A modified immuno-polymerase chain reaction for the detection of beta-glucuronidase from Escherichia coli

A modified immuno-polymerase chain reaction (immuno-PCR) for the detection of E. coli beta-glucuronidase (GUD) is described. Flexible polycarbonate microtiter plates (Biozyme, Landgraaf) with 96 V-bottomed wells were used throughout all steps including the antigen-antibody reaction and polymerase chain reaction. The plates were coated with anti-GUD antibodies to capture the antigen, which was then detected using biotinylated anti-GUD antibodies. Following this, avidin was used to bridge the biotinylated antibodies and biotinylated lamda phage DNA, which was amplified by PCR to produce a product of 500 nucleotides. Following optimization, the detection limit of the immuno-PCR for GUD was 1 x 10(-17) g/ml (or 5 x 10(-19) g/well); this is equivalent to two GUD molecules in a sample solution of 50 microliters. The method was used to detect GUD in a cell extract of E. coli, and it was found that the enzyme released from a single E. coli cell in a solution of 10 l could be detected. So far, this is the most sensitive method ever published for the detection of an antigen. In addition to high sensitivity, the present protocol is capable of automation.

Nasopharyngeal carcinoma: MRI and CT assessment

Precise assessment of the extent of nasopharyngeal carcinoma (NPC) represents the basic step towards optimal treatment. We compared the capacity of CT and MRI in assessing the extent of NPC in 67 patients. MRI was superior to CT in demonstrating lesions in the retropharyngeal node, skull base, intracranial area, carotid space, longus colli muscle and levator palatini muscle. Of 25 cases in which retropharyngeal adenopathy was recognised only on MRI, seven had been reported as showing oropharyngeal involvement and 18 as primary extension to the carotid space on CT. MRI showed skull-base involvement in 40 patients compared with 27 on CT and intracranial involvement in 38 patients versus 24 on CT. There was not a single case in which skull base invasion was seen on CT but not on MRI. MRI enabled improved recognition of tumour infiltration of longus colli muscles (34 cases compared with 15 on CT). It allowed us to clarify 12 questionable sinonasal opacities on CT. Overall, T-staging was changed in 18 of 67 patients (26.9%), including upstaging in 15 cases and down-staging in 3 cases, after comparing CT with MRI. The nodel status was changed from negative on CT to positive on MRI in 4 of 67 patients (6%). We believe that MRI allows more accurate evaluation of the extent of NPC than CT and should be the primary mode of investigation.

Dexamethasone suppresses apoptosis in a human gastric cancer cell line through modulation of bcl-x gene expression

Treatment of human gastric cancer TMK-1 cells with transcription and translation inhibitors rapidly triggered cell apoptosis. Along with cell apoptosis, the Bcl-xS level was markedly upregulated suggesting a crucial role of this protein in promoting the apoptotic process. In the presence of dexamethasone, however, cell apoptosis was greatly attenuated as demonstrated by DNA histogram shift and DNA fragmentation. Studies using the glucocorticoid receptor antagonist RU486 indicated that attenuation of apoptosis was mediated through glucocorticoid receptors. Dexamethasone not only suppressed the apoptosis-associated upregulation of Bcl-xS but also enhanced the basal level of Bcl-xL in the cells. In addition, bcl-x mRNA stability was significantly extended in the presence of dexamethasone. These results indicate that dexamethasone exerted a protective effect and delayed apoptosis of TMK-1 cells by modulating bcl-x gene expression.

