A human putative Suv3-like RNA helicase is conserved between Rhodobacter and all eukaryotes

We have cloned and sequenced a cDNA of the human homologue of the Saccharomyces cerevisiae Suv3 putative RNA helicase which is indispensable for mitochondrial function in yeast. The human Suv-3-like protein has a typical mitochondrial leader sequence. Northern blot data and analysis of ESTs in the data banks indicate that this human gene (SUPV3L1) is expressed in practically all tissues, though at different levels. Sequence homology analysis has shown a strong conservation of the protein in a number of eukaryotic organisms -- plants, mammals and fungi, but no close homologues exist in bacteria with the exception of the purple bacterium Rhodobacter sphaeroides. This gene is thus ubiquitously present in all eukaryotic organisms.

Liver graft bile duct necrosis--indication for retransplantation

The authors describe the first in Poland case of liver retransplantation in an adult recipient, in whom the indication for the procedure was bile duct necrosis following liver transplantation due to liver cirrhosis of an uncertain origin.

Doxorubicin- and daunorubicin-glutathione conjugates, but not unconjugated drugs, competitively inhibit leukotriene C4 transport mediated by MRP/GS-X pump

Overexpression of the multidrug resistance-associated protein (MRP1) gene encoding a human GS-X pump in cultured cells resulted in increased cellular resistance to antitumor agents, including doxorubicin (Dox) and daunomycin (Dau), as well as certain heavy metals. However, studies with membrane vesicles prepared from the resistant cells revealed that Dox and Dau are poor substrates for the transport mediated by MRP/GS-X pump, suggesting that metabolic modifications of these drugs might be required for the transport. To test this hypothesis, we prepared four glutathione conjugates by linking the cysteine residue of GSH to Dox and Dau at eitehr the C-7 or C-14 position. The affinity of the synthesized conjugates toward MRP/GS-X pump was examined in the LTC4 transport assay using membrane vesicles prepared from an MRP1 gene-overexpressing cell line, SR3A. Unconjugated Dox and Dau failed to inhibit the transport of LTC4, whereas 30 microM GS-Dox or GS-Dau conjugates completely inhibited the transport. Kinetic analyses revealed that the inhibition by these GS-conjugates is competitive with Ki values ranging from 60 to 200 nM, suggesting that these compounds have high affinities toward MRP/GS-X pump and share the common binding site(s) with LTC4. Our present results support the hypothesis that glutathionation can facilitate the transport of anthracyclines by the MRP/GS-X pump.

[Results of surgical treatment for Zenker's diverticula]

From 1976 to 1996, thirty nine patients were surgically treated for pharyngoesophageal diverticulum. The present study aimed to compare two methods of operative treatment of Zenker's diverticulum: excision (group I) and pexy, both of which were associated with upper esophageal sphincter myotomy. The main indication for surgery was dysphagia. The diagnosis of Zenker's diverticulum was based on clinical symptoms and the result of upper GI tract barium examination. In 75% of patients the diameter of diverticulum exceeded 2 cm. No patient died in the perioperative period. The main complications observed in the postoperative period were of pulmonary origin. In group I (excision) a leakage from the suture line occurred in 2 patients (12.5%). Time of follow-up ranged from 1 to 20 years (mean: 7 years). The comparison of both methods of treatment employed is in favour of diverticulopexy, being a safer and less complications-bearing method, although both of them give similar functional results.

[Orthotopic liver transplantation using timely veno-venous bypass]

The authors present their own experience in the use of veno-venous bypass during the anhepatic phase of orthotopic liver transplantation. The selected hemodynamic parameters (arterial pressure, central venous pressure, peripheral resistance) of the anhepatic phase as well as the effects of the graft reperfusion were analyzed in the group of 14 adult orthotopic liver allograft recipients transplanted in the Dept. of General Surgery & Liver Diseases from December 1994 to April 1997. In conclusion, the use of the veno-venous bypass allowed to avoid severe hemodynamic disturbances during the anhepatic phase and to minimize the complications of the reperfusion syndrome. The possibility of the relatively safe prolongation of the anhepatic phase is particularly important during the period of gaining experience by the surgeons and anesthesiologists.

