Successful multidisciplinary treatment of an endodermal sinus tumor of the pineal region

The case presented is a 17-year-old male patient with a pineal region endodermal sinus tumor manifested by obstructive hydrocephalus and upward gaze limitation. The highly aggressive nature of this rare malignancy was evidenced by spontaneous tumor bleeding. The patient was treated with a cerebrospinal fluid (CSF) shunt and microsurgical tumor excision followed by irradiation and combination chemotherapy consisting of cisplatin, vincristine, methotrexate and bleomycin. The response to therapy was monitored by serial measurements of serum and CSF alpha-fetoprotein level. The patient remains free of any clinical or radiographic evidence of tumor recurrence 38 months after the initial diagnosis. This experience supports the rationale for an aggressive multidisciplinary approach toward this rare and highly malignant neoplasm.

Sequence-independent inhibition of in vitro vascular smooth muscle cell proliferation, migration, and in vivo neointimal formation by phosphorothioate oligodeoxynucleotides

Phosphorothioate oligodeoxynucleotides (PS oligos) are antisense (sequence-specific) inhibitors of vascular smooth muscle cell (SMC) proliferation when targeted against different genes. Recently an aptameric G-quartet inhibitory effect of PS oligos has been demonstrated. To determine whether PS oligos manifest non-G-quartet, non-sequence-specific effects on human aortic SMC, we examined the effects of S-dC28, a 28-mer phosphorothioate cytidine homopolymer, on SMC proliferation induced by several SMC mitogens. S-dC28 significantly inhibited SMC proliferation induced by 10% FBS as well as the mitogens PDGF, bFGF, and EGF without cytotoxicity. Moreover, S-dC28 abrogated PDGF-induced in vitro migration in a modified micro-Boyden chamber. Furthermore, S-dC28 manifested in vivo antiproliferative effects in the rat carotid balloon injury model. S-dC28 suppressed neointimal cross-sectional area by 73% and the intima/media area ratio by 59%. Therefore, PS oligos exert potent non-G-quartet, non-sequence-specific effects on in vitro SMC proliferation and migration as well as in vivo neointimal formation.

Intelligence quotient in childhood acute lymphoblastic leukemia after prophylactic treatment in central nervous system with 18 Gy cranial irradiation and intrathecal methotrexate

The purpose of this study is to evaluate whether central nervous system prophylactic treatment (CNSP) with cranial irradiation therapy (CrRT) 18 Gy and intrathecal methotrexate would decline the intelligence quotient (IQ) scores of children with acute lymphoblastic leukemia (ALL). In protocol TCL 842, children with ALL received CrRT 18 Gy in 12 fractions, and 5 concomitant doses of intrathecal methotrexate 15 mg/m2/dose with 15 mg as the maximum, for CNSP after remission achieved. The first IQ test was performed immediately after CNSP. Those who had no CNS relapse for more than 5 years after CNSP had a second IQ test. For children between 3 and 6 years old, the Stanford-Binet (S-B) IV test was used, and for older children, the Wechsler Intelligence Scale for Children-Revised (WISC-R) was used. Fourteen consecutive children at our hospital were enrolled. There were 7 boys and 7 girls. The age at diagnosis ranged from 3 to 9 years old. Two of them were in the high-risk group, eight in the intermediate-risk group, and four in the standard-risk group. The IQ scores of all patients fell within the average range. In the first IQ tests, the mean IQ score was 104.29 (range 83-124, S.D. 14.55). In the second IQ tests, the mean IQ score was 100.93 (range 85-128, S.D. 11.57). Statistically, there was no significant difference between the first and second IQ scores (paired t-test, two-tailed P = 0.4232; one-tailed P = 0.2116). Our findings suggested that CNSP used in protocol TCL 842 did not reduce IQ scores of children with ALL 5 years after CNSP.

Transthoracic endoscopic sympathectomy for primary palmar hyperhidrosis in children

Primary palmar hyperhidrosis often starts in childhood. It usually causes academic and social disabling at the age children begin primary school. This study included 65 children (44 girls and 21 boys, mean age 13.5 years) who underwent one-stage bilateral transthoracic endoscopic sympathectomy. The proper sympathetic segment was visualized in almost all cases and electrocautery ablation was performed. The immediate postoperative course was uneventful in all cases and no major morbidity was encountered. Horner's syndrome did not occur in any case. All patients were discharged the day of surgery or after an overnight stay. The duration of follow-up was from 6 months to 3 years. Although compensatory sweating was found in 40% of the patients, long-term satisfaction was reported in 63 cases (96%). This procedure is effective, simple, and is recommended as the method of choice for surgical treatment of severe upper extremity hyperhidrosis in children.

Group B streptococcal cellulitis of perineum and lower abdomen: report of one case

This report describes a 4-week-old female baby with disseminated group B streptococcus (GBS) infection. The illness began as a swelling with violaceous hue of perineum and lower abdomen, a manifestation that may be falsely attributed to a traumatic injury. GBS septicemia, meningitis and cellulitis of lower abdomen was confirmed by cultures. This case illustrated an unusual presentation of GBS infection as cellulitis of lower abdomen. The presence of concurrent septicemia and meningitis in this case indicated that a more extensive diagnostic work-up and a more aggressive therapeutic approach are needed for young infants with cellulitis.

