) patients, CT demonstrated masses of markedly low attenuation, which corresponded to areas of diffuse microcystic change seen at histologic examination of resected specimens. In ten (63%) patients, the results of stool or intradermal tests for Clonorchis sinensis were positive. In all ten cases of clonorchiasis, mild, diffuse dilatation of the intrahepatic bile ducts was seen in addition to the low-attenuation masses, but there was no dilatation of the extrahepatic biliary tree. In five of the ten patients with clonorchiasis, stippled or aggregated, powderlike areas of high attenuation were seen on precontrast CT scans; at pathologic examination, those areas were found to be mucin. Extrahepatic metastases were demonstrated in ten (63%) patients. Peripheral cholangiocarcinoma should be the primary diagnostic consideration when these characteristic CT findings are detected in a noncirrhotic patient.

Infective endocarditis in a patient with Williams' syndrome--case report

An 18-year-old male was admitted to Seoul National University Hospital for the evaluation of fever and chill on February 3, 1988.

On physical examination, his face showed a characteristic “elfin” facial appearance. His face was characterized by abnormalities of dental development, a broad overhanging upper lip, high arched palate and gum hypertrophy. He also showed mental retardation.

Cardiac catheterization with selective cineangiocardiography demonstrated a supravalvular aortic narrowing, grade 2 aortic insufficiency, and moderately dilated proximal coronary arteries with normal distribution without an intraluminal narrowing. There was a systolic pressure gradient (55mmHg) between the aortic root and ascending aorta distal to a stenotic segment.

MRI showed a supravalvular aortic stenosis.

Vegetation was not found on echocardiograpghy. Unidentified G(−) rods were isolated in 3 out of 9 bottles in blood culture test.

He was treated with Na-penicillin and gentamicin for 28 days.

Analysis of signals controlling expression of the Chinese hamster ovary aprt gene

The 5' end of the Chinese hamster ovary aprt gene was sequenced and transcription start sites were determined by both S1 nuclease protection and primer extension assays. Deletion mutants covering the same area were constructed, and adenine phosphoribosyltransferase (APRT) or chloramphenicol acetyltransferase (CAT) activity was measured by transient-expression assays. The aprt gene uses a single cluster of transcription start sites and lacks consensus sequences such as TATA and CCAAT, which are general components of eucaryotic promoters. The 5' deletion mutations of the promoter sequences demonstrated that (i) there is no decrease in either APRT activity or transcription extending to position -89 (relative to the main transcription start site); (ii) an additional 29-base-pair (bp) deletion decreases APRT activity and transcription twofold; and (iii) a deletion past the transcription start sites (P5' delta +27) abolishes both APRT activity and transcription, indicating that a 60-bp fragment immediately upstream of the main transcription start site is involved in basic transcription and a 29-bp fragment just upstream of the 60 bp-fragment stimulates transcription twofold. The 3' deletion mutations showed that a deletion of a 61-bp fragment in the 5' leader and coding sequence abolishes the efficient translation of an aprt-CAT gene transcript. In addition, there are two polyadenylation signals at the genomic 3' end, with the proximal one being sufficient for functional polyadenylation.

Reduced mucosal prostaglandin synthesis after massive small bowel resection

Exogenous 16,16-di-methyl-prostaglandin (PG) E2 administration augments mucosal hyperplasia after massive small bowel resection in the rat. We, therefore, evaluated the ability of aspirin to inhibit mucosal PG synthesis in the small intestine and further evaluated the effects of reduced PG synthesis on mucosal adaptation after a 70% jejunoileal resection in male Sprague-Dawley rats. Sixteen of 27 resected and 8 of 16 sham-operated rats were given aspirin 20 mg/kg body wt subcutaneously every 8 h for 12 days; the remainder were given vehicle only. Although mucosal PGE2, PGF2 alpha, and thromboxane B2 synthesis were all reduced by aspirin administration to 20-40% of the control values, mucosal adaptation in resected animals as measured by mucosal weight, DNA, protein, and maltase levels was only inhibited in the distal ileum. Aspirin did not affect these values in the duodenum, the upper jejunum, and the midileum. This study provides evidence for some involvement of endogenous PGs in regulation of the mucosal adaptation process in the distal ileum after massive small bowel resection in the rat. However, lack of inhibition more proximally suggests that factors other than PGs are more important.