[Esophageal resection for cancer--analysis of postoperative complications from personal materials]

The aim of the present study was to analyse the rate of postoperative complications in patients after esophageal resection for cancer, as well as the dependence of its frequency from surgical tactics employed during the operation. Postoperative complications occurring in 38 patients who underwent esophagectomy and intrathoracic esophagogastric anastomosis (treated from 1978 to 1987) were compared with the same data of 74 patients (1988-1996) in whom the operation consisted of the total intrathoracic esophagectomy, cardia, lesser curvature of the stomach and large regional lymph nodes dissection. In these latter cases the esophagogastric anastomosis was performed in the neck. The most frequent postoperative complications in both groups were of cardiopulmonary origin. The anastomotic leak occurred less frequently in patients with cervical esophagogastric anastomosis. However, when occurred, healing was more likely by local drainage and conservative treatment. Anastomotic leaks after intrathoracic esophagogatric anastomoses were usually fatal. In these cases the only chance of patient's survival was an aggressive surgical treatment consisting of disconnection of alimentary tract: esophageal fistula in the neck and feeding jejunostomy.

[Orthotopic liver transplantation in clinical materials]

The authors present their own experience in orthotopic liver transplantation as a treatment of acute and chronic liver failure. 18 transplantations were performed in 16 patients. The indications for transplantation: acute liver failure-3 cases, chronic advanced disease of the liver-13 cases, graft failure requiring retransplantation-2 cases. All 3 patients with acute failure died after transplantation. Out of 13 patients after elective transplantations 11 remain alive, (in this number both retransplanted). The longest follow-up period is 2.5 years.

[Complications of laparoscopic cholecystectomy]

Complications of laparoscopic cholecystectomy were evaluated in the group of 1.284 patients operated on from June 1991 to December 1996. Serious complications were observed in 38 (2.9%) patients. Conversion to open cholecystectomy was required in 50 patients, including 4 patients with common bile duct injury, 3 patients with bleeding from the gall bladder bed, 2 with cholecysto-duodenal fistula and 6 with intraperitoneal adhesions. In 35 patients the conversion was performed due to inflammatory changes in the Calot triangle. The authors did not observe any serious vascular injury as well as lethal complications. They conclude, that the correct indications to surgery and adequate surgical technique are the most important factors preventing the complications.

[Analysis of morbidity risk in patients after liver resection]

The authors present the retrospective analysis of the morbidity risk in patients undergoing hepatic resection for various indications. The most important complications, according to the literature, were: postoperative liver failure, massive pleural effusion, ascites resistant to pharmacological treatment, intraperitoneal hemorrhage or septic complications requiring relaparotomy. There was the correlation between the increased morbidity and preoperative risk factors like: diabetes mellitus, liver insufficiency with coagulopathy, and intraoperative blood loss, requiring massive transfusions.

[Selected aspects of nutritional support in patients after liver transplantation]

The majority of liver transplanted patients are severely malnourished that increases the incidence of postoperative morbidity and mortality. The authors analysed the effects of nutritional support-total parenteral nutrition-in 11 adult orthotopic liver allograft recipients (9 women, 2 men) transplanted for chronic or acute liver failure in 1994-1997. 4.3-9.75 g of N/24h, 1200-1700 kcal in 1750-2750 ml, from 2-5th postoperative day was administered via central vein in all-in-one system for 4-46 days. Neither metabolic nor septic complications related to the nutrition were observed. The function of the transplanted liver was not impaired by the nutrition. One patient died in course of hepatic coma, 10 patients are alive and in good general condition (1-29 months). In conclusion, the total parenteral nutrition is safe, beneficial and thus recommended routine therapy in the treatment of the liver transplanted malnourished patients.

[Reconstructive surgery in iatrogenic bile duct injuries]

The paper presents the results of surgical treatment performed in 54 patients with iatrogenic injury of biliary tract. All cases of injury were made during open and laparoscopic cholecystectomy. We concluded that Roux-en-Y hepatico-jejunostomy should be recommended. There were no deaths after surgery. This technic was successful therapeutic management more than 95% of cases.

