Adult granulosa cell tumor of the ovary: 35 cases in a single Korean Institute

BACKGROUND

Adult granulosa cell tumor of the ovary is an uncommon neoplasm. The overall prognosis is favorable. The prognostic factors that are related to survival have not been well defined and are discussed in the literature amidst controversy.

METHODS

Thirty-five patients diagnosed with adult granulosa cell tumor of the ovary were reviewed retrospectively. Demographic data, pathologic findings, treatments, and survival times were reviewed and analyzed for prognostic significance.

RESULTS

Of the 35 cases, there were 30 cases representing stage I tumors, one case at stage II, four cases at stage III, and no cases at stage IV. The mean overall survival time of all patients was 140.3 months. The 5- and 10-year survival rates were 92.0% and 85.8% respectively. The FIGO stage was the only independent prognostic factor.

CONCLUSIONS

Despite the small number of patients, the study showed that the less advanced stage is the only favorable prognostic factor of significance.

Sensory innervation of temporomandibular joint disk

PURPOSE

To investigate the nerve endings of the adult temporomandibular joint disk, in particular the presence and configuration of the sensory nerve endings by silver staining and electron microscopy.

METHODS

20 cadaveric temporomandibular joints impregnated with silver stain were studied using an optical microscope; 2 other joints were studied using a transmission electron microscope.

RESULTS

Free nerve endings were found in the disk parenchyma of all joints. Golgi-Mazzoni corpuscles, Ruffini corpuscles, and articular corpuscles were also observed as sensory nerve end organs. Myelinated and nonmyelinated nerve fibres were visualised in the disk parenchyma using the transmission electron microscope.

CONCLUSION

Free nerve endings and sensory nerve end organs are present in the disk parenchyma of the human temporomandibular joint and are associated with sensation and proprioception, just as they are in the acetabular labrum, glenoid labrum, triangular fibrocartilage complex, and meniscus.

Expression profiling of cyclin B1 and D1 in cervical carcinoma

AIM

Cyclins are a family of regulatory proteins that play a key role in controlling the cell cycle. Abnormalities of cell cycle regulators, including cyclins and cyclin dependent kinases, have been reported in various malignant tumors. This study was undertaken to quantitatively detect cyclin B1 and D1 in cervical cancer.

METHODS

A quantitative real-time reverse transcription polymerase chain reaction and Western blot assay were used to analyze the expression of cyclin B1/D1 mRNA and proteins, respectively, in fresh invasive cervical cancer (n = 41) and normal cervical tissues (n = 10).

RESULTS

There was significantly greater cyclin B1 expression in invasive cervical cancer than in normal cervical tissue (P = 0.019). However, cyclin D1 expression was not significantly different. A Western blot assay yielded similar results.

CONCLUSION

Our results were consistent with the concept that up-regulation of cyclin B1 expression occurred in cervical cancer and an aberrant expression of cyclin B1 might play an important role in cervical carcinogenesis.

EPCR Ser219Gly: elevated sEPCR, prothrombin F1+2, risk for coronary heart disease, and increased sEPCR shedding in vitro

We have progressively analysed three studies of coronary heart disease (CHD) for a variant in EPCR (Ser219Gly). Initially, in a prospective study, NPHSII, while no overall CHD-risk was identified in heterozygotes, homozygotes for 219Gly exhibited a three-fold elevated risk (HR 3.3, CI 1.22-8.96). In diabetics within NPHSII, there was a suggestion that 219Gly+ was associated with elevated CHD-risk (HR 1.89, CI 0.39-9.06) although numbers were small. To further assess the effect of the variant in diabetes, a case-control study of MI, HIFMECH, was used, in which previous analysis had defined a group with metabolic syndrome, by factor analysis. A significant CHD-risk interaction was identified between genotype and the 'metabolic syndrome' factor (interaction p=0.009). To further assess CHD-risk for this variant in type-2 diabetes and to assess the effect of the variant upon thrombin generation and plasma levels of soluble EPCR, a cross-sectional study of type-2 diabetes was used. A significant CHD-risk was identified for European Whites (OR 2.84, CI 1.38-5.85) and Indian Asians in this study (OR 1.6, CI 1.00-2.57) and the frequency of 219Gly was two-fold higher in Indian Asians. Soluble EPCR levels were strongly associated with genotype, with homozygotes for 219Gly having four-fold higher levels (p<0.0001). In vitro studies of EPCR-transfected cells suggested increased basal release of sEPCR from cells expressing the 219Gly EPCR phenotype. Furthermore, in base-line samples from NPHSII and in the diabetic study, a significant increase in prothrombin F1+2 level was observed for 219Gly. The increased CHD-risk and thrombin generation appears to be acting through increased shedding of the Gly allele from the cell surface.

Pretreatment levels of serum squamous cell carcinoma antigen and urine polyamines in women with squamous cell carcinoma of the cervix

OBJECTIVES

To investigate whether pretreatment levels of serum squamous cell carcinoma antigen (SCCA) and urine polyamines can predict lymph node metastases in patients with early stage cervical carcinoma.

METHODS

Pretreatment measurement of serum SCCA and urine polyamine levels was carried out for 419 women. Of those women, 104 with stage IB and IIA cancer received radical surgery and had tumor size reassessed postoperatively.

RESULTS

The women had increased levels of serum SCCA (>2.0 ng/mL) and elevated urine polyamines (>45 micromol/g of creatinine) with advanced cancer stage (P<0.01). The median SCCA level was significantly higher in women with metastatic disease than that in those without lymph node involvement (3.9 vs. 1.1; P<0.01). Women with nodal involvement also had significantly higher median levels of urine polyamines than those without nodal disease.

CONCLUSIONS

Pretreatment measurement of SCCA and urine polyamine levels may help in predicting lymph node metastases in women with early stage cervical carcinoma.

Malignant mixed mullerian tumors of the ovary: experience with cytoreductive surgery and platinum-based combination chemotherapy

This study reviews the clinical outcome and prognosis of patients with malignant mixed müllerian tumors (MMMTs) of the ovary treated with optimal cytoreductive surgery, leaving no residual disease, and platinum-based chemotherapy. Ten patients diagnosed with MMMT of the ovary after complete surgical staging from February 1993 to February 2004 at Asan Medical Center in Korea were studied retrospectively. All ten patients were treated with optimal cytoreductive surgery, leaving no gross residual disease. Seven patients received ifosfamide/cisplatin chemotherapy, and the remaining three patients received other platinum-based combination chemotherapy. Demographic data, pathologic findings, treatments, and survival time were reviewed. Of the ten patients, two were scored at FIGO stage IIC, seven were at stage IIIC, and one was at stage IV. The median survival time of all ten patients was 46 months. The overall survival rate was 60.0% at 1 year, 40.0% at 2 years, and 20.0% at 5 years. Platinum-based combination chemotherapy after optimal cytoreductive surgery may be effective in the treatment of ovarian MMMT.