Retrograde lymphatic spread: a likely route for metastatic ovarian cancers of gastrointestinal origin

In order to outline the pathways of gastrointestinal malignancies metastasizing to the ovaries, we reviewed 103 cases of metastatic ovarian tumors, and also performed para-aortic lymph node sampling on 11 patients at operation for metastatic ovarian tumors. Of the 103 patients, 74% (26/35) with gastric cancer and 67% (45/67) with colorectal cancer had lymph node metastasis at or before the diagnosis of ovarian tumor. Intraperitoneal metastases presented in 49 and 42% of patients with gastric and with colorectal cancers, respectively. Twenty-three percent of gastric cancer patients and 25% of colorectal cancer patients presented with both lymph node and intraperitoneal metastases. The ovary was the first or among the early metastatic organs diagnosed in 51 of the 53 patients with metachronous ovarian metastases. Only 4 patients with colorectal cancer and none with gastric cancer showed parenchymal organ metastases. These 4 patients also showed intraperitoneal lesions, and 3 of these 4 patients had node metastasis. Among the 11 patients who underwent prospective para-aortic lymph node sampling during operation for the ovarian tumors, only 1 had enlarged para-aortic nodes depicted by computed tomography, 2 had grossly enlarged (>/=1.5 cm) para-aortic lymph nodes noted at surgery, and 6 of the 7 patients with gastric cancer and all 3 with colorectal cancer had metastatic nodes histologically. Among the 58 nodes taken from these patients, 67% showed metastatic foci. We concluded that lymph node metastasis is frequently seen in patients with metastatic ovarian tumors of gastrointestinal origin, and hypothesized that retrograde lymphatic spread is a likely route for the metastases.

Relationships of orbital computed tomographic findings and activity scores to the prognosis of corticosteroid therapy in patients with Graves' ophthalmopathy

To elucidate the relationships of orbital computed tomographic findings and activity scores to the prognosis of corticosteroid therapy in patients with Graves' ophthalmopathy, 22 cases were treated with corticosteroid. Orbital computed tomographic was performed before treatment and the maximal muscle areas of rectus muscle bellies were calculated from the coronal images. Activity scores were calculated according to the recommendations of an international ad hoc committee. The clinical severity of the eye disease was based on the NOSPECS classification. Observation of the effectiveness of treatment at 6 months allowed patients to be classified into good responders or poor responders. Twelve of 22 patients (54.5%) belonged to the good responders. The total muscle areas were less in good responders. Although the total muscle areas were significantly correlated with the activity scores, no difference in the activity scores was noted between these two groups. We concluded that although activity score seems to be a predictor of initial responsiveness to anti-inflammatory drugs, the maximal muscle area is a prognostic factor of corticosteroid therapy in patients with Graves' ophthalmopathy.

Rapid detection of oxacillin-resistant Staphylococcus aureus in blood cultures by an impedance method

The feasibility of using an impedance method for direct detection of oxacillin-resistant Staphylococcus aureus (ORSA) in blood cultures was evaluated. An aliquot (0.1 ml) of the positive blood culture, which showed growth of gram-positive cocci and demonstrated thermonuclease activity, was inoculated into the module well of a Bactometer incubator (bioMerieux Vitek, Hazelwood, Mo.) containing 0.6 ml of Mueller-Hinton agar supplemented with oxacillin (2 microg/ml). The modules were incubated at 37 degrees C, and the change in impedance in each well was continuously monitored by the instrument at 6-min intervals for 24 h. ORSA strains from blood cultures could multiply in the oxacillin-containing medium, and a time point (detection time [DT]) at which an accelerating change of impedance occurred in the medium was obtained, with an average of 5.5 h. The growth of oxacillin-sensitive S. aureus (OSSA) strains was largely inhibited, and no DT was obtained for these strains within an incubation period of 24 h. For 96 positive blood cultures (38 ORSA and 58 OSSA) tested, 36 and 57 were found to be oxacillin resistant and oxacillin sensitive, respectively, by the impedance method. The impedance method had a sensitivity and specificity of 94.7 and 98.3%, respectively, for the detection of ORSA and had an agreement of 96.9% with the disc diffusion method. Comparable results were obtained by the testing of 235 clinical stock cultures of S. aureus (149 ORSA and 86 OSSA). The impedance test is simple for detecting ORSA in blood cultures and may allow proper antimicrobial treatment almost 36 h before the results of the conventional culture methods are available.