Essential fatty acid deficiency and postresection mucosal adaptation in the rat

The effect of short-term (biochemical) and long-term (clinical) essential fatty acid (EFA) deficiency on mucosal adaptation was studied in a surgical model of short bowel syndrome. Rats fed an EFA-deficient diet for 4 wk had biochemical evidence of EFA deficiency (hepatic and red blood cell triene to tetraene ratios greater than 0.4). Resected animals (70% proximal jejunoileal resection) receiving an EFA-deficient diet had a significantly impaired intestinal mucosal hyperplasia response in all remaining small bowel segments compared with resected controls. The effect of refeeding a control diet to clinically EFA-deficient resected rats was also evaluated. Short-term refeeding (2 wk) of a control diet resulted in a significant return toward normal tissue triene to tetraene ratios. Concomitantly, refed animals had significantly greater mucosal adaptation in the remaining duodenal/jejunal segment compared with resected animals maintained on an EFA-deficient diet postoperatively. These experiments underscore the dynamic nature of tissue EFA status and the importance of fatty acids in the normal compensatory mechanisms of mucosal adaptation after resection.

Purification and characterization of protease Re, a cytoplasmic endoprotease in Escherichia coli

Protease Re, a new cytoplasmic endoprotease in Escherichia coli, was purified to homogeneity by conventional procedures, using [3H]casein as the substrate. The enzyme consists of a single polypeptide of 82,000 molecular weight. It is maximally active between pH 7 and 8.5 and is independent of ATP. It has a pI of 6.8 and a Km of 10.8 microM for casein. Since diisopropyl fluorophosphate and phenylmethylsulfonyl fluoride inhibited this enzyme, it appears to be a serine protease. Protease Re was sensitive to inhibition by L-1-tosylamido-2-phenylethylchloromethylketone but not to that by 1-chloro-3-tosylamido-7-aminoheptanone, thiol-blocking reagents, chelating agents, or various peptide aldehydes. Re also degraded [125I]globin, [125I]glucagon, and 125I-labeled denatured bovine serum albumin to acid-soluble products (generally oligopeptides of greater than 1,500 daltons), but it showed no activity against serum albumin, growth hormone, insulin, or a variety of fluorometric peptide substrates. It also hydrolyzed oxidatively inactivated glutamine synthetase (generated by ascorbate, oxygen, and iron) four- to fivefold more rapidly than the native protein. Protease Re appears to be identical to the proteolytic enzyme isolated by Roseman and Levine (J. Biol. Chem. 262:2101-2110, 1987) by its ability to degrade selectively oxidatively damaged glutamine synthetase in vivo. Its role in intracellular protein breakdown is uncertain.

Effects of cytochalasin B on the synthesis and secretion of plasma proteins by developing rat liver

Antimicrotubular drugs such as colchicine impair plasma protein secretion markedly less from developing liver than from mature tissue, suggesting the reduced participation of microtubules in hepatic protein secretion during liver development. In order to evaluate the possible contribution of microfilaments to protein export by immature liver, we incubated slices prepared from adult and gestation day 19 fetal rat liver for up to 4 h with the antimicrofilamentous agent cytochalasin B and with colchicine in various concentrations. In adult tissue, cytochalasin B did not reduce either the synthesis or secretion of [14C]leucine-labeled proteins and albumin. Cytochalasin B decreased apparent albumin synthesis by fetal liver, but otherwise, its effects on [14C]leucine incorporation did not differ from those observed in the adult. In contrast with leucine, the uptake of [3H]glucosamine into both adult and fetal liver was reduced by cytochalasin B. When this reduced uptake was normalized to that in corresponding control incubations, [3H]glucosamine incorporation into glycoproteins was markedly diminished in fetal slices, but was unaffected in the adult. Despite this age-dependent difference, cytochalasin B only minimally affected glycoprotein secretion in each group. Cytochalasin B never modified the antisecretory effects of colchicine. These results suggest that during early development, liver protein synthesis is more sensitive to toxic effects of cytochalasin B than during adulthood. However, microfilaments are not required for plasma protein export at either time.