Effects of Na+-Ca2+ exchanger activity on the alpha-amino-3-hydroxy-5-methyl-4-isoxazolone-propionate-induced Ca2+ influx in cerebellar Purkinje neurons

Variations in intracellular calcium activity ([Ca2+]i) play crucial roles in information processing in Purkinje neurons such as synaptic plasticity. Although Na+-Ca2+ exchanger (NCX) has been shown to participate in the regulation of homeostasis and secretion in neuronal cells, the physiological role of NCX in Purkinje neurons, such as a role in cerebellar synaptic plasticity, is not well understood. NCX in acutely dissociated rat Purkinje neurons was identified by double staining with anti-calbindin D-28k antibody and anti-NCX antibody. The physiological activity of NCX was examined by measuring transient intracellular Ca2+ changes resulting from the Ca2+ influx via reverse mode of NCX (with 0 mM Na+/2.5 mM Ca2+ solutions) and the efflux via the forward mode of NCX (with 140 mM Na+/0 mM Ca2+ solutions). This transient increase in Ca2+ concentration was not elicited in the cells pretreated with NCX antisense oligodeoxynucleotides. And the Ca2+ influx resulting from the reverse mode of NCX was significantly reduced by 2-[2-[4-(4-nitrobenyloxy) phenyl] ethyl] isothiourea methanesulfonate, while the Ca2+ efflux via forward mode was inhibited by bepridil. The physiological role of NCX in synaptic function was studied by measuring Ca2+ transients induced by alpha-amino-3-hydroxy-5-methyl-4-isoxazolone-propionate (AMPA) receptor activation. This AMPA-evoked response was decreased with the inhibition of NCX forward mode and also, to less degree, with the inhibition of reverse mode. In antisense oligodeoxynucleotides pretreated cells, the AMPA-evoked response was also reduced, as was the case in NCX-inhibitor treated cells. The inhibition of NCX activity had depressant effects on Ca2+ transients induced by AMPA receptor activation. These results suggest that NCX plays a physiological role in modulating the activity of cerebellar Purkinje neurons, such as synaptic plasticity, via interaction with AMPA receptors in Purkinje neurons.

Immunochemical and Biological Analysis of Allergenicity with Excretory-Secretory Products of Anisakis simplex Third Stage Larva

BACKGROUND

Anisakis simplex third stage larvae (L3) are parasites that frequently give rise to allergic responses. The larvae molt into fourth stage larvae (L4), and at each stage they produce L3-excretory-secretory products (L3-ESP) and L4-ESP, respectively, which are different in their main protein constituents. Although the allergenicity of L4-ESP has been investigated by several research groups, research on the allergenicity of L3-ESP has not been carried out by any researcher. In this investigation, the allergenicity and antigenicity of L3-ESP were investigated in comparison with L4-ESP, using rat sera.

METHODS

Rat sera were produced by L3 oral infection two times with a 9-week interval. Larvae ESP prepared by culture were concentrated and fractioned using lyophilizer and a centrifugal filter device, respectively. Immunochemical analysis was performed using both indirect ELISA and immunoblot. Biological allergenicity was analyzed by RBL-2H3 exocytosis.

RESULTS

With the indirect ELISA, the optical density (OD) value of the nonfractioned (NF)-L3ESP was only one third of that of the NF-L4ESP in both specific IgM and IgG. On measuring specific IgE, the OD of NF-L3ESP was less than one tenth of that of NF-L4ESP. In addition, neither antigen nor allergen was shown in NF-L3ESP, but it was shown in NF-L4ESP with immunoblot. However, the biological allergenicity of NF-L3ESP was comparable to that of NF-L4ESP. To demonstrate the presence of any allergen, L3-ESP was fractioned and found to carry twelve visualized allergen bands from 10 to 186 kDa by immunoblot.

CONCLUSIONS

These results indicate that L3-ESP may include the important allergens necessary to induce the allergy by L3 oral infection, as compared to L4-ESP.

Prognostic significance of DNA quantification by flow cytometry in ovarian tumors

OBJECTIVE

The objective of our study is to evaluate prognostic significance of DNA quantification by flow cytometry in ovarian tumor.

METHODS

A prospective analysis was performed on 56 ovarian tumor patients treated in the Yonsei Medical Center from Feb. 2000 to Jan. 2003.

RESULTS

Regarding the association between tumor grade and the DNA quantitative analysis, as tumor grade increased, the quantity of aneuploid cells and S-phase fraction (SPF) increased. In addition, SPF was increased significantly in the advanced staged patients (P=0.04) and SPF was significantly increased in aneuploid tumors (P=0.03). The overall survival rate was poor for patients with aneuploid tumors and for patients with tumors showing over SPF (10%).

CONCLUSION

Our data demonstrated that the prognosis was poor for patients with aneuploid cancers or increased SPF. Therefore, DNA quantification by flow cytometry may provide important information for predicting the prognosis of the disease.

Relation between deranged antioxidant system and cervical neoplasia

The purpose of this study was to compare the plasma levels of the anti-oxidant system and oxidative stress between a cervical neoplasia group and a normal control group and to investigate the relationship between the levels of micronutrients of antioxidant system and various clinicopathological parameters of cervical carcinoma. A cross-sectional sample of 180 women, including 90 normal controls, was recruited from November 2000 to January 2001. Plasma concentration of malondialdehyde (MDA) was spectrophotometrically measured as the parameter of lipid peroxidation. Plasma levels of antioxidant vitamins were analyzed with the help of reverse-phase, high-pressure liquid chromatography, whereas glutathione peroxidase activity was evaluated by using coupled enzyme procedure. While the activity of glutathione peroxidase and the plasma levels of antioxidant vitamins, such as lutein, beta-carotene, lycopene, and zeaxanthin, were all significantly lower, the concentration of MDA was significantly higher in women with cervical intraepithelial neoplasia (CIN) or invasive cervical cancer, compared to those of the normal control group. The status of the plasma antioxidant system showed no significant correlation with the prognostic factors of cervical cancer. These findings suggest a potential role of oxidative stress-induced lipid peroxidation and the impairment of the anti-oxidant system in the pathogenesis of CIN and carcinoma of the uterine cervix.

Risk factors for pancreatitis in patients with anomalous union of pancreatobiliary duct

BACKGROUND/AIMS

The clinical features of pancreatitis in patients with an anomalous union of the pancreatobiliary duct (AUPBD) are unclear. This study analyzed the clinical features, pathogenic mechanisms, risk factors, and clinical courses after treatment in AUPBD patients.

METHODOLOGY

The medical records and cholangiopancreatograms of 58 patients with AUPBD and a choledochal cyst diagnosed between 1982 and 2001 were retrospectively reviewed.

RESULTS

Sixteen (27.6%) out of the 58 AUPBD patients experienced pancreatitis. The incidence of pancreatitis was significantly higher in those patients with a long (>21mm) and wide (>5mm) common channel, a wide diameter of the proximal pancreatic duct (>2.5mm), the presence of a filling defect in the common channel, and the presence of a pancreatic duct anomaly (p<0.05). A bile duct diversion from the pancreatic duct by a choledochal cyst excision prevented the recurrence of pancreatitis in most cases. A duodenopancreatectomy was required in some cases.