Endotracheal tube size selection guidelines for Chinese children: prospective study of 533 cases

Appropriate selection of the size of an endotracheal tube (ETT) for use in children is important both in general anesthesia and critical care practice. Past published data on guidelines for selecting ETT size in children are based on Caucasian measurements. As body build is generally different in Chinese children compared with Caucasians of the same age group, guidelines for Chinese children are needed. The aim of this study was to determine guidelines for ETT size selection by recording and comparing age, body weight, length, head girth and circumference of the right fifth finger of the child. Correlations between internal diameter (ID) of the chosen ETT and the child's data were calculated and compared. In this study, 533 Chinese children. American Society of Anesthesiolgists class I or II, aged from 3 months to 6 years, undergoing oral intubation for general anesthesia for minor pediatric surgery were enrolled. Our results showed that body length (height) had the best correlation to the size of an uncuffed oral ETT. Through stepwise regression, a formula. ETT ID = 2 + (body length (cm)/30), was obtained.

Effects of transcription and translation inhibitors on a human gastric carcinoma cell line. Potential role of Bcl-X(S) in apoptosis triggered by these inhibitors

The effects of the macromolecular synthesis inhibitors 5,6-dichloro-1-beta-D-ribofuranosyl benzimidazole (DRB), actinomycin D, and cycloheximide on the human gastric cancer TMK-1 cell line were studied. These agents inhibited DNA, RNA, or protein synthesis efficiently and induced cell death rapidly in a wide range of concentrations. After 8 hr of exposure to these agents, the cells exhibited morphological features of apoptosis, including cell shrinkage, nuclear condensation, DNA fragmentation, and formation of apoptotic bodies. Western blot analysis revealed that these inhibitors altered the protein levels of apoptosis-related gene products such as c-Myc, Bcl-X(S), and the mutant p53 (mp53) in TMK-1 cells markedly. The c-myc mRNA and protein levels were decreased initially and were then induced markedly to a new level after 4 hr of exposure to DRB, a RNA polymerase II inhibitor. The Bcl-X(S) levels were increased rapidly after treatment with all of these agents, whereas the levels of Bcl-X(L) and Bax remained largely unchanged. Northern blot analysis indicated that the c-myc overexpression is concomitant to DRB-induced DNA fragmentation and that the increased mp53 protein level was mainly a posttranscriptional event. Our observations suggest that the up-regulation of Bcl-X(S) may serve as an important mechanism for the apoptosis triggered by these inhibitors. This study also provides evidence for the notion that interference with the cellular survival pathway may lead to apoptosis.

Serial changes in ultrasound-guided fine needle aspiration cytology in subacute thyroiditis

OBJECTIVE

To elucidate the serial cytologic presentations of subacute thyroiditis (SAT) with ultrasound-guided fine needle aspiration (FNA).

STUDY DESIGN

Nine patients with clinically evident SAT were recruited; serial sonography and ultrasound-guided fine needle aspiration cytology were performed.

RESULTS

Sixty-one follow-up examinations were obtained in nine patients. The follow-up ranged from 1 to 5 months (mean, 3.3). Initial sonographic presentations revealed focal hypoechogenicity in three patients and multiple hypoechogenicity in six. Initial cytologic findings showed chiefly enlarged, degenerated follicular cells with prominent nucleoli, lymphocytes, colloid substance, multinucleated giant cells and neutrophils. Regression of sonographic hypoechogenicity paralleled the disappearance of acute inflammatory cells and enlarged, degenerated follicular cells and the appearance of cohesive follicles.

CONCLUSION

Improvement of SAT in sonography is fairly parallel to that in cytology even though there is a lag of improvement in the latter. Smear pattern is also related to the clinical stage of SAT. Ultrasound-guided FNA is a convenient method of obtaining sufficient and representative specimens in patients with SAT.