Cognitive impairment among the elderly in a Korean rural community

Cognitive function among the elderly aged 65 or older was studied in a rural community of Korea. The prevalence rates of cognitive impairment were significantly higher in females (64%) than in males (33%). Sex differences of prevalence of both mild impairment (25% in males vs 45% in females) and severe (8% in males vs 19% in females) reached statistically significant levels. The prevalence of severe impairment increased with age, and the age-related increase was steeper after 80 in males and after 75 in females. The prevalence of mild impairment, on the other hand, did not increase so prominently with aging. From this point of view, it could be assumed that severe cognitive impairment may be highly related to real dementia, and that the elderly with mild impairment may consist of heterogenous groups associated with cognitive dysfunction of mild degree.

Functional pools of oxidative and glycolytic fibers in human muscle observed by 31P magnetic resonance spectroscopy during exercise

Quantitative probing of heterogeneous regions in muscle is feasible with phosphorus-31 magnetic resonance spectroscopy because of the differentiation of metabolic patterns of glycolytic and oxidative fibers. A differential recruitment of oxidative and glycolytic fibers during exercise was demonstrated in 4 of 10 untrained young men by following changes in phosphate metabolites. Concentrations of inorganic phosphate (Pi), phosphocreatine, and ATP were estimated in the wrist flexor muscles of the forearm at rest, during two cycles of three grades of exercise, and in recovery. At high work levels (40% of maximum strength), two distinct Pi peaks were observed and identified with Pi pools at pH 6.9 and pH 5.9-6.4, respectively. These could be accounted for as follows. At the lowest level of work (using 20% of maximum strength), early recruitment primarily of oxidative (type I) and possibly some intermediate (type IIA) muscle fibers occurs with relatively little net lactate production and consequently little decrease in pH. At higher work loads, however, primarily glycolytic (type IIB) muscle fibers are recruited, which have relatively high net lactate production and therefore generate a second pool of Pi at low pH. ATP depletion (35-54%) and Pi losses accompanied the reduction in ability to perform during the first exercise cycle. When the cycle of graded exercise was repeated immediately, the total Pi remained high but gave rise to only one peak at pH 6.8-7.0. These observations indicated exhaustion of glycolytic type IIB fibers, removal of lactate by high local blood flow, and sustained contractions largely by oxidative type I and IIA fibers. A functional differentiation of fiber types could also be demonstrated during recovery if exercise was stopped while two pools of Pi were still apparent. In the first 3 min of recovery, the Pi peak at pH 6.8-6.9 disappeared almost entirely, whereas the Pi peak at pH 6.0 remained unaltered, reflecting the faster recovery of oxidative type I fibers. The potential of magnetic resonance spectroscopy to characterize oxidative and glycolytic fibers, predict capacity for aerobic performance, and signal the presence of muscle pathology is discussed.

