Expression of the c-erb-B2 and p53 protein in gallbladder carcinomas

Gallbladder carcinoma is the most common malignancy of the biliary tract in Korea and known to be more common in East Asia and Latin America than in Europe and North America. However, their exact histopathological characteristics and carcinogenesis are not well-elucidated. A total of 71 cases of gallbladder carcinomas, two cases of gallbladder dysplasia and 20 cases of gallbladder adenoma were immunohistochemically studied to evaluate the expression of c-erb-B2 and p53 proteins in the light of their relationship with various prognostic factors. Thirty-three gallbladder carcinomas (46.5%) showed positive staining for c-erb-B2, but none of the dysplasia and adenoma were positive (p<0.05). c-erb-B2 was stained in the cell membrane of the cancer cells. Adjacent normal mucosa was negative for c-erb-B2 staining. Forty-eight gallbladder carcinomas (67.6%) showed positive staining in the nucleus for p53 protein. None of the cases with dysplasia, adenoma, and normal mucosa stained positive for p53 protein. There was no significant correlation between c-erb-B2 and p53 expression and age, gender, histological tumor grade, and tumor stage. In the multivariate analysis, tumor stage approached statistical significance (p=0.05), but c-erb-B2 and p53 expression was not significant (p=0.14 and p=0.29, respectively). The mean survival periods of the c-erb-B2 positive and negative groups were 26 months and 52 months, respectively (p=0.02). However, the mean survival periods of the p53 protein positive and negative patients were 34 months and 35 months, respectively (p=0.45). In conclusion, our results suggest that c-erb-B2 and p53 protein expression is strongly associated with neoplastic progression in gallbladder carcinomas, and that c-erb-B2 expression identifies patients with a worse prognosis.

Genetic alterations in gallbladder adenoma, dysplasia and carcinoma

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

Effects of capsaicin on Ca(2+) release from the intracellular Ca(2+) stores in the dorsal root ganglion cells of adult rats

We have investigated the effect of capsaicin on Ca(2+) release from the intracellular calcium stores. Intracellular calcium concentration ([Ca(2+)](i)) was measured in rat dorsal root ganglion (DRG) neurons using microfluorimetry with fura-2 indicator. Brief application of capsaicin (1 microM) elevated [Ca(2+)](i) in Ca(2+)-free solution. Capsaicin-induced [Ca(2+)](i) transient in Ca(2+)-free solution was evoked in a dose-dependent manner. Resiniferatoxin, an analogue of capsaicin, also raised [Ca(2+)](i) in Ca(2+)-free solution. Capsazepine, an antagonist of capsaicin receptor, completely blocked the capsaicin-induced [Ca(2+)](i) transient. Caffeine completely abolished capsaicin-induced [Ca(2+)](i) transient. Dantrolene sodium and ruthenium red, antagonists of the ryanodine receptor, blocked the effect of capsaicin on [Ca(2+)](i). However, capsaicin-induced [Ca(2+)](i) transient was not affected by 2-APB, a membrane-permeable IP(3) receptor antagonist. Furthermore, depletion of IP(3)-sensitive Ca(2+) stores by bradykinin and phospholipase C inhibitors, neomycin, and U-73122, did not block capsaicin-induced [Ca(2+)](i) transient. In conclusion, capsaicin increases [Ca(2+)](i) through Ca(2+) release from ryanodine-sensitive Ca(2+) stores, but not from IP(3)-sensitive Ca(2+) stores in addition to Ca(2+) entry through capsaicin-activated nonselective cation channel in rat DRG neurons.

Intestinal protein and LPH synthesis in parenterally fed piglets receiving partial enteral nutrition and enteral insulinlike growth factor 1

BACKGROUND

Providing partial enteral nutrition (PEN) supplemented with insulinlike growth factor-1 (IGF-1) to parenterally fed piglets increases lactase-phlorizin hydrolase (LPH) activity, but not LPH mRNA. The current aim was to investigate potential mechanisms by which IGF-1 up-regulates LPH activity.

METHODS

Newborn piglets (n = 15) received 100% parenteral nutrition (TPN), 80% parenteral nutrition + 20% parenteral nutrition (PEN), or PEN + IGF-1 (1.0 mg. kg-1. d-1) for 7 days. On day 7, [2H3]-leucine was intravenously administered to measure mucosal protein and brush border LPH (BB LPH) synthesis.

