Common mutation of plasminogen detected in three Asian populations by an amplification refractory mutation system and rapid automated capillary electrophoresis

Congenital deficiency and dysfunction of plasminogen (PLG) are associated with a mild thrombotic tendency. To facilitate the genetic diagnosis of dysPLGemia, we combined an amplification refractory mutation system and rapid automated capillary electrophoresis. Two different fluorescence-labeled PLG-specific primers for exon XV were designed so that each DNA amplified by PCR showed fluorescence of a different wavelength. Single peaks were detected for the normal and the mutant Ala601 -Thr alleles, respectively. A study of 90 normal Caucasians revealed no individuals with the mutation, whereas its gene frequency was 0.021 in Japanese. This mutation was also detected in Korean and Chinese populations at gene frequencies of 0.016 and 0.015, respectively. All of the Korean and Chinese cases with the mutation had at least one haplotype I of the PLG gene, as did most Japanese cases. The high frequency of the Ala601-Thr mutation among these Asian populations may be due to the founder effect.

The management of bleeding peptic ulcer in the elderly with heater probe thermocoagulation

BACKGROUND/AIMS

The aim of this study was to compare the clinical characteristics of bleeding peptic ulcers in the elderly with those in younger patients, retrospectively.

METHODOLOGY

Between 1986 and 1994, 274 patients with bleeding peptic ulcers were treated with heater probe endoscopically. They were divided into 2 groups: 48 in the elder group (70 years of age or older) and 226 in the younger group (<70). We evaluated the rate of concomitant disease, rebleeding rate, incidence of emergency surgery, mortality and blood transfusion requirement between the 2 groups.

RESULTS

The incidence of concomitant disease was significantly higher in the elderly group (83.3%) than in the younger group (33.3%) (p<0.01). The rate of rebleeding (younger group 23.5% vs. elderly group 31.3%), the incidence of emergency surgery (5.8% vs. 6.3%, respectively) and the rate of mortality due to hemorrhage (2.2% vs. 4.2%, respectively) were similar in the 2 groups. There was no significant difference in the mean volume of blood transfused.

CONCLUSIONS

It was revealed that aggressive endoscopic hemostasis improved the mortality rate and the incidence of emergency surgery in elderly patients as well as in younger patients, provided that their general condition was monitored carefully.

Immunohistochemical study of insulin-like growth factor II (IGF-II) and insulin-like growth factor binding protein-2 (IGFBP-2) in choroid plexus papilloma

Insulin-like growth factor-II (IGF-II), a mitogen for various kinds of cells, has been shown to be secreted from the choroid plexus in animals. Insulin-like growth factor binding protein-2 (IGFBP-2), one of the six carrier proteins for IGFs, is also thought to be released from the choroid plexus, bind to IGF-II in the cerebrospinal fluid (CSF) and modulate the action of this growth factor. Little is known about the expression and localization of these substances in human choroid plexus and choroid plexus papillomas. The present immunohistochemical study demonstrated all six choroid plexus papillomas were positive for IGF-II, whereas normal choroid plexuses were negative for IGF-II. On the other hand, IGFBP-2 was positive in the endothelium and vascular media in the normal choroid plexus, while it was weakly positive in four and negative in two out of six choroid plexus papillomas. These results suggest that the alterations in the IGF-II/IGFBP-2 axis might be involved in the tumorigenesis of choroid plexus papilloma.

Single breath-hold left ventricular volume measurement by 0.3-sec turbo fast low-angle shot MR imaging

OBJECTIVE

In this study, we measured global cardiac parameters during a single breath-hold using T1-weighted single-shot turbo fast low-angle shot (turboFLASH) MR imaging.

SUBJECTS AND METHODS

Ten cardiac patients who had undergone cardiac catheterization were examined with MR imaging to evaluate cardiac function. On average, 10 slices, which covered enough of the heart to measure the left ventricular volume, were acquired in a single breath-hold. During the acquisition of each slice, T1-weighted turboFLASH MR imaging with inversion recovery of both end diastole and end systole was sequentially accomplished twice in the same R-R interval. The end-diastolic volume, end-systolic volume, and ejection fraction calculated from MR images were compared with data obtained from left ventriculography.