Prognostic factors in patients with bulky stage IB or IIA cervical carcinoma undergoing neoadjuvant chemotherapy and radical hysterectomy

All patients with bulky (> or =4 cm) Stage Ib or IIa cervical carcinoma treated at Chang Gung Memorial Hospital between August 1988 and December 1991 using a strategy of neoadjuvant chemotherapy with cisplatin, vincristine, and bleomycin and radical hysterectomy were reviewed. Fifty-nine evaluable patients received 1 to 3 courses of chemotherapy, and 51 underwent subsequent hysterectomy. The remaining 8 patients, not completing planned surgery, were treated with definitive radiotherapy. The overall clinical response rate was 81.4% (48/59) with 18.6% complete response. Clinical response to chemotherapy was not different by stage, histologic type, tumor size, level of squamous cell carcinoma antigen, or DNA ploidy. However, tumors with DNA indices (DI) greater than 1.3 were associated with higher clinical response rates than tumors with DI < or = 1.3 (P = 0.043). Histologically proven pelvic node metastases was noted in 18.5% (10/54) who had laparotomy. Concomitant pregnancy and more than one node metastases had significant adverse influence on recurrence and death. The 5-year survival rate of those patients who received hysterectomy was 80.3%, while only 1 of the 8 patients without hysterectomy survived. Of the 7 patients received hysterectomy despite clinical poor response, only 2 had node metastases and 3 died, whereas all the 4 patients deterred hysterectomy for poor response died. This study demonstrates the value of DNA flow cytometry in predicting chemosensitivity. However, with a DI cutoff at 1.3, only 29.2% patients could be selected. Further studies are necessary to find additional indicators that predict histological response to select better candidates for this approach and to determine optimal adjunctive treatment in case that poor prognostic features are found.

Nuclear area measurements of parathyroid adenoma, parathyroid hyperplasia and thyroid follicular adenoma. A comparison

OBJECTIVE

To determine whether nuclear area (NA) measurement could help to differentiate parathyroid adenoma, parathyroid hyperplasia and thyroid follicular adenoma in aspirated smears.

STUDY DESIGN

Aspirated smears of 15 patients with parathyroid adenoma, 11 patients with parathyroid hyperplasia and 11 patients with thyroid follicular adenoma were included. NA of 100 cells in each case were measured by image analysis; then the mean and coefficient of variation were calculated.

RESULTS

There was no statistically significant difference in the mean of NA between parathyroid adenoma and parathyroid hyperplasia, but the former displayed greater NA variation. Thyroid follicular adenoma revealed a significant elevation in the mean of NA when compared with parathyroid lesions and also shared the feature of greater NA variation when compared with parathyroid hyperplasia, as noted in parathyroid adenoma.

CONCLUSION

Quantitative assessments on NA and calculation of their coefficient of variation are helpful in differentiating between parathyroid adenoma, parathyroid hyperplasia and thyroid follicular adenoma.

Third trimester fetal growth and measures of carbohydrate and lipid metabolism in umbilical venous blood at term

AIM

To compare measures of carbohydrate and lipid metabolism in umbilical venous blood after birth at term in pregnancies with normal and retarded fetal growth during the third trimester.

METHODS

Three groups of pregnancies reaching term, in which fetal growth had been prospectively monitored by repeated ultrasound measurements during the third trimester, were studied. Sequential fetal abdominal circumference measurements remained above the 10th centile in 42 (normal size, normal growth group), below the 10th centile but did not depart further than 1.5 SD (small, normal growth group), or below the 10th centile and subsequently fell away by more than 1.5 SD before delivery (small, growth retarded group). Birthweight, neonatal morphometric measures (ponderal index, mid arm:head circumference ratio, subscapular and triceps skinfold thickness), umbilical venous blood concentrations of glucose, insulin, pro-insulin, des 31,32 proinsulin, total cholesterol, free cholesterol, cholesterol ester, triglycerides, lipoprotein (a), apolipoprotein A-1 and apolipoprotein B were measured.