CONCLUSIONS

The morphological characteristics of the common channel and pancreatic duct contribute to the development pancreatitis in AUPBD patients and bile reflux into the pancreatic duct might be the main mechanism of pancreatitis in these patients.

Granulocytic sarcoma of the uterine cervix

Granulocytic sarcoma (GS) is a rare manifestation of leukemia and has been reported in 3-5% of acute myelogenous leukemia (AML) patients. GS in the uterine cervix is very rare and is also called chloroma because of its greenish appearance. We present the case of a patient whose disease relapsed as chloroma of the uterine cervix after bone marrow transplantation (BMT). She remained in continuous complete remission for 2 years after allogeneic BMT. However, she visited the hospital because of painless vaginal bleeding. She was diagnosed as having chloroma by cervical smear and colposcopically directed biopsy of the cervix. Systemic chemotherapy was administered on the presumption that myelogenous leukemia had recurred as chloroma, and a good clinical response was achieved. We describe the first case of AML that relapsed as chloroma of the uterine cervix after complete remission of the AML, which had complete response to only systemic chemotherapy.

Three-dimensional reconstructed images using multidetector computed tomography in evaluation of the biliary tract

The recent development of multidetector computed tomography (MDCT) and the parallel escalation in the capabilities of the workstation allow the use of high-quality multiplanar and three-dimensional reconstruction images. As a noninvasive technique, MDCT dedicated to the biliary tract represents an alternative to magnetic resonance cholangiography. The usefulness of three-dimensional reconstructed images using MDCT in evaluating biliary tract abnormality is illustrated.

The effects of anti-idiotypic antibody on antibody production and apoptosis of anti-dsDNA antibody producing cells

OBJECTIVE

Systemic lupus erythematosus is an autoimmune disease characterized by the production of anti-dsDNA antibody. Because the titer of anti-dsDNA antibody is correlated with disease severity, especially in lupus nephritis, controlling anti-dsDNA antibody production is important in the treatment of SLE. There are many regulatory mechanisms of autoantibody production; one of these is the interaction between idiotype and anti-idiotype antibody (anti-Id). The purpose of the present study was to assess the effect of anti-Id on anti-dsDNA antibody production and apoptosis and to study the mechanism of anti-Id induced apoptosis.

METHODS

After anti-dsDNA antibody producing hybridomas were treated with anti-Id, we checked the amount of anti-dsDNA antibody production, the rate of transcription, cellular proliferation, and apoptosis. Also, after treatment with anti-oxidant (N-acetyl-Lcysteine), phorbol esters with calcium ionophore and corticosteroids, we compared their effect on apoptosis with anti-Id.

RESULTS

Two types of anti-dsDNA antibody producing hybridomas (G1-2, gamma and kappa chains; M2-10, mu and kappa chains) were treated with anti-Id and it was found that: (1) the amount of anti-dsDNA antibody production decreased; (2) the rate of transcription and cellular proliferation did not decrease; and (3) the level of apoptosis increased. The two cells expressed Fas and Fas-ligand, and the Fas of G1-2 was functional but that of M2-10 was not. The treatment of these cells with anti-Id resulted in no change in Fas-ligand and Bax expression, but the expression of Bcl-2 was decreased. In addition, treatment with antioxidant (N-acetyl-L-cysteine) inhibited anti-Id-induced apoptosis in G1-2 and M2-10. Phorbol esters with calcium ionophore also inhibited anti-Id induced apoptosis in M2-10. Corticosteroids induced apoptosis in both cells and showed similar results with anti-Id induced apoptosis.

CONCLUSION

The anti-Id suppressed the production of anti-dsDNA antibody in two cells by inducing apoptosis, as did prednisolone. Furthermore, Bcl-2, oxygen-free radicals and protein kinase C might be involved in the induction of apoptosis by anti-Id.

Synthesis of Si, Mg substituted hydroxyapatites and their sintering behaviors

Si, Mg-substituted hydroxyapatites, alone and co-substituted, have been prepared to obtain biomaterials having an improved biocompatibility. From FT-IR, XRD and ICP analyses, it was confirmed that single phases of hydroxyapatite substituted by Si alone or co-substituted by Si, Mg. The XRD data indicated the absence of extra phases related to silicon and magnesium oxide or other calcium phosphate species. Si-substituted hydroxyapatite of up to 2 wt% for Si and Si, Mg co-substituted hydroxyapatite of 1 wt% for the each ion keep their original structures intact for the sintering temperatures of up to 1200 degrees C. However, it is observed that ion substitutions by an amount higher than the above ratios for each hydroxyapatite lead to destabilization of original structures of the hydroxyapatite and to the production of tricalcium phosphate and calcium phosphate silicate phases when the samples were sintered at 1100 degrees C or higher.

Surgery in thoracic esophageal perforation: primary repair is feasible

Prompt diagnosis and effective treatment are important for thoracic esophageal perforations. The decision for proper management is difficult especially when diagnosed late. However, there is an increasing consensus that primary repair provides good results for repair of thoracic esophageal perforations, which are not diagnosed on time. Primary repair for thoracic esophageal perforations was applied in 20 out of 25 consecutive patients. The time interval between perforation and repair was less than 24 h in six patients (group I), and more than 24 h in 14 patients (group II). The remaining five patients underwent esophagectomy with simultaneous or staged reconstruction because of incorrectable underlying esophageal pathology. Group I had much more iatrogenic causes (P < 0.05). Preoperative sepsis occurred only in group II (P=0.05) and was highly associated with Boerhaave syndrome (P=0.001). Regional viable tissue was used to reinforce the sites of primary repair (n=15, 75%). All of the postoperative morbidity (n=9, 45%) including esophageal leaks (n=6, 30%) and operative death (n=1, 5%) occurred in group II. In patients with postoperative leaks, five eventually healed, but one became a fistula that required reoperation. Primary healing with preservation of the native esophagus was achieved in all 19 patients except one operative death. In addition, the increased incidence of leak and morbidity did not lead to an increase in mortality. In the esophagectomy group, there was no mortality, but one minor suture leak. Regardless of the time interval between the injury and the operation, primary repair is recommended for non-malignant, thoracic, esophageal perforations, but not for anastomotic leaks. Reinforcement that may change the nature of a possible leak is also useful. For incorrectable underlying esophageal pathology, esophagectomy with simultaneous or staged reconstruction is indicated.

