Spinal pseudarthrosis in advanced ankylosing spondylitis with sagittal plane deformity: clinical characteristics and outcome analysis

STUDY DESIGN

A retrospective study of consecutive ankylosing spondylitis (AS) patients with spinal pseudarthrosis.

OBJECTIVES

To review the clinical characteristics and assess the outcomes of surgical treatment of spinal pseudarthrosis in advanced AS patients with sagittal plane deformity.

SUMMARY OF BACKGROUND DATA

There have been several reports describing the clinical findings of spinal pseudarthrosis in AS. However, few have studied the outcomes of surgical treatment of spinal pseudarthrosis with sagittal plane deformity in advanced AS patients.

METHODS

A total of 19 destructive vertebral lesions in 12 patients were reviewed. We performed Smith-Petersen osteotomy (SPO) at the same level for correction of sagittal plane deformity and anterior interbody fusion (AIF) for repair of pseudarthrosis. Pedicle subtraction osteotomy (PSO) was performed additionally at the lumbar spine in six severe kyphotic patients. Outcome variables included radiographic measurement from preoperative, immediate postoperative and follow-up films (mean, 51 months; range, 35-108 months), and clinical assessment using visual analog scale for back pain and the modified SRS outcome instruments satisfaction domain and the review of postoperative complications.

RESULTS

Clinical characteristics including trauma and inflammatory reaction were variable. The mean time for radiographic union of pseudarthrosis was 4.2 months (range, 2.5-6 months). Average correction of segmental kyphosis with SPO at the level of pseudarthrosis was 20.9 degrees (range, 5 degrees -34 degrees ) and 26.3 degrees (range, 20 degrees -32 degrees ) with lumbar PSO. Mean sagittal imbalance had improved 15.2 cm (range, 6.7-34.7 cm) at the last follow-up. All 12 patients had improvement of pain and neurologic deficit. The mean visual analog scale for pain had improved 4.8 (range, 4-7). The mean SRS score for patient satisfaction at the last follow-up was 4.6 of a possible 5. There were 7 cases of complications, including 3 cases of intraoperative dural tear, 2 cases of postoperative radiculopathy, and 1 case of wound infection. There was no permanent complication.

CONCLUSIONS

SPO at the level of pseudarthrosis was a safe and effective technique to correct sagittal imbalance without vascular complication. Surgical repair of pseudarthrosis with AIF provided successful fusion and good clinical results. For patients with lumbar hypolordosis, additional PSO was effective in restoration of sagittal balance.

Identification of differentially expressed genes using annealing control primer-based GeneFishing in human squamous cell cervical carcinoma

AIMS

To compare different gene expression patterns between squamous cell cervical carcinoma (SCC) and normal cervical tissue in Korean women and to identify those genes that are specifically or predominantly expressed in SCC by employing annealing control primer (ACP)-based GeneFishing polymerase chain reaction (PCR).

MATERIALS AND METHODS

Cervical cancer specimens were obtained from patients enrolled at the Department of Obstetrics and Gynecology, Kang Nam St. Mary's Hospital, Catholic University of Korea. We used a common reference that was mixed with an equal amount of RNA extracted from patients without cervical cancer. The profiles of expressed genes were compared between the SCC and normal cervix identified using GeneFishing differentially expressed gene kits, screened by a BLAST search, and confirmed by semi-quantitative reverse transcription-PCR (RT-PCR).

RESULTS

Almost 100 differentially expressed genes were identified in the control and SCC samples. Using 60 arbitrary ACPs, 50 differentially expressed genes were identified, and 30 up-regulated and 20 down-regulated expressed genes were sequenced. Among 50 clones selected by ACP-based GeneFishing PCR, six genes with different expression patterns were determined and confirmed by semi-quantitative RT-PCR. The functional roles of two up-regulated genes, fibrillarin and calgranulin A, and one down-regulated gene, clusterin, were previously identified. However, the functional roles of two up-regulated genes and one down-regulated gene were not identified.

CONCLUSION

We identified distinctive gene expression profiles in Korean women with SCC using ACP-based GeneFishing PCR.