Epoxidation of trans-4-hydroxy-2-nonenal by fatty acid hydroperoxides and hydrogen peroxide

In this study, we reported that fatty acid hydroperoxides and hydrogen peroxide are capable of epoxidizing 4-hydroxy-2-nonenal, a lipid peroxidation product, to the mutagenic epoxide. The evidence of its formation is provided (i) by trapping with [8-3H]deoxyadenosine for the formation of 7-(1',2'-dihydroxyheptyl)-1,N6-ethenodeoxyadenosine as a pair of diastereomers, (ii) by derivatization with (2,4-dinitrophenyl)hydrazine in acidic methanol, and (iii) by comparing its 1H-nuclear magnetic resonance and mass spectra to those of the authentic standard. After incubating 4-hydroxy-2-nonenal with 9- or 13-linoleic acid hydroperoxide at 37 degrees C for 24 h, the epoxide was produced in 13.4% or 12.5% yield, and with hydrogen peroxide, the yield was 21.5%. In the presence of fatty acid (linoleic acid, gamma-linolenic acid, or arachidonic acid) and lipoxygenase, the epoxide of 4-hydroxy-2-nonenal was formed in 15.3%, 7.2%, or 6.2% yield, respectively. The xanthine/xanthine oxidase/superoxide dismutase system generated the epoxide in 1.2% yield. These yields are estimated on the basis of a standard curve obtained from reactions of deoxyadenosine and epoxide. These results show that 4-hydroxy-2-nonenal is epoxidized by biological oxidants, suggesting a plausible endogenous pathway for the in vivo formation of etheno adducts.

On the consistency of a physical mapping method to reconstruct a chromosome in vitro

During recent years considerable effort has been invested in creating physical maps for a variety of organisms as part of the Human Genome Project and in creating various methods for physical mapping. The statistical consistency of a physical mapping method to reconstruct a chromosome, however, has not been investigated. In this paper, we first establish that a model of physical mapping by binary fingerprinting of DNA fragments is identifiable using the key assumption-for a large randomly generated recombinant DNA library, there exists a staircase of DNA fragments across the chromosomal region of interest. Then we briefly introduce epi-convergence theory of variational analysis and transform the physical mapping problem into a constrained stochastic optimization problem. By doing so, we prove epi-convergence of the physical mapping model and epi-convergence of the physical mapping method. Combining the identifiability of our physical mapping model and the epi-convergence of a physical mapping method, finally we establish strong consistency of a physical mapping method.

T-cell lymphokines, interleukin-4 and gamma interferon, modulate the induction of vascular smooth muscle cell tissue plasminogen activator and migration by serum and platelet-derived growth factor

Platelet-derived growth factor (PDGF)-induced smooth muscle cell (SMC) fibrinolysis is necessary for SMC migration. In order to determine whether the T-cell lymphokines interleukin-4 (IL-4) and gamma interferon (gamma-IFN) affect SMC fibrinolysis and migration, we examined the effects of human recombinant IL-4 and gamma-IFN on human aortic SMC tissue-type plasminogen activator (TPA), urokinase-type plasminogen activator (UPA), and plasminogen activator inhibitor type-1 (PAI-1) antigen production, as determined by enzyme-linked immunosorbent assays. Although IL-4 had no direct effect on SMC TPA antigen, IL-4 potentiated SMC TPA antigen levels and activity in conditioned media and cellular lysates in media containing 2% fetal bovine serum but did not change UPA or PAI-1 production. gamma-IFN attenuated IL-4 augmentation of SMC TPA antigen production in conditioned media, although gamma-IFN itself had no direct effects on SMC TPA and PAI-1 antigen production. IL-4 augmented PDGF induction of SMC TPA antigen. gamma-IFN inhibited PDGF induction of SMC TPA antigen and IL-4 potentiation of this process. gamma-IFN diminished the promigratory effects of both IL-4 and PDGF on in vitro SMC migration. Tranexamic acid, a plasmin inhibitor, abrogated the stimulation of SMC migration by IL-4. Therefore, IL-4 and gamma-IFN modulate the induction of SMC TPA and SMC migration by 2% fetal bovine serum and PDGF.

[Distant metastasis after irradiation alone in carcinoma of the uterine cervix--the patterns and results]

From 1988 to May, 1992, there were 286 patients with pathology-proved carcinoma of the uterine cervix referred to Chang Gung Memorial Hospital, Kaohsiung to receive definite radiotherapy. Sixty-one (21%) patients were found to develop distant metastasis after radiotherapy for at least 2 years follow-up. By FIGO stage, the incidence of distant metastasis was as follows: I :2/39, II a:1/19, II b:20/118, III :34/101, IV a: 4/9. Eighty-five percent patients (52/61) began to develop distant metastasis within the first 2 years after radiotherapy. Twenty-three patients developed single organ metastasis, and 38 patients developed multiple organ metastasis. Lymph nodes (38 patients), lung (28 patients), bone (27 patients), and abdomen (20 patients) were the common sites of distant metastasis. Lymph nodes metastasis occurred most often at supraclavicular lymph nodes (15 patients), para-aortic lymph nodes (18 patients), and inguinal lymph nodes (5 patients). Spine (23 patients), especially the lumbar spine (20 patients) was the most common site of bony metastasis. Abdominal metastasis occurred in abdominal cavity (15 patients) or liver (5 patients). The incidence of metastasis within the first two years after radiotherapy was lung: 75% (21/28), bone: 62% (18/29), left supraclavicular lymph nodes: 60% (9/15), para-aortic lymph nodes: 72% (13/18), intra-abdominal cavity: 86% (13/15), liver: 66% (2/3), brain: 0% (0/4). The 2-year actuarial survival rate for the 61 patients after developing distant metastasis was 14%, with a median survival time of 6.4 months. There was no significant difference in survival when comparing patients with single organ metastasis and with multiple organ metastasis (p > 0.05), or patients with distant metastasis alone and with distant metastasis combined with local recurrence (p > 0.05). Otherwise, after distant metastasis twenty-three patients receiving chemotherapy or radiotherapy had a significantly higher 2-year survival rate than 38 patients receiving supportive care only after distant metastasis (34% vs. 2.4%, p < 0.05).

Peduncular hallucinosis following microvascular decompression for trigeminal neuralgia: report of a case

Peduncular hallucinosis usually presents as a visual disorder and is often a genuine hallucination associated with mesencephalic lesions. A 62-year-old woman with trigeminal neuralgia underwent microvascular decompression for facial pain through a lateral suboccipital approach. The pain completely disappeared after surgery, but a visual hallucination developed on the second postoperative day and continued for 5 days. Magnetic resonance imaging confirmed the lesions around the mesencephalon.

