Clinical courses of pure sleep epilepsies

This study aims to understand seizure control outcomes and the risk of developing new wake seizures (WS) related to the different types of pure sleep epilepsies (SE), which is important in making rational management plans. A retrospective review of the Yonsei Epilepsy Clinic Registry identified 63 patients with pure SE not belonging to any specific epileptic syndromes. They were divided into the group of generalized tonic-clonic seizures during sleep (S-GTCS : n = 21) and the group of partial epilepsies during sleep (S-PE: n = 42) on the basis of seizure phenomenology, EEG, and neuroimaging data. These patients were followed for 2 years and their clinical variables were analysed for seizure control outcomes and development of new WS. Of 21 patients with S-GTCS, 17 achieved a seizure-free outcome and only one patient developed a new WS, which was consistent with a partial-onset secondary GTCS in phenomenology. Of 42 patients with S-PE only 15 patients achieved a seizure-free outcome and 11 patients developed WS during the 2-year follow-up period. Higher baseline seizure frequency and longer duration of epilepsy were associated with a higher incidence of new WS. The results suggest that the patients with S-GTCS carry a favorable clinical course, thus driving privileges or freedom of daily activities can be conferred without delay once their seizures are well controlled. However, the seizure control outcome was poor and the development of WS was frequent in patients with recurrent S-PE.

Differences in Keratocyte Apoptosis Following Transepithelial and Laser-scrape Photorefractive Keratectomy in Rabbits

BACKGROUND

Anterior stromal keratocyte cells undergo programmed cell death (apoptosis) in response to corneal epithelial injury. Keratocyte apoptosis may be an initiator of the corneal wound healing response that includes keratocyte proliferation and activation, as well as changes to the overlying epithelium, occurring following refractive surgical procedures such as photorefractive keratectomy (PRK). This study compared the effect of laser-scrape and transepithelial PRK on keratocyte apoptosis.

METHODS

Photorefractive keratectomy was performed in both eyes of 10 New Zealand white rabbits using the Summit Apex excimer laser. Surgery was performed using transepithelial PRK in one eye and laser-scrape PRK in the other. The central cornea was analyzed at 4 hours after surgery using a quantitative TUNEL assay that detects fragmented DNA characteristic of apoptosis. Hepatocyte growth factor (HGF) production by keratocytes was detected by immunocytochemistry.

RESULTS

Average apoptotic cells per 400X microscopic field determined by 2 independent masked observers were 0.9 +/- 0.5 (scanning electron microscopy) and 0.2 +/- 0.2 in the transepithelial PRK group compared with 5.1 +/- 2.9 and 4.1 +/- 3.2 in the laser-scrape group. The difference between the two groups was statistically significant for both observers (P < .05, ANOVA). HGF was detected within keratocytes throughout the corneal stroma. Less HGF was detected in the anterior stroma in the laser-scrape group at 4 hours after surgery, consistent with more anterior keratocyte apoptosis in this group.

CONCLUSIONS

Transepithelial PRK induced less anterior keratocyte apoptosis in rabbits than laser-scrape PRK. This suggests that transepithelial PRK could be useful in preventing or minimizing refractive regression and subepithelial scarring.

The morphology of the polyhedra of a host range-expanded recombinant baculovirus and its parents

The host range-expanded recombinant baculovirus, RecB-8 was isolated from BmN-4 cells coinfected with Autographa californica and Bombyx mori nuclear polyhedrosis viruses. Its genome was compared with those of its parents by restriction endonuclease digestion and their polyhedra compared in an electron microscope. Interestingly, the polyhedra of RecB-8 were tetrahedral although the polyhedrin gene was the same as that of the BmNPV parent which has icosahedral polyhedra. Thus the morphology of the RecB-8 polyhedra resulted from host cell factors and/or another viral genome in the host cells.

Keratocyte apoptosis after corneal surgery

PURPOSE

Programmed cell death (apoptosis) is the controlled death of cells that occurs with minimal collateral damage to surrounding cells or tissue during development, homeostasis, and wound healing. The authors hypothesize the keratocyte apoptosis is an initiating factor in the wound-healing response after refractive surgical procedures. To evaluate the effects of different corneal manipulations, keratocyte apoptosis was examined qualitatively and quantitatively after traditional epithelial scrape-photorefractive keratectomy (PRK), transepithelial PRK, removal of a cap of superficial cornea using a microkeratome, production of a flap of superficial cornea with a microkeratome, and laser-assisted in situ keratomileusis (LASIK) compared with unwounded controls in rabbit corneas.

METHODS

Refractive surgical procedures or their components were performed in rabbit eyes. Keratocyte apoptosis was monitored using the terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick-end labeling assay to detect DNA fragmentation. Cellular morphologic changes were evaluated by electron microscope examination.

RESULTS

Keratocyte apoptosis was noted with each refractive procedure or corneal manipulation and was variable from eye to eye with each procedure. Transepithelial PRK was associated with the lowest levels of central corneal apoptosis, even if the stromal surface was scraped after the procedure. Keratocyte apoptosis is confined to the superficial stroma extending to a depth of approximately 50 microns to 75 microns after epithelial scrape-PRK and transepithelial PRK. Apoptosis was noted in the deeper central corneal keratocytes located anteriorly and posteriorly to the lamellar cut in LASIK.

CONCLUSIONS

There are qualitative and quantitative differences in keratocyte apoptosis between LASIK, epithelial scrape-PRK, and transepithelial PRK. Epithelial injury is an important factor modulating keratocyte apoptosis. The level and distribution of keratocyte apoptosis, along with subsequent repopulation by activated stromal keratocytes, are likely to be important determinants of corneal wound healing associated with variability and regression after PRK and LASIK. Transepithelial PRK induces low levels of keratocyte apoptosis, and, therefore, this approach may be useful for treating higher levels of myopia and for retreatment after regression.

The Effect of Topical Corticosteroids on Refractive Outcome and Corneal Haze after Photorefractive Keratectomy

BACKGROUND

The effect of topical corticosteroids after excimer laser photorefractive keratectomy (PRK) remains a matter of some controversy. Refractive effects may be different according to the amount of myopia and timing of instillation.

METHODS

Two groups of patients were studied: Study A consisted of 215 eyes (128 patients) with PRK (mean baseline myopia, -6.53 +/- 2.22 D) that received no corticosteroids (No Corticosteroid Group) unless significant regression or corneal haze appeared (Delayed Corticosteroid Group), and in Study B, we randomly assigned eyes to the Initial Corticosteroid Group (mean baseline myopia, -6.39 +/- 1.84 D) or the No/delayed Corticosteroid Group (mean baseline myopia -5.78 +/- 2.02 D). Clinical results after PRK for low-to-moderate and high myopia were compared.