Nonradical treatment is as effective as radical surgery in the management of cervical cancer stage IA1

This study was designed to evaluate a series of patients who underwent surgical management due to cervical cancer stage IA1 fitting the 1995 FIGO definition. A total of 149 patients were followed from 3 years to 11.7 years with a median follow-up interval of 5 years. The cases with invasions of ≤ 1 mm and > 1 mm but ≤ 3 mm were noted in 89 (59.7%) and 60 (41.3%) patients, respectively. Lymphvascular space invasion was identified in five patients. In 49 patients, conization or nonradical hysterectomy was performed without pelvic lymph node dissection (PLND) and pelvic recurrence developed in one patient who had an extended hysterectomy. PLND was performed in 100 patients and the average number of lymph nodes examined per case was 26.5 ± 10.1. None of the 100 patients had metastasis to the pelvic lymph node and recurrence. None of the 149 patients has died from recurrent disease. In conclusion, this study suggests that patients with cervical cancer stage IA1 have an extremely low risk of pelvic lymph node metastasis, very rarely recur, and present an excellent prognosis, so nonradical management that excludes PLND could be as effective as radical surgery in these patients.

Analysis of alkali-soluble glucan produced by Saccharomyces cerevisiae wild-type and mutants

The alkali-soluble glucan of the yeast cell wall contains beta-(1,3)- and (1,6)-D-linkages and systemically enhances the immune system. To isolate Saccharomyces cerevisiae mutants producing glucan with a high degree of beta-(1,6)-D-glycosidic bonds, a wild-type strain was mutagenized with ultraviolet light. The mutants were then selected by treatment with 1.0 mg laminarinase, endo-beta-(1,3)-D-glucanase/ml. The alkali-soluble glucan was extracted by modified alkalysis followed by the Cetavlon method and concanavalin-A chromatography. The prepared alkali-soluble glucans from the wild-type and the mutants were compared with respect to yield and polymer structure using gas chromatography, 13C-NMR spectrometry, high performance liquid, and multi-angle laser light scattering and refractive index detectors. The results indicated that the S. cerevisiae mutants had ten-fold more alkali-soluble glucan than the wild-type. Structural analysis revealed that the alkali-soluble glucan from the mutants also had a higher degree of beta-(1,6)-D-linkage than that from the wild-type.

Dynamic sagittal imbalance of the spine in degenerative flat back: significance of pelvic tilt in surgical treatment

STUDY DESIGN

A retrospective study of 26 patients with degenerative flat back treated with corrective osteotomy.

OBJECTIVE

To analyze dynamic sagittal imbalance and to elucidate the cause of postoperative persistent stooping in degenerative flat back.

SUMMARY OF BACKGROUND DATA

Sagittal spinal imbalance in degenerative flat back was more evident on walking, suggesting its dynamic nature. The most puzzling complication in its surgical treatment was postoperative persistent stooping.

METHODS

This study analyzed 26 surgically treated patients with preoperative gait analysis. Patients were divided into two groups according to postoperative improvement in stooping: Group 1 with marked improvement in stooping and Group 2 with persistent stooping. Various radiographic and gait parameters were compared between the two groups.

RESULTS

Comparison of radiographic parameters, representing the static status of the spine, did not indicate any clue to the mechanism for persistent stooping. However, comparison of gait parameters, representing the dynamic status of the spine, revealed meaningful differences between the two groups. Among various gait parameters compared, pelvic tilt seemed to be the most important clue. Patients in Group 1 showed posterior pelvic tilt, whereas those in Group 2 showed marked anterior pelvic tilt.

CONCLUSION

Degenerative flat back could be classified into two types based on pelvic position during walking: one with posterior pelvic tilt and the other with marked anterior pelvic tilt. In the former type, corrective surgery improved the stooping. In the latter, corrective surgery was ineffective, resulting in postoperative persistent stooping.

Cloning and sequence analysis of the interleukin-8 gene from flounder (Paralichthys olivaceous)

A cDNA library of mRNA from flounder leukocytes stimulated with bacterial lipopolysaccharide (LPS) and hemagglutinin was constructed to clone cytokine genes of this fish. Initial screening of this library with human cytokine gene probes was not productive and clones with inserts of over 400 nucleotides (nt) were randomly sequenced, and a homologue of the vertebrate interleukin-8 (IL-8) gene was isolated. The flounder IL-8 cDNA encompassed 884 nt, including a coding region of 330 nt. Four cysteines characteristic of CXC chemokines were identified at conserved locations in the putative protein. The deduced amino acid sequence showed 36 and 35% sequence identity with counterpart genes in monkey and human, respectively, and 52% sequence similarity with these genes. However, the putative flounder IL-8 amino acid sequence showed 25% identity and 52% similarity to that of lamprey, the only other piscine IL-8 gene that has been cloned. Flounder IL-8 transcripts were detected in the head-kidney and spleen of LPS-injected flounder and leukocytes stimulated with LPS. It was not detected in the muscle or liver of LPS-injected flounder, tissues taken from non-stimulated flounder and non-stimulated leukocytes.

Genetic alterations in gallbladder adenoma, dysplasia and carcinoma

Adenoma and dysplasia in the gallbladder (GB) have been reported as precancerous lesions, but the genetic evidence of this is not clearly defined. The purpose of this study was to analyze the frequencies of K-ras, p53, and p16 gene mutations, of microsatellite instability (MI) and of loss of heterozygosity (LOH) in GB cancer, dysplasia, and adenoma. Tissues from 15 GB cancers, five dysplasias around cancerous tumors, and three adenomas were collected prospectively. The mutation rates of K-ras, p53, and p16 were 20.0, 35.7, and 30.7%, respectively, in GB cancers. However, no mutations were found in dysplasia or adenoma. Reduced staining for p16 was seen in 23% of carcinomas. All of the GB carcinomas and four out of five (80%) of the dysplasias showed LOH in a minimum of one locus, but one out of three (33%) cases of adenoma displayed LOH in only one locus. All of the loci of LOH in the dysplasias, except one, showed the same patterns of allelic loss as the adjacent carcinomas. Only one dysplasia showed multiple MI. In conclusion, multiple LOH may be associated with the development of dysplasia and the malignant transformation of GB carcinoma. Gene alterations of K-ras, p53, and p16 are important steps in the malignant changes of dysplasia. However, MI seems to have only a limited role in GB cancer development.

Inhibitory activity for chitin synthase II from Saccharomyces cerevisiae by tannins and related compounds

In the course of search for potent inhibitors of chitin synthase II from natural resources, seven tannins and related compounds were isolated from the aerial part of Euphorbia pekinensis and identified as gallic acid (1), methyl gallate (2), 3-O-galloyl-(-)-shikimic acid (3), corilagin (4), geraniin (5), quercetin-3-O-(2"-O-galloyl)-beta-D-glucoside (6), and kaempferol-3-O-(2"-O-galloyl)-beta-D-glucoside (7). These and nine related compounds, (-)-quinic acid (8), (-)-shikimic acid (9), ellagic acid (10), kaempferol (11), quercetin (12), quercitrin (13), rutin (14), quercetin-3-O-(2"-O-galloyl)-beta-D-rutinoside (15) and 1,3,4,6-tetra-O-galloyl-beta-D-glucose (16), were evaluated for the inhibitory activity against chitin synthase II and III. They inhibited chitin synthase II with IC(50) values of 18-206 microM, except for two organic acids, (-)-quinic acid (8) and (-)-shikimic acid (9). Among them, 3-O-galloyl-(-)-shikimic acid (3) was the most potent inhibitor against chitin synthase II of Saccharomyces cerevisiae with an IC(50) value of 18 microM. The inhibition appears to be selective for chitin synthase II, as they did not appreciably inhibit chitin synthase III.

