Small hepatocellular carcinoma: high dose internal radiation therapy with superselective intra-arterial injection of I-131-labeled Lipiodol

The aim of the present study was to deliver a high internal radiation dose to small hepatocellular carcinoma (HCC) lesions in an attempt to treat this disease. A total of 18 patients with HCC lesions measuring less than 4.5 cm in diameter (25 lesions) were treated with superselective intra-arterial injection of I-131-labeled Lipiodol (370-1,100 MBq in 3-5 ml) using a 5-F or coaxial catheter. All the lesions were nodular, multinodular, or hypervascular on pretreatment angiography. In all, 15 lesions that received over 180 Gy of cumulative radiation decreased in size in proportion to the Lipiodol retention on CT, and no pericapsular recurrence was found on angiography after 14-54 months of follow-up. In five patients who subsequently underwent surgery, 65% to 100% tumor necrosis was detected. No abnormal change in liver function tests or untoward clinical symptom of the lung, thyroid, or bone marrow was detected in patients who survived for more than 3 years after the treatment. Superselective high-dose internal radiation therapy of small HCC offers hope of treatment and long-term local control without complications.

Inhibition of norepinephrine release from rat cortex slices by opioids: differences among agonists in sensitivities to antagonists suggest receptor heterogeneity

Receptors mediating opiate-induced inhibition of potassium-stimulated release of [3H]norepinephrine (NE) from slices of rat cortex incubated in vitro have been characterized by comparison of the pA2 values of the competitive antagonists, naloxone, D-Pen-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH2 (CTOP), nor-binaltorphimine, naltrindole and bremazocine against the agonists, Tyr-D-Ala-MePhe-Gly-ol (DAMGO), Tyr-D-Arg-Phe-Sar (TAPS), [D-Ser2, Leu5]enkephalyl-Thr (DSLET), beta-endorphin [beta-END(1-31)] and ethylketocyclazocine (EKC). There were significant differences among agonists in their sensitivities to each antagonist. The delta receptor selective agonist, DPDPE, and the kappa 1-agonist, U69593, did not inhibit NE release, indicating that delta and kappa 1 receptors are not involved. DAMGO, TAPS and DSLET generally behaved as mu agonists, although TAPS and DSLET were less sensitive to antagonism by CTOP than by DAMGO. TAPS and DSLET showed similar sensitivities to all antagonists, suggesting that they acted through similar receptors, possibly of the mu 1 type. beta-END(1-31) and EKC differed from DAMGO and from each other in their sensitivities to most antagonists. Shifts in agonist concentration-response curves induced by prior treatment of the rats with the noncompetitive antagonists, beta-funaltrexamine and naloxonazine, also suggested that EKC and beta-END(1-31) acted through mechanisms differing from those used by DAMGO, TAPS and DSLET. It is possible that EKC and beta-END(1-31) acted via kappa 2 and/or epsilon receptors. These results suggest that there is heterogeneity in the opioid receptors regulating NE release in rat cortex.

Influence of uraniferous black shales on cadmium, molybdenum and selenium in soils and crop plants in the Deog-Pyoun-g area of Korea

The influence of naturally occurring uraniferous black shales on cadmium, molybdenum and selenium concentrations in soils and plants is examined. The possible implications of element concentrations to animal and human health are considered for the Deog-Pyoung area.Geochemical surveys have been undertaken within 13 river tributary valleys in the area underlain by uraniferous black shales and black slates or grey chlorite schists. Sampling of rocks, soils and plants has been carried out along transect lines within each valley. Samples were analysed for trace elements by Inductively Coupled Plasma Atomic Emission Spectrometry (ICP-AES) and for uranium by Neutron Activation Analysis (NAA). Soil pH, cation exchange capacity, loss on ignition and particle size distribution have been measured for selected samples.Average trace element concentrations of the Okchon uraniferous black shales were 6.3 μg g(-1) Cd, 136 μg g(-1) Mo and 8.6 μg g(-1) Se. Soils derived from these rocks tend to reflect their extreme geochemical composition. Trace element concentrations in alluvial soils derived in part from these black shales averaged 1.2 μg g(-1) Cd, 20 μg g(-1) Mo and 1.5 μg g(-1) Se. Trace element concentrations in plants were found to be influenced by those of soils. Cadmium accumulated in tobacco leaves up to 46 μg g(-1) (D.M.) and leafy plants such as lettuce contain up to 0.5 μg g(-1) Se (D.M.).In addition to total concentrations in soils, soil pH is a major factor influencing uptake of Mo into crop plants and soil texture for Se. Concentrations of trace elements in plants also varied between plant species. The relative concentrations of Cd were found to vary in the order tobacco > lettuce > red pepper > rice grain.Elevated concentrations of Cd in crop plants and in tobacco may possibly have deleterious effects on human health in this area. The low Cu:Mo ratio in rice stalk of 2.65:1 may be associated with disturbed Cu metabolism in ruminant animals which regularly consume this material.