RESULTS

Weight gain, nutrient intake, and jejunal weight and length were similar among the treatment groups. Partial enteral nutrition alone increased mucosal weight, villus width and cross-sectional area, LPH activity, mRNA expression, and high mannose LPH precursor (proLPHh) abundance compared with TPN (P<0.05). Insulinlike growth factor-1 further increased mucosal weight, LPH activity, and LPH activity per unit BB LPH approximately twofold over PEN alone (P < 0.05) but did not affect LPH mRNA or the abundance of proLPHh (one of the LPH isoforms) or mature LPH. Isotopic enrichment of [2H3]-leucine in plasma, mucosal protein, and LPH precursors, and the fractional and absolute synthesis rates of mucosal protein and LPH were similar among the treatment groups. Insulinlike growth factor-1 treatment increased total mucosal protein synthesis (60%, P < 0.05) but not LPH synthesis compared with the other two groups.

CONCLUSIONS

Because IGF-1 did not affect the fractional synthesis rate of either mucosal protein or LPH, the authors suggest that enteral IGF-1 increases mucosal protein mass and LPH activity by suppressing mucosal proteolytic degradation.

Acanthoparyphium tyosenense: the discovery of human infection and identification of its source

Acanthoparyphium tyosenense Yamaguti, 1939 (Digenea: Echinostomatidae), was originally reported as an avian intestinal parasite; here, its presence is reported in 10 humans in the Republic of Korea. The patients were 9 adults aged 35-66 yr (males and females) and a young girl aged 7 yr residing in 2 coastal villages in Puan-gun, Chollabuk-do. The worms were recovered after treatment with praziquantel and purgation with magnesium salts. A total of 158 specimens (1-107 specimens/individual) was collected, together with varying numbers of other intestinal flukes. The patients had eaten various kinds of brackish water mollusks caught in an estuary near their villages. Five bivalves and a gastropod species suspected as sources of human infection were collected and examined. Two bivalves (Mactra veneriformis and Solen grandis) and the gastropod (Neverita bicolor) were found to be infected with the metacercariae of A. tyosenense; adult flukes were confirmed after the experimental infection of chicks. The results show that A. tyosenense infects humans and that brackish water mollusks are the source of human infection.

Overexpression of p53 and absent genetic mutation in clear cell chondrosarcoma

Clear cell chondrosarcoma is one of the extremely rare chondrosarcomas. The pathogenesis and the molecular genetic events, which contribute to the development of clear cell chondrosarcoma, are not well elucidated, due in part to the lack of sufficient tumor tissue available. To characterize the involvement of the p53 gene abnormality in this disease, we analyzed expression and sequence alteration of p53 by immunohistochemical analysis of the protein expression and quantitative DNA/PCR and PCR-SSCP assays of the gene in 28 paraffin-embedded tissue specimens. Immunohistochemical analysis demonstrated that 7 (25%) showed patchy positive nuclear staining for p53 and 5 (18%) showed diffuse positive nuclear staining patterns. Sixteen (57%) were negative for p53 immunostaining. Quantitative DNA/PCR analysis revealed that none of the cases we studied showed significantly reduced levels of p53 amplification (<0.50), strongly suggesting an allelic deletion of the p53 gene. In contrast, however, DNA/PCR-SSCP analysis failed to detect any types of mutations resulting in amino acid substitution within exons 5-9 regions of the gene. Taken together, our data suggest that genetic alteration of p53 is a relatively rare event in clear cell chondrosarcomas but a substantial fraction of this type of tumors carries abnormal overexpression of p53, which might result from an as yet unidentified mechanism(s).

Accumulation of intraventricular fat in an intracranial epidermoid tumor: case report

OBJECTIVE AND IMPORTANCE

A fat component within the ventricles or subarachnoid space in fat-containing tumors such as an epidermoid or a dermoid has been observed in rare instances. However, there have been no reports regarding an increase in the size of such a fat component. We describe the case of an epidermoid tumor with intraventricular fat that showed an increase in size and amount.

CLINICAL PRESENTATION

A 26-year-old woman was admitted with headache and diplopia. Computed tomography and magnetic resonance imaging of the brain revealed a fat-containing suprasellar tumor and widespread fat globules in adjacent sulci and cisterns and within the frontal horn of the lateral ventricle.