Stimulation of epidermal protein synthesis in vivo by topical triamcinolone acetonide

The rate of epidermal protein synthesis in vivo was determined in the hairless mouse by a method in which a large dose of [3H]phenylalanine (150 mumol/100 g body wt.) is administered via the tail vein. The epidermal free phenylalanine specific radioactivity rapidly rose to a plateau value which by 10 min approached that of plasma, after which it declined. This dose of phenylalanine did not of itself alter protein synthesis rates, since incorporation of co-injected tracer doses of [3H]lysine and [14C]threonine was unaffected. The fractional rate of protein synthesis obtained for epidermis was 61.6%/day, whereas values for liver and gastrocnemius muscle in the same group of mice were 44%/day and 4.8%/day respectively. When expressed on the basis of RNA content, the value for epidermis (18.6 mg of protein/day per mg of RNA) was approx. 3-fold higher than those for liver and gastrocnemius muscle. Topical administration of 0.1% triamcinolone acetonide increased the epidermal fractional protein synthesis rate by 33% after 1 day and by 69% after 7 days, compared with vehicle-treated controls. These effects were entirely accounted for by the increase in protein synthesis rates per mg of RNA. RNA/protein ratios were unaffected by this treatment.

Augmentation of postresection mucosal hyperplasia by plerocercoid growth factor (PGF). Analog of human growth hormone

Postresection villus hyperplasia is a major compensatory mechanism in the short-bowel patient. Substances capable of augmenting postresection mucosal hyperplasia could have therapeutic implications. Human growth hormone (hGH) and human growth hormone releasing factor (hGHRF) stimulate growth of the gastrointestinal tract; however, the diabetogenic actions of growth hormone limit its usefulness in clinical practice. Plerocercoid larvae of the tapeworm Spirometra mansonoides produce an analog of hGH void of diabetogenic side effects. We assessed effects of plerocercoid growth factor (PGF) on mucosal adaptation following 70% proximal jejunoileal resection in young rats. Mucosal weight, DNA, protein, and total sucrase activity per centimeter of bowel were increased in resected PGF-treated animals compared to resected controls. We conclude PGF augments intrinsic postresection mucosal hyperplasia following extensive intestinal resection.

Interactions of vitamin E and penicillamine in the treatment of hereditary avian muscular dystrophy

Our prior work demonstrated that penicillamine treatment of dystrophic chickens delayed the onset of symptoms, partially alleviated contractures, improved muscle function, and lowered serum creatine kinase. Penicillamine, a sulfhydryl compound with reducing properties, also prevented inactivation of glycolytic enzymes by protecting thiol groups. The present study shows that vitamin E enhances the therapeutic effects of penicillamine. Interaction of these two reductants is dose related. With vitamin E as adjunct therapy, the dosage level of penicillamine could be lowered by 50%, thereby minimizing side effects. The therapeutic rationale for two antioxidants is that penicillamine may act primarily in the cytoplasm to prevent oxidative damage, whereas the more hydrophobic vitamin E may protect membrane bilayers. Additionally, penicillamine may prevent collagen cross-linking and, deposition of insoluble collagen in muscle and thus decrease contracture formation. General applications of combined penicillamine and vitamin E therapy are discussed regarding prevention of free radical and oxidative damage in Duchenne dystrophy and a wide range of human diseases.

Percutaneous pulmonary valvuloplasty with a double-balloon technique

Percutaneous pulmonary valvuloplasty with a double-balloon technique was used in eight patients, aged 10-40 years, in whom valvuloplasty with a single 20-mm balloon resulted in inadequate dilatation of the stenosis. The diameters of the additional balloon varied from 10 to 20 mm. Balloons were inflated manually at about 30-45 psi (206.7-310.1 kPa) and deflated immediately after disappearance of the balloon waist. The mean peak systolic pressure gradient was 85 mm Hg +/- 37 before valvuloplasty, and it decreased to 38 mm Hg +/- 28 afterward (P less than .05). Double-balloon dilation and simultaneous computed tomography were done in two cardiac specimens from adult cadavers. At inflations at 30 and 45 psi (206.7 and 310.1 kPa), the outflow tract was elongated, and the balloons also deformed into ovoid shape at the lower pressure. The double-balloon technique appears to be safe and effective for relief of pulmonary valvular stenosis in those cases in which single-balloon technique is inadequate, especially in older children and adults.