Apolipoprotein E genotypes of normal and hyperlipidemic subjects

Apolipoprotein E (apo E) plays a role in the regulation of the lipid metabolism of humans. Apo E, 229 amino acid polypeptide, is classified into three major isoform (E2, E3, E4) according to the differences of amino acid in position 112 and 158. In the normal population apo E3 isoform is most prevalent and apo E2 or E4 is frequently associated with hyperlipoproteinemia. To find out the frequency of apo E isoform distribution in the Korean population, apo E genotyping was performed. After amplification of apoE gene by polymerase chain reaction (PCR), restriction isotyping was done by cleavage with restriction enzyme Hha I and polyacrylamide gel electrophoresis. The apo E allele frequency in 73 normal subjects was 4.8% for E2, 84.9% for E3 and 10.3% for E4. In diabetic patient with hyperlipoproteinemia, the frequency of apo E allele was 6.3% for E2, 81.0% for E3 and 12.7% for E4. There was no significant difference in apo E isoform distribution between diabetics and normal populations. But in patients with cardiovascular disease with hyperlipidemia, the apo E4 allele frequency was significantly higher than normal (20.0% vs 10.3%, p < 0.005). Apo E3 was the most common isoform in normal and diabetic subjects and apo E2 isoform was rather low frequency compared to Caucasians. This pattern is similar to the Japanese population but somewhat different from other populations. From the data of a high association of apo E4 allele and cardiovascular disease with hypercholesterolemia, apo E isoform may be one of the determinants of hyperlipoproteinemia. The PCR method may be useful in apo E genotyping.

CT of retroperitoneal extension of hepatoma mimicking adrenal tumor

OBJECTIVE

The anatomy of the superior aspect of the renal fascia is still controversial. We recently saw three cases of hepatoma extension into perirenal space and believed the bare area of the liver communicated with the perirenal space.

MATERIALS AND METHODS

We reviewed the CT of the three cases of hepatoma with retroperitoneal extension. One was pedunculated and the others were exophytic.

RESULTS

One pedunculated hepatoma was operated upon while we were under the impression that it was an adrenal carcinoma. The others were initially mistaken for a metastatic or primary adrenal carcinoma.

CONCLUSION

The bare area of the liver opens widely into the superior aspect of the perirenal space and permits easy extension of pedunculated or exophytic masses of the liver arising in this location, mimicking and adrenal mass.

Structure of malformin B, a phytotoxic metabolite produced by Aspergillus niger

Malformin B, produced by Aspergillus niger, was separated into six compounds by HPLC. Their structures were determined by amino acid analyses, and by mass spectral and two-dimensional NMR experiments to be cyclic pentapeptides structurally related to malformin A1. Both the NMR and MS/MS experiments suggest cyclo-D-cysteinyl-D-cysteinyl-L-amino acid-D-amino acid-L-amino acid as the essential structure of malformins.

Reduced expression of PLC-gamma during the differentiation of mouse F9 teratocarcinoma cells

Expression of phosphoinositide-specific phospholipase C (PLC)-gamma during the retinoic acid (RA)-induced differentiation of F9 teratocarcinoma stem cells was investigated. PLC-gamma activity and PLC-gamma protein content were decreased during the differentiation of F9 teratocarcinoma stem cells induced by a combination (RACT) of RA, dibutyryl cyclic AMP (C) and theophylline (T). However, PLC-gamma activity and protein levels in RA- or C- and T-treated F9 cells remained the same as that of the F9 stem cells. Northern analysis of the 5.4-kb PLC-gamma transcript in differentiated F9 cells by RACT revealed that RACT decreased the PLC-gamma gene expression. These results suggest that the expression of PLC-gamma is negatively controlled by RACT treatment in the differentiation of F9 teratocarcinoma stem cells.

Characterization of the T cell antigen receptor--p60fyn protein tyrosine kinase association by chemical cross-linking

Engagement of the TCR by specific antigen results in activation of a tyrosine kinase pathway. A candidate for the kinase responsible for the rapid tyrosine phosphorylation detected with T cell activation is p60fyn, a member of the src kinase family. In an earlier study [Samelson et al. (1990) Proc. Natl Acad. Sci. USA 87:4358] this enzyme was co-immunoprecipitated with the TCR from T cells solubilized in digitonin. In that study a sensitive in vitro kinase assay was used to detect the associated p60fyn. It was subsequently found that the reproducibility of the interaction depended on lot-to-lot variations in digitonin. To eliminate the possibility that the association of antigen receptor and kinase is an artifact of solubilization with ill-defined digitonin preparations, a cross-linking protocol was developed to stabilize the interaction between the TCR and p60fyn. T cells were permeabilized with tetanolysin and proteins were cross-linked with the water soluble chemical cross-linker, 3,3' dithiobis(sulfosuccinimidylpropionate). These experiments allowed the confirmation of the interaction between the TCR, p60fyn, and several additional proteins. The cross-linking studies also enabled the mapping of the interaction of p60fyn and associated proteins to the TCR zeta-chain. This technique should have a general use in stabilizing interactions between other receptors and molecules required for intracellular signaling.