RESULTS

The median birthweight of the three groups was significantly different (3570, 2569, and 2277 g, respectively). Median values of ponderal index and mid arm:head circumference ratio were significantly lower in the small, growth retarded group and did not differ between the small and normal size groups with normal growth. Both groups with small fetuses had significantly lower mean glucose and cholesterol ester concentrations, and higher mean free cholesterol:cholesterol ester ratios, compared with the normal size, normal growth group. The group showing fetal growth retardation had mean total cholesterol and mean cholesterol ester concentrations that were significantly lower than those of both the other two groups. Mean des 31,32 proinsulin concentrations were low in both groups of small fetuses, but only significantly so in the group without fetal growth retardation. Mean insulin, proinsulin, free cholesterol, triglycerides, lipoprotein(a), apolipoprotein A-1, apolipoprotein B concentrations and the ratio of A-1:B were similar in all three groups.

CONCLUSION

The similarity in the umbilical venous blood carbohydrate and lipid profile at term between pregnancies with documented third trimester fetal growth retardation and those with "genetically" small babies argues against a major role for intrauterine nutritional deprivation as a cause for the association between birth-weight and subsequent adult disease.

Comparison of the beta-glucuronidase assay and the conventional method for identification of Escherichia coli on eosin-methylene blue agar

The purpose of this study was to compare the IMViC (indole, methyl red, Voges-Proskauer and citrate utilization) tests with the beta-glucuronidase (GUD) assay for the identification of suspect Escherichia coli on Levine's eosin-methylene blue (EMB) agar. After testing 258 suspect E. coli colonies from raw meat and meat products, 163 and 44 were found to be E. coli and non-E. coli, respectively, by both methods. Nine isolates were IMViC positive (i.e., + + - - or - + - -) but GUD negative; among these isolates, six were confirmed to be E. coli by API 20E (bioMerieux, Marcy-I'Etoile, France) with the remaining three being non-E. coli. There were 42 isolates that were IMViC negative but GUD positive; among these isolates, seven were pure E. coli cultures, 33 were mixed cultures containing E. coli, and the remaining two were Proteus spp. The sensitivities for the identification of E. coli on EMB were 80.9% (169/209) and 97.1% (203/209), respectively, by the IMViC tests and GUD assay; whereas the specificities were 93.9% (46/49) and 95.9% (47/49), respectively, by the IMViC tests and GUD assay. It is proposed that the GUD assay can be an effective alternative to the conventional IMViC tests for the identification of suspect E. coli on EMB.

Squamous cell carcinoma arising in mature cystic teratoma of the ovary

Treatment results of 26 patients with squamous cell carcinoma (SCC) arising in mature cystic teratoma of the ovary were analyzed. Four nulliparous patients with stage Ia tumors underwent conservative salpingo-oophorectomy. Following surgery, 2 patients had successful pregnancies. The remaining 7 patients with stage Ia tumors were observed after hysterectomy and bilateral salpingo-oophorectomy. Fifteen patients with stage Ic-IV tumors underwent cytoreductive surgery followed by cis-platinum-based chemotherapy with or without sequential radiotherapy. The mean survival was 63.9 months. The overall actuarial disease-free survival at 2 years was 69%, and by stage was as follows: stage I, 100% (13/13); stage II, 100% (2/2); stage III, 30% (3/10); and stage IV, 0% (0/1). A significant difference in disease-free survival was noted in stage (P = 0.0001). Optimal versus suboptimal operation was associated with a median Kaplan-Meier survival of 65 months versus 34.8 months, with actuarial disease-free survival at 2 years of 60 and 0%, respectively (P = 0.0210). Our study shows that 67% (16/24) of the patients had SCC antigen levels exceeding 2 ng/ml, which by stage was as follows: stage I, 5/11 (45%); stage II, 1/2 (50%); stage III, 9/10 (90%); and stage IV, 1/1(100%). After completion of treatment, all 8 patients with recurrent lesions had reelevated SCC antigen levels in series SCC antigen monitoring. In conclusion, positive prognostic factors of disease-free survival were optimal cytoreduction and lower FIGO stage. We suggest that multimodality therapy, including aggressive cytoreduction followed by cis-platinum-based chemotherapy with or without sequential radiotherapy, is recommended. In addition, we suggest that serum SCC antigen monitoring may be helpful in early detection of cancer recurrence.