Mediastinal tuberculous lymphadenitis: CT manifestations

An analysis was done of computed tomographic (CT) scans of 23 Korean patients who had presented with a mediastinal or hilar mass on plain chest radiographs and had subsequently been found to have tuberculous lymphadenitis. Most patients were young adults. Findings of pulmonary tuberculosis were seen on plain radiographs in 14 patients. On CT, findings were of an overwhelming preponderance of involvement of the right paratracheal and tracheobronchial nodes. After injection of contrast medium, nodes larger than 2 cm in diameter invariably showed central areas of relative low density and peripheral rim enhancement. Enhanced walls were usually irregular in thickness. Some smaller nodes did not show low-density areas, but instead showed varying degrees of homogeneous enhancement. Although metastatic nodes can be of low density, experience in this study suggests that mediastinal lymphadenopathy in a young adult with the CT findings described above is characteristic enough to support a diagnosis of tuberculosis.

Percutaneous removal of residual intrahepatic stones

In the Orient there is a high frequency of residual intrahepatic stones after biliary tract surgery. Percutaneous removal of residual intrahepatic stones was attempted in a group of 74 patients. Stones were exclusively intrahepatic in 57 patients, whereas 17 patients also had stones in the common bile duct. Biliary strictures were present in 60 cases (81%). A combination of techniques was used, including preshaped angulated catheters, irrigation-suction, balloon dilation of strictures, and crushing of large stones. In 36 cases all stones were removed and in 14 cases most stones were removed, for a success rate of 67.6%. Biliary stricture was the factor most often responsible for failure.

Renal arterial embolization with absolute ethanol

Twenty separate infarction procedures with absolute ethanol were performed on eighteen renal tumors in seventeen patients at Department of Radiology, Seoul National University Hospital since 1982. Fifteen were hypernephroma cases and two were angiomyolipoma cases. The indications for renal infarction were the preoperative interruption of renal arterial flow in eight cases of hypernephroma, and primary therapy or palliation of symptoms in seven cases of hypernephroma and two cases of angiomyolipoma. Average 15ml of absolute ethanol was injected for renal arterial embolization at a rate of 1-2 ml/sec via balloon occlusion catheter or superselective administration technique. Though the long-term beneficial effect on survival was not confirmed, transcatheter embolization with absolute ethanol was suggested to be used as indispensible treatment in preoperative and inoperable or symptomatic cases of renal tumor.

Augmentation of mucosal adaptation following massive small-bowel resection by 16,16-dimethyl-prostaglandin E2 in the rat

Survival following massive resection of the small intestine is often possible due to substantial hyperplasia of the mucosal surface in the remaining small intestine. While nutrients provide the major stimulus for hyperplasia in the clinical setting, the availability of drugs to augment this process would have obvious therapeutic implications. We evaluated the ability of 16,16-dimethyl-prostaglandin E2 (PGE2 to augment mucosal hyperplasia following massive small bowel resection in the rat. Three groups of 7 Sprague-Dawley rats, 160 g body weight, were subjected to 70% jejunoileal resection. One group was given 150 micrograms/kg of 16,16-dimethyl-PGE2 intragastrically twice daily, a second group 75 micrograms/kg subcutaneously, and a third group was untreated. After 17 days, segmental evaluation of mucosal mass in the remaining small intestine was determined by measuring mucosal protein, DNA, and disaccharidase levels. A significantly greater increase in mucosal mass was developed in the duodenum proximal to the anastomosis in both treatment groups, but neither the proximal nor distal ileum demonstrated significantly more adaptation. Histological examination in the duodenum confirmed the presence of a greater adaptive response in both the intragastrically and subcutaneously treated animals. 16,16-dimethyl-PGE2 appears to augment mucosal adaptation following massive small bowel resection in the rat, primarily in the very proximal small intestine.