A protease inhibitor of the serpin family is a major protein in carp perimeningeal fluid: I. Protein purification and characterization

Two isoforms of a protease inhibitor of the serpin family (p62) have been purified from bighead carp perimeningeal fluid. Both isoforms migrate with an apparent molecular mass of 62 kDa on reducing and nonreducing sodium dodecyl sulfate-polyacrylamide gels. Both proteins inhibited the activities of bovine trypsin, bovine chymotrypsin, and porcine pancreatic elastase. They also formed complexes with these proteases that were resistant to sodium dodecyl sulfate treatment. p62 exists in the extracts of all tissues examined, including brain, head kidney, kidney, liver, muscle, ovary, pituitary, and spleen. It is also present in serum, ovarian fluid, and milt as well as perimeningeal fluid. The protease inhibitor is a glycoprotein, and its carbohydrate moiety could be removed by endoglycosidase F. Because p62 resembles mammalian alpha 1-antitrypsin in many aspects, it is likely a fish equivalent of alpha 1-antitrypsin.

Use of Tc-99m HMPAO brain SPECT to evaluate cerebral collateral circulation during Matas test

Five patients with traumatic carotid-cavernous fistulae and two patients with internal carotid artery aneurysms inside the cavernous sinus are presented. A quantitative method was used for the evaluation of brain collateral circulation in the anterior and middle cerebral artery territories by using Tc-99m HMPAO SPECT before and during the Matas test. It affords a more reliable quantitative measurement of reduced activity than conventional carotid angiography during the Matas test. In this study, a reduction of radioactivity of less than 15% during the Matas test did not reveal any postoperative neurological deficit after a carotid artery trapping procedure. This noninvasive method seems to be useful to determine the appropriate surgical treatment.

Use of a single lumen endotracheal tube and continuous CO2 insufflation in transthoracic endoscopic sympathectomy

BACKGROUND

Transthoracic endoscopic sympathectomy (TES) is an accepted standard surgical treatment for palmar hyperhidrosis. For anesthetic management, a double lumen endobronchial tube is usually used to deflate the lung on the operative side. Recently we have applied continuous insufflation of carbon dioxide (CO2) into the pleural cavity to merely compress one lung while ventilating both lungs with a conventional single lumen endotracheal tube.

METHODS

We have studied 45 patients (ASA I and II) who underwent bilateral TES, Thirty-three were ventilated by single lumen tube and the other 12 by double lumen endobronchial tube with one lung ventilation. In both groups I and II, CO2 was insufflated slowly through the scope to a intrapleural pressure of 20 cm H2O. Both lungs were ventilated with peak pressure of less than 20 cmH2O at tidal volume of 5-12 ml/kg at 10-16 beats/min.

RESULTS

In these patients, no CO2 retention was noted. Oxygenation and cardiovascular stability were maintained and there were no complications. In the double lumen series, we found that oxygen saturation was less uniform and less stable than those in the single lumen series.

CONCLUSIONS

It is concluded that the use of single lumen endotracheal tube with continuous insufflation of CO2 in TES is easy, simple and safe.

An altered spectrum of herpes simplex virus mutations mediated by an antimutator DNA polymerase

The mutation spectrum attributable to an antimutator DNA polymerase in a eukaryotic cell was examined. Drug-resistant thymidine kinase (tk) mutants derived from both a wild-type (wt) strain, KOS and an antimutator DNA polymerase (pol) mutant, PAAr5, of herpes simplex virus (HSV), were isolated, and the mutated tk genes were characterized at the sequence level. While both transition and frameshift mutations were found in the mutated tk genes derived from the wt KOS Pol, all the PAAr5-mediated mutants analyzed were frameshift mutations. These results imply that the wt HSV Pol is less faithful than the antimutator enzyme, at least in part, because of its propensity to mediate transition mutations.

Kluver-Bucy syndrome: report of a case with nasopharyngeal cancer after irradiation and chemotherapy

A case of Kluver-Bucy syndrome associated with delayed cerebral necrosis after radiation therapy and chemotherapy is reported. The patient--a 51-year-old man who was a victim of nasopharyngeal cancer--developed a complex behavioral disturbance consisting of visual agnosia, alteration of sexual behavior, strong oral tendency, placidity, memory deficit and speech disturbance one year after two courses of irradiation and chemotherapy. Brain computed tomography disclosed bilateral temporal hypodensity with edema. The patient expired from cachexia three months later. The clinical picture fulfilled the criteria of Kluver-Bucy syndrome. It should be emphasized that this syndrome may occur after irradiation and chemotherapy in patients with nasopharyngeal cancer.

Formation of etheno adducts in reactions of enals via autoxidation

4-Hydroxy-2-nonenal (HNE) and crotonaldehyde (CA) are alpha,beta-unsaturated aldehydes (enals) produced by lipid peroxidation. Previous studies have shown that enals form tricyclic propano adducts with purine nucleosides. When epoxidized by tert-butyl hydroperoxide, enals yield the more reactive epoxy aldehydes which are capable of modifying adenine and guanine in DNA by forming etheno adducts. The epoxides are considerably more mutagenic and tumorigenic than the parent aldehydes. In this study, we found that, in addition to the propano adducts, etheno adducts are detected upon incubation of enals with deoxyadenosine (dAdo) or deoxyguanosine (dGuo) at 37 degrees C (pH 7.4). When carried out under oxygen-enriched atmosphere, the reaction of HNE with dAdo yielded 1,N6-ethenodeoxyadenosine (1,N6-EdAdo) and 7-(1',2'-dihydroxyheptyl)-1,N6-EdA in 0.03% and 0.48% yield. The reaction with dG gave 0.19% 1,N2-ethenodeoxyguanosine (1,N2-EdGuo) and 0.79% 7-(1',2'-dihydroxyheptyl)-1,N2-EdGuo. In the case of CA, the reaction with dAdo produced 7-(1'-hydroxyethyl)-1,N6-EdAdo in 0.67% yield, while the reaction with dGuo yielded 0.34% 1,N2-EdGuo and 0.97% 7-(1'-hydroxyethyl)-1,N2-EdGuo, respectively. When the above reactions were carried out under nitrogen, yields of etheno adducts were significantly reduced. These results provide evidence for a pathway by which the etheno adducts may be formed by enals via autoxidation.