Promoter methylation of p16, DAPK, CDH1, and TIMP-3 genes in cervical cancer: correlation with clinicopathologic characteristics

This study was conducted to investigate the promoter methylation status of the p16, DAPK, CDH1, and TIMP-3 genes in primary cervical cancer and its correlation with clinicopathologic characteristics. Promoter methylation was evaluated using a methylation-specific polymerase chain reaction in 78 cervical cancer tissue specimens and 24 control, normal cervical tissue specimens. Clinicopathologic parameters were obtained from medical records, and the relationship between the discrete variables and the methylation status was evaluated. The frequencies of promoter methylation of p16, DAPK, CDH1, and TIMP-3 in cervical cancer were 57%, 44.9%, 52.6%, and 9%, respectively. Primary cervical cancer had significantly higher methylation frequencies for the p16 and DAPK promoters than did the control, normal cervix (P < 0.0001). The promoter methylation of TIMP-3 was significantly higher in adenocarcinoma than in squamous cell carcinoma (41.7% vs 3%, respectively, P= 0.0175). High-stage cancers exhibited an increased promoter methylation frequency for p16 (P= 0.0061). The promoter methylation of the p16 gene is a frequent event in cervical carcinogenesis and may have potential clinical application as a marker for the progression and prognosis of cancer.

Outcome and management of spinal tuberculosis according to the severity of disease: a retrospective study of 137 adult patients at Korean teaching hospitals

STUDY DESIGN

A retrospective study examining the clinical features, management, and treatment outcome of patients with spinal tuberculosis (TB).

OBJECTIVE

To determine the influence of disease severity and treatment modality on outcome of patients with spinal TB.

SUMMARY OF BACKGROUND DATA

Although anti-TB chemotherapy is now the mainstay treatment for spinal TB, it may not be applicable to all situations, especially in patients with risk of deformity, instability, and progression of neurologic deficit.

METHODS

In this retrospective study (1994-2003), medical records and radiographic findings of patients with spinal TB were reviewed at 7 teaching hospitals in South Korea. The duration of triple chemotherapy with isoniazid, rifampin, and ethambutol, disease severity, operative procedures, and outcome were analyzed. The outcome was assessed as both favorable and unfavorable according to predefined criteria.

RESULTS

A total of 137 patients were diagnosed with spinal TB during the study period. Twenty-one patients were lost to follow-up and excluded from analysis. The mean age was 44.07 +/- 16.57 years. The most common vertebral area involved was the lumbar (44.8%). The mean number of vertebra involved was 2.25. The mean angle of kyphosis was 21.58 degrees. Forty-seven patients (35.1%) had severe symptoms. Radical surgery was carried out in 84 (62.2%) patients. Twenty patients were treated with short-term chemotherapy, while 96 under long-term. At the end of chemotherapy, 94 patients had achieved a favorable status and 22 an unfavorable one. Statistically, there was no significant difference between the 2 groups in terms of gender, chemotherapy duration, or the severity of spinal TB; however, age (P = 0.025; odds ratio = 0.963; 95% confidence interval 0.932-0.995) and radical surgery (P = 0.043; odds ratio = 3.047; 95% confidence interval 1.038-8.942) were significantly related to a favorable outcome by logistic analysis.

CONCLUSIONS

Our results showed that a younger age and radical surgery in conjunction with anti-TB chemotherapy were significant favorable prognostic factors.

Tophaceous gout of the lumbar spine mimicking pyogenic discitis

BACKGROUND CONTEXT

Gout of the spine is very rare. Forty-one cases of gout affecting the spine have been reported.

PURPOSE

To present a patient with tophaceous gout of the lumbar spine mimicking pyogenic discitis.

STUDY DESIGN

Case report.

METHODS

The medical record, including operative notes, progress notes, discharge summary, clinical notes, radiological study, and pathological studies was reviewed.

RESULTS

The patient had acute low back pain and radiculopathy with high spiking fever. Therefore, pyogenic discitis was suspected. However, histological diagnosis revealed tophaceous gout.

CONCLUSIONS

Tophaceous gout of the spine is very rare. However, when a patient presents with acute back pain and fever, spinal gout should be considered, particularly in a patient with a previous history of hyperuricemia or gout.

Clinical outcomes of 3 fusion methods through the posterior approach in the lumbar spine

STUDY DESIGN

This prospective randomized study compared 3 fusion methods: posterolateral fusion (PLF), posterior lumbar interbody fusion (PLIF), and PLIF combined with PLF (PLF+PLIF).

OBJECTIVES

To compare the outcomes of the 3 fusion methods and find a useful fusion method.

SUMMARY OF BACKGROUND DATA

Many studies have shown clinical results, advantages, and postoperative complications of each fusion method, but few have compared the 3 fusion methods prospectively.