RESULTS

In the first group, 70.9% (73 eyes) of moderately myopic eyes (mean, -4.56 +/- 1.10 D) belonged to the No Corticosteroid Group that had a mean refraction of -5.39 +/- 1.77 D. Delayed Corticosteroid Group eyes were more myopic (mean, -7.52 +/- 2.10 D), and showed more severe haze than those in the No Corticosteroid Group. In study B, only in high myopes with more than -6.00 D (mean, -7.76 +/- 1.15 D) did refraction and corneal haze outcomes show significant difference between the Initial Corticosteroid Group and the No/delayed Corticosteroid Group.

CONCLUSIONS

The effects of topical corticosteroids after PRK were less in moderate myopes compared to high myopes. Delayed instillation of corticosteroids did not reverse the regression or haze whereas initial instillation showed a beneficial effect on high myopes but not on moderate myopes.

Multifactorial involvement of multidrug resistance-associated [correction of resistance] protein, DNA topoisomerase II and glutathione/glutathione-S-transferase in nonP-glycoprotein-mediated multidrug resistance in human bladder cancer cells

BACKGROUND

Multiple mechanisms are important in multidrug resistance in urothelial cancers. We investigated the acquisition of a multidrug resistance phenotype in human bladder cancer cells exposed to doxorubicin.

METHODS

Human bladder cancer cell line 5637 and 2 doxorubicin drug-resistant sublines (5637/DR5.5 and 5637/DR50) were used. Measurements were made of the steady state mRNA levels of the multidrug resistance gene (mdr1), multidrug resistance-associated protein (MRP), glutathione-S-transferase-pi and DNA topoisomerase II (topo II) genes, P-glycoprotein (PgP) and MRP expression, glutathione (GSH) and GSH enzyme activity, and topo II catalytic activity. The pharmacokinetics were compared between the parent and the drug-resistant sublines.

RESULTS

5637/DR5.5 and 5637/DR50 cells were 7.6- and 16.2-fold more resistant to doxorubicin and 16.7- and 48.3-fold more resistant to etoposide, respectively, compared with 5637 cells. A dose escalation of doxorubicin increased the MRP expression, GSH levels and glutathione-S-transferase (GST) activity, although no PgP expression was observed in any cell line. Resistance was brought about by decreased drug accumulation through drug efflux, although intracellular daunorubicin concentrations were similar between DR5.5 and DR50 cells. Topo II catalytic activity was undetectable in DR50 cells, but maintained in both the parent and DR5.5 cells.

CONCLUSION

Reduced drug accumulation in doxorubicin-resistant cells was mediated by MRP instead of PgP indicating that MRP-mediated drug efflux functions in a limited manner for drug resistance. An increase in drug efflux via MRP, reduced topo II activity, and increased GSH levels/GSH-related enzyme activities may play major roles in nonPgP-mediated multidrug resistance in urothelial cancers treated with anthracyclines.

Single photon emission computed tomography-EEG relations in temporal lobe epilepsy

The role of single photon emission computed tomography (SPECT) as an independent confirmation test in presurgical evaluation of medically intractable temporal lobe epilepsy has not been critically investigated. Because spreading ictal discharges may cause a concomitant increase of cerebral blood flow in remote cerebral regions, a careful analysis of peri-injection EEG patterns and their relation to ictal SPECT may be important in evaluating the reliability of ictal SPECT. Both interictal and ictal EEG and SPECT were reviewed in 19 patients with temporal lobe epilepsy who achieved a successful seizure outcome after surgery. Patients were divided into unitemporal and bitemporal groups according to the lateralization of interictal epileptiform discharges (IED). Ictal EEG features were classified into lateralized and nonlateralized groups. The concordance between SPECT and EEG lateralizations was examined in each patient and correlated to the documented epileptogenic temporal lobe. Interictal SPECT correctly lateralized in eight of nine patients with unitemporal IED and in five of 10 patients with bitemporal IED. Ictal SPECT was highly concordant with the peri-injection ictal EEG but correctly lateralized the epileptogenic region in only 11 of 19 patients. When both pre- and postinjection EEG epochs lateralized ipsilaterally, all ictal SPECT images showed concordant lateralization. If pre- and postinjection EEG epochs were either different in lateralization or nonlateralization, ictal SPECT images often showed complex patterns of cerebral perfusion with a high incidence of false lateralization. Interictal SPECT was more sensitive and reliable in patients with unitemporal IED than in patients with bitemporal IEDs. Ictal SPECT was closely related with peri-injection EEG epochs but with frequent false lateralization. The role of ictal SPECT as an independent confirmation test in presurgical evaluation should be reappraised.

Additive Effects on the Microstructure Evolution in Hexadecyltrimethylammonium Bromide Solution and Its Rheological Properties

The effects of various additives on the microstructure evolution in hexadecyltrimethylammonium bromide micellar solution and its rheological properties are investigated. The additives considered in the present study are primary, secondary, and tertiary heptanols and sodium salicylate (NaSal). The microstructure is developed via the two-step shape transitions in the micellar solution; first, the initial spherical micelles undergo shape transition to rod-like or disc-like micelles as the micelles tend to be packed compactly with increase in the surfactant concentration; then further increment in the surfactant concentration makes the anisotropic rod-like micelles overlap each other. Solutions in these states exhibit typical non-Newtonian behaviors such as shear thinning at high shear rates. In the present study, the additive effects on the microstructure evolution are investigated by employing various techniques including a phase modulated flow birefringence, a dynamic light scattering and a dynamic oscillatory rheometry. The results show that addition of the solubilized additives enhances the microstructure transitions, which are affected by the additive concentration and its chemical structure. Presence of the cosurfactants such as heptanols with hydrophobic alkyl chains reduces the repulsion by forming surfactant-alcohol mixed micelles. The primary heptanol can penetrate easily into the micelles and aligned parallel to the surfactant molecules compared with the secondary and tertiary heptanols. Thus, the primary heptanol enhances the two-step shape evolutions more effectively than the other types. In the presence of NaSal, on the other hand, the micellar solution exhibits the viscoelastic properties and the yield stress owing to the formation of networked or worm-like micelles. Copyright 1997 Academic Press. Copyright 1997Academic Press

Apoptosis in the cornea: further characterization of Fas/Fas ligand system

This study was performed to further characterize expression and function of the Fas/Fas ligand system in the cornea. Specifically, these experiments examined (1) the effect of genetic inactivation of Fas or Fas ligand genes on keratocyte apoptosis in response to corneal epithelial wounding, (2) whether cultured human corneal epithelial and endothelial cells are competent to undergo apoptosis in response to Fas activation, (3) expression of membrane bound and soluble Fas and Fas ligand in corneal cells, and (4) the effect of IL-1 on expression of Fas and Fas ligand in corneal fibroblasts. Keratocyte apoptosis in response to corneal epithelial scrape detected by TUNEL assay and transmission electron microscopy was significantly decreased, but not eliminated, in Fas ligand -/- mice compared with control +/+ mice. There was also a decrease in Fas -/- mice that did not reach statistical significance. Thus, while the Fas/Fas ligand system is likely involved in regulating keratocyte apoptosis in response to epithelial wounding, systems with redundant function probably also modulate this response. Activation of the Fas receptor triggered death with ultrastructural changes characteristic of apoptosis in corneal epithelial and endothelial cells in culture. Since these cell types express both Fas and Fas ligand in vivo, systems must be in place to prevent uncontrolled activation via autocrine ligand-receptor interaction. Messenger RNAs coding for both membrane bound and soluble splicing variants of Fas were expressed in each corneal cell type, suggesting that soluble Fas production could be one mechanism to antagonize membrane bound Fas activation. Soluble Fas ligand protein was expressed in wounded ex vivo corneal epithelium, providing a mechanism for Fas ligand from epithelium to mediate keratocyte apoptosis. IL-1, however, also stimulated corneal fibroblasts to express Fas ligand mRNA and protein. Therefore, an alternative mode for epithelial injury to trigger keratocyte apoptosis may be by release of IL-1, subsequent induction of Fas ligand in keratocytes, and apoptosis mediated by autocrine mechanisms.