Arsenic-related Bowen's disease and paraquat-related skin cancerous lesions show no detectable ras and p53 gene alterations

We have investigated point mutations of codons 12, 13, and 61 in H-, K-, and N-ras oncogenes as well as p53 tumour suppressor gene exon 5 through exon 9 by PCR-SSCP analysis in 26 skin biopsy tissues from 16 arsenic-related Bowen's disease patients and 6 skin samples from 4 paraquat manufacturing workers. No mutation was found. These results are different from findings with UV associated skin cancers. Interestingly, a silent change at codon 27 of H-ras in one allele was detected in all 4 paraquat manufacturing workers and in 2 of 16 arsenic-related Bowen's disease patients. It is likely that the molecular mechanisms involved in arsenic and paraquat induced skin cancers differ from sunlight-related skin malignancies.

Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis

OBJECTIVE

Transthoracic endoscopic electrocauterization of the sympathetic chain for palmar hyperhidrosis is presented.

DESIGN

A retrospective study of 180 patients during a 2-year period was carried out. The duration of follow-up was from 2 to 12 months.

SETTING

General community, referral center, and hospitalized care.

PATIENTS

This study was carried out in 180 patients (116 female and 64 male). The age distribution was between 13 and 43 years (mean age, 21.6 years). They complained of palmar hyperhidrosis without other underlying diseases.

INTERVENTIONS

One-stage bilateral surgery except for three patients with unilateral pleural adhesions.

MAIN OUTCOME MEASURES

Patients were interviewed 1 week after surgery and then they were contacted by a questionnaire about improvement of hyperhidrosis and complications.

RESULTS

This procedure shows a success rate in 98% of the patients. No pneumothorax requiring a chest tube drainage and no Horner's syndrome were recorded. The most common side effect was compensatory sweating in 70% of these patients.

CONCLUSION

This procedure is effective, simple, and requires only an overnight study. It is recommended as the method of choice for surgical treatment of upper extremity hyperhidrosis.

A 32P-postlabeling method for simultaneous detection and quantification of exocyclic etheno and propano adducts in DNA

A 32P-postlabeling method is described that specifically detects and quantifies the 1,N2-propanodeoxyguanosine adducts derived from acrolein (AdG) and crotonaldehyde (CdG) and 1,N2-ethenodeoxyguanosine (EdG) in DNA. These exocyclic adducts are potential DNA lesions caused by exposure to enals as environmental pollutants and as endogenous compounds. This method was developed with the use of the synthetic adduct standards of these exocyclic adducts. The assay relies on HPLC for adduct enrichment prior to labeling and for quantitation and identification after labeling. The labeling efficiencies of adducts at the 1 fmol level ranged from 74 to 96%, whereas they were only 49-60% at the 100 fmol level. This method can detect as low as 0.2 fmol of adduct and allows the detection and quantitative determination of stereoisomers of AdG and CdG. The method was validated by using a sample of enzyme digests of 180 micrograms calf thymus DNA spiked with 25 or 75 fmol of adducts, which is equivalent to 5 or 15 adducts in 10(8) nucleotides. The recovery rates of these adducts in DNA ranged from 30 to 90% at the 25 fmol level and 21 to 55% at the 75 fmol level. Similar to the labeling efficiency, a greater recovery was observed with a lower amount of adduct in DNA. Overall, this method allows the simultaneous identification and quantification of exocyclic adducts AdG, CdG and EdG in DNA. Therefore, it provides a potential tool for studies of the in vivo formation of exocyclic adducts.

Sympatholytic effect of captopril in regression of cardiovascular remodeling in spontaneously hypertensive rats

Fifty-eight spontaneously hypertensive rats (SHR) at 12 wk of age were divided into 3 groups: A) captopril (Cap) 20 mg.kg-1.d-1; B) clonidine (Clo) 30 micrograms.kg-1.d-1; C) Clo 30 micrograms.kg-1.d-1 + Cap 20 mg.kg-1.d-1 orally for 24 wk. Concomitant administration of Cap and Clo did not result in more lowering of the systolic blood pressure (SBP) than that by Cap alone. Regression of left ventricular hypertrophy (LVH) were remarkable in Groups A and C, but not to the extent in that of WKY. No significant difference between these two groups was found. Cap alone resulted in a greater decrease of myocardial norepinephrine (NE) than that of Groups B and C. The wall/lumen ratio and the number of smooth muscle cell (SMC) layers of renal artery decreased in Groups A and C, but little difference was found between them. It seemed that combined blockade of renin-angiotensin-aldosterone (RAA) system and sympathetic nervous system (SNS) did not produce more significant BP reduction and reversal of cardiovascular remodeling than Cap alone did. The sympathetic inhibitory effect of angiotensin converting enzyme inhibitor (ACEI) was not enhanced by sympatholytic treatment.

Formation of the acrolein-derived 1,N2-propanodeoxyguanosine adducts in DNA upon reaction with 3-(N-carbethoxy-N-nitrosamino)propionaldehyde

3-(Methylnitrosamino)propionaldehyde (MNPA) is a carcinogenic nitrosamine formed by nitrosation of arecoline, a major alkaloid in areca nut which is a constituent of betel quid. While DNA adducts of its analogue, 3-(methylnitrosamino)propionitrile, have been characterized, little is known about the structures of DNA adducts by MNPA. In this paper, we report that the acrolein-derived 1,N2-propanoguanine adducts are formed upon incubating deoxyguanosine or DNA with 3-(N-carbethoxy-N-nitrosamino)propionaldehyde, a stable carbamate precursor of the metabolically activated MNPA. The identities of these adducts were confirmed by HPLC co-migration, by their NMR and UV spectra, and by chemical properties as compared with those of the synthetic standards. Analogous results were obtained from the reaction of the carbamate with calf thymus DNA. Upon acid or enzyme hydrolysis of the carbamate-modified DNA, acrolein-guanine adducts were detected, and the levels were quantitated. Again, the identities of the adducts were verified by co-chromatography with the standards, by UV spectroscopy, or by the ring-opening with NaOH/NaBH4. Consistent with its ability to modify DNA, the carbamate was found to be mutagenic in Salmonella tester strains. These results show that acrolein is a likely metabolite from the activation of MNPA and that the formation of 1,N2-propanoguanine adducts may contribute to the mutagenicity of the carbamate of MNPA.