[Surgical treatment of biliary tract neoplasms]

The authors present their own experiences concerning the treatment of the 34 patients with the benign and malignant tumors of the biliary tract. In the group of patients with malignant tumors, the type and extent of the surgery were dictated by the stage of the disease. Patients with benign tumors were subjected to resection of the region of bile duct bifurcation with Roux-Y hepaticojejunostomy.

[Complications after pancreatoduodenectomy in material from clinics in the years 1989-1996]

On the basis of 101 pancreatoduodenectomies the authors present early postoperative complications. Cancer was surgical indication for pancreatoduodenectomy in 87 patients and inflammatory tumor of pancreatic head in 14 patients. Complications occurred in 37 cases. The most frequent complications were pancreatic fistula and disturbances of stomach emptying, in most cases treated conservatively. Mortality rate was 6.9%.

[Treatment of liver injuries in personal clinical material from 1990-1996]

From 1990 to 1996 two hundred and sixteen patients with abdominal trauma were treated in our Department. In 170 cases there were blunt, and in 46-penetrating injuries (stab and gunshot wounds). Injuries of the other regions of the body coexisted in 117 patients (multiple trauma). In 42 cases (19.4%) abdominal trauma caused injury to the liver. In this group blunt mechanism of trauma also dominated (71%). The victims were usually young men (90% of the group, mean age - 35.3 years). The most common cause of injury were traffic accidents (47.6%), penetrating injury being the second commonest cause (12 patients i.e. 29%). Four patients were treated conservatively, the remaining 38 required surgical intervention. Most frequently liver suture and peritoneal drainage were performed (20), followed by liver tissue resections (16) and liver packing (12). Other surgical procedures to treat coexisting injuries were performed in 24 patients. In 22 patients postoperative complications occurred: liver abscess in 6 cases, hemorrhage in 4, wound infection in 4, biliary fistula in 2, intrahepatic aneurysm in 2 and other complications in 8 patients. The mean time of hospitalisation were of 20 days (range: 0-64 days). Mean volume of blood transfused equaled 6.9 U. There were 16 deaths (38%), in all cases in multiple trauma victims. All patients with penetrating liver trauma survived.

[Complications after liver resection for benign lesions]

The paper presents the results of 76 hepatic resection in the group of patients with benign liver lesions. The most common indication to the resection were liver cysts and hemangioma. Morbidity occurred in 13% of patients. After liver trauma the highest mortality we observed.

Results of surgical treatment of cervical esophageal diverticula

On the basis of 20 years' experience, the authors present the immediate and long-term results of operative treatment of Zenker's diverticulum. Comparison of two methods of surgery--diverticulopexia (in 21 patients) and excision (in 16), both associated with upper esophageal sphincter myotomy--shows good immediate and long-term results (from 1 to 19 years), with disappearance of symptoms (dysphagia) in all patients. There was no perioperative mortality. Postoperative complications were most commonly of pulmonary origin and were observed in a third of patients in both groups. In two patients from the group treated with excision, a leak from the suture line occurred, which healed spontaneously. These two patients had transient dysphagia in the postoperative period. On the basis of this analysis, the authors conclude that diverticulopexia is a safer surgical procedure than excision, giving less complications and a very good long-term functional result.

[Autologous peripheral blood stem cell transplantation as an effective treatment for recurrent Hodgkin's disease]

Autologous peripheral blood stem cell transplantation (APBSCT) is a method used analogically to autologous bone marrow transplantation (ABMT) to obtain hematological reconstitution following myeloablative therapy in patients with hematological malignancies. We have now applied this procedure in two patients with recurrent high risk Hodgkin's disease. Collection of circulating stem cells mobilised with cyclophosphamide/G-CSF was performed by several leukaphereses on Fenwal 3000, with access through inferior vena cava. Nucleated cells were separated by dextran sedimentation, cryopreserved, and stored at (-) 196 degrees C. Additional marrow collection was performed in one patient. Conditioning regimen consisted of BCNU, etoposide and cyclophosphamide delivered at days -3 and -2. Collected material containing on average 3.6 x 10(8)/kg nucleated cells and 8.0 x 10(6)/kg CD34(+) cells was transfused at day 0. G-CSF was administered following transplantation to one patient to hasten the recovery. Hematological recovery was relatively quick. Neither serious adverse events nor signs of relapse were observed following transplantation. Our results supported by other's reports indicate, that APBSCT enables hematological recovery similarly to ABMT in Hodgkin's disease. The advantage of APBSCT is a possibility to collect material in patients with marrow involvement, hypoplasia or fibrosis. Outcomes obtained following APBSCT are at least as good as following ABMT. High-dose chemotherapy followed by APBSCT or ABMT should be considered in all patients with recurrent Hodgkin's disease sensitive to chemotherapy.