Loss in 3p and 4p and gain of 3q are concomitant aberrations in squamous cell carcinoma of the vulva

Neoplasm of the vulva is a rare malignancy accounting for <5% of all female genital-tract cancer. However, in recent years the incidence of vulva intraepithelial neoplasia, known to serve as a precursor to carcinoma, has increased in young women generating considerable interest in its pathogenesis. Genetic changes at the molecular level in precursor or invasive vulvar tumors are not well investigated, and DNA copy number changes have not been reported until now. We used comparative genomic hybridization (CGH) to analyze genetic alterations in 10 primary invasive squamous cell carcinomas of the vulva. Chromosomal aberrations were identified in 8/10 cases. The most frequent chromosomal losses were 4p13-pter (five cases), 3p (four cases), and 5q (two cases), and less frequent losses were detected at 6q, 11q, and 13q (one case each). The most frequent chromosomal gains were 3q (four cases) and 8p (three cases), and less frequent gains were found in 9p, 14, 17, and 20q (one case each). The pattern of chromosomal imbalance in vulvar cancer detected by CGH was revealed to be very similar to that in cervical cancers, despite regional differences in their prevalence. These results suggest that the pathogenic pathways in vulvar and cervical carcinomas may be similar and that the genetic background may be common to these two squamous cell carcinomas.

Is it necessary to resect the diseased esophagus in performing reconstruction for corrosive esophageal stricture?

OBJECTIVE

The incidence of carcinoma of the esophagus among patients with chronic esophageal stricture caused by ingestion of corrosive agents is reported to be significantly higher than that of the general population. The question of whether or not a resection of the diseased esophagus should be included in the surgical reconstruction procedure of the undilatable esophageal stricture continues to be a controversial.

METHODS

During the 12 year period from 1988 to 1999, a total of 54 consecutive patients with caustic stricture of the esophagus were treated in our department. We retrospectively reviewed these cases and analyzed the incidence of cicatrical carcinoma among the patients and the risk of esophagectomy according to the procedures performed.

RESULTS

We found seven cases of esophageal cancer among these patients. There was no significant increase in mortality or morbidity related to esophagectomy.

CONCLUSIONS

Considering the high incidence of cicatrical carcinoma from the stricture sites as well as the possible chance of hidden malignancy, we concluded that the simultaneous resection of the esophagus with reconstruction for patients with chronic intractable caustic stricture would give the patients a better probability of being completely cured of the disease.

Extraovarian granulosa cell tumor

A 54-year-old woman was admitted to our hospital complaining of postcoital bleeding. Sonography of the abdomen showed a 8.2 x 8.9 cm-sized solid heterogeneous mass occupying the cul-de-sac, which appeared to be in no way connected with the ovary. On exploratory laparotomy, the tumor mass protruded from the posterolateral retroperitoneum of the pelvic cavity and severely replaced the uterus and adnexa with the outer surface being grossly intact. It grossly measured 10 cm in maximal diameter. The histologic features closely resembled those of ovarian granulosa cell tumor. The primary extraovarian granulosa cell tumor is extremely rare such that in the English literature only 7 cases have been reported to date. Of those granulosa cell tumors are especially rare and only two cases have been reported to arise from retroperitoneum. We herein present a case of retroperitoneal granulosa cell tumor with special regard to differential diagnosis from other solid tumors with similar histology.

CDNA for an immune response gene encoding low molecular weight polypeptide from flounder, Paralichthys olivaceus

The cDNA for an immune response gene encoding the low molecular weight polypeptide (LMP7) was cloned and sequenced from a flounder (Paralichthys olivaceus) leukocyte cDNA library. The cDNA clone was 1,160 bp, and composed of an open reading frame of 822 bp that corresponded to a protein of 273 amino acid residues with a calculated mass of 30.5 kDa. The ScanProsite search indicated that the deduced amino acid sequence from the flounder LMP7 contains a proteasome beta-type subunit signature, which is well conserved during evolution. The sequence shares a high degree of identity with other LMP7 sequences varying from a 66% identity with zebra fish (Danio renio) to a 57% identity with the African clawed frog (Xenopus laevis), which was confirmed from a phylogenetic tree. A reverse transcription-polymerase chain reaction (RT-PCR) was used to determine tissue specificity, and the expression of LMP7 was detected from the liver, kidney, leukocyte, and spleen of the flounder.

Ossification of the acetabular labrum

We report a rare case of extensive ossification of the unilateral acetabular labrum in a 40-year-old man. Radiological manifestations of diffuse skeletal hyperostosis were not found in the spine.

The application of comparative genomic hybridization as an additional tool in the chromosome analysis of acute myeloid leukemia and myelodysplastic syndromes

In acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) there are frequently complex karyotypes with multiple structurally altered chromosomes, many of which are marker chromosomes of unknown origin. The aim of this study was to apply comparative genomic hybridization (CGH) to cases of AML or MDS in transformation submitted for routine cytogenetic analysis to investigate whether this approach would yield any further information and, if possible, to predict which cases would benefit from CGH analysis. Nineteen cases with AML or MDS in transformation were analyzed. CGH revealed nine cases with gains or losses of chromosomal material. In six of these cases the chromosomal location of this material was not apparent from cytogenetic analysis especially when multiple markers were present. By using fluorescence in situ hybridization (FISH) with specific libraries for the chromosome regions that showed discordance between CGH and conventional cytogenetics, we were able to identify the chromosome location of material within the karyotype. In this group of six patients, four cases of an unbalanced translocation involving regions of chromosomes 5 and 17 were characterized. Three of these cases had additional abnormalities, including two cases with regions of amplification in which oncogenes are located (MYC, MLL) and one case with a dic(7;21)(p10;p10). In all six cases it was possible to characterize complex chromosomal aberrations such as derivative chromosomes, marker chromosomes, and ring chromosomes. This study demonstrates that CGH can detect true gain and loss of critical chromosome regions more accurately than conventional karyotyping in cases with very complex karyotypes, and can thus prove useful in predicting prognosis and pinpointing areas of the genome that require further study. Also, CGH can be a useful technique to identify the origin of marker chromosomes, and it can assist in choice of probes for confirmatory FISH, when there is no clue provided from the analysis of G-banded chromosomes.