Effect of silkworm hemolymph on the expression of E. coli beta-galactosidase in insect cell lines infected with recombinant baculoviruses

The effects of silkworm hemolymph on the expression of foreign genes by recombinant baculoviruses in cell lines were studied. The expression efficiency of beta-galactosidase by recombinant virus containing the E. coli lacZ gene at various concentrations of hemolymph and FBS was determined in BmN and Sf cell lines. The addition of hemolymph to the medium containing FBS accelerated the expression of beta-galactosidase by recombinant viruses in both cells. It was more effective in BmN cells than in Sf cells. Hemolymph was most effective in enhancing virus multiplicity under conditions of 5% FBS.

Rapid purification, partial characterization, and antimicrobial spectrum of the bacteriocin, Pediocin AcM, from Pediococcus acidilactici M

The bacteriocin from Pediococcus acidilactici M, designated as Pediocin AcM, was rapidly purified to homogeneity by the pH mediated cell adsorption-desorption method and semi-preparative reversed-phase HPLC. The purification yield was 40.4% and the specific activity was increased by 2450-fold. It gave a single band and a single peak on SDS-PAGE and HPLC analysis, respectively. When subjected to electrospray LC-MS analysis, the protein was found to be highly pure and the molecular weight was determined as 4,618 Da. High concentration of the bacteriocin (> 50 micrograms/ml) showed good resistance to extremes of pH (1-12) and temperature (121 degrees C). Pediocin AcM was deduced to be a monomer with an intra-peptide disulfide bond from the results of reversed-phase analytical HPLC analyses after reduction, oxidation and trypsin digestion. P. acidilactici M inhibited a large number of bacteria, including Staphylococcus aureus, Listeria monocytogenes, Clostridium perfringens, Bacillus coagulans, B. cereus, and Aeromonas hydrophila.

Experiences of epilepsy surgery in intractable seizures with past history of CNS infection

We studied the clinical characteristics, location of epileptogenic regions, and the surgical outcomes in 18 patients with intractable epilepsy associated with previous CNS infections. All patients underwent an extensive presurgical evaluation and 11 patients had intracranial EEG monitoring. On the basis of presurgical evaluation, epileptic regions were localized to the mesial temporal (n = 12) and the neocortical (n = 6) regions. The age of the time of CNS infection was significantly younger and the latent period of non-febrile seizures after CNS infection was longer in patients with mesial temporal lobe epilepsy (MTLE). MRI showed hippocampal atrophy and hippocampal signal changes in 11 of 12 patients with MTLE. Among 6 patients with neocortical epilepsy (NE) 5 patients had normal MRI and one showed cerebral hemi-atrophy. Surgery was successful (class I & II) in all patients with MTLE, however, in the patients with neocortical epilepsy, seizure-free results were not achieved in any patients after resective surgery (6 patients) and only 2 patients achieved Class II outcomes after a second epilepsy surgery consisting of neocortical resection. Patients with MTLE after CNS infection were differentiated from the group of neocortical epilepsy by an earlier onset of CNS infection, a prolonged latent period and a higher frequency of meningitis. The characteristic pathology in this group was hippocampal sclerosis and the surgical result was excellent. Neocortical epilepsy following CNS infection usually had no focal lesion on MRI and was associated with a relatively poor surgical result. This study suggested that the surgical outcome was influenced by the type of epileptic syndromes rather than the etiology of seizures. The association of MTLE with the younger age of CNS infections and with meningitis more frequently suggested that the neocortical neurons during infancy or early childhood may be more resistant to the epileptogenesis, or that the CNS infections in patients with MTLE might be milder in severity to cause selective injuries to the hippocampal neurons during their vulnerable stage.

Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis

STUDY DESIGN

This is a retrospective study analyzing 76 patients treated by decompression, pedicle screw instrumentation, and fusion for spondylolytic spondyiolisthesis with symptomatic spinal stenosis.

OBJECTIVES

To verify the advantages of adding posterior lumbar interbody fusion to the usual posterolateral fusion with pedicle screw instrumentation.

SUMMARY OF BACKGROUND DATA

Stabilization after decompression of spondylolytic spondylolisthesis is difficult because of a lack of fusional bone bases, gap between the transverse process bases, and incompetent anterior disc support. Posterior lumbar interbody fusion offers anterior support, reduction, and a broad fusion base.

METHODS

Forty patients were treated with posterolateral fusion, and 36 were treated with additional posterior lumbar interbody fusion. They were compared for union, reduction of the deformity, and clinical results.

RESULTS

The patients were followed up for more than 2 years. Nonunion was observed in three patients who underwent posterolateral fusion (7.5%), and no cases of nonunion was found in patients who underwent posterior lumbar interbody fusion. Reduction of slippage was 28.3% in those who underwent posterolateral fusion and 41.6% in those who had posterior lumbar interbody fusion (P = 0.05). In the posterolateral fusion group, eight patients (20%) had recurrence of deformity, with loss of reduction more than 50%. Hardware failures occurred in two patients who had posterolateral fusion. There was no major neurologic complications in both groups. Both groups had satisfactory results in more than 90% of patients, with marked improvement of claudication. However, subjective improvement of back pain by Kirkaldy-Willis criteria revealed differences in the excellent results. An excellent result was reported by 45% in the posterolateral fusion group and by 75% in posterior lumbar interbody fusion group.

CONCLUSIONS

The addition of posterior lumbar interbody fusion to posterolateral fusion after a complete decompression and pedicle screw fixation is a recommended procedure for the treatment of spondylolytic spondylolishesis with spinal stenosis.

Effect of optic zone size on the outcome of photorefractive keratectomy for myopia

PURPOSE

To determine the effect of optic zone size on the outcome of photorefractive keratectomy (PRK) for myopia.

SETTING

Department of Ophthalmology, Samsung Medical Center, Seoul, Korea.