INTERVENTION

The patient underwent a pterional craniotomy. Removal of the suprasellar tumor was nearly total. Histopathological examination revealed an epidermoid tumor. Sequential magnetic resonance imaging throughout the ensuing 65-month period revealed no evidence of tumor recurrence; however, the intraventricular fat remained and increased in size. The patient underwent surgery via the transcallosal approach at 69 months after the initial operation, and the presence of free-floating oily fat globules was confirmed.

CONCLUSION

In the case of a fat-containing tumor with free fat in the cerebrospinal fluid spaces, careful serial examination is necessary, with particular attention to the possibility of changes in size.

Inhibitory effect of glycolic acid on ultraviolet-induced skin tumorigenesis in SKH-1 hairless mice and its mechanism of action

Glycolic acid, an alpha-hydroxy acid derived from fruit and milk sugars, has been used commonly as a cosmetic ingredient since it was discovered to have photoprotective and anti-inflammatory effects and antioxidant effects on ultraviolet (UV)B-irradiated skin. Little is known, however, about the functional role of glycolic acid on UV-induced skin tumorigenesis. In the present study, we examined the effect of glycolic acid on UV (UVA + UVB)-induced skin tumorigenesis and assessed several significant contributing factors in SKH-1 hairless mice. Inbred hairless female mice (15 animals/group) were irradiated for 5 d/wk at a total dose of 74.85 J/cm(2) UVA and 2.44 J/cm(2) UVB for 22 wk. Glycolic acid was applied topically twice a week at a dose of 8 mg/cm(2) immediately after UV irradiation. Glycolic acid reduced UV-induced skin tumor development. The protective effect of glycolic acid was a 20% reduction of skin tumor incidence, a 55% reduction of tumor multiplicity (average number of tumors/mouse), and a 47% decrease in the number of large tumors (larger than 2 mm). Glycolic acid also delayed the first appearance of tumor formation by about 3 wk. The inhibitory effect of glycolic acid on UV-induced tumor development was accompanied by decreased expression of the following UV-induced cell-cycle regulatory proteins: proliferating cell nuclear antigen (PCNA), cyclin D1, cyclin E, and the associated subunits cyclin-dependent kinase 2 (cdk2) and cdk4. In addition, the expression of p38 kinase, jun N-terminal kinase (JNK), and mitogen-activated protein kinase kinase (MEK) also was lower in UV + glycolic acid-treated skin compared with expression in UV-irradiated skin. Moreover, transcription factors activator protein 1 (AP-1) and nuclear factor kappaB (NF-kappaB) activation was significantly lower in UV + glycolic acid-treated skin compared with activation in UV-irradiated skin. These results show that glycolic acid reduced UV-induced skin tumor development. The decreased expression of the cell-cycle regulatory proteins PCNA, cyclin D1, cyclin E, cdk2, and cdk4 and the signal mediators JNK, p38 kinase, and MEK may play a significant role in the inhibitory effect of glycolic acid on UV-induced skin tumor development. In addition, the inhibition of activation of transcription factors AP-1 and NF-kappaB could contribute significantly to the inhibitory effect of glycolic acid.

A trial for a DNA diagnosis of Plasmodium vivax malaria recently reemerging in the Republic of Korea using microtiter plate hybridization assay

The polymerase chain reaction-based microtiter plate hybridization (PCR-MPH) assay was utilized for a DNA diagnosis of Plasmodium vivax malaria, which has recently reemerged in the Republic of Korea. The subjects were 18 parasite-proven patients and 5 healthy controls. Follow-up blood samples were collected from 4 patients after a standard course of treatment. Polymerase chain reaction and electrophoresis of all the patients' blood showed a prominent band at the 138 base pair area, but not in the controls or after treating the patients. Hybridization of the PCR products with known species-specific probes of the 18S rRNA of various malaria species revealed strong positive reactions against the Plasmodium vivax-specific probe (absorbance 1.30-1.90 at 405 nm) in all of the patients. The absorbance was positively correlated with the degree of blood parasitemia, but with a borderline significance. Sequencing of the probe region of the Korean P. vivax revealed no significant variations from the typical P. vivax. The results show that the PCR-MPH is a highly useful technique for the DNA diagnosis of Korean vivax malaria.