Routine administration of phenobarbital for the prevention of intraventricular hemorrhage in premature infants: five years' experience

After it was reported in 1981 that phenobarbital reduced the incidence of intraventricular hemorrhage from 46.7% in control infants to 13.3% in treated premature infants, routine phenobarbital prophylaxis (loading dose, 20 mg/kg; maintenance, 5 mg/kg per day for 5 days) was introduced at the hospital of the original trial for all premature infants with birth weights of < or = 1800 gm. To assess continued efficacy, we reviewed all records of these infants from 1985 through 1989. The overall incidence of intraventricular hemorrhage was 27.5% (168/612); the proportion of severe intraventricular hemorrhage (grade 3 and 4) was 41.1% (69/168). The incidence of intraventricular hemorrhage was lower when loading occurred at < 4 hours: 25.9% (124/478) versus 32.8% (44/134). Outborn infants had a higher incidence of intraventricular hemorrhage than inborn infants (45.3% vs 23.0%). In addition to already known risk factors (gestational age, vaginal delivery, outborn status, pneumothorax, birth asphyxia, patent ductus arteriosus), intraventricular hemorrhage occurred more often in infants with hyperoxia (PO2 > 180 mmHg), hypocarbia (PcO2 > 28 mmHg), hypercarbia (PcO2 > 55 mmHg), and hypotension and hypertension (blood pressure > norm +/- 15 mmHg). These results support the hypothesis that phenobarbital has a role in the prophylaxis against intraventricular hemorrhage. Differences in the efficacy of phenobarbital prophylaxis between various studies may be caused by variations of age at loading and differences in the proportion of very low birth weight infants.(ABSTRACT TRUNCATED AT 250 WORDS)

Mutational analysis of the cation-independent mannose 6-phosphate/insulin-like growth factor II receptor. A consensus casein kinase II site followed by 2 leucines near the carboxyl terminus is important for intracellular targeting of lysosomal enzymes

The cation-independent mannose 6-phosphate/insulin-like growth factor II receptor (CI-MPR) mediates intracellular sorting of lysosomal enzymes, binding lysosomal enzymes in the Golgi and delivering them to a lysosomal compartment. The receptor also mediates endocytosis of extracellular ligands. We have devised a new method that rigorously measures function of the CI-MPR in intracellular sorting and used it to identify a previously uncharacterized signal near the COOH terminus of the receptor that is required for sorting. We stably transfect mutant receptors into CI-MPR-deficient mouse L cells, isolate homogeneous clonal cell lines that express a range of receptor levels for each mutant, and assay each cell line for levels of receptor expression and secretion of total phosphorylated lysosomal enzymes. Examination of the secretion phenotype of the cells as a function of receptor levels provides a sensitive indicator of the intrinsic sorting efficiency of each mutant receptor. We find that chimeric CI-MPRs that contain the bovine extracytoplasmic domain and the human or mouse transmembrane and cytoplasmic domains function identically to the bovine receptor, thus demonstrating that sorting signals are conserved. Analysis of a series of truncation and alanine scanning mutants reveals that a consensus casein kinase II site followed by 2 leucines near the COOH terminus that has the sequence (-10)DDSDEDLL(-3) is important for receptor function in sorting of lysosomal enzymes.

2,3-epoxy-4-hydroxynonanal as a potential tumor-initiating agent of lipid peroxidation

Trans-4-hydroxy-2-nonenal (HNE) is a product of lipid peroxidation. In the presence of t-butyl hydroperoxide the racemic HNE readily converts to its epoxide, 2,3-epoxy-4-hydroxynonanal (EH), as a pair of diastereomers. In this study, the potential roles of HNE and EH as tumor initiating agents were assessed. The mutagenicities of HNE and EH isomers in Salmonella strains TA100 and 104 were examined. In addition, the tumor initiating activities of HNE and EH were evaluated in bioassays involving either topical application in CD-1 mice or i.p. administration in newborn CD-1 mice. In the mutagenicity assays, EH isomers induced similar levels of revertants in both tester strains, although EG isomers were previously shown to react with bases in DNA with different specificity (Sodum, R.S. and Chung, F.-L., Cancer Res., 51, 137-143, 1991). The major isomer induced approximately 20,000 revertants/mumol in TA100 and 15,000 revertants/mumol in TA104, whereas, the minor isomer induced approximately 40,000 revertants/mumol in TA100 and 20,000 revertants/mumol in TA104. HNE was, however, not mutagenic under the assay conditions. In the tumor bioassays, EH was a weak tumorigen in CD-1 mice upon topical application followed by TPA promotion, yielding 0.55 tumors/mouse and 40% tumor incidence at a total dose of 128 mumol/mouse versus 0.02 tumors/mouse and 5% tumor incidence in the control group. Both HNE and EH induced liver tumors in male mice, but not in female mice. However, the incidences were not statistically significant. EH administered i.p. at a total dose of 200 nmol/mouse exacerbated the chronic spontaneous nephropathy in newborn CD-1 mice. Although the incidence of mild nephropathy was comparable in both EH-treated and control groups, the incidence of more severe lesions in mice treated with 200 nmol/mouse was 21%; while it was 0% in the control group. Furthermore, two mice at each dose level of EH showed a tubule profile with complex hyperplastic lining, suggestive of atypical hyperplasia. Again, HNE was not as active as EH in these bioassays. These results suggest a possible role of EH in tumorigenesis associated with lipid peroxidation.

Metastatic atrial myxoma presenting as intracranial aneurysms with hemorrhage: case report

A 68-year-old woman, developed subsequent recurrent hematomas of the left occipital lobe about 1 year after open-heart surgery for the left atrial myxoma. Radiological studies revealed multiple intracranial aneurysms with hemorrhage. Microscopic examination showed the presence of myxoma invasion of the vascular wall with aneurysmal formation and organized hematoma.