RESULTS

In these 10 cardiac patients, the ejection fraction calculated from turboFLASH MR images showed a good correlation with the measurements from radiographic left ventriculography (r = .87). The inter- and intraobserver variabilities in calculating the ejection fraction were 7.8% and 4.7%, respectively.

CONCLUSION

Single-shot turboFLASH MR imaging with inversion recovery can provide data for the quantification of the ejection fraction during a single breath-hold.

Transcriptional regulation of cell type-specific expression of the TATA-less A subunit gene for human coagulation factor XIII

To study the mechanism of gene regulation for coagulation factor XIII A subunit (FXIIIA), we characterized its 5'-flanking region using a monocytoid (U937), a megakaryocytoid (MEG-01), and other cells. Our results confirmed that U937 and MEG-01 contained FXIIIA mRNA. A tentative transcription start site was determined to be 76 bases upstream from the first exon/intron boundary. Reporter gene assays revealed that a 5'-fragment (-2331 to +75) was sufficient to support basal expression in U937 and MEG-01 but not in the other cells. Deletion analysis confined a minimal promoter sequence from -114 to +75. DNase footprinting, electrophoretic mobility shift, and reporter gene assays demonstrated that promoter elements for a myeloid-enriched transcription factor (MZF-1-like protein) and two ubiquitous transcription factors (NF-1 and SP-1) in this region were important for the basal FXIII expression. It was also revealed that an upstream region (-806 to -290) had enhancer activity in MEG-01 but silencer activity in U937. DNA sequences for binding of myeloid-enriched factors (GATA-1 and Ets-1) were recognized in this region, and the GATA-1 element was found to be responsible for the enhancer activity. These transcription factors play a major role in the cell type-specific expression of FXIIIA, which differs from other transglutaminases.

K-ras point mutations in the supernatants of pancreatic juice and bile are reliable for diagnosis of pancreas and biliary tract carcinomas complementary to cytologic examination

In order to clarify whether DNA analysis for K-ras mutation can be used to diagnose cancers in supernatants of pancreatic juice and bile, samples from 29 cases of pancreatic, biliary tract, gastric, and neuroendocrine carcinomas, 1 malignant lymphoma case, 2 cases of pancreatic adenoma, 9 cases of chronic pancreatitis and 21 other non-cancer cases were examined. Polymerase chain reaction (PCR) products for K-ras gene codons 2 to 97 of exons 1 and 2 were generated with 33/33 (100%) pancreatic juice and 41/41 (100%) bile samples. By the single strand conformation polymorphism (SSCP) method, point mutations were detected in the pancreatic juice or bile supernatants of 13/13 (100%) pancreas cancer cases, 5/14 (35.7%) biliary tract cancer cases, 1/2 (50.0%) pancreatic adenoma cases and 3/9 (33.3%) chronic pancreatitis cases. Direct sequencing confirmed identical point mutations in the supernatants, malignant cells of cytologic smears of pancreatic juice or bile and cancer tissues. The DNA analysis demonstrated the presence of K-ras point mutations in 3 cases of pancreatic carcinomas with false-negative cytologic diagnoses. This novel method allows simultaneous testing for genetic abnormalities in supernatants of pancreatic juice and bile, after removing cells for cytologic diagnosis and screening for pancreatic and biliary tract tumors.