Nodular hepatocellular carcinoma. Treatment with subsegmental intraarterial injection of iodine 131-labeled iodized oil

Internal radiation therapy with subsegmental arterial injection of iodine 131(131I)-labeled iodized oil (Lipiodol; Laboratorie, Guerbet, France) was evaluated in 24 patients with nodular hepatocellular carcinoma (HCC) ranging from 2.5 to 8.0 cm in size. 131I Lipiodol (555 to 2220 MBq in 3 to 8 ml) was injected depending on the tumor size. Tumor reduction was seen in 88.9% of tumors smaller than 4.0 cm in diameter, 65.5% of tumors between 4.1 to 6.0 cm, and 25.0% of tumors larger than 5.1 cm. The tumor size reduction corresponded to the gradual drop of serum alpha-fetoprotein (AFP) levels and devascularization on follow-up angiography. Adverse reactions from treatment included fever, mild abdominal pain, nausea, and elevation of transaminases. These were mild and well tolerated by patients. This method provided long-term local control without complications related to the thyroid, lung, gastrointestinal tract, and bone marrow.

Effect of glucose on the expression of c-myc gene in cultured RINm5F cell

The study was designed to examine the effect of glucose on the expression of c-myc gene in cultured RINm5F cells. After monolayer culture was established in RPMI 1640 media supplemented with 10% fetal calf serum (FCS), the cells were cultured in various concentrations of glucose and 1 or 10% FCS for another 24 hours. A mRNA was extracted from the cultured cells by a single step method, and Northern analysis was done to detect RNA band. A 0.5 kilobase single band was detected as c-myc mRNA. The expression of c-myc gene mRNA was reduced with increased concentration of glucose with 1% FCS. However, supplementation of 10% FCS abolished the effect of glucose on expression of c-myc gene. These findings suggested that glucose in conjunction with other growth promoting factors played an important role in expression of oncogene and cell growth in RINm5F cells.

A case of herpes zoster myelitis: positive magnetic resonance imaging finding

A 33-year-old man developed a progressive myelopathy after a characteristic skin lesion of herpes zoster involving the right C3 and C4 dermatomes. The lesions were recognizable in the T2-weighted image of the magnetic resonance imaging (MRI) as increased signal intensities throughout the long segments of the spinal cord with maximal in the cervical portion, which was compatible with the pathological findings reported in autopsy studies.

Effect of capsular infarct size on clinical presentation of stroke

We reviewed the medical records and cranial computed tomograms of 74 patients with acute capsular infarcts to investigate the correlation between infarct size and clinical symptoms. Average infarct size varied significantly by clinical syndrome; patients with sensorimotor stroke had the largest infarcts, patients with pure motor hemiparesis had middle-sized infarcts, and patients with ataxic hemiparesis or the dysarthria-clumsy hand syndrome had the smallest infarcts. Although it has been proposed that the type of lacunar syndrome is determined entirely by the infarct location, our results suggest that infarct size is another important factor influencing the clinical presentation of lacunar syndromes.

Right perirenal space. Computed tomography evidence of communication between the bare area of the liver

Computed tomography (CT) images from one cadaver and 11 patients with perirenal fluid collection were reviewed to study whether the right perirenal space communicates with the bare area of the liver. CT of a cadaver obtained after meticulous right perirenal injection of contrast media showed that contrast media extended superiorly into the bare area of the liver. CT of 11 patients with right perirenal hemorrhage or infection showed that fluid collection within the right perirenal space continued upward, crossing the coronary ligament, extending into the bare area of the liver. The inferior vena cava were completely or partially surrounded by fluid. CT of two patients with bleeding hepatocellular carcinoma showed that blood in the bare area continued extending downward into the perirenal space. We conclude that the right perirenal space is open toward the bare area of the liver and fluid collection within one space may communicate with the other space across the coronary ligament.