METHODS

A total of 167 patients who underwent 1 or 2-level fusion surgery because of degenerative lumbar disease from January 1996 to September 2000 were studied. Minimum follow-up was 3 years. The patients were randomized into 1 of 3 treatment groups: group 1 (PLF; n = 62); group 2 (PLIF; n = 57); and group 3 (PLF+PLIF; n = 48). A visual analog scale, the Oswestry Disability Questionnaire, and Kirkaldy-Willis criteria were used to measure low back pain, leg pain, and disability. For radiologic evaluation, disc height, lumbar lordosis, segmental angle, and bone union were examined. Postoperative complications were also analyzed.

RESULTS

At the last follow-up, good or excellent results were obtained in 50 cases of PLF (80.7%), 50 cases of PLIF (87.8%), and 41 cases of PLF+PLIF (85.5%). No statistical differences were found among the 3 groups (P = 0.704). All methods indicated significant improvement in the disc height (P < 0.05), with PLF having the highest loss in disc height. Lumbar lordosis and segmental angle increased significantly, and improvement of the segmental angle in the 3 fusion methods had statistically significant differences. The nonunion rates at the last follow-up in the 3 fusion groups were not statistically significant, with 8% in group 1, 5% in group 2, and 4% in group 3 (P > 0.05). Complications included deep infection in 3 cases, transient nerve palsy in 4, permanent nerve palsy in 1, and donor site pain in 6.

CONCLUSIONS

No significant differences in clinical results and union rates were found among the 3 fusion methods. PLIF had better sagittal balance than PLF. PLIF without PLF had advantages of the elimination of donor site pain, shorter operating time, and less blood loss.

The quantitative analysis of tissue injury markers after mini-open lumbar fusion

STUDY DESIGN

A prospective and comparative analysis of tissue injury after mini-open lumbar fusion and conventional technique.

OBJECTIVE

To evaluate the tissue injury quantitatively after mini-open lumbar fusion.

SUMMARY OF BACKGROUND DATA

The advantages of minimally invasive techniques demonstrated by clinical reports have been a smaller scar, lesser pain, and rapid rehabilitation. It has not been established, however, that the minimally invasive technique has less tissue injury and less systemic response than the conventional spine surgery.

METHODS

Twenty patients who had undergone posterior decompression and the fusion of the L4-L5 segment for spinal stenosis were studied prospectively. Ten patients that had the conventional posterior decompression and posterior lumbar interbody fusion (PLIF) at L4-L5 were enrolled in a control group. The remaining 10 patients who underwent MISS techniques (paramedian mini-open approach using a tubular retractor) were enrolled in a study group. The serum enzymes representing skeletal muscle injury (creatinine kinase and aldolase), pro-inflammatory cytokines (IL-6, IL-8), and anti-inflammatory cytokines (IL-10, IL-1 receptor antagonist) were analyzed with ELISA techniques. They were checked on the day before operation and 1, 3, 7, and 14 days after operation.

RESULTS

Serum creatinine kinase and most of the inflammatory cytokines were significantly high in the control group on postoperative days 1 and 3 and returned to the normal level on postoperative day 7. Serum aldolase was significantly high on postoperative day 1, and IL-8 remained elevated until postoperative day 7 in the control group.

CONCLUSION

Mini-open lumbar fusion may significantly contribute to the reduction of muscle injury and systemic inflammatory reactions during the acute postoperative period. This study suggests that mini-open lumbar fusion may also play an important role in preventing medical morbidity after spinal surgery.

The effects of pulsatile versus non-pulsatile extracorporeal circulation on the pattern of coronary artery blood flow during cardiac arrest

BACKGROUND

In sudden cardiac arrest, the effective maintenance of coronary artery blood flow is of paramount importance for myocardial preservation as well as cardiac recovery and patient survival. The purpose of this study was to directly compare the effects of pulsatile versus non-pulsatile circulation to coronary artery flow and myocardial preservation in a cardiac arrest condition.

METHODS

A cardiopulmonary bypass circuit was constructed in a ventricular fibrillation model using fourteen Yorkshire swine weighing 25-35 kg each. The animals were randomly assigned to group I (n=7, non-pulsatile centrifugal pump) or group II (n=7, pulsatile T-PLS pump). Extracorporeal circulation was maintained for two hours at a pump flow of 2 L/min. The left anterior descending coronary artery flow was measured with an ultrasonic coronary artery flow measurement system at baseline (before bypass) and at every 20 minutes after bypass. Serologic parameters were collected simultaneously at baseline, 1 hour, and 2 hours after bypass in the systemic arterial and coronary sinus venous blood. The Mann-Whitney U test of STATISTICA 6.0 was used to determine intergroup significances using a p value of <0.05.