Staging of gastric cancer with endoscopic ultrasonography and endoscopic mucosal resection

Since it was found that the gastrointestinal wall is visualized as a five-layered structure corresponding to the histological layers of the wall, endoscopic ultrasonography (EUS) has become recognized clinically as the most accurate method for diagnosing and assessing the local staging of gastric cancer. However, some problems have remained, including how to differentiate between cancer invasion and ulcer fibrosis, how to detect microinvasion, and how to recognize malignant lymph nodes. Using the pattern analysis for depressed-type gastric cancer, it is usually possible to distinguish between cancer invasion and ulcer fibrosis, except in cases of microinvasion into ulcer fibrosis or inadequate scanning. However, the sensitivity of EUS for evaluating metastatic lymph nodes is still problematic. Endoscopic mucosal resection (EMR) for early gastric cancer has been widely accepted as a standard treatment in Japan due to its minimal invasiveness. According to our data, the overall rate of radical resection was 68.3% (168 of 246), and 31.7% of the remaining patients additionally received laser treatment, surgery, or heater-probe treatment. There were no deaths owing to gastric cancer. Some lesions in which there was microinvasion of the submucosa were incorrectly diagnosed by EUS. It may be possible to solve this problem using three-dimensional EUS (3D-EUS) in the near future.

Coronary artery fistula after cardiac transplantation

A cardiac transplant recipient with multiple coronary artery fistulae draining into the right ventricle is described. These fistulae presumably resulted from repeated endomyocardial biopsies. The diagnosis of coronary artery fistulae was made at the annual coronary arteriography. The magnitude of the shunt remained small over eight years of follow-up.

Presence of two plasminogen alleles in normal populations

When we compared nucleotide sequences of the 5'-flanking regions for plasminogen genes from 11 individuals, six substitutions were identified even among normal subjects. A new haplotype (termed allele II) was screened by PCR-RFLP analysis among 54 Japanese and 58 Caucasian normal subjects. The frequency of allele II was 0.787 in the Japanese and 0.560 in the Caucasians, indicating that the ratio of alleles differs between populations. Examination of 118 cases with dysplasminogenemia revealed that the Ala601-Thr mutation was present on allele I in most cases. This mutation was also associated with allele II in one-fourth of all cases, suggesting possible recombination within the plasminogen gene. Interestingly, we previously demonstrated that the expression activity of allele II was about 1.8 fold that of allele I in vitro.

Primary endodermal sinus tumor of the vulva: a case report and review of the literature

BACKGROUND

Extragonadal endodermal sinus tumors arising in the external genitalia represent an exceedingly rare malignancy in women. Six cases of endodermal sinus tumors of the vulva have been reported to date, with three cases failing to respond to conservative surgery and vincristine-based chemotherapy. We report a seventh case of vulvar endodermal sinus tumor that was treated with radical surgery and platinum-based chemotherapy.

CASE

RT is an 18-year-old female who presented with a vulvar mass that was diagnosed as endodermal sinus tumor at the time of biopsy. She was subsequently treated with modified radical vulvectomy and ipsilateral groin lymphadenectomy, followed by bleomycin, etoposide, and cisplatin chemotherapeutic regimen. She has since remained free of disease for 18 months as evidenced by serum alpha-fetoprotein and physical exam at 18 months.

CONCLUSIONS

Vulvar endodermal sinus tumors represent a very small number of germ cell tumors in women. Based on the previous accounts, this disease appears to be more fatal than endodermal sinus tumor arising at other sites. These tumors also have a predilection for local metastasis. Due to the previous accounts, we chose to treat this patient with radical surgery and platinum-based chemotherapy. This treatment regimen has resulted in a disease-free state for 18 months.

Characterization of the 5'-flanking regions of plasminogen-related genes A and B

We examined the promoter activity of two homologous plasminogen-related genes (PRGA and PRGB) employing HepG2 cells. The 5'-flanking regions of these genes were sequenced first, then inserted into the upstream region of the CAT gene in an expression vector. CAT assays revealed that the promoter activity of PRGA was 3-fold that of plasminogen, while the activity of PRGB was 5-fold. Deletion analysis of these genes demonstrated that a region between -283 and +153 bp relative to the transcription initiation site was essential for their expression, and that there were regions with either negative or positive effects on expression farther upstream.

Bullous esophagitis due to chronic graft-versus-host disease

Vesiculobullous lesions of esophagus in patients post bone marrow transplantation may occur due to infectious agents or acute graft-versus-host disease (GVHD). We report the case of a patient who developed a large bulla in the esophagus as a result of chronic GVHD. Potential etiologies, diagnosis and management of bullous esophagitis are reviewed.