Therapeutic responses to corticosteroids in Graves' ophthalmopathy

To elucidate the therapeutic responses to corticosteroids and prognostic factors in the treatment of Graves' ophthalmopathy, 23 patients with Graves' ophthalmopathy were treated with intravenous methylprednisolone 0.5 g daily for 3 days, followed by prednisolone 40 mg daily. Dosage was reduced gradually to 10 mg daily over 4 weeks. The symptoms and signs of the eyes were recorded. Orbital computed tomography and urinary glycosaminoglycan excretion testing were performed before treatment. We observed the effectiveness of treatment at 6 months as the endpoint of this study and classified the response as good or poor. We compared the differences in parameters between these two groups. The results showed that 12 (52%) out of 23 patients had a good response, and three (25%) of those with a good response recovered completely. Corticosteroid therapy dramatically improved lacrimation, reduced soreness and congestion of the eyes and ameliorated exophthalmos, lagophthalmos and extraocular muscle movement. Four (36%) of the 11 patients with a poor response had rebound of symptoms and/or signs after the dosage of prednisolone was decreased. Those with a good response were usually younger, and enlargement of the extraocular muscle was also milder than in those with a poor response. This study demonstrated that corticosteroid therapy is effective in Graves' ophthalmopathy and that extraocular muscle size demonstrated by orbital computed tomography is a prognostic factor of therapy.

Detection of protein A produced by Staphylococcus aureus with a fiber-optic-based biosensor

Staphylococcus aureus is a pathogen important in causing human infections and intoxication. A sensitive fiber-optic that produces evanescent waves was developed for the detection of protein A, a product secreted only by S. aureus. In the immunosensor, a 40-mV argon-ion laser that generated laser light at 488 nm was used together with plastic optical fiber and antibodies to protein A were physically adsorbed onto the fiber. The principle of the detection involved a sandwich immunoassay with fluorescein isothiocyanate conjugated with anti-(protein A) immunoglobulin G to produce signals of the antigen-antibody reaction. The detection limit was 1 ng of protein A per milliliter. The fiber-optic immunosensor could be used for rapid and specific detection of S. aureus in clinical specimens and foods.

Multivariate analyses of the relationship between umbilical cord length and obstetric outcome

To investigate the clinical significance of umbilical cord length in human pregnancies, 1087 deliveries at Kaohsiung Chang Gung Memorial Hospital from May 1995 to August 1995 were studied. Our data showed that male fetuses had longer cord length than female and vertex presentation had longer cord length than breech presentation. The cord length and placental weight were significantly related to the birth weight. We found that: 1) only intrauterine growth retardation was associated with the increased risk of fetal distress; 2) secondary arrest of labor and advanced gestational age were correlated with meconium stain; and 3) birth weight and presence of meconium stain were correlated with the secondary arrest (p < 0.05). However, there was no significant correlation between umbilical cord length and fetal well-being. As a result of multivariate analyses, we conclude that the umbilical cord length does not significantly correlate with either maternal age, gestational age (> or = 28 weeks), parity fetal outcome or intrauterine fetal well-being. Birth weight is the only characteristic that is correlated with cord length.

Staged operation for Graves' ophthalmopathy

A four-staged operation is currently the most effective treatment available in the management of stable Graves' ophthalmopathy. This report describes the results of four-staged therapy in 51 patients with Graves' ophthalmopathy. Stage I, orbital decompression: 58 orbits in 32 patients underwent orbital decompression, with an average retroplacement effect of 4.2 +/- 2.2 mm (mean +/- SD). This procedure is effective to restore vision and correct the proptosis due to Graves' ophthalmopathy. Careful intraoperative titration of the retroplacement effect during orbital decompression is very important to achieve successful results. Stage II, strabismus surgery: 24 patients underwent strabismus surgery, including 11 with previous decompression surgery and six with previous simultaneous decompression and strabismus surgery. The overall success rate was 87% and previous decompression or strabismus surgery had no influence on the final results. Stage III, fissure width adjustment: 28 patients (45 eyes) received fissure width adjustment. Various procedures were performed and we found Müllerectomy with levator muscle stripping to be the most useful procedure for fissure width adjustment. The average improvement of fissure height was 3.1 +/- 1.8 mm. The rate of overall satisfactory results was 89%. There were five patients who received Staged IV cosmetic procedures with satisfactory results. Graves' ophthalmopathy is a chronic disease that needs thorough cooperation between doctor and patient. Careful evaluation of clinical parameters and individualized surgical goals are the keys to success.