RESULTS

The resistance index of the coronary artery was lower in group II and the difference was significant at 40 min, 80 min, 100 min and 120 min (p<0.05). The mean velocity of the coronary artery was higher in group II throughout the study, and the difference was significant from 20 min after starting the pump (p<0.05). The coronary artery blood flow was higher in group II throughout the study, and the difference was significant from 40 min to 120 min (p<0.05) except at 80 min. Serologic parameters showed no differences between the groups at 1 hour and 2 hours after bypass in the systemic and coronary sinus blood (p=NS).

CONCLUSION

In the cardiac arrest condition, pulsatile extracorporeal circulation provides more blood flow, higher flow velocity and less resistance to coronary artery than non-pulsatile circulation.

Interleukin-18 gene polymorphisms in Korean patients with Behçet's disease

OBJECTIVE

There is strong evidence that Th1-type cytokines play an important role in the pathogenesis of Behçet's disease (BD). Interleukin (IL)-18 is a proinflammatory cytokine that mediates Th1-polarized immune responses, and elevated levels of IL-18 have been observed in the sera and bronchoalveolar lavage fluid of patients with active BD. Therefore, the aim of this study was to investigate the potential associations of two single nucleotide polymorphisms (SNPs) at positions -137 (G/C) and -607 (C/A) in the promoter region of the IL-18 gene with a susceptibility to BD in the Korean population.

METHODS

Ninety-eight patients with BD and 105 healthy controls were studied. All of the subjects were genotyped using sequence specific PCR. The genotypes and alleles between patients with BD and controls were compared using the chi2 test, together with Yate's correction where appropriate. Haplotype analysis was assessed using the EH program.

RESULTS

The genotype and allele distributions of the two SNPs did not differ significantly between patients with BD and controls. The haplotype frequencies of the IL-18 promoter polymorphisms were also similar between patients with BD and controls. However, the frequency of the GG genotype at position -137 was significantly higher in BD patients with ocular lesions than in those without ocular lesions (p = 0.026, pc = 0.048, OR = 4.1).

CONCLUSION

Although the IL-18 gene polymorphisms were not associated with a susceptibility to BD in the Korean population, the patients carrying the GG genotype at position -137 had a higher risk of developing the ocular lesions. Further studies in other populations are required to confirm these results.

Extraordinary Strengthening Effect of Carbon Nanotubes in Metal-Matrix Nanocomposites Processed by Molecular-Level Mixing

Carbon-nanotube-reinforced Cu matrix nanocomposites have been fabricated by molecular-level mixing of functionalized carbon nanotubes (CNTs) with Cu ions, followed by spark plasma sintering. The compressive strengths and Young's moduli of CNT-reinforced nanocomposites are considerably higher than those of the Cu matrix due to the homogeneously dispersed CNTs embedded in the Cu matrix.

Endothelial nitric oxide synthase gene polymorphisms in Behçet's disease and rheumatic diseases with vasculitis

OBJECTIVE

To assess potential associations between Korean Behçet's disease (BD) or other rheumatic diseases with vasculitis and two polymorphisms of the endothelial nitric oxide synthase (eNOS) gene, which include the Glu298Asp polymorphism in exon 7 and a variable number of tandem repeats (VNTR) polymorphism in intron 4.

METHODS

65 patients with BD, 27 with rheumatic diseases with vasculitis, and 80 controls were studied. Analyses of the Glu298Asp polymorphism in exon 7 and VNTR polymorphism in intron 4 of the eNOS gene were made by the polymerase chain reaction (PCR)-restriction fragment length polymorphism technique and PCR genotyping, respectively. Additionally, HLA-B51 typing was performed in the BD group and controls by a two step PCR sequence-specific primers method.

RESULTS

Significant differences in Glu298Asp genotype frequencies were found between the BD or vasculitis groups and the controls (BD group v controls: p(corr)=0.006; vasculitis group v controls: p<0.001). The Asp298 frequency was much higher in the BD and vasculitis groups than in the controls. Even after stratification of the BD group based on the results of HLA-B51 testing, a significant association of the Glu298Asp polymorphism was still found (p=0.002, Mantel-Haenszel weighted odds ratio 4.3, 95% confidence interval 1.7 to 10.9). Distribution of the genotype frequencies in two eNOS gene polymorphisms was similar in connective tissue diseases-associated vasculitis and primary vasculitic syndromes. In contrast, distribution of alleles and genotypes of VNTR polymorphism did not differ between BD or vasculitis groups and the controls.