METHODS

Twenty patients, 10 with myopia under 6.00 diopters (D) and 10 with myopia over 6.00 D, had bilateral PRK with identical dioptric corrections in both eyes. One eye was treated with a 5.0 mm diameter optic zone and the other with a 6.0 mm diameter optic zone. An identical postoperative eyedrop regimen was used. During the 6 month follow-up, changes in refraction, uncorrected visual acuity, and corneal anterior stromal haze were evaluated. At the end of the follow-up, patients completed a questionnaire on night-vision disturbance, foreign-body sensation, tenderness, and preference.

RESULTS

Two weeks postoperatively, eyes with a 5.0 mm optic zone had a significantly greater hyperopic shift than those with a 6.0 mm optic zone. Eyes with myopia over 6.00 D and a 6.0 mm optic zone had significantly faster recovery of uncorrected visual acuity at 2 and 12 weeks. There was no increased anterior stromal haze in the 6.0 mm optic zone eyes, despite the deeper stromal ablation. Night-vision problems were more prevalent in the 5.0 mm optic zone group, which also had a greater incidence of ablation decentration.

CONCLUSION

A 6.0 mm optic zone for myopic PRK seems to produce better outcomes. Further evaluation of long-term results is needed.

Expression of multidrug resistance-related genes (mdrl, MRP, GST-pi and DNA topoisomerase II) in urothelial cancers

OBJECTIVE

To characterize the multidrug resistance (MDR) phenotype in human urothelial cancers, the expression levels of four MDR-related genes (multidrug resistance, mdrl; multidrug resistance-associated protein, MRP; glutathione S-transferase-pi, GST-pi; and DNA topoisomerase II, topo II) were analysed in urothelial cancers.

MATERIALS AND METHODS

Fifty-two tumour tissue and three normal urothelial mucosa samples were obtained from 44 patients with urothelial cancers. The expression of each gene was analysed with a reverse-transcription polymerase chain reaction (RT-PCR) method using beta 2-microglobulin (b2m) mRNA as an endogenous control. Levels of expression were expressed as the ratio of the specific products of the target gene to those specific to b2m.

RESULTS

In primary urothelial cancer tissues, the mean (SD) expression of mdrl, MRP, GST-pi and topo II relative to b2m expression were 0.067 (0.061), 0.27 (0.23), 0.35 (0.31) and 0.12 (0.05), respectively. The mean expressions of MRP and GST-pi were higher than those of mdrl and topo II. The mean ratios of mdrl/b2m, MRP/b2m, GST-pi/b2m and topo II/b2m in normal urothelial mucosa were 0.06 (0.03), 0.12 (0.09), 0.30 (0.32) and 0.14 (0.01), respectively. There was no significant association of the expression of each gene with either the grade or extent of the primary tumour. The level of MRP expression in each sample was correlated significantly with the expression of mdrl and GST-pi in the urothelial cancers (r = 0.637 and 0.537, respectively). Chemotherapy did not markedly influence the induction of expression of the MDR-related genes, except for one case in which mdrl expression was 15 times greater than before chemotherapy. The expression of GST-pi in the patients not receiving chemotherapy was significantly higher than in those that did.

CONCLUSIONS

These results suggest that the activation of MRP and GST-pi expression occurs during the tumorigenesis of urothelial cancers and that it may confer de novo and acquired drug resistance on urothelial cancers. These results should provide further insight into the complex role postulated for MDR-related genes in chemotherapy, carcinogenesis and tumour progression.

Expression patterns of multidrug-resistance (MDR1), multidrug resistance-associated protein (MRP),glutathione-S-transferase-pi (GST-pi) and DNA topoisomerase II (Topo II) genes in renal cell carcinomas and normal kidney

PURPOSE

Expression levels of the multidrug-resistance (mdr1), multidrug resistance-associated protein (MRP), glutathione-S-transferase-pi (GST-pi) and DNA topoisomerase II (Topo II) genes in normal kidney and renal cell carcinomas were analyzed to study the complexity of the roles of these genes.

MATERIALS AND METHODS

The reverse transcription-polymerase chain reaction (RT-PCR) assay was used with beta 2 microglobulin (beta 2 m) as the internal control.

RESULTS

In normal kidneys, the expression levels of the 4 genes in individual normal kidney samples correlated significantly with one another. Comparisons of the expression levels between normal kidneys and renal cell carcinomas showed that only the mean MRP gene expression level was higher in renal cell carcinomas than in normal kidneys (p = 0.018). The expression patterns of the 4 genes in renal cell carcinomas differed markedly for nonpapillary and papillary tumors. The mean MRP/beta 2 m ratio for the papillary type was significantly lower than that for the nonpapillary alveolar type carcinoma (p = 0.004). The 4 genes showed moderate positive correlations with one another in alveolar type renal carcinoma similar to the correlations observed in normal kidneys. In contrast, in papillary type, MRP expression was inversely correlated with mdr1 and Topo II expression.

CONCLUSION

Differences in cytogenetic changes, origins and natural histories between papillary and nonpapillary carcinoma may be associated with these distinct expression patterns of the resistance-related genes. Further study is required to clarify whether the differences in the expression patterns between these 2 structural types of carcinoma affect their chemosensitivities and clinical outcomes.

Overexpression of human mutT homologue gene messenger RNA in renal-cell carcinoma: evidence of persistent oxidative stress in cancer

Data regarding oxidatively modified DNA bases suggest that cancer cells are more exposed to oxidative stress than adjacent non-tumorous tissue. This novel concept may contribute to the understanding of certain aspects of tumor biology such as activated transcription factors, genetic instability, chemotherapy-resistance and metastasis. We therefore tested this concept in human renal-cell carcinomas (RCCs) by evaluating the expression of hMTH1, an enzyme preventing the misincorporation into DNA of 8-oxo-dGTP (8-oxo-7,8-dihydrodeoxyguanosine triphosphate), an oxidized form of dGTP in the nucleotide pool. The expression of hMTH1 messenger RNA (mRNA) in RCC was significantly higher than that in adjacent non-tumorous kidney. Moreover, advanced-stage tumors showed significantly higher hMTH1 mRNA expression than early-stage tumors, and there was a modest linear correlation between hMTH1 expression and c-myc expression. The results provide logical support for the concept of "persistent oxidative stress in cancer" and suggest a role of hMTH1 mRNA level as a prognostic marker.

Overexpression of human mutT homologue gene messenger RNA in renal-cell carcinoma: evidence of persistent oxidative stress in cancer

Data regarding oxidatively modified DNA bases suggest that cancer cells are more exposed to oxidative stress than adjacent non-tumorous tissue. This novel concept may contribute to the understanding of certain aspects of tumor biology such as activated transcription factors, genetic instability, chemotherapy-resistance and metastasis. We therefore tested this concept in human renal-cell carcinomas (RCCs) by evaluating the expression of hMTH1, an enzyme preventing the misincorporation into DNA of 8-oxo-dGTP (8-oxo-7,8-dihydrodeoxyguanosine triphosphate), an oxidized form of dGTP in the nucleotide pool. The expression of hMTH1 messenger RNA (mRNA) in RCC was significantly higher than that in adjacent non-tumorous kidney. Moreover, advanced-stage tumors showed significantly higher hMTH1 mRNA expression than early-stage tumors, and there was a modest linear correlation between hMTH1 expression and c-myc expression. The results provide logical support for the concept of "persistent oxidative stress in cancer" and suggest a role of hMTH1 mRNA level as a prognostic marker.