[Pancreatoduodenectomy in treatment of inflammatory tumors of the pancreatic head]

On the basis of their own experience the authors present indications and results of pancreatoduodenectomy for chronic pancreatitis. In a group of 18 patients. With appropriate evaluation of patients, meticulous surgical technique and postoperative care the complications aren't life-threatening. The long-term results are fully satisfactory.

Erratic evolution of glycerol-3-phosphate dehydrogenase in Drosophila, Chymomyza, and Ceratitis

We have studied the evolution of Gpdh in 18 fruitfly species by sequencing 1,077 nucleotides per species on average. The region sequenced includes four exons coding for 277 amino acids and three variable-length introns. Phylogenies derived by a variety of methods confirm that the nominal genus Zaprionus belongs within the genus Drosophila, whereas Scaptodrosophila and Chymomyza are outside. The rate of GPDH evolution is erratic. The rate of amino acid replacements in a lineage appears to be 1.0 x 10(-10)/site/year when Drosophila species are considered (diverged up to 55 million years ago), but becomes 2.3 x 10(-10) when they are compared to Chymomyza species (divergence around 60 My ago), and 4.6 x 10(-10) when species of those two genera are compared with the medfly Ceratitis capitata (divergence around 100 My ago). In order to account for these observations, the rate of amino acid replacement must have been 15 or more times greater in some lineages and at some times than in others. At the nucleotide level, however, Gpdh evolves in a fairly clockwise fashion.

[Techniques of positive isolation of CD34(+) cells. Personal experience with the immunomagnetic method]

In this article the contemporary methods of positive stem cells isolation have been reviewed, with special regard to their application in the hematological transplantology, and the results of our own studies on isolation with the immunomagnetic method have been presented.

Evidence against the exon theory of genes derived from the triose-phosphate isomerase gene

The exon theory of genes proposes that the introns of protein-encoding nuclear genes are remnants of the DNA spacers between ancient minigenes. The discovery of an intron at a predicted position in the triose-phosphate isomerase (EC 5.3.1.1) gene of Culex mosquitoes has been hailed as an evidential pillar of the theory. We have found that that intron is also present in Aedes mosquitoes, which are closely related to Culex, but not in the phylogenetically more distant Anopheles, nor in the fly Calliphora vicina, nor in the moth Spodoptera littoralis. The presence of this intron in Culex and Aedes is parsimoniously explained as the result of an insertion in a recent common ancestor of these two species rather than as the remnant of an ancient intron. The absence of the intron in 19 species of very diverse organisms requires at least 10 independent evolutionary losses in order to be consistent with the exon theory.

Resection of the liver in a metastatic disease caused by renal carcinoma

Two patients are presented who had their livers resected because of the metastasis of the kidney tumour. It is a contribution in the discussion on the possibility of treatment of a well-advanced cancer disease. The treatment chosen was possible because of the close co-operation between two different teams of surgeons.

[Leiomyoma of the stomach as a cause of hemorrhage from the upper segment of the gastrointestinal tract]

Two cases of female patients operated fo the tumors of the stomach are presented. Result of histologic examination was rather surprising in both cases--leiomyoma.

[Acute biliary and alcoholic pancreatitis: two different diseases?]