CONCLUSION

The Glu298Asp polymorphism in exon 7 of the eNOS gene seems to be a susceptibility gene for Korean BD and other rheumatic diseases.

Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients

STUDY DESIGN

A prospective study.

OBJECTIVES

To assess the significance of chin-brow vertical angle in planning and evaluating the correction of kyphotic deformity with ankylosis of the cervical spine in ankylosing spondylitis patients.

SUMMARY OF BACKGROUND DATA

Accurate assessment and measurement of spinal kyphotic deformity is required when planning treatment and assessing its results.

METHODS

Thirty-four ankylosing spondylitis patients with cervical ankylosis who had undergone pedicle subtraction extension osteotomy for correction of kyphotic deformity were studied. Radiographic assessment for sagittal balance was performed by measuring thoracic kyphosis, lumbar lordosis, the distance between the vertical line on the anterosuperior point of T1 and that of S1, and sacral inclination. Chin-brow vertical angle was measured on the clinical photos of the patients. Clinical outcomes were assessed by a questionnaire.

RESULTS

The preoperative and postoperative chin-brow vertical angles were 35.5 degrees and 1.8 degrees, respectively. Final follow-up radiographs showed an increase in lumbar lordosis from 5.5 degrees to 43.2 degrees (an increase of 37.7 degrees ), and thoracic kyphosis remained stable from 50.4 degrees to 50.2 degrees. Sagittal imbalance significantly improved from 101.5 mm to 12.7 mm. The decreased chin-brow vertical angle correlated negatively with the correction angle. The patients with a chin-brow vertical angle of less than -10 degrees had significantly low scores on horizontal gaze.

CONCLUSIONS

Chin-brow vertical angle was an objective index for evaluating horizontal gaze. Based on the results of this study, measurement of chin-brow vertical angle is recommended for planning correction of kyphosis and accurate evaluation of treatment outcome.

Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity

STUDY DESIGN

A prospective study was performed in 45 patients with ankylosing spondylitis.

OBJECTIVES

To assess the outcomes of decancellation pedicle subtraction extension osteotomy in ankylosing spondylitis patients with severe fixed kyphotic deformity.

SUMMARY OF BACKGROUND DATA

There have been several studies regarding correction of kyphotic deformity in ankylosing spondylitis. However, most of them concern surgical technique. There have been no reports concerning clinical results of decancellation pedicle subtraction osteotomy in ankylosing spondylitis.

METHODS

The kyphotic deformity was corrected by a one-stage pedicle subtraction extension osteotomy. Radiographic assessment for sagittal balance was performed by measuring thoracic kyphosis, lumbar lordosis, distance between the vertical line on anterosuperior point of T1 and that of S1, and sacral inclination. Chin brow-vertical angle was measured on the preoperative and postoperative clinical photograph of patients. Clinical outcomes were assessed by questionnaire measuring changes in physical function, indoor activity, outdoor activity, psychosocial activity, pain, and patient satisfaction with surgery.

RESULTS

Final follow-up radiograph showed an increase in lumbar lordosis from 10 degrees to 44 degrees (an increase of 34 degrees), whereas thoracic kyphosis remained stable from 50 degrees to 54 degrees. Sagittal imbalance significantly improved from 94 to 8 mm, whereas sacral inclination increased from 8 degrees to 24 degrees. The chin brow-vertical angle was 32.0 degrees before surgery and 0.9 degrees after surgery. Satisfactory clinical outcome was achieved; however, clinical improvements did not correlate with changes in radiologic measurements.

CONCLUSIONS

Most of the patients maintained good correction and had good clinical results. Based on the results of this study, pedicle subtraction extension osteotomy is effective for correction of kyphotic deformity in ankylosing spondylitis.

Blocking of acidosis-mediated apoptosis by a reduction of lactate dehydrogenase activity through antisense mRNA expression

Lactic acid produced from the cells is a potential cause of extra- and intracellular acidification. Due to scarce technical tools, lactic acid that leads to acidification could not be reduced and direct evidence of the relationship between metabolic lactate and apoptosis has not yet been elucidated. In this study, we designed a cellular pH regulation system in CHO cells by a reduction of lactate dehydrogenase (LDH) activity through LDH antisense mRNA expression. This inhibited lactate production and, therefore, acidification of the cytosol. Under HCO3(-)-buffered growth conditions, both the parent CHO cells and the engineered CHO cells maintained their extracellular pH and intracellular pH fairly well. However, upon acidification of the cytosol, only the parent CHO cells underwent apoptosis under HCO3(-)-free conditions. In fact, we observed a number of apoptosis-related events only in control cells, including mitochondrial dysfunction, cytochrome c release, and an increase in caspase-3 enzymatic activity.