Isolation and characterization of antioxidative peptides from gelatin hydrolysate of Alaska pollack skin

Gelatin extracted from Alaska pollack skin was hydrolyzed with serial digestions in the order of Alcalase, Pronase E, and collagenase using a three-step recycling membrane reactor. The fraction from the second step, which was hydrolyzed with Pronase E, was composed of peptides ranging from 1.5 to 4.5 kDa and showed high antioxidative activity. Two different peptides showing strong antioxidative activity were isolated from the hydrolysate using consecutive chromatographic methods including gel filtration on a Sephadex G-25 column, ion-exchange chromatography on a SP-Sephadex C-25 column, and high-performance liquid chromatography on an ODS column. The isolated peptides, P1 and P2, were composed of 13 and 16 amino acid residues, respectively; and both peptides contained a Gly residue at the C-terminus and the repeating motif Gly-Pro-Hyp. The antioxidative activities of the purified peptides were measured using the thiobarbituric acid method, and the cell viability was measured with MTT assay. The results showed that P2 had potent antioxidative activity on peroxidation of linoleic acid. Moreover, the cell viability of cultured liver cells was significantly enhanced by addition of the peptide. These results indicate that the purified peptide, P2, from gelatin hydrolysate of Alaska pollack skin is a natural antioxidant which has potent antioxidative activity.

Up-regulation of MUC5AC mRNA expression in endotoxin-induced otitis media

We investigated the expression levels of MUC5AC in endotoxin-induced otitis media with effusion (OME) in the rat using competitive polymerase chain reaction (PCR) and the morphology of middle ear mucosa using transmission electron microscopy (TEM). Experimental OME in the rat was induced after middle ear instillation of Escherichia coli lipopolysaccharides (LPS). Middle ear mucosa were obtained at 0 h, 12 h, Day 1, Day 3, Day 7 and Day 14 and reverse transcriptase (RT)-PCRs were then performed for the identification of MUC1, MUC2, MUC5AC and submandibular mucin 1 expression, followed by competitive PCRs for MUC5AC and beta2-microglobulin expression. Normal middle ear mucosa revealed no expression of mucin genes, whereas endotoxin upregulated the expression of MUC5AC mRNA between 12 h and Day 7, with maximal expression at Days 1 and 3. Middle ears treated three times with LPS upregulated more MUC5AC mRNA expression, by a factor of approximately 3.5, than those 1 day after one instillation. On TEM, dark granulated cells were observed at Day 3 after endotoxin instillation, but mixed granulated cells were seen on the ears treated three times with LPS. These results suggest that MUC5AC could be one of the major mucin genes in the middle ear mucosa related to otitis media.

Increased expression of peroxiredoxin II confers resistance to cisplatin

Peroxiredoxin II (Prx II) has been known to be induced by various oxidative stimuli and to play an important protective role from oxidative damage by hydrogen peroxide (H2O2). In this study, we observed that cisplatin as well as H2O2 induced Prx II expression. To examine the correlation between the increased expression of Prx II and chemoresistance, we prepared a Prx II-overexpressing cell line, SNU638 cells, and found it to be more resistant to cell death induced by cisplatin and H2O2 than neo-transfectant cells. We also observed that enhanced expression of Prx II inhibited cisplatin- and H2O2-induced apoptosis, demonstrating that resistance to these cytotoxic agents was due to inhibition of apoptosis. The above results led us to suggest that the overexpressed Prx II protein inhibits cisplatin-induced apoptosis, thereby contributing to chemoresistance of tumor cells, especially to oxidative stress producing anticancer drugs.

Replication and cytolysis of an E1B-attenuated adenovirus in drug-resistant ovarian tumour cells is associated with reduced apoptosis

Therapeutic approaches which are effective in tumour cells resistant to conventional chemotherapy would be of value. An E1B 55 kDa-deleted adenovirus (ONYX-015) induces lysis in cells with mutant p53, although the specificity of these observations for different cell types is unclear. We have used a matched set of drug-resistant human ovarian tumour cell lines to examine the potential of ONYX-015 for preferential replication and lysis of drug-resistant ovarian tumour cells with documented alterations in p53 function. Marked preferential replication of ONYX-015 is observed after infection of mutant p53 transfectant and cisplatin-resistant derivatives, compared to the wild-type p53 expressing parental A2780 line. Infection causes increased cytopathic effects in vitro and inhibition of tumour growth in vivo of the drug-resistant derivatives, but not the parental line. In apparent contrast, increased apoptosis and reduced clonogenic survival is induced by ONYX-015 infection of the chemosensitive parental cell line. ONYX-015 induces increased pro-apoptotic BAX and reduced anti-apoptotic BCLX(L) in parental cells, but not in the resistant derivative A2780/cp70. We propose that induction of apoptosis is one factor which prevents ONYX-015 spread and cytolysis after infection of chemosensitive cells, while it is the failure to engage apoptosis in drug-resistant cells that allows preferential viral replication, spread and cytolysis.

Primary structures and chain dominance of anti-DNA antibodies

Using several anti-DNA autoantibodies, we analyzed the relative involvement of heavy and light chains in their interactions with DNA. We previously obtained eight hybridomas producing monoclonal anti-DNA autoantibodies by fusing spleen cells from an MRL-lpr/lpr mouse with myeloma cells. The chain dominance was analyzed by UV cross-linking experiments, in which the antibodies were covalently cross-linked with radioisotope-labeled oligonucleotides by short-wavelength UV-light, and the cross-linked H and L chains were analyzed by SDS-PAGE and densitometric scanning. Among these, three were found to be heavy chain dominant antibodies in which heavy chains are dominantly involved in DNA binding. The other five were co-dominant antibodies in which both heavy and light chains are involved in DNA binding. To determine the factor(s) that can explain the chain dominance in DNA binding, we determined the amino acid sequences of the variable regions of both heavy (VH) and light (VL) chains of all eight monoclonal antibodies. By analyzing the data, we were able to draw the following conclusions: (1) The arginine residues are found in the CDR3 regions of both VH and VL of the co-dominant antibodies; whereas, the same residues are found only in the CDR3s of VH, but not in VL, of the heavy chain dominant antibodies. (2) The net charges of the V regions affect the chain dominance. From the results of this study it is suggested that the presence of arginine residue in CDR3 is a critical factor in determining chain-dominance, as well as DNA binding of anti-DNA antibodies in general.

Y chromosome microdeletions in idiopathic azoospermia and non-mosaic type of Klinefelter syndrome

The objective of this study was to elucidate the cause of the spermatogenic defect in idiopathic azoospermia and non-mosaic type of Klinefelter syndrome. Genomic DNAs from 9 cases of Korean idiopathic azoospermia and 6 of Korean non-mosaic type of Klinefelter syndrome were used for the detection of Y chromosome microdeletions by polymerase chain reaction using 60 primers. Microdeletions of the Y chromosome were found in 1 of 9 (11.1%) patients with idiopathic azoospermia, whereas none was deleted in non-mosaic type of Klinefelter syndrome. This result suggests that Y chromosome microdeletions could be one of the etiologic factors in idiopathic azoospermia.

K-ras oncogene mutation in cancer and precancerous lesions of the gallbladder

BACKGROUND AND OBJECTIVES

To determine whether K-ras mutation plays any role in the development and progression of gallbladder cancer, or has any clinical or pathological significance in gallbladder cancer patients, we investigated the presence and incidence of this mutation in the normal mucosa, and precancerous and cancerous lesions of the gallbladder.