Facial pain relieved by dorsal root entry zone lesions in the trigeminal nucleus caudalis: report of two cases

Microvascular decompression by suboccipital craniectomy often cures medically untreatable trigeminal neuralgia. However, pain involving the same distribution persists in a few patients despite surgical treatment. In two cases, one with postherpetic pain and the other with tic douloureux, the author used the radiofrequency lesion technique in the dorsal root entry zone of the trigeminal nucleus caudalis to treat the surgically-failed cases of trigeminal neuralgia. The pain ceased postoperatively and has not recurred during three to four years of follow-up. Trigeminal nucleus caudalis surgery provides a satisfactory solution to this relatively rare pain syndrome.

Repeat balloon occlusion of a pulmonary arteriovenous fistula following cavopulmonary anastomosis in tetralogy of Fallot

A 30-year-old woman with tetralogy of Fallot and cavopulmonary anastomosis (Glenn shunt) presented with a large pulmonary arteriovenous fistula in the right lower lobe. This report describes the successful management following two successive therapeutic balloon embolizations.

Spinal epidural meningioma in a child

A case of spinal epidural meningioma in a 14-year-old girl is presented. Myelographic and computed tomographic findings led to the preoperative diagnosis of a metastatic lesion. Histological examination revealed the tumor to be a meningioma. Total resection was accomplished and the patient made a very good neurological recovery. A review of the literature reveals that these tumors have rarely been reported, especially in childhood.

Occurrence of nasopharyngeal carcinoma in aboriginals of Taiwan: report of 14 cases

The authors describe the rare occurrence of nasopharyngeal carcinoma (NPC) in 14 aboriginals of Taiwan (ABT), a minor ethnic group now accounting for less than 2% of the total population in Taiwan. The observation is epidemiologically unusual, representing a low-risk ethnic group in an NPC prevalent area. With regard to patient characteristics, symptomatology and pathology, we have not found any appreciable differences in reports from other geographic areas. Serological profiles of antiEBV-VCA (Epstein-Barr virus, viral capsid antigen) antibody in 7/9 patients available for review of IgA and 5/7 patients available for review of IgG were found significantly elevated, ranging respectively from 1:40-640/1:160-1280. Interestingly, 12 of the 14 patients were found to be exclusively from the Paiwan tribe residing in Pintung, a district in southern Taiwan. Since the exact prevalence of NPC in this minority remains unknown, it is not clear whether the apparent preponderance is real or merely causal due in part to geographic bias. To a lesser extent, however, our observations indicate that NPC is not an uncommon malignancy in Paiwan aboriginals of southern Taiwan.

Treatment of cerebellar infarction by decompressive suboccipital craniectomy

BACKGROUND AND PURPOSE

We present an anecdotal series of 11 patients without past history of stroke with progressive neurological deterioration while on medical therapy for large cerebellar infarctions. Clinical signs of brain stem compression developed in these patients. Computerized tomography of the head confirmed mass effect from brain edema. It was the clinical judgment of the neurologists and neurosurgeons that each of these 11 patients would expire without surgical intervention.

METHODS

All 11 patients (seven men, four women; mean age, 54 years) were treated with suboccipital craniectomy for decompression and temporary ventriculostomy for cerebrospinal fluid pressure monitoring and drainage.

RESULTS

Seven patients demonstrated neurological improvement on the first postoperative day. Two patients returned to their previous jobs 3 months after surgery. The Barthel Index indicated that six individuals were functioning with minimal assistance within a follow-up period of 16-60 months. The remaining three were functionally dependent. No mortality was noted in this series.

CONCLUSIONS

These results suggest that decompressive suboccipital craniectomy may be an effective, lifesaving procedure for malignant cerebellar edema after a large infarction.

Urinary ANP, ADH, and electrolyte excretion during saturation-excursion diving to pressures equivalent to 250 and 300 m

Four male divers were exposed to an environment of 26 and 31 atm abs He-O2 for 2 days. Urine was collected during the day (0700-1900 h) and at night (1900-0700 h) before (predive 1 atm abs air), during, and after (decompression and postdive 1 atm abs air) the exposure. Urine flow increased markedly and was mostly attributable to the urine flow during 1900-0700 h. The secretion of atrial natriuretic polypeptide (ANP) increased only at night during hyperbaria. On the other hand, the secretion of antidiuretic hormone (ADH) was suppressed, but increased during compression and the early phase of hyperbaric exposure before it decreased. Linear regression analysis showed that urinary excretion of ANP was correlated significantly with urine flow (r = 0.88, P less than 0.01) and that excretion of ADH negatively correlated with urine flow (r = -0.61, P less than 0.01). Urinary excretion of Na, Cl, Ca, and Mg increased significantly at night during hyperbaria, whereas there was no consistent change in the excretion of K and P. These results suggest that both stimulated ANP secretion and suppressed ADH secretion correlate with the increase of urine and that nocturia is mostly attributable to stimulated ANP secretion. We observed that urinary excretion of ANP increased significantly as early as during the compression phase, which suggested that ANP plays a decisive role in the early diuresis.

Dorsal root entry zone lesions in the treatment of pain following brachial plexus avulsion and herpes zoster

Fifteen patients with brachial plexus avulsion injury and four patients with postherpetic pain submitted to dorsal root entry zone surgery. Nashold's method was used in all cases. The initial results in the group with brachial plexus avulsion injury were satisfactory. Twelve patients experienced pain relief. Only one patient had a poor result. Ten patients (66%) continued to have good pain relief in the follow-up period of 15-48 months. Three patients with postherpetic pain had good pain relief in the initial stage after surgery. Two of these four cases were found to have a recurrence of some pain, which could be relieved more or less by oral analgesics. No mortality or major complications were found in this series, although eight patients complained postoperatively of mild sensory weakness which disappeared within two weeks.