Holmium:YAG Laser Thermokeratoplasty for Astigmatism in Rabbits

BACKGROUND

Holmium:YAG laser thermokeratoplasty has generated considerable interest as a technique for correcting hyperopia. In this study, the effect of holmium:YAG laser on inducing astigmatism according to application patterns was evaluated.

METHODS

An experimental study based on the results of astigmatic holmium:YAG laser thermokeratoplasty using the Summit OmniMed laser system (Summit Technology Inc, Waltham, Mass) in 36 rabbit eyes is presented. We divided the rabbits into four groups: arcuate, reverse arcuate, linear, and control group according to application patterns. All rabbits were followed for 3 months and cycloplegic refractive measurements were carried out.

RESULTS

The average surgically induced astigmatism was 1.86 diopters (D) for the arcuate group, 2.93 D for the reverse arcuate group, and 1.31 D for the linear group. No significant complications related to the operation were noted.

CONCLUSION

The reverse arcuate pattern of holmium:YAG laser thermokeratoplasty is most effective in inducing astigmatism in rabbits.

A clinical study of chronic headaches: clinical characteristics and depressive trends in migraine & tension-type headaches

BACKGROUND & OBJECTIVES

Chronic headache is commonly encountered in the neurology outpatient clinic and it is often associated with depression. In Korea, however, chronic headache has not yet been systematically investigated. We conducted this study to investigate this clinical characteristics and level of depression in patients who presented migraine, tension-type headache, or transformed migraine.

METHOD

Among those with chronic headache during the period from January 1, 1994 through December 31, 1994, 131 patients were diagnosed to have either migraine, tension-type headache (by IHS classification), or transformed migraine: migraine in 60 patients, tension-type headache in 49 patients, and transformed migraine in 22 patients. Beck Depression Inventory (BDI) was performed in 116 of the 131 patients.

RESULTS & CONCLUSION

There was no significant difference in the age of onset, duration of headache, and family history among the three groups. However, patients with migraine had a more severe, unilateral, and throbbing characteristic pain than those with a tension-type headache. The mean BDI scores in the transformed migraine and the tension-type headache patients were significantly higher than those of migraine, but the level of depression did not correlate with the patient's age, duration, character, severity, and frequency of headache. These findings suggest that migraine, tension-type headache and transformed migraine may be considered clinically distinct entities in viewing their different clinical characteristics and level of depression.

Comparison of multidrug resistance gene expression levels with malignant potentials and influence of chemotherapy in urothelial cancers

BACKGROUND

We sought to determine how often P-glycoprotein is involved in the drug-resistance of urothelial cancer, and whether MDR1 gene expression is correlated with tumor grade, invasiveness, or metastasis.

METHODS

Forty-two tumor specimens and two normal bladder mucosal samples obtained from 34 urothelial cancer patients were analyzed. Reverse-transcription and polymerase chain reaction were conducted. MDR1 mRNA levels were determined by measuring the relative ratio of the MDR1 to beta-2-microglobulin (b2 m) mRNA specific PCR products.

RESULTS

The MDR1/b2 m in two normal urothelial samples were 0.044 and 0.045. For untreated primary tumors, levels of MDR1 gene expression in 46% tumor samples were less than that of normal urothelium, while 27% showed expression levels with a MDR1/b2 m ratio more than 0.1. There was no statistical correlation between MDR1 mRNA level and tumor grade, stage, or metastatic status. There was higher MDR1 gene expression in two lymph node metastasis specimens and almost equal expressions in two more. There was no significant difference in the mean MDR1/b2 m ratio between postchemotherapy and untreated tumors. A remarkable elevation of the MDR1 mRNA level (15 times greater than prechemotherapy) was found in one tumor; mRNA levels of the multidrug resistance-associated protein (MRP) gene, glutathione S-transferase pi (GST-pi) gene or DNA topoisomerase II (topo II) gene did not increase.

CONCLUSIONS

It is still unclear whether the MDR1 gene expression in urothelial tumor cells is inducible by the current combination chemotherapy regimens. RT-PCR quantitation is useful for determining the expression level of MDR1 gene in urothelial cancer.

Multidrug resistance-associated protein-mediated multidrug resistance modulated by cyclosporin A in a human bladder cancer cell line

A doxorubicin-resistant subline (5637/DR5.5) from human bladder cancer cells (5637) was induced by stepwise increase in the doxorubicin concentration. 5637/DR5.5 cells were cross-resistant to vinblastine and etoposide but not to mitomycin C and cisplatin. We analyzed the mdr1, MRP (multidrug resistance-associated protein), and DNA topoisomerase II gene expression using the reverse transcription polymerase chain reaction assay (RT-PCR) and investigated possible differences in the accumulation and efflux of radiolabeled daunorubicin. 5637/DR5.5 cells do not express the mdr1 gene, but the expression levels of MRP are markedly higher than in drug-sensitive 5637 cells. The intracellular accumulation of radiolabeled daunorubicin was markedly decreased in the 5637/DR5.5 cells in comparison with the parent cells. This reduced drug accumulation was associated with an enhanced drug efflux, but was reversed when cells were incubated with cyclosporin A. Cyclosporin A at the concentration of 5 microM caused 3.4-fold enhancement of daunorubicin-sensitivity in the 5637/DR5.5 cells. On the other hand, there was no difference in DNA-topoisomerase II activity between the parent and resistant cells. The resistance of the 5637/DR5.5 cells is therefore associated with an enhanced drug efflux mediated by the MRP gene overexpression, as distinct from P-glycoprotein, and is modulated by cyclosporin A.

Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis

STUDY DESIGN

This retrospective clinical study compared the results of correction of idiopathic thoracic scoliosis using Cotrel-Dubousset segmental pedicle screw fixation with those of hooks and screws inserted in a hook pattern.

OBJECTIVES

The study's objective was to evaluate the efficacy and safety of segmental pedicle screw fixation in the management of idiopathic thoracic scoliosis.

SUMMARY OF BACKGROUND DATA

Seventy-eight idiopathic thoracic scoliosis patients were treated with Cotrel-Dubousset instrumentation from 1987 to 1991. Thirty-one were treated with hooks; 23 were treated with pedicle screws inserted in a hook pattern; and 24 were treated with segmental pedicle screws.

METHODS

After a minimum follow-up of 2 years (range, 25-52 months), the results of frontal, sagittal, and rotational correction of each group were compared and statistically analyzed using analysis of variance.