[Diagnostic value of serum soluble interleukin-2 receptor levels in interstitial pneumonia of the patients with hematological disorders]

Serum levels of soluble interleukin-2 receptor (SIL-2R) and C-reactive protein (CRP) were measured in 12 patients with interstitial pneumonia (IP) and 10 patients with bacterial pneumonia (BP) of hematological malignancies. Mean SIL-2R levels (U/ml) were 394 +/- 140 in normal controls, 755 +/- 320 in BP, and 2328 +/- 943 in IP. A significantly higher level was found in IP than BP (p < 0.05). Moreover, the SIL-2R/CRP ratio which was over 260 in all cases of IP completely distinguished IP from BP. Levels of SIL-2R rose before the onset of IP and were closely associated with clinical course in most cases. From these results, measurement of serum SIL-2R may be useful for the diagnosis and monitoring of the clinical course of IP complicated with hematological diseases.

Expression and induction by IL-6 of the normal and variant genes for human plasminogen

We examined the promoter activity of the gene for human plasminogen (PLG) employing its 1.1 kb fragment of the 5'-flanking region inserted in front of a reporter gene. Deletion analysis revealed that a region surrounding the transcription start site was essential for the PLG expression. Since the PLG gene has three sequences for the interleukin-6 (IL-6) responsive element, we examined the effect of IL-6 on the PLG expression. IL-6 stimulation of PLG resulted in a 2.5-fold increase in its transcription. This is also true for the PLG gene of a case with dysplasminogenemia. Although the patient's gene had six mutations in the 5'-flanking region, its promoter activity was 1.8-fold that of normal PLG.

[Recent advance of endoscopic ultrasonography for evaluating gastroenterologic early cancer]

Lutz et al. made the first report in which ultrasonographic probe could differentiate cystic tumor from solid one. After that, endoscopic ultrasonography (EUS) have advanced rapidly in engineering and clinical application. EUS is the most accurate diagnostic method presently available to determine the depth of gastrointestinal cancer invasion. We have proposed the pattern analysis for the differentiation between cancer invasion and ulcer fibrosis, because fibrosis and cancer invasion have of the same echo level. USP is more useful and easy than EUS in cases with small and flat lesion without ulcer, and EUS should perform in remaining lesions that look like early cancer with ulcer and advanced cancer. Clinically, it is believed that the invasion of early gallbladder cancer limited to the proper muscle, the early pancreas cancer is less than 1 cm. It is also practicable with EUS to detect the these cancer easily and diagnose the local stage of gall bladder and pancreas cancer. Now we are performing IDUS (ER-US, PT-US) and 3D-EUS, and believing that these technics will be used commonly in the near future.

[Intra-arterial infusion chemotherapy for advanced liver metastases from lung cancer via implantable vascular access: report of six cases]

Six patients with advanced liver metastases judged as a survival limiting factor from lung cancer were treated with intra-arterial infusion chemotherapy employing totally implantable vascular access. The treatment regimen included 5-FU/CDDP/EPIR/MMC/etoposide in various combinations and this therapy was repeated as long as possible. There were no serious side-effects or complications, such as bone marrow suppression or gastrointestinal symptoms. The therapy could be continued for a mean duration of 7.2 months (ranging from 2 to 13 months). Cause of death was due to extra-hepatic lesion in all 5 patients. The direct effect on liver metastases reviewed on CT scan was 83.3% (CR: 1, PR: 4, NC: 1), and the median survival period was 108 days (for small-cell group: 92 days; for non-small-cell group: 407 days). We conclude that this therapy is useful in the treatment of liver metastases from lung cancer because of its limited toxicity and high direct effect.

Pancreatic adenocarcinoma presenting as a splenic abscess: case report and diagnostic approach

As the fourth leading cause of cancer death in the United States, pancreatic adenocarcinoma is both a diagnostic and a therapeutic challenge. Its incidence has risen in the past four decades so that pancreatic cancer ranks second to colon cancer as a leading cause of death from gastrointestinal malignancy. Despite technical and therapeutic advances, the prognosis remains dismal; the average survival time after diagnosis is characteristically only five to eight months. The current patient had a pancreatic adenocarcinoma that mimicked other disorders. Variability in clinical presentation and imaging studies warrants consideration of this entity in the differential diagnoses of many splenic and pancreatic lesions.