The role of DNA flow cytometry in borderline malignant ovarian tumors

BACKGROUND

The role of flow cytometric DNA analysis in predicting prognosis of patients with borderline malignant ovarian tumors has been controversial.

METHODS

Fifty cases of patients with borderline malignant ovarian tumors were analyzed by histology and by flow cytometry on paraffin embedded tissue. Multiple tissue blocks and serial sections were analyzed for each tumor. The results of DNA analysis were correlated to clinicopathologic data.

RESULTS

DNA aneuploidy was demonstrable in 4 cases (8%) when the most atypical section was analyzed. The overall rate of aneuploidy was 14% if additional blocks and serial sections were studied. Two patients died from tumor. One of the two patients had an initial diagnosis of Stage IIc mucinous borderline tumor with DNA indices (DI) of 1.12, 1.42, and 2.04. She had a recurrence in the contralateral ovary 1 year later (DI = 1.83), and a second frankly malignant recurrence diffusely in peritoneum (DI = 1.89). The other patient had an initial diagnosis of Stage IIIc mucinous borderline ovarian tumor with pseudomyxoma peritonei. DNA diploidy was obtained in all of the samples from the primary tumor. An aneuploid peak (DI = 1.28) was demonstrated in only one serial section of the peritoneal implants. Of the other 5 patients who had aneuploid histograms but were disease-free, the DNA indices were 1.35, 1.14/1.18, 1.15, 1.20, and 1.31 and were demonstrable only in either 1 or 2 of the blocks or unproven on serial sections. All patients with diploid-peridiploid tumors were alive and disease free.

CONCLUSIONS

Reproducible DNA aneuploidy of high DI may be predicting a poor outcome, whereas the significance of inconsistently reproducible aneuploidy of low DI remains to be determined. Further studies of prospective DNA analysis with adequate sampling are necessary to define the role of flow cytometry in patients with borderline malignant ovarian tumors.

Embryonal rhabdomyosarcoma of the uterine corpus mistaken for small cell carcinoma: a case report

Pure rhabdomyosarcomas of the female genital tract mostly occur in infancy and childhood, in the form of sarcoma botryoides (a variant of embryonal rhabdomyosarcoma), with vagina and cervix as typically involved sites. Such tumors rarely occur in the uterine corpus and cervix of adults. We would like to report a pure embryonal rhab-domyosarcoma of the uterine corpus that arose in a 31-year-old, gravida 1, para 1, female patient with widespread bony metastasis, and which was originally mistaken for metastatic small cell carcinoma to bone marrow.

Cloning and sequencing of complete thyrotropin receptor transcripts in pretibial fibroblast culture cells

Pretibial fibroblasts are considered to be targets of autoimmune attack in pretibial myxedema. A possibility of the pathogenesis of pretibial myxedema is that T cells, reacting with thyrotropin (TSH) receptor, will be targeting to the pretibial fibroblasts where, in the presence of antigen (TSH receptor), they will secrete various cytokines and stimulate fibroblasts to secrete glycosaminoglycans. We have demonstrated that TSH and TSH receptor antibody can bind to fibroblasts and the presence of RNA encoding the extracellular domain of the TSH receptor in fibroblasts derived from skin lesions of two patients with pretibial myxedema. The present study was designed to determine whether there are complete TSH receptor transcripts in pretibial fibroblasts obtained from patients with pretibial myxedema. RNA was prepared from pretibial fibroblasts obtained from 11 patients with pretibial myxedema and from four normal subjects, then reverse-transcribed by polymerase chain reaction using three sets of primers (-11/+8 and +754/+773; +353/+373 and +1265/+1285; +1000/+1017 and +2284/+2301). The overlapped 2312 bp cDNA sequence was expected to contain the genetic sequences of the signal peptide (+1/+60), extracellular domain (+61/+1254), transmembrane domain (+1255/+2046), and cytoplasmic domain (+2047/ +2292) of the TSH receptor. The sequences were determined using dideoxy sequencing method. All of the 2312 nucleotide sequences in 15 samples were consistent with the reported TSH receptor sequence of transcripts in thyroid. These data suggest that the complete TSH receptor transcripts are very possible to be present in the fibroblasts derived from pretibial skin.