Abrogation of disease development in plants expressing animal antiapoptotic genes

An emerging topic in plant biology is whether plants display analogous elements of mammalian programmed cell death during development and defense against pathogen attack. In many plant-pathogen interactions, plant cell death occurs in both susceptible and resistant host responses. For example, specific recognition responses in plants trigger formation of the hypersensitive response and activation of host defense mechanisms, resulting in restriction of pathogen growth and disease development. Several studies indicate that cell death during hypersensitive response involves activation of a plant-encoded pathway for cell death. Many susceptible interactions also result in host cell death, although it is not clear how or if the host participates in this response. We have generated transgenic tobacco plants to express animal genes that negatively regulate apoptosis. Plants expressing human Bcl-2 and Bcl-xl, nematode CED-9, or baculovirus Op-IAP transgenes conferred heritable resistance to several necrotrophic fungal pathogens, suggesting that disease development required host-cell death pathways. In addition, the transgenic tobacco plants displayed resistance to a necrogenic virus. Transgenic tobacco harboring Bcl-xl with a loss-of-function mutation did not protect against pathogen challenge. We also show that discrete DNA fragmentation (laddering) occurred in susceptible tobacco during fungal infection, but does not occur in transgenic-resistant plants. Our data indicate that in compatible plant-pathogen interactions apoptosis-like programmed cell death occurs. Further, these animal antiapoptotic genes function in plants and should be useful to delineate resistance pathways. These genes also have the potential to generate effective disease resistance in economically important crops.

Microinvasive video-assisted thoracoscopic sympathicotomy for primary palmar hyperhidrosis

BACKGROUND

Although video-assisted thoracoscopic surgery for palmar hyperhidrosis is now widely accepted as the approach of choice, the optimal technique has remained a subject of controversy. We have used 2-mm dual port video-assisted thoracoscopic sympathicotomy for primary palmar hyperhidrosis. This study evaluates the short-term results of the technique.

METHODS

A retrospective review was carried out of 45 patients, 20 men and 25 women, with a mean age of 24.2 years. In the period from April 1998 to August 1999, 90 consecutive video-assisted sympathicotomy for primary palmar hyperhidrosis either in isolation (n = 56) or in combination with axillary and plantar hyperhidrosis (n = 34) was performed. The mean follow-up period was 11.3 months. Attention was focused on patient's satisfaction, complications, and morbidity.

RESULTS

Dry limbs were immediately achieved in all patients after surgery. There was no operative mortality and one case of transient Horner's syndrome developed. Eight of 20 with plantar hyperhidrosis showed simultaneous improvement. The overall mean satisfaction rate was 92% +/- 2% with a median 93% improvement using a visual linear analogue scale from 0% (poor) to 100% (excellent). Only 2 patients were dissatisfied with the operative results owing to compensatory hyperhidrosis, which occurred in 25 patients and improved in 20 patients within the follow-up period.

CONCLUSIONS

The video-assisted thoracoscopic sympathicotomy with 2-mm endoscope is a speedy and safe way of controlling hyperhidrosis with excellent cosmetic results while minimizing complications.

P53 mutations in Ewing's sarcoma

The p53 tumor suppressor gene is one of the most frequently altered genes in human malignancies. To explore the implication of p53 alteration in Ewing's sarcoma, we analyzed the deletion and sequence alterations of p53 and abnormal amplification of MDM2, which acts as a functional inhibitor of p53, in 35 tissue specimens. Quantitative genomic PCR analysis showed that 2 of 35 tumors have extremely low levels of the p53 gene, indicating a homozygous deletion of the gene. Mutational analysis of exons 4 to 9 of p53 by PCR-SSCP revealed that 3 of 35 tumors carry sequence alterations in exons 5 or 8, and DNA sequencing analysis identified missense point mutations at codon 132 (AAG-->ATG, lysine-->methionine) and codon 135 (TGC-->TCC, cystein-->serine) in exon 5, and codon 287 (GAG-->GTG, glutamic acid-->valine) in exon 8 from these tumors. No abnormal amplification of the MDM2 gene was recognized. Taken together, our data demonstrate that p53 is genetically altered in a small fraction of Ewing's sarcoma.