Ultrasonic esophagoprobe for TNM staging of highly stenosing esophageal carcinoma

BACKGROUND

Endosonographic staging of esophageal carcinoma may be limited in one third of cases by tumor stenoses that cannot be traversed with conventional echoendoscopes. We designed and evaluated a new endosonographic instrument (ultrasonic esophagoprobe) for TNM staging of highly stenosing esophageal carcinomas.

METHODS

Eighty-seven consecutive patients (64 men, mean age 61 years) with highly stenosing esophageal carcinomas were studied with the esophagoprobe (features: diameter of 7.9 mm, bougie-shaped tip, no fiber optics, insertion over a guide wire).

RESULTS

The esophagoprobe was successfully inserted past the stenosis without complication in all patients. Nine patients (10%) required preliminary bougienage to 33 F. The imaging quality was high and allowed for complete T and N staging in all patients. M staging was indeterminate in 15 patients because of inadequate visualization of the celiac axis region. Histopathologic correlation in 38 patients who underwent surgery showed an overall T stage accuracy rate of 89% (T2 = 80%, T3 = 95%, T4 = 87%), and N and M stage accuracies of 79% (N0 = 44%, N1 = 90%) and 91% (M0 = 94%, M1 = 75%), respectively.

CONCLUSIONS

The esophagoprobe enables safe passage of highly stenosing esophageal carcinomas for TNM staging. Accuracy rates are similar to those reported for conventional echoendoscopes.

Automated homogeneous liposome-based assay system for total complement activity

We developed an automated homogeneous immunoassay, based on immune lysis of dinitrophenyl (DNP)-labeled liposomes, for measuring total complement activity. Liposome lysis caused by complement activity was detected spectrophotometrically from entrapped glucose-6-phosphate dehydrogenase activity. Complement activity in human sera was quantified by comparison with a calibration curve. For ease of application to fully automated routine clinical analyzers, we adopted a two-reagent system, one reagent containing a homogeneous population of small DNP-labeled liposomes and one containing antibody/substrate. This system required calibration only once a week. Within-run and between-run CVs were 0.4-1.3% (n = 10) and 1.8-4.7% (n = 10), respectively. Serum results were linear upon dilution (with saline) over a twofold range. Bilirubin, hemoglobin, Intrafat, and serum proteins such as rheumatoid factor, M protein, IgG, and IgA did not affect the assay results. The results (y) correlated well with those from a hemolytic complement activity test (x): y = 1.05x - 1.14, r = 0.92, on 66 samples in the range < 10- > 50 kU/L. This method should therefore be of great use for the determination of complement activity.

Automated homogeneous liposome-based assay system for total complement activity

We developed an automated homogeneous immunoassay, based on immune lysis of dinitrophenyl (DNP)-labeled liposomes, for measuring total complement activity. Liposome lysis caused by complement activity was detected spectrophotometrically from entrapped glucose-6-phosphate dehydrogenase activity. Complement activity in human sera was quantified by comparison with a calibration curve. For ease of application to fully automated routine clinical analyzers, we adopted a two-reagent system, one reagent containing a homogeneous population of small DNP-labeled liposomes and one containing antibody/substrate. This system required calibration only once a week. Within-run and between-run CVs were 0.4-1.3% (n = 10) and 1.8-4.7% (n = 10), respectively. Serum results were linear upon dilution (with saline) over a twofold range. Bilirubin, hemoglobin, Intrafat, and serum proteins such as rheumatoid factor, M protein, IgG, and IgA did not affect the assay results. The results (y) correlated well with those from a hemolytic complement activity test (x): y = 1.05x - 1.14, r = 0.92, on 66 samples in the range &lt; 10- &gt; 50 kU/L. This method should therefore be of great use for the determination of complement activity.