RESULTS

Major curve correction was 55% with hooks, 66% with hook pattern screws, and 72% with segmental screws, with loss of correction of 6%, 2%, and 1%, respectively. Compensatory curve correction was 57% with hooks, 67% with hook pattern screws, and 70% with segmental pedicle screws. In patients with hypokyphosis, all showed significant improvement with best restoration in segmental screws. Rotational correction of the apical vertebra measured by the Perdriolle method was 19% with hooks, 26% with hook pattern screws, and 59% with segmental screws. Thirteen screws (3%) were malpositioned, but they did not cause neurologic impairment or adversely affect the results of treatment.

CONCLUSIONS

Segmental pedicle screw fixation is a safe and effective method for correcting the triplanar deformity of the idiopathic thoracic scoliosis.

Expression of yeast O6-methylguanine-DNA methyltransferase (MGMT) gene

We cloned the full genomic DNA of yeast (Saccharomyces cerevisiae) O6-methylguanine-DNA methyltransferase (MGMT) gene and examined its expression. The expression of yeast MGMT gene is decreased when cells reach stationary phase and cannot be induced by the pretreatment with alkylating agents, methylmethanesulfonate (MMS) or N-methyl-N'-nitroso-N-nitrosoguanidine (MNNG). The transcription initiation site was determined by primer extension analysis. This analysis showed that the authentic start codon is the ATG at position +32 from transcription initiation site.

International adoption: a case review of Korean children

In contrast to the controversial transracial adoption of African American children by Caucasian families in the U.S., international, transracial adoption of Asian children has not received much scientific or societal attention. There has been a steady increase in this unnoticed minority group, made up largely of Korean children. This paper reviews the developmental characteristics of post-adoption adjustments among Korean adoptees and discusses the dynamics of their positive adjustments. Sociopolitical issues of international adoptions are also addressed.

A training guideline of cultural competence for child and adolescent psychiatric residencies

The author proposes a curriculum guideline of cultural competence for child and adolescent psychiatric residencies, including specific educational objectives, didactic topics and suggested references. These guidelines can be easily incorporated into the existing training curriculum and stress ethnogeneric and developmental perspectives, which can be expanded further to include ethnospecific issues depending on the needs of each training program and trainee.

Molecular modeling of RNA polymerase II mutations onto DNA polymerase I

Genetic and molecular analysis in Drosophila melanogaster identifies eight suppressor mutations in the second largest subunit of RNA polymerase II. The suppressor mutations fall into two classes: five are strong, result from the same serine to cysteine amino acid residue substitution and rescue one conditional lethal allele in the largest subunit of RNA polymerase II; three are mild, result from a change in the same methionine residue to either isoleucine or valine, are located seven amino acid residues away from the strong suppressors and rescue two conditional lethal alleles in the largest subunit. Sequence analysis of the three regions around these mutations demonstrates that they are located within highly conserved domains but fails to explain the observed genetic interactions. One of the conditional lethal alleles maps within a region previously reported to share sequence similarity to Escherichia coli DNA polymerase I. As the gross structure of RNA polymerase II and DNA polymerase I is similar, even though their primary sequence is not, we predict that more similarities exist but may be too highly divergent to be detected by normal homology searches. We identify the most similar regions between each of the three conserved domains of RNA polymerase II, identified as functionally important because of the mutations we isolated, and DNA polymerase I. Molecular modeling these regions of RNA polymerase II onto the tertiary structure of DNA polymerase I predicts that all lie adjacent to the DNA binding cleft in positions such that they could interact with the phosphate backbone of DNA. This juxtaposition of mutations in the two largest subunits of RNA polymerase II suggest a mechanism for their genetic interactions.

Impairement of endothelium-dependent relaxation in chronic two-kidney, one clip hypertensive rats

OBJECTIVES

Hypertension is commonly associated with an endothelial dysfunction that may contribute to the rise in blood pressure. Little information has been available so far on the role of endothelium-derived nitric oxide(EDNO) in renin-dependent, 2-kidney, 1 clip(2KIC) hypertension. The present study was aimed to determine a role for EDNO in the development and maintenance of 2KIC hypertension.

METHODS

The effects of blocking synthesis or supplementation with precursor of EDNO on the development of hypertension were determined in 2KIC rats. Vascular responses to acetylcholine, nitroprusside, atrial natriuretic peptide and nifedipine were examined in 7- and 12-week hypertensive 2KIC rats.

RESULTS

NG-nitro-L-arginine-methyl ester caused a sustained increase of blood pressure in normal rats, while it was only partially associated with a more pronounced increase of blood pressure in the developmental phase of hypertension in 2KIC rats. In 7-week and 12-week hypertensive rats, phenylephrine-induced contraction of the isolated thoracic aortic rings was more sensitive compared with control. Their acetylcholine-induced relaxation was attenuated while the responses to nitroprusside or atrial natriuretic peptide were unaltered. Although their blood pressure did not differ between 7-week and 12-week hypertensive groups, the attenuation in the acetylcholine-induced relaxation was more prominent in the latter with a longer duration of hypertension. Indomethacin did not affect the attenuated relaxation to acetylcholine. The relaxation response to nifedipine was more pronounced in 2KIC rats.

CONCLUSION

These results indicate that ENDO has little influence of the 2KIC hypertension, at least during its developmental phase, which is associated with an activated reninangiotensin system. The chronic stage of 2KIC hypertension, however, is associated with an endothelial dysfunction which may contribute to the enhanced vasoconstriction and sustained high blood pressure.

A new function for a phosphotyrosine phosphatase: linking GRB2-Sos to a receptor tyrosine kinase

Autophosphorylated growth factor receptors provide binding sites for the src homology 2 domains of intracellular signaling molecules. In response to epidermal growth factor (EGF), the activated EGF receptor binds to a complex containing the signaling protein GRB2 and the Ras guanine nucleotide-releasing factor Sos, leading to activation of the Ras signaling pathway. We have investigated whether the platelet-derived growth factor (PDGF) receptor binds GRB2-Sos. In contrast with the EGF receptor, the GRB2 does not bind to the PDGF receptor directly. Instead, PDGF stimulation induces the formation of a complex containing GRB2; 70-, 80-, and 110-kDa tyrosine-phosphorylated proteins; and the PDGF receptor. Moreover, GRB2 binds directly to the 70-kDa protein but not to the PDGF receptor. Using a panel of PDGF beta-receptor mutants with altered tyrosine phosphorylation sites, we identified Tyr-1009 in the PDGF receptor as required for GRB2 binding. Binding is inhibited by a phosphopeptide containing a YXNX motif. The protein tyrosine phosphatase Syp/PTP1D/SHPTP2/PTP2C is approximately 70 kDa, binds to the PDGF receptor via Tyr-1009, and contains several YXNX sequences. We found that the 70-kDa protein that binds to the PDGF receptor and to GRB2 comigrates with Syp and is recognized by anti-Syp antibodies. Furthermore, both GRB2 and Sos coimmunoprecipitate with Syp from lysates of PDGF-stimulated cells, and GRB2 binds directly to tyrosine-phosphorylated Syp in vitro. These results indicate that GRB2 interacts with different growth factor receptors by different mechanisms and the cytoplasmic phosphotyrosine phosphatase Syp acts as an adapter between the PDGF receptor and the GRB2-Sos complex.