Low-dose levalbuterol in children with asthma: safety and efficacy in comparison with placebo and racemic albuterol

BACKGROUND

Racemic albuterol (RAC) is an equal mixture of (R)-albuterol and (S)-albuterol. Only the (R)-isomer, levalbuterol (LEV), is therapeutically active. Lower doses of LEV, devoid of (S)-albuterol, have demonstrated efficacy comparable to that of higher doses of the (R)-isomer administered as a component of RAC.

OBJECTIVE

The purpose of this study was to determine whether LEV results in improved safety and efficacy in children.

METHODS

Asthmatic children aged 4 to 11 years (n = 338; FEV(1), 40% to 85% of predicted) participated in this multicenter, randomized, double-blinded study and received 21 days of 3-times-a-day treatment with nebulized LEV (0.31 or 0.63 mg), RAC (1.25 or 2.5 mg), or placebo. The primary endpoint was FEV(1) (peak percent change). Adverse events, clinical laboratory test results, vital signs, and electrocardiograms were evaluated for safety.

RESULTS

All active treatments significantly improved the primary endpoint in comparison with placebo (P < .001). Significant differences in FEV(1) were noted immediately after nebulization (median change, 2.0%, 19.0%, 18.1%, 12.4%, and 15.6% for placebo, LEV 0.31 and 0.63, RAC 1.25 and 2.5 mg, respectively; P < .05 vs placebo; P < .05 for LEV 0.31 and 0.63 vs RAC 1.25 mg). LEV 0.31 mg was the only treatment not different from placebo for changes in ventricular heart rate, QT(c) interval, and glucose (P > .05). All active treatments decreased serum potassium (range, -0.3 to -0.6; P < .002 vs placebo), and RAC 2.5 mg caused the greatest change (P < .005 vs other actives). In a patient subset with severe asthma, a dose-response relationship was observed for levalbuterol, indicating that higher doses were more effective.

CONCLUSION

LEV was clinically comparable to 4- to 8-fold higher doses of RAC, and it demonstrated a more favorable safety profile. LEV 0.31 mg should be used as the starting dose in 4-11 year old children with mild to moderate persistent asthma. Patients with severe disease might benefit from higher doses.

Fine-needle aspiration cytology of pleuropulmonary blastoma: a case report with unusual features

Pleuropulmonary blastoma (PPB) is a rare and aggressive intrathoracic neoplasm of childhood, typically presenting as a pulmonary and/or pleural-based mass with cystic, solid, or combined features. Histologically, the tumor is well characterized with a mixture of primitive mesenchymal and variably differentiated sarcomatous components, and the cytologic features described in the three previous reports are also compatible to the histologic ones. Now, we present another case of PPB showing unusual features. A 3-yr-old boy presented with a pleural- or chest wall-based tumor. The fine-needle aspiration cytologic smears were highly cellular with poorly differentiated cells showing variable size and shape rather than those of typical blastemal cells. The histologic findings were also distinctive, exhibiting diffuse sheets of poorly differentiated cells without typical blastemal cell component. Diagnosis was confirmed by the support of immunohistochemical and ultrastructural features. The patient underwent a typical aggressive clinical course to death within 8 mo after diagnosis.

A simple and secure technique for tracheal T-tube insertion

We describe a simple and secure technique for the insertion of a long Montgomery type T-tube in patients with tracheal stenosis. An endotracheal tube is placed into the lumen of the T-tube and by maintaining the airway during insertion, the technique has been found to be safe and it can prevent the kind of tracheal damage occurring with blind techniques.

Potentiation of PGE(2)-mediated cAMP production during neuronal differentiation of human neuroblastoma SK-N-BE(2)C cells