Documentation of successful treatment of prosthetic mitral valve thrombosis with intravenous urokinase infusion for twenty-four hours

Prosthetic valve thrombosis is a life-threatening situation requiring prompt diagnosis and treatment. Treatment has usually been surgical and has been associated with a high mortality. Thrombolytic therapy is a therapeutic alternative to surgery and has been successful in a number of cases. This report concerns the technique used to diagnose the condition, treatment strategy, and documentation of the results of therapy.

Application of magnetic resonance imaging in functional stereotactic thalamotomy for the evaluation of individual variations of the thalamus

An application of MRI in functional stereotactic thalamotomy is presented. To estimate the individual anatomic variations of the thalamus prior to stereotactic thalamotomy, a special study using a proton density image that shows myeloarchitectonic features of the thalamus was performed. The proton density MRI was demonstrated to be very useful to determine the safest trajectory and tentative target point. However, as a detailed functional localization of the thalamic subnuclei cannot be yet obtained by MRI, the final target should be decided on the basis of electrophysiological findings.

Measurement of tissue impedance in dorsal root entry zone surgery for pain after brachial plexus avulsion and herpes zoster

Fifteen patients with brachial plexus avulsion and five patients with postherpetic pain underwent dorsal root entry zone surgery with intraoperative impedance monitoring. The usual range of initial impedance values recorded in the superficial layers of the normal cord is from 1,000 to 1,500 omega. The recordings usually decrease to less than 1,000 omega in the segments of root avulsion injuries. Some variation in recordings occurs owing to atrophy and scarring of the damaged cord. In postherpetic neuralgia, measurements of impedance are abnormally low in the involved area, in which the roots appear macroscopically abnormal. In this study, tissue impedance was correlated with gross pathologic changes in the spinal cord.

Rotavirus gastroenteritis in children: a clinical study of 125 patients in Hsin-Tien area

During a 2-year period from January 1988 to December 1989, 125 patients (68 boys, 57 girls), aged 30 days to 9 years, were diagnosed as rotavirus gastroenteritis at this hospital. Diagnosis was made by identification of the rotavirus antigen in stool samples by latex agglutination assay. Ninety-nine (79.2%) of them were under 2 years of age. The seasonal peak in incidence was from January to March. The most common clinical characteristics were watery diarrhea (100%), followed by vomiting (68.8%), fever (68.0%), cough (42.4%), rhinorrhea (17.6%), convulsions (6.4%) and moderate to severe dehydration (1.6%). Fecal occult blood was positive in 4 patients and fecal leukocytes were positive in one patient. Stool cultures revealed concomitant infections with enteropathogenic Escherichia coli in 4 patients. Of the 106 patients who underwent serum electrolyte examinations, serum sodium concentrations ranged from 135-145 meq/L in 81.9% (86/106) and serum potassium concentrations ranged from 3.5-5.0 meq/L in 86.8% (92/106). Leukocyte counts greater than 15,000/mm3 were found in 10.8% (13/120) of the patients. All 125 patients recovered from the diarrheal illness on follow-up. Our results showed a different seasonal distribution of this disease from that of a previous observation between 1983-1984 in Taipei City and provides original clinical information on rotavirus gastroenteritis in children living in an area of Taipei County. Using the simple and rapid latex agglutination assay, we can make early diagnosis of rotavirus gastroenteritis. Thus, early treatment and early isolation of patients to prevent nosocomial infection among hospitalized patients is possible.

[A modified technique of obturator fabrication for cleft palate infants]

Cleft palate is a commonly observed congenital maxillofacial defect. The first problem to be faced is the interference of feeding. It is a hard challenge for both the parents and the dentist. A cleft palate infant is unable to produce negative pressure in the oral cavity, thus resulting in feeding difficulty. The maxillary obturator resolves feeding problem and induces better maxillary growth patterns before operation. The maxillary obturator should be applied as early as possible to avoid the post surgical problems. The material for traditional obturator is tough and often injures the soft tissue. In order not to interfere with the growth of the dental arch, the border of the obturator must be trimmed regularly, until the retention becomes insufficient. In this paper, a modified technique of obturator fabrication was presented. The new method uses silicone relining material instead of ortho resin, as the packing of the obturator. It has been applied to dozens of patients. After a long follow up and comparison with the traditional method, the advantages of the new design can be summarized as follows: (1) Silicone is softer and does not injure the soft tissue. (2) It does not require the trimming of the border of obturator. (3) It has better retention and comfort for the patients.

[Delayed intracranial aneurysm of left atrial myxoma--a case report]

Although embolism is known as a common complication in the early growing stage of atrial myxoma, development of further neurologic disorders after the removal of tumor is rarely encountered. Arterial aneurysm formation and metastatic tumor growth represent the two disorders that had been reported in the literature. Based on the pathogenesis of hematogeneous disseminating, atrial myxoma may lodge its fragment or its adherent thrombus on intracranial vessels to produce cerebral infarct. Besides, several reports have indicated that myxoma emboli in the cerebral vessels may invade the vessel wall to produce delayed disorders. Embolization from atrial myxoma is now recognized as a potentially treatable cause of cerebral infarct. However, the long-term course following resection of the tumor remain complicated, partly due to these inconsistent delayed complications, or the therapeutic dilemma. We report a case with delayed intracranial aneurysm formation and reviewed the literature. A 67-year old woman with a past history of left cerebral infarction was transferred to our hospital for further evaluation of her gross hematuria. Infarction of the left kidney was then demonstrated by angiography. A left atrial myxoma was found in a echocardiographic screen, and the patient received a successful resection of the myxoma subsequently. Unfortunately, three episodes of stroke developed in a half year after the operation of the cardiac myxoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital spinal arachnoid cysts: report of 2 cases with review of the literature

Two cases of congenital spinal arachnoid cysts with paraparesis are presented. Case 1, a 16-year-old male patient, had a 2-year history of progressive weakness of the lower limbs. Postmyelographic axial computed tomography (CT) and myelography revealed a dorsally located extradural mass. The configuration of the mass was further assessed with magnetic resonance imaging (MRI). He underwent laminectomy from T8 to L1 with total excision of an extradural arachnoid cyst. A communication with the subarachnoid space found at the T8 level was surgically closed. The patient made an uneventful recovery. Case 2, a 9-year-old girl, developed paraparesis and the cauda equina syndrome two days prior to admission. Postmyelographic CT and myelography revealed an anteriorly located intradural mass. She underwent laminectomy from C6 to T2 and partial removal of an intradural arachnoid cyst. One week later, her neurological functions had recovered completely. The literature dealing with this rare spinal lesion is also reviewed.