Diagnosis of tuberculous meningitis by detection of immunoglobulin G antibodies to purified protein derivative and lipoarabinomannan antigen in cerebrospinal fluid

Enzyme-linked immunosorbent assay of immunoglobulin G (IgG) activity in cerebrospinal fluid (CSF) and sera was conducted prospectively in 27 patients with tuberculous meningitis (TBM) by using purified protein derivative (PPD) and lipoarabinomannan (LAM) antigens, from January 1989 to August 1990. 29 patients with aseptic meningitis and 49 patients with non-inflammatory neurological illnesses served as controls. All patients had a computed tomography (CT) scan of the head before a lumbar puncture. The IgG antibodies to the antigens were significantly elevated in TBM, and the reactivity was more frequently positive in the CSF than in the sera, suggesting a local synthesis of IgG in the central nervous system (CNS). The sensitivity and the specificity for the diagnosis of TBM were 59.2% and 93.9% for PPD antigen, and 85.2% and 95.9% for LAM antigen, respectively. Assay of IgG reactivity to LAM antigen was clinically very useful for the early diagnosis of TBM and was superior to PPD for detecting the serological evidence of TBM.

The action of diazepam in the isolated rat detrusor muscle

Diazepam is one of the benzodiazepines, a group of drugs that depresses the central nervous system. It also inhibits the contractility of smooth muscles in the periphery, but the mechanism of this inhibitory action has not been clarified. Our study was undertaken to investigate the effect of diazepam on the contractility of the detrusor muscle. Detrusor muscle strips isolated from rat urinary bladder were examined by isometric myography. Diazepam, as well as baclofen, a gamma-aminobutyric acid (GABA)B receptor agonist, reduced the electric field stimulation-induced contractions; delta-aminovaleric acid, a GABAB receptor antagonist, completely antagonized the inhibitory effect of baclofen, but not the inhibitory action of diazepam. Diazepam reduced the basal tone of detrusor muscle concentration dependently, and this inhibitory action was not affected by tetrodotoxin. Diazepam suppressed the contractile responses to bethanechol, adenosine triphosphate and potassium chloride. Diazepam diminished the calcium-induced recovery of tension in calcium-free PSS. A23187, a calcium ionophore, partially recovered the basal tone which had been reduced by diazepam in normal physiologic salt solution (PSS). The loss of tension in calcium free PSS containing diazepam could not be recovered by addition of A23187. On the other hand, the loss of tension in calcium-free PSS containing 3,4,5-trimethoxybenzoic acid 8(diethylamino)octyl ester (TMB-8), an inhibitor of intracellular calcium release, was considerably recovered by addition of A23187. Based on these results, it is suggested that diazepam inhibits the contractility of detrusor muscle acting directly on the smooth muscle cell, which is unrelated to the activation of GABA receptors. Its inhibitory action appears to be mediated through interference with the influx of extracellular calcium.

Is an abnormal Doppler umbilical artery waveform ratio a risk factor for poor perinatal outcome in the non-small for gestational age fetus?

To determine if abnormal umbilical artery velocimetry is associated with a higher rate of perinatal morbidity in pregnancies in which the outcome is not manifested by a small for gestational age (SGA) fetus, perinatal outcome was compared according to the results of Doppler umbilical artery velocimetry. Doppler study was performed in 328 singleton pregnancies with non-SGA fetuses within 7 days of delivery. The prevalence of abnormal Doppler studies was 10%. Patients with abnormal umbilical artery velocimetry had a significantly higher rate of complications, including cesarean section for fetal distress, preterm delivery, low Apgar scores, congenital anomalies, admission to the neonatal intensive care unit, and perinatal death, than patients with a normal umbilical artery velocimetry. Ten perinatal deaths were associated with major congenital anomalies. Moreover, in the absence of congenital anomalies patients with abnormal Doppler results also had a significantly higher incidence of adverse perinatal outcome compared with patients with normal umbilical artery velocimetry. Our data suggest that even the non-SGA fetus with an abnormal Doppler umbilical artery waveform ratio is at increased risk for poor perinatal outcome.

Long-term results of myopic epikeratoplasty

Twenty-three eyes of 20 patients who had had myopic epikeratoplasty were evaluated and the mean 21-month postoperative results (range: 12 to 47 months) tabulated. Average preoperative myopia was -16.7 diopters (D) spherical equivalent (range: -10 to -33 D), and average postoperative refractive correction was 13 D. Of 22 eyes, 17 eyes (77%) were within 4 D of emmetropia. Preoperative visual acuities without correction were between 2/200 and 20/100 (average = 2/40); postoperative acuities were between 2/200 and 20/20 (average = 20/40). Average preoperative best corrected visual acuity was 20/30. Best corrected visual acuities were unchanged or improved in 82% of cases. Re-epithelialization was complete within an average of seven days (range: three to 16 days) postoperatively except in one case in which the lenticule was removed because re-epithelialization did not occur. Five cases showed progressive loss of lenticular power.

Actions of potassium channel openers in rat detrusor urinae

This study was performed to investigate the action of potassium channel openers on the mechanical activity of detrusor muscle isolated from rats. Detrusor muscle strips, 15 mm in length, were myographied isometrically in an isolated organ bath. P 1060, RP 49356 and BRL 38277, potassium channel activators, reduced the basal tone and diminished the phasic activity of detrusor concentration-dependently. P 1060, RP 49356 and BRL 38227 suppressed the maximal responses to bethanechol and shifted the concentration-response curves of bethanechol-induced contraction to the right. RP 49356 and BRL 38227 reduced the contraction by low (20 mM) concentration of potassium. P 1060, however, diminished the high (80 mM) and low (20 mM) concentration of potassium-induced contraction. Glibenclamide, an inhibitor of ATP-dependent potassium channel, antagonized the suppressive action of P 1060, RP 49356 and BRL 38227 on the basal tone. Apamin or procaine did not antagonize it significantly. Based on these results, it is suggested that the relaxation of detrusor muscle strip caused by P 1060, RP 49356 and BRL 38227 may predominantly involve opening of the same potassium channel, i.e., the ATP-dependent potassium channel.

Identification and characterization of an alpha-mannosidase from Trypanosoma cruzi

In this report we describe the first purification and characterization of the acid alpha-mannosidase from the human parasite Trypanosoma cruzi. The purified enzyme exhibited a native mol. wt of 240,000 Da and is apparently composed of four identical subunits of mol. wt 58,000 Da. Each of the four subunits contains one N-linked high-mannose-type oligosaccharide. The alpha-mannosidase exhibited a pH optimum of 3.5 and a pI of 5.9. This low pH optimum and the ability of swainsonine to inhibit its activity suggest that the alpha-mannosidase is a lysosomal enzyme. Antibodies against the T.cruzi enzyme did not react with mammalian lysosomal alpha-mannosidase and, conversely, antibody against a rat lysosomal alpha-mannosidase did not react with the T.cruzi enzyme. Thus, the T.cruzi enzyme appears to be distinct from its mammalian counterpart.