An analysis of 174 patients with an acute biliary or alcoholic pancreatitis who were admitted to the Surgical University Clinic Mannheim from 1986 until 1989 showed significant differences in the course of the disease and surgical treatment. 77.2% of our patients with an acute alcoholic pancreatitis were men. Mean age of all patients was 45.7 years. 72.3% of our patients had a mild pancreatitis and 27.7% a necrotising pancreatitis. In 26.8% of the patients an operation was necessary (necrosectomy, lavage of the lesser sac). In 35% of these patients occurred complications. Total lethality was 9.9% (mild pancreatitis: 0%, severe pancreatitis: 17.6% and total necrosis of the pancreas: 63.6%). 58.9% of our patients with an acute biliary pancreatitis were women. Mean age of all patients was 62.4 years. In 50% of all cases an operation was necessary (in most cases cholecystectomy and extraction of a prepapillary concrement but also necrosectomy and lavage of the lesser sac). In 17% of these patients occurred complications. Total lethality was 11.0% (mild pancreatitis: 0%, severe pancreatitis 8.3% and total necrosis: 77.7%). The conclusion is a surgical therapy depending of the cause of the pancreatitis and also a different prognosis of the disease.

Preoperative concurrent chemotherapy and radiotherapy for local-regional and advanced squamous cell carcinoma of the thoracic oesophagus: preliminary results of a pilot study

Preliminary experience based on the results of a pilot study on preoperative concurrent continuous i.v. infusion chemotherapy and radiotherapy for squamous cell carcinoma of the oesophagus in eight consecutive patients is presented. Chemotherapy consisted of 5-fluorouracil and cisplatin. Radiotherapy (Co-60) was delivered to a total dose of 3000 cGy. Clinical tolerance was good in four of eight patients, but poor in the remaining four, including three septic deaths. Oesophagectomy was performed in five patients with no postoperative deaths. Postoperative complications (Horner syndrome, hydrothorax, abdominal wound dehiscence) were observed in three cases. The response was categorized as complete (CR), partial (PR) or stable disease (SD), based on a comparison of the initial and immediate preoperative imaging studies and on the presence of tumour degeneration and/or necrosis in pathological examination of operative specimens. CR was observed in 1/8 patients, PR in 4/8 and SD in 3/8. Concurrent preoperative chemo- and radiotherapy may be effective as a neo-adjuvant or remission-inducing modality in the combined treatment of oesophageal carcinoma, however, it may also lead to fatal complications.

[Evaluation of the myelogram carried out on the 6th day of remission- inducing treatment of acute nonlymphoblastic leukemia in adults as an indicator of therapeutic effectiveness]

Aspiration biopsy in 31 patients with AML was performed prior to and in the 6th day of induction therapy. Studied group included 17 women and 14 men of 40 yrs mean age. Blastosis prior to and on the 6th day of the observation were compared and the index of blastosis reduction counted. Median value of blastosis reduction was 29.5%, 40% of the patients with the index below the median value showed complete remission, while the patients with the indexes above the median value obtained significantly higher number of complete remission (CR = 81%, p less than 0.05). Statistically significant reduction of leukaemic infiltration in examined myelograms was as s rule the sign of oncoming favourable therapeutic result. In cases of nonaplastic marrow with persistent blastosis (blastosis reduction 29.5%) one should consider a change of the therapeutic regimen.

Cash! Cash! Cash! 5 true stories of bottom-line brilliance

These CEOs have filled a vacuum in the health care market place or found a way to slash costs. Displaying drive, managerial moxy and a formidable business sense, they represent a new kind of administrator - the entrepreneur.

[Changes of brush border enzyme activity following ileojejunal transposition or jejunum resection in the dog]

The maltases, saccharase, and alkaline phosphatase activity of different intestinal segments of dogs was determined 0, 3, 6 and 9 weeks after an operation which altered the integrity of the intestinal tube (resection of jejunum, ileo-jejunal transposition, sham operation). Enzyme levels increase from duodenum to the proximal ileum but are very low more distally. At different time intervals enzyme activity remains unchanged in shame operated animals. After resection of the jejunum the activity in the duodenum increased, but was found almost unaltered in the proximal and distal ileum. In contrast, after ileo-jejunal transposition a reduced activity of 50% and 60% was observed in former jejunal or ileal loops, respectively. The levels of the different measured enzymes change in a similar fashion, and the described alterations occur within 3 weeks after operation. The results show depending on the type of operation (resection versus transposition of the jejunum) a different alteration of ileal brush border enzymes.