Nucleotide sequence and estrogen induction of Xenopus laevis 3-hydroxy-3-methylglutaryl-coenzyme A reductase

We have isolated and sequenced overlapping cDNA clones encompassing the entire protein coding region of Xenopus laevis 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA reductase). This 3-kilobase cDNA codes for an 883-amino acid protein, which exhibits extensive amino acid sequence homology to mammalian HMG-CoA reductases. The highly conserved 341-amino acid membrane spanning domain exhibits 89% amino acid sequence identity with hamster HMG-CoA reductase. In contrast to the high degree of homology in the coding regions of the mRNAs, the nucleotide sequences of the 5'- and 3'-untranslated regions of Xenopus and mammalian HMG-CoA reductase mRNAs exhibit negligible homology. Primer extension data suggests that Xenopus HMG-CoA reductase mRNA is transcribed from multiple initiation sites. The Xenopus HMG-CoA reductase cDNA clones were used as hybridization probes to examine estrogen regulation of hepatic HMG-CoA reductase mRNA levels. Northern blot analysis demonstrates that estradiol-17 beta induced HMG-CoA reductase mRNA in livers of male X. laevis 10-fold within 24 h. Reductase mRNA levels reach a plateau 23-fold higher than basal levels between 5 and 8 days after initial estrogen administration. In contrast to the vitellogenin and retinol binding protein genes whose transcription is induced by estrogen in Xenopus liver, the runoff transcription rate of HMG-CoA reductase does not increase significantly on administration of estradiol-17 beta. These data suggest that the estrogen induction of HMG-CoA reductase mRNA may be achieved through posttranscriptional mechanisms.

Conformational changes in ornithine decarboxylase enable recognition by antizyme

Rapid, polyamine-induced degradation of mammalian ornithine decarboxylase (L-ornithine carboxy-lyase, EC 4.1.1.17) (ODC) is though to be controlled by the availability of a small, ODC-binding protein termed antizyme. In this study we have investigated the ability of antizyme to bind ODC protein in various altered physiological states. In particular, cold, NaCl, spermidine and deprivation of coenzyme and substrate enhance enzyme-antizyme complex formation and are all found to promote ODC homodimer dissociation. Conversely, conditions that maintain the active ODC homodimer state prevent antizyme binding and inactivation of ODC. Further, covalent modification of ODC near its active site by difluoromethylornithine or phosphate also increases its sensitivity to antizyme. These results suggest that the initial signal in ODC degradation may actually be a subtle conformational change in the enzyme that enables antizyme to bind to the enzyme and may subsequently facilitate its degradation.

Comparison of hemodynamic changes induced by adenosine monophosphate and sodium nitroprusside alone and during dopamine infusion in the anesthetized dog

Adenosine receptor stimulation, such as by adenosine monophosphate (AMP), elicits systemic vasodilation that may be useful to control cardiac afterload during treatment of acute low-output cardiac failure. This study compared the hemodynamic effects of graded doses of sodium nitroprusside (SNP) with those of AMP when infused alone or in combination with the positive inotropic agent dopamine (DA) in anesthetized dogs. Both SNP (2-25 micrograms.kg-1.min-1) and AMP (200-2500 micrograms.kg-1.min-1) were effective vasodilators and reduced systemic vascular resistance and arterial pressure in a dose-dependent manner. Heart rate and cardiac index were increased by both agents. When compared at dosages that caused similar decreases in arterial pressure, cardiac index was increased more by AMP than by SNP. Also, AMP-induced vasodilation was associated with less tachyphylaxis. Sodium nitroprusside and AMP, at the dosages used, did not depress atrioventricular nodal conduction or antagonize DA-induced increases in renal blood flow. At equivalent decreases in mean arterial pressure, the increase from baseline in cardiac and stroke indices observed with AMP alone was further increased by the concomitant administration of DA. These results suggest that AMP and DA-AMP may offer significant advantages over SNP or DA-SNP in situations where elevation of cardiac output and reduction in afterload are required.

Interrelation between the charge isoforms of mammalian ornithine decarboxylase

Ornithine decarboxylase (ODC) isolated from a variety of tissues has been separated, using DEAE ion-exchange chromatography, into multiple peaks of activity that appear to be related to control of this enzyme stability. Reports of these charge isoforms in current literature are generally unclear as to whether these represent a covalent posttranslational modification or merely an alteration in structural conformation or association. In this study we investigated the relationship of this form separation to the degree of enzyme polymerization, interaction with other proteins and buffer components, and the multiple isoelectric forms of this enzyme noted in denaturing concentrations of urea. High-performance chromatography techniques were used to demonstrate that two of the major enzyme forms, ODC I and II, are really monomers of the enzyme, while minor peaks of activity frequently observed to elute after ODC II contain various dimeric enzyme states. Pyridoxal 5'-phosphate (0.05 mM) added to isolated enzyme preparations composed of I and II monomers induced the formation of I and II dimers as well as a mixed I-II dimer. All three dimer forms were observed to be natural components of freshly isolated crude cell homogenates. The charge distinction between the monomer forms I and II was found to be maintained during ion-exchange chromatography in the presence of 8 M urea, and the enzyme isoforms demonstrated distinct bands on isoelectric focusing gels run in the presence of 9 M urea. Thus, although some of the multiple ornithine decarboxylase forms identified by ion-exchange chromatography of crude mammalian cell homogenates are related to enzyme conformation, the two major forms are distinctly charged protein states that can be visualized using two-dimensional gel electrophoresis of highly purified samples.