HIV-1 reverse transcriptase purified from a recombinant strain of Escherichia coli

A better understanding of the structure and biochemical properties of the replicative machinery of human immunodeficiency virus type 1 (HIV-1) may be useful in the screening and design of drugs that could be used to treat AIDS. We have previously described a recombinant strain of Escherichia coli that produces HIV-1 reverse transcriptase (RT). Fermentation conditions for the large-scale growth of the bacterial strain and a protocol for the purification of an enzymatically active 66-Kd form of the RT have been developed. The purified RT has all of the appropriate enzymatic functions and properties. The recombinant protein can be substituted for the viral enzyme in structural and biochemical studies and used in screens for drugs that could inhibit HIV replication.

Nodular hepatocellular carcinoma--treatment with intraarterial injection of I-131 Lipiodol

Twenty four patients with hepatocellular carcinoma who refused surgery or had unresectable tumor ranging 2.5 to 8.0 cm in size were treated with intrahepatic arterial injection of iodine-131-labeled iodized oil (I-131 Lipodol) in an attempt to achieve internal radiation of tumor. 555-2,220 MBq in 3-8 ml of I-131 Lipiodol was injected into the hepatic artery or proximal to the tumor feeding vessel depending on the tumor size. Tumor size reduction was observed in 88.9% of tumor smaller than 4.0 cm in diameter, 65.5% between 4.1 to 6.0 cm, and 25.0% of larger than 6.1cm, respectively. The tumor size reduction was corresponded to the gradual drop of serum AFP levels, decreased uptake on gallium-67 scintigraphy, and devascularization on follow-up angiography. Tumors having significant A-V shunts revealed further tumor growth. Adverse reactions from the treatment include fever, mild abdominal pain, nausea and elevation of transaminases. These have been mild and well-tolerated by the patients. This method was able to provide long term local control without complications related to thyroid, lung, GI tract and bone marrow.

Leptospirosis in Chonbuk Province of Korea in 1987: a study of 93 patients

Leptospirosis is a zoonosis with protean clinical manifestation. Diagnosis requires a high index of suspicion and is confirmed by isolation of the organism or, more commonly, by serologic studies. In the fall of 1987, after severe flooding, we saw 93 patients with leptospirosis, confirmed by a microagglutination test. Thirteen percent of the patients had no clinical or laboratory findings except fever and headache, but the rest had mild to severe manifestations. Jaundice, renal failure, and aseptic meningitis were not common, but pulmonary symptoms, when present, were striking. The mortality rate was 5%. The main cause of death was asphyxiation due to massive hemoptysis from pulmonary hemorrhage and acute respiratory failure.

Viruses as a triggering factor of type 1 diabetes and genetic markers related to the susceptibility to the virus-associated diabetes

Type 1 diabetes results from the destruction of insulin-producing pancreatic beta cells. Genetic and environmental factors are implicated in the beta cell destruction. As environmental factors affecting the induction of type 1 diabetes, diabetogenic viruses, chemicals, toxins, and diet are likely candidates as either primary injurious agents of beta cells or triggering agents for the induction of autoimmunity. Regarding viruses as a triggering factor of type 1 diabetes, there are at least two different pathogenic mechanisms in virus-induced diabetes: cytolytic infection of beta cells, leading to their destruction, and triggering of autoimmunity, leading to the autoimmune-mediated destruction of beta cells. Since there is no correlation between the induction of antibodies to Coxsackie B viruses and the presence of islet cell autoantibodies in patients with type 1 diabetes, the induction of diabetes by Coxsackie B viruses may be due to cytolytic infection of beta cells rather than an autoimmune response. In contrast, rubella virus and cytomegalovirus (CMV) do appear to be somehow associated with autoimmune type 1 diabetes since there is a strong correlation between the presence of islet cell autoantibodies and persistent infections. Regarding genetic factors, there are distinct markers related to the susceptibility to Coxsackie B4 virus-associated type 1 diabetes and CMV-associated type 1 diabetes. Four specific DNA restriction endonuclease fragments (BamHI-DQ-beta 6.6, TaqI-DR-beta 4.3, TaqI-DR-beta 2.5 and TaqI-DR-beta 1.5 kb) are related to the susceptibility to Coxsackie B4 virus-associated type 1 diabetes while six specific DNA restriction endonuclease fragments (BamHI-DQ-alpha 12.5, -beta 3.7 and -beta 3.2 kb, TaqI-DQ-alpha 7.2, -beta 7.2 and -beta 5.4 kb) are related to the susceptibility to CMV-associated type 1 diabetes.

Coxsackie B virus assays in IDDM families: the GAW5 data on antibody prevalence

There is evidence that infection by Coxsackie viruses can serve as an environmental "trigger" for insulin-dependent diabetes mellitus (IDDM). This background information is summarized briefly, and the data in the IDDM component of Genetic Analysis Workshop 5 (GAW5) concerning serum antibodies to Coxsackie B viruses are described.