The prostaglandin-evoked cAMP production was studied in human neuroblastoma SK-N-BE(2)C cells during neuronal differentiation induced by all-trans retinoic acid. The incubation with 5 microM all-trans retinoic acid for 4-6 days promoted neurite outgrowth of cells. After differentiation, prostaglandin E(2) (PGE(2))-induced cAMP production was dramatically increased, whereas forskolin- and AlF-induced cAMP productions were not changed. The increase reached maximum after 4-days of incubation with all-trans retinoic acid. The differentiation caused an increase in the maximal response and a decrease in the half-maximal effective concentration of the PGE(2)-induced cAMP production. In addition, the binding of [(3)H]PGE(2) to membrane receptors was enhanced in differentiated cells. However, the order of potency of the various prostaglandins (PGE(1) = PGE(2) > PGD(2) = PGF(2alpha) = PGI(2)) in cAMP production did not change during the differentiation, suggesting that mainly E-prostanoid (EP) receptors were involved. Butaprost, an EP(2) receptor specific agonist, increased the cAMP level in a concentration dependent manner and had a similar potentiating effect on cAMP production as PGE(2) upon differentiation. Northern blot analysis using the human cDNA probes shows that the EP(2) mRNA level was about seven times higher in differentiated cells, while the dopamine beta-hydroxylase (DBH) mRNA completely disappeared. Our results, thus, suggest that elevated gene expression of the prostanoid EP(2) receptor results in an increase in the PGE(2)-evoked cAMP production in SK-N-BE(2)C cells during neuronal differentiation.

P2X7 nucleotide receptor mediation of membrane pore formation and superoxide generation in human promyelocytes and neutrophils

The P2X(7) receptor, which induces cation channel opening imparting significant permeability to Ca2+ and pore formation with changes in the plasma membrane potential, has been known to be rather restrictedly expressed in cells of the macrophage lineage including dendrites, mature macrophages, and microglial cells. However, we show here that the P2X(7) receptor is also expressed in cells of granulocytic lineage such as HL-60 promyelocytes, granulocytic differentiated cells, and neutrophils. Exposure of these cells to 2',3'-O-(4-benzoyl)benzoyl-ATP (BzATP) triggered intracellular Ca2+ rise through the mediation of phospholipase C-independent and suramin-sensitive pathways. BzATP also induced depolarization of the plasma membrane in the absence of extracellular Ca2+, whereas it hyperpolarized the cells in the presence of external Ca2+, probably in part through the activation of Ca2+-activated K(+) channels. However, the hyperpolarization phenomenon was markedly attenuated in differentiated HL-60 cells and neutrophils. RT-PCR and Northern blot analysis revealed the presence of P2X(7) receptors on both HL-60 and neutrophil-like cells. This was further confirmed by pore formation through which the uptake of Lucifer yellow and YO-PRO1 occurred on BzATP treatment. BzATP stimulated in a concentration-dependent manner the production of superoxide in differentiated HL-60 cells via a pathway partially dependent on extracellular Ca2+. Moreover, in human neutrophils, BzATP was a more effective inducer of superoxide generation than PMA. Taken together, this is a first demonstration of the expression of P2X(7) receptors on neutrophils, which shows that the receptor is functionally involved in the defense mechanism by activation of the respiratory burst pathway.

Inhibition of H2 histamine receptor-mediated cation channel opening by protein kinase C in human promyelocytic cells

Histamine, through H(2) receptors, triggers a prominent rise in intracellular free Ca(2+) concentration ([Ca(2+)](i)) in addition to an elevation of cAMP level in HL-60 promyelocytes. Here we show that the histamine-induced [Ca(2+)](i) rise was due to influx of Ca(2+) from the extracellular space, probably through nonselective cation channels, as incubation of the cells with SKF 96365 abolished the histamine-induced [Ca(2+)](i) rise, Na(+) influx, and membrane depolarization. The Ca(2+) influx was specifically inhibited by pretreatment of the cells with PMA or extracellular ATP with 50% inhibitory concentrations of 0.12 +/- 0.03 nM and 185 +/- 17 microM, respectively. Western blot analysis of protein kinase C (PKC) isoforms revealed that PMA (< or =1 nM) and ATP (300 microM) caused selective translocation of PKC-delta to the particulate/membrane fraction. Costimulation of the cells with histamine and SKF 96365 partially reduced histamine-induced granulocytic differentiation, which was evaluated by looking at the extent of fMet-Leu-Phe-induced [Ca(2+)](i) rise and superoxide generation. In conclusion, nonselective cation channels are opened by stimulation of the H(2) receptor, and the channels are at least in part involved in the induction of histamine-mediated differentiation processes. Both effects of histamine were selectively inhibited probably by the delta isoform of PKC in HL-60 cells.

Ten-year survival of patients with locally advanced, stage ib-iib cervical cancer after neoadjuvant chemotherapy and radical hysterectomy

OBJECTIVE(S)

The aim of this study was to evaluate the effects of neoadjuvant chemotherapy and radical hysterectomy on long-term survival in stage IB-IIB locally advanced cervical cancer by conducting a 10-year follow-up.