METHODS

DNA was obtained from normal mucosa, dysplastic mucosa, primary cancer tissues, and metastatic lymph nodes that were identified and microdissected from the paraffin blocks of 20 gallbladder cancer cases. K-ras codon 12 mutations were investigated using a modified two-step polymerase chain reaction and the restriction fragment length polymorphism method, and by direct sequencing with an automated sequencer.

RESULTS

K-ras mutations were detected in the tissues of 10 out of the 20 patients. A mutation was present in the dysplastic epithelium associated with the primary carcinoma in 3 out of 12 specimens, in metastatic carcinoma in 1 out of 5 patients, and in primary carcinoma in 8 out of 20 patients. Mutation was found only once in the dysplastic, noncancerous epithelium, and only once in a metastatic tumor although not detectable in the primary cancer. Direct sequencing showed that the mutations were G to C substitutions (GGT-->CGT) at the first site of codon 12, except in two cases (GGT-->TGT). There were no correlations between K-ras mutations and clinicopathological factors.

CONCLUSIONS

K-ras mutations were detected in half of the gallbladder cancer cases. We suggest that K-ras mutation may play a role in the development of premalignant lesions or early carcinogenesis in some gallbladder cancers. We were unable to find any evidence that K-ras mutation plays any role in tumor progression or metastasis, or that it has any clinicopathological significance.

Efficacy of a replication-selective adenovirus against ovarian carcinomatosis is dependent on tumor burden, viral replication and p53 status

Intraperitoneal (i.p.) recurrence of cisplatin-refractory and p53 mutant ovarian cancer is a major clinical problem, despite surgery and chemotherapy. dl1520 (ONYX-015) is an E1B-55 kDa gene-deleted adenovirus engineered selectively to replicate in and destroy cancer cells lacking functional p53. However, a correlation between efficacy and p53 function has not been definitively studied in vivo to date, and efficacy following i.p. administration had not been previously described. We therefore carried out experiments to address these issues in three nude mouse-human ovarian carcinomatosis xenograft models. Intraperitoneal treatment with dl1520 led to complete tumor eradication and/or significantly improved survival in two p53(-) nude mouse-human ovarian tumor xenograft models. OVCAR3 i.p. xenografts underwent complete regressions in 11 of 12 mice (versus one of seven controls; P = 0.001), while mice bearing cisplatin-resistant A2780 tumors had significantly improved survival versus controls (P = 0.05). In contrast, the A2780 p53(+) ovarian cancer xenograft was resistant to dl1520. The efficacy of i.p. dl1520 in the p53(-) models correlated strongly with tumor burden present at the time of treatment initiation, and no efficacy was seen with non-replicating/UV-inactivated dl1520. Selectively replicating viruses such as dl1520 hold promise as i.p. therapies for p53-deficient and chemotherapy-resistant ovarian carcinomas. A phase I clinical trial of i.p. dl1520 (ONYX-015) is underway in patients with cisplatin-resistant ovarian carcinoma.

Structural characterization of beta-D-(1 --> 3, 1 --> 6)-linked glucans using NMR spectroscopy

Nondestructive structural analysis of a series of beta-D-(1 --> 3, 1 --> 6)-linked glucans (laminaran, curdlan, yeast glucan, scleroglucan, etc.) was performed using two-dimensional NMR spectroscopy. The relative ratios of H-1 at different AGUs provided the information about DPn and DB. The alpha-, and beta-anomeric protons on reducing terminals were assigned at 5.02 to approximately 5.03 ppm (J 3.6 to approximately 3.7 Hz), and 4.42 to approximately 4.43 ppm (J 7.6 to approximately 7.9 Hz), respectively, whereas the H-1 protons of internal AGUs and beta-(1 --> 6)-branched AGUs appeared at 4.56 to approximately 4.59 ppm (J 7.6 to approximately 7.8 Hz), and 4.26 to approximately 4.28 ppm (J 7.6 to approximately 10.6 Hz), respectively, in a mixed solvent of 6:1 Me2SO-d6-D2O at 80 degrees C. In the solvent, the OH peaks were eliminated from the spectra allowing the H-1 protons to appear clearly. In addition, the nonreducing terminal H-1 and H-1 at the AGU next to reducing terminal could be assigned at 4.45 to approximately 4.46 ppm (J 7.8 to approximately 7.9 Hz), and 4.51 to approximately 4.53 ppm (J 7.8 Hz), respectively. The DPn of the laminaran was 33 (polydispersity 1.12) and the DB was 0.07. The number of glucosyl units in the side chain of laminaran is more than one. The DPn and DB of the water-insoluble yeast glucan were 228 and 0.003, respectively. However the DPn of water soluble yeast glucan phosphate and curdlan was changed upon the number of freeze-drying processes and the content of water in the mixed solvent, respectively. And the DB of those were calculated as 0.02 and 0, respectively. The DB of scleroglucan was precisely calculated as 0.33, compared with the previously reported data. The H-1s at different AGUs of the various beta-D-(1 --> 3, 1 --> 6)-linked glucans having different DB can be exactly assigned by their chemical shifts in the mixed solvent system. This NMR analysis can be effectively used to determine the DP and DB of polysaccharides in a simple and non-destructive manner.

Computation of dendritic microstructures using a level set method

We compute time-dependent solutions of the sharp-interface model of dendritic solidification in two dimensions by using a level set method. The steady-state results are in agreement with solvability theory. Solutions obtained from the level set algorithm are compared with dendritic growth simulations performed using a phase-field model and the two methods are found to give equivalent results. Furthermore, we perform simulations with unequal diffusivities in the solid and liquid phases and find reasonable agreement with the available theory.

Expression of cyclin E in placentas with hydropic change and gestational trophoblastic diseases: implications for the malignant transformation of trophoblasts

BACKGROUND

Although much is known about the morphologic, cytogenetic, and clinical characters of gestational trophoblastic diseases, little information has appeared concerning the parameters related to their persistence or neoplastic transformation. Cell cycle alterations in tumor tissue were examined in this study in light of obvious changes in the clinical behavior of malignant cells. There is an increasing body of evidence suggesting that the abnormal expression of cyclins is considered one of the most important events in malignant transformation of various human cancers. Among these cell cycle regulators, the role of cyclin E in the neoplastic transformation of trophoblast populations has been poorly defined.

METHODS

Using formalin fixed, paraffin embedded trophoblastic tissues, the authors investigated the expression of cyclin E by immunohistochemistry in placentas with hydropic change and gestational trophoblastic diseases. The specimens examined included tissue from 29 patients with complete hydatidiform mole, 18 patients with partial hydatidiform mole, and 6 patients with choriocarcinoma after term pregnancy or abortion. The authors also studied four cases of hydropic abortion.