Metastatic choriocarcinoma with spontaneous splenic rupture following term pregnancy: a case report

Choriocarcinoma is a rare neoplasm which often spreads extensively. The metastases sometimes appear in the abdominal cavity where they can cause dramatic symptoms. We here describe a patient who had received a cesarean section twelve days before and intraperitoneal hemorrhage was diagnosed when she visited Chang Gung Memorial Hospital's emergency department. At laparotomy, ruptured spleen with active bleeding was found and splenectomy was performed. The histopathologic study revealed a metastatic choriocarcinoma. Multiagent chemotherapy was administrated and the patient responded well. To our knowledge, this is the fourth reported case that metastatic choriocarcinoma resulted in spleen rupture presenting as the principal sign of acute hemoperitoneum. Metastatic choriocarcinoma with rupture should be considered a cause of intraperitoneal hemorrhage in women of child-bearing age.

Efficacy of a latex agglutination test for rapid identification of Staphylococcus aureus: collaborative study

Fifteen laboratories completed a collaborative study comparing the efficacy of a latex agglutination kit (Aureus Test) with that of AOAC Official Method 987.09 (coagulase test for identification of Staphylococcus aureus). Each laboratory analyzed 240 strains of bacteria, including 160 isolates of S. aureus and 80 isolates of other bacteria. Upon receipt of cultures, collaborators subcultured each isolate on both tryptic soy agar (TSA) and Baird-Parker agar medium (BPA) to determine whether the growth medium has any effect on either method. For cultures grown on TSA, the latex test had sensitivity and specificity rates of 99.2 and 97.1%, respectively, whereas the coagulase test had respective rates of 98.4 and 92.5%. For cultures able to grow on BPA, the latex test had sensitivity and specificity rates of 99.2 and 96.6%, respectively, while the coagulase test had respective rates of 98.3 and 91.3%. By using the McNemar pairwise comparison test of the 2 methods, the false-positive and false-negative rates of the latex test were significantly lower (p < 0.01) than those of the coagulase test for strains grown either on TSA or BPA. The latex agglutination test for identification of S. aureus isolated from foods has been adopted by AOAC INTERNATIONAL.

Rapid detection of Vibrio parahaemolyticus in oysters by immunofluorescence microscopy

A method of indirect immunofluorescence microscopy was developed for the rapid detection of Vibrio parahaemolyticus in oysters. Affinity-purified antibodies against two outer membrane proteins (molecular mass 36 and 34 kDa, respectively) of V. parahaemolyticus were used as the primary antibodies to label the vibrio, and fluorescein isothiocyanate-conjugated goat anti-rabbit immunoglobulin G was used to reveal the antigen-antibody reaction. Of 85 strains of V. parahaemolyticus tested, all produced strong fluorescence under the fluorescence microscope. However, for 63 strains (including 27 vibrios) of other bacteria tested, 6 produced weak to moderate fluorescence. The sensitivity and specificity of the immunostaining technique were 100 and 90.5%, respectively. In the inoculation experiments, as low as 1.7 CFU/g of V. parahaemolyticus spiked in oysters could be detected by the immunostaining method after 18-h enrichment in alkaline peptone water containing 3% NaCl. The immunofluorescence microscopy is recommended for rapid screening of V. parahaemolyticus in oysters; a presumptive positive result could be obtained within 24 h.