METHODS

Between August 1983 and May 1990, 80 locally advanced, stage IB-IIB cervical cancer patients with tumor diameter greater than or equal to 4 cm were treated with neoadjuvant VBP chemotherapy (cisplatin, vinblastine, and bleomycin) followed by radical hysterectomy with pelvic lymphadenectomy. After this therapeutic modality, patients were followed for more than 10 years. Ten-year survival rates and factors affecting recurrence after this therapy were evaluated.

RESULTS

Of 80 patients, 75 (93.7%) showed a reduction in tumor size after neoadjuvant chemotherapy. At pathologic examination, stage reduction was noted in 53 (66.2%) patients and 20 patients (25%) showed no residual or microinvasive cervical tumor. Pelvic lymph node metastases were found in 17 patients (21.3%). During the 10-year follow up, 2 patients were lost and 16 patients recurred. Overall 5-year and 10-year disease-free actual survival rates were 82.0 (64/78) and 79.4% (62/78), respectively. Clinical stage, initial tumor size, clinical response, and residual tumor size were not risk factors for recurrence after this therapy. However, pelvic lymph node metastasis was a significant risk factor for recurrence.

CONCLUSION(S)

Neoadjuvant VBP chemotherapy followed by radical hysterectomy in locally advanced, stage IB-IIB cervical cancer patients seemed to improve the long-term survival rate for these patients compared to that of conventional therapy. However, randomized controlled trials are needed to confirm this result.

Effects of polychlorinated biphenyl 19 (2,2',6-trichlorobiphenyl) on contraction, Ca2+ transient, and Ca2+ current of cardiac myocytes

Polychlorinated biphenyls (PCBs) have been known as serious environmental pollutants, causing developmental delays, motor dysfunction, and decrease in brain dopamine level in humans and animals. We have investigated the effects of a PCB congener, 2,2',6-trichlorobiphenyl (PCB 19) on contractile force, Ca2+ transient, and L-type Ca2+ current (I(Ca,L)) in guinea pig ventricular myocytes stimulated at a rate of 0.25-0.33 Hz. PCB 19 decreased contractile force in a concentration-dependent manner. During the negative inotropic response, the action potential duration at 20% (APD20), 90% of repolarization (APD90), and the action potential amplitude (APA) were decreased concentration dependently: 30 microM PCB 19 reduced APD20, APD90 and APA by 36.7 +/- 3.5%, 22.6 +/- 3.9%, and 2.4 +/- 0.6%, respectively (n = 11, p < 0.01). PCB 19 30 microM decreased the Ca2+ transient and the I(Ca,L) by 46.8 +/- 1.8% (n = 9, p < 0.01) and 47.1 +/- 3.1% (n = 9, p < 0.01), respectively. The results suggest that PCB 19 decreased the Ca2+ transient through inhibition of L-type Ca2+ channels and that the decreased Ca2+ transient consequently caused a negative inotropic effect in cardiac myocytes.

Characteristics of body heat balance of paraplegics during exercise in a hot environment

The purpose of this investigation was to clarify the characteristics of body temperature regulation in paraplegics due to spinal cord injury (SCI) during an arm cranking exercise in a hot environment. Twelve paraplegics with lesions located between Th3 and L1,2 and seven able-bodied subjects (AB) participated in this study. The subjects were exposed to a hot (33 degrees C) or a moderate temperature (25 degrees C) environment for one hour and during the last 10 min of the exposure, the subjects performed arm cranking exercises at an exercise intensity of 40 W. The skin temperatures at the chest, the upper arm, the thigh and the calf, the tympanic membrane temperature (Tty), and the skin blood flow of the thigh (SBFT) were continuously monitored during the experiment. Although no systematical variation was found in the Tty at 25 degrees C, the Tty at 33 degrees C in paraplegics during exercise was significantly greater than that at rest (P < 0.01), which indicated a pronounced heat stress for paraplegics at 33 degrees C. SBFT of paraplegics with high lesions of the SCI remained unchanged during the experiment at 25 degrees C and 33 degrees C, while paraplegics with low lesions in this study showed consecutive increases in SBFT during exercise in both environmental conditions similar to AB. The increased core temperature in paraplegics with high lesions was considered to be due to a lack of sweat response and vasomotor activity in the paralyzed area. On the basis of the findings in this study, it can be suggested that high core temperature without any increment of SBFT may be characterized as body heat balance of paraplegics with high lesions during exercise in a hot environment.