Unilateral congenital ocular motor apraxia: a case report

Congenital ocular motor apraxia (COA), first described by Cogan in 1953, is a rare disorder which shows characteristic defects of the horizontal voluntary saccades, and compensatory head thrust. Until now, most cases have showed a presumably congenital origin, bilaterality, and a tendency to various stages of recovery with aging. But the cause and mechanism of COA are not completely known. Occasionally, it combines with other neurologic abnormalities and metabolic diseases such as Gaucher's disease exhibit similar clinical characteristics to COA. We recently experienced a case of a 3-year-old girl who showed the clinical features of unilateral congenital ocular motor apraxia.

Characteristics of adopted juvenile delinquents

There have been many reports describing the uniqueness of adopted children and adolescents' delinquent behaviors in terms of both their delinquent characteristics and courts' treatment of them. A total of 43 adopted juveniles, 32 extrafamilial (1.0%) and 11 intrafamilial (0.3%) adoptions were initially identified out of 3,280 juvenile delinquents. The adopted subjects were then compared with the demographically matched and offense matched nonadopted subjects. The family variables, such as marital and employment status of parents, were significantly different. However, there were only a few discernible trends, and in general there were no significant differences between the adopted and nonadopted juveniles in terms of their offense characteristics and dispositions.

Psychiatric aspects of epileptic children and adolescents

Epilepsy is the most prevalent neurological disorder of childhood and adolescence and a very heterogenous disease with a diverse course of illness. It may be a benign disease for the majority of children and adolescents, who recover spontaneously or are managed well medically; however, a sizeable group of children and adolescents with epilepsy, at least one-third, do manifest various difficulties--seizure control, academic, emotional, behavioral, and family problems. As a group, they have a much higher rate of psychiatric disorder than healthy children and children with other chronic illnesses. This review is undertaken to summarize the literature on epilepsy in children and adolescents, especially with respect to epidemiology, developmental and psychiatric problems, and psychiatric treatment issues.

Synthesis and biological activity of novel 3-(2-propenyl)-cephalosporins. I

The synthesis, antibacterial activity and oral absorption of novel cephalosporins (3a-3d) having a 2-propenyl group at the C-3 position are described. Diphenylmethyl 7-amino-3-(2-propenyl)-3-cephem-4-carboxylate HCl (4) prepared from 7-aminocephalosporanic acid in 12 steps was acylated with various acid moieties to give cephems 3a-3d. The cephems 3a-3c showed similar antibacterial activities as cefixime. However, these cephems were not well absorbed orally.

Synthesis and biological activity of novel 3-(2-propenyl)-cephalosporins. II. Preparation of prodrugs

Three prodrug esters (2a approximately 2c) of 3-(2-propenyl)cephem (1a) have been prepared and their oral absorption was determined in rats and mice. While pivaloyloxymethyl ester (2a) did not improve the oral absorption of the parent cephem 1a, [(1-methyl)ethoxycarbonyloxy]ethyl ester (2b) and (5-methyl-2-oxo-1,3-dioxolen-4-yl)methyl ester (2c) improved oral absorption by a factor of five.

Epikeratoplasty for keratoconus

The 6 eyes of 6 patients operated on using keratoconic epikeratoplasty are evaluated, and the mean 11-month postoperative results are reported. Uncorrected visual acuities improved in 4 patients and were maintained in 1 patient. One patient revealed a decrease of uncorrected visual acuity in the postoperative 6th month. Two patients showed an improvement of over 2 Snellen lines. Two patients showed the same corrected visual acuity, and that of 2 patients decreased within the postoperative 6-months follow-up. There was a significant decrease of myopia in terms of spherical equivalent. As a result, 4 cases showed a postoperative refractive error from +1.0 to -2.5D. Two cases were myopic deviated, -4.0 and -5.0D, and need further observation. In all cases, there was an effective flattening of the protruding cone with a mean decrease of over 11D of keratometry readings. Complete reepithelization occurred within 12 days, (average 7.5 days) and a moderate pressure patch was used as a routine procedure to promote the reepithelization.

Separation reaction of psychiatrically hospitalized children: a pilot study

This paper reports on the development of the Children's Separation Rating Scale (CSRS), its initial reliability and validity, and clinical/research utility with psychiatrically hospitalized children. The CSRS appears to be a reliable and valid instrument, and useful in distinguishing children's separation reaction from their general psychopathology. Findings from this pilot study support the notion that inpatient treatment programs should address the developmental needs and abilities of the various age groups and the particular deficits reflected in their psychopathology.

Antagonistic interactions between alleles of the RpII215 locus in Drosophila melanogaster

The RpII215 locus encodes the large subunit of RNA polymerase II (polII). Three of 22 RpII215 alleles cause a synergistic enhancement of the mutant phenotype elicited by mutations in the Ultrabithorax (Ubx) locus. We have recovered and analyzed three new mutations that suppress this enhancement. All three mutations map to the RpII215 locus. In addition to suppressing the Ubx enhancement of other RpII215 alleles, two of the new mutations, JH1 and WJK2, themselves enhance Ubx. RpII215 alleles can be placed into three classes based on their ability to enhance Ubx. Class I alleles, including Ubl, C4, C11, JH1, and WJK2, enhance Ubx when heterozygous with class II alleles, which include wild-type RpII215. Class III alleles, which include amorphic alleles, do not enhance Ubx. The third new mutation, WJK1, is a conditional amorphic allele, which behaves like a class III allele at 29 degrees but like a class II allele at 19 degrees. Another mutant phenotype is caused by certain RpII215 alleles, including all class I alleles. This phenotype is a synergistic enhancement of a mutant phenotype elicited by mutations at the Delta (Dl) locus. Unlike the enhancement of Ubx, the enhancement of Dl is not dependent upon antagonistic interactions between different classes of RpII215 alleles.

Endoscopic laser treatment of Dieulafoy's lesion

Dieulafoy’s disease is a distinctive arteriovenous malformation of the stomach, which presents with massive or recurrent gastrointestinal bleeding.

A case of Dieulafoy’s disease in an adult female, in which an endoscopic Nd: YAG (neodymium: yttrium aluminum garnet) laser was used successfully in controlling bleeding, is presented here.

A large pedunculated left ventricular thrombus with recurrent systemic thromboembolism in a young man

We present the case of a young man who has suffered from recurrent systemic thromboembolism since he developed an acute interior wall myocardial infarction at the age of 27. A large elongated, pendunculated left ventricular thrombus was found by two dimensional echocardiography and was successfully removed by open heart surgery.