RESULTS

The cyclin E indexes (CEI) were as follows: 25.7% +/- 6.2% for hydropic change, 35.3% +/- 12.7% for triploid partial moles, 42.2% +/- 13.1% for diploid/tetraploid complete moles, and 63.6% +/- 9.5% for choriocarcinomas. There was a significant difference in CEI between placentas with hydropic change and partial mole (P = 0.04) and placentas with hydropic change and complete mole (P = 0.003). Choriocarcinomas had significantly higher cyclin E expression compared with placentas, partial moles, and complete moles, respectively. A significant correlation between the expression of cyclin E and S-phase fraction was observed in gestational trophoblastic diseases (rank correlation coefficient = 0.45, P < 0. 05). The relation between cyclin E expression and proliferation was abrogated in placentas with hydropic change, suggesting that cyclin E up-regulation represents a genuine aberration.

CONCLUSIONS

The results of this study were consistent with the concept that cyclin E overaccumulation may play an important role in the uncontrolled proliferation and neoplastic transformation of trophoblasts.

Polymorphisms of N-acetyltransferase 2, glutathione S-transferase mu and theta genes as risk factors of bladder cancer in relation to asthma and tuberculosis

PURPOSE

We investigated whether the polymorphisms of N-acetyltransferase 2 (NAT2), glutathione S-transferase-mu (GSTM1) and glutathione S-transferase-theta (GSTT1) genes were risk factors of bladder cancer among Korean people in relation to other risk factors.

MATERIALS AND METHODS

In this case-control investigation of 113 patients with primary bladder cancer and 221 control subjects, we compared the association of bladder cancer with genetic polymorphisms of NAT2, GSTM1 and GSTT1, demographic characteristics, smoking status, and medical histories in a molecular epidemiological way.

RESULTS

The risk of bladder cancer was significantly increased in patients with a medical history of tuberculosis (OR 3.61, 95% CI 1.57 to 8.26) and bronchial asthma (OR 4.15, 95% CI 1.61 to 10.75), while smoking history turned out to be insignificant. GSTM1 null genotype was a significant risk factor of bladder cancer (OR 1.81, 95% CI 1.12 to 2.93). On the other hand, slow acetylator and GSTT1 genotypes were insignificant. Also, we could not find any association between GSTM1, GSTT1, slow acetylator genotypes and bladder cancer risk among smokers. The rapid acetylator, GSTM1 null and GSTT1 null genotypes with a medical history of asthma or tuberculosis combinations were significant risk factors in Korean subjects.

CONCLUSIONS

Among Korean subjects, GSTM1 null genotype was a significant risk factor for bladder cancer. The reason why bronchial asthma and tuberculosis are risk factors in Korean subjects is yet unknown, but a variety of factors, including enzyme activities for detoxification, medication for these diseases and immunological background might be involved.

Ultra-thin needle thoracoscopic surgery for hyperhidrosis with excellent cosmetic effects

BACKGROUND

In spite of its cosmetic benefits over open surgical techniques, endoscopic sympathectomy using 5 mm or larger instruments still has the problems of operative scar as well as pain on the trocar sites. Recently we have begun using 2 mm endoscopic instruments. The purpose of this study was to confirm the safety and feasibility of fine needle endoscopic instruments in thoracic sympathetic ablation.

METHODS

We have exclusively used 2 mm endoscopic instruments since January 1997, and from that time to May 1999 417 patients were underwent surgical procedures for hyperhidrosis. T2 or T2/T3 sympathectomy was performed for the first 56 patients, after June 1997, in 361 patients the interconnecting sympathetic trunk was divided instead of ganglion resection, and this procedure was named sympathicotomy. Palmar hyperhidrosis was presented in 375 patients (89.9%) and facial in 28 (6.7%) and axillary in 14 (3.4%). The level of division or resection of the ganglion differed according to the patient's symptoms.

RESULTS

Sympathicotomy and sympathectomy were successful and all patients were satisfied with immediate dryness of affected sites. There were not any cases of bleeding or reoperation or hospital mortality. A large endoscope was required to eliminate the pleural adhesion in fourteen cases (7.7%). Thoracotomy conversion was required in two pleural adhesion cases. Minor complications were occurred in 17 patients (4.1%); such as closed thoracostomy in ten cases, peripheral nerve injury in three, pulmonary parenchymal injury in two, Horner's syndrome in two and atrial fibrillation in one. We have five cases of recurrent symptoms (1.2%).

CONCLUSION

Our experience indicates that, for the treatment of hyperhidrosis, 2 mm ultra-thin needle endoscopic instruments are safe and effective to operate on palmar and facial hyperhidrosis patients.

Closing volume influences the postural effect on oxygenation in unilateral lung disease

In normal adults, both blood flow and ventilation are distributed preferentially to the dependent lung zones. In adults with unilateral lung disease, arterial oxygenation improves when they are positioned with their good lung down because of improved matching of ventilation and perfusion. When the closing volume is increased, dependent airways are closed during tidal breathing, so that reduced ventilation-perfusion ratio and hypoxia develops and ventilation is preferentially distributed to the upper lung zones. We undertook an observational study on the effects of lateral recumbency on arterial oxygenation in adult patients with unilateral lung disease and tested the hypothesis that oxygenation in lateral recumbency might be influenced by an increase in closing volume. Arterial blood gases were analyzed in the supine, right and left lateral decubitus positions and the AaPO(2) was calculated in 44 randomly selected patients 49.9 +/- 18.7 yr of age with unilateral pneumonia (23 cases) or pulmonary tuberculosis (21 cases). In 26 patients, individual Pa(O(2)) with the normal lung in the dependent position was higher than that with the diseased lung; the opposite was true for 18 patients. The difference in Pa(O(2)) and AaPO(2) between the two positions was statistically significant in both groups. In 16 patients (10 men and six women 49.2 +/- 18.2 yr of age), we measured closing volume and determined the fractional ventilation to each lung by (133)Xe lung scan in the three positions. In these 16 patients, the difference in Pa(O(2)) between the normal and the diseased lung in the dependent position was related significantly to the difference in the fractional ventilation going to the normal lung between the dependent and the supine position (r = 0.642, p = 0. 007). The latter was related significantly to the % predicted closing volume (CV/VC) (r = -0.597, p = 0.015). This study has shown that closing volume, as well as posture, might be involved in determining oxygenation in lateral recumbency in patients with unilateral lung disease.

Expression of mucin genes in chronic ethmoiditis

We have investigated the profiles of MUC genes expressed in chronic ethmoiditis mucosa and normal ethmoid mucosa using RT-PCR, and the morphology of chronic ethmoiditis by a combination of light and electron microscope was observed. In the light- and electron-microscopic studies, chronic ethmoiditis mucosa revealed increased numbers of goblet cells with higher production of mucus in comparison to normal ethmoid mucosa. RT-PCR of cDNAs from three normal ethmoid mucosa revealed the same pattern of mucin gene expression, such as MUC5AC and MUC8. However, RT-PCR of cDNAs from eight chronic ethmoiditis mucosa showed the expression of two MUC1, six MUC4, eight MUC5AC, five MUC5B, seven MUC7, and eight MUC8. MUC2 and MUC6 were not detected. These results suggest that MUC4, MUC5AC, MUC5B, MUC7, and MUC8 are major mucins in the ethmoid mucosa and are up-regulated by chronic inflammation.