Distal anterior cerebral artery aneurysms: clinical features and surgical outcome

Aneurysms of the distal anterior cerebral artery (DACA) are rare and their surgical treatments present some unique difficulties from a technical standpoint. In this report, we presented our experiences of cases with DACA aneurysms, and analyzed the clinical features and prognostic factors affecting the final outcomes. Among 770 cases of intracranial aneurysms operated from 1990 to 1998, 19 cases of DACA aneurysms (2.5%) were studied retrospectively. The characteristic findings were female preponderance (M:F = 1:2.8), common multiple aneurysms (57.9%), and frequent intracerebral hemorrhage (ICH) on initial brain CT scan (42.1%). All patients were operated via interhemispheric approach. Intraoperative aneurysmal rupture was developed only in 3 cases (15.8%), and had no relationship with the final outcome Fifteen out of 19 patients (78.9%) showed favorable outcome with a mortality rate of 5.3%. The follow-up data suggest that the initial ICH on brain CT scan portend a poor prognosis.

Hemangioendothelioma of the sphenoid bone: a case report

Hemangioendothelioma is borderline or intermediate type of vascular neoplasm. Hemangioendothelioma is rare lesion that constitutes less than 0.5% of the malignant tumors of bone. We present a case of low-grade hemagioendothelioma of the skull in a 29-yr-old woman. She had pain, diplopia and exophthalmos of the left eye. Radiographic images showed a relatively well-demarcated, expansile osteolytic lesion with irregularly thickened trabeculae and calcifications in the left greater wing of sphenoid bone. Histologically, the tumor was an infiltrative vasoformative lesion. The vessels are generally well-formed with open or compressed lumina surrounded by endothelial cells showing mild atypia. It lacked frequent mitotic figures and severe atypia. Although excessive bleeding occurred during the operation, the mass was totally resected. Postoperative radiation was not necessary. She is free of disease and well 6 months postoperatively.

Mutational alterations of the p16CDKN2A tumor suppressor gene have low incidence in mesenchymal chondrosarcoma

Mutational inactivation of the cyclin-dependent kinase inhibitors (CDKIs) (p16INK4A/MTS1) tumor suppressor gene has been found in a variety of human tumor types. To investigate the involvement of CDKI abnormality in mesenchymal chondrosarcoma, alterations of CDKIs were examined in human mesenchymal chondrosarcoma tissues using a quantitative DNA/PCR, PCR-SSCP. Seven of 33 specimens (21.2%) showed abnormally low levels of p16CDKN2A amplification, suggesting that the allelic deletion of the gene might be a less frequent event in progression of this tumor. To detect subtle sequence alterations such as point mutations, SSCP analysis of the entire coding region of the p16CDKN2A gene, exons 1, 2, and 3 regions, showed no altered SSCP patterns in 33 mesenchymal chondrosarcoma specimens. A low incidence of genetic alterations of the p16CDKN2A was found in mesenchymal chondrosarcoma. Through this study, we conclude that alteration of the p16CDKN2A gene does not participate significantly in the tumorigenesis of mesenchymal chondrosarcoma.

Multicentric telangiectatic osteosarcoma

A rare case of multicentric telangiectatic osteosarcoma in a 29-year-old woman is described. A plain X-ray showed a pure osteolytic lesion of the navicular, cuboid and I, II, III cuneiform bones. On magnetic resonance images, a T1-weighted image showed heterogeneous low signal intensity. A T2-weighted image showed heterogeneous high signal change with multicentric cystic foci and fluid-fluid levels. Histologically, the lesion showed typical telangiectatic osteosarcoma with numerous atypical giant cells.

Livedoid vasculitis responding to PUVA therapy

BACKGROUND

Livedoid vasculitis is a chronic disorder manifested as recurrent, painful, reticulated, and ulcerative lesions of the legs, which result in ivory atrophic scars with peripheral telangiectasia and hyperpigmentation. Its etiology remains obscure and therapy is difficult. In this study, we evaluated the clinical efficacy of psoralen plus UVA (PUVA) therapy and its side-effects in the treatment of livedoid vasculitis.

METHODS

Eight South Korean patients with livedoid vasculitis were treated with UVA and 8-methoxypsoralen (8-MOP). Systemic PUVA was started with 4 J/cm2 of UVA two or three times a week, and then the dose was increased by 0.5 or 1 J/cm2 increments at each subsequent treatment as tolerated. The effects of treatment were evaluated using photographs of before, during, and after the study.

RESULTS

All patients experienced rapid cessation of new lesion formation, significant symptom relief, and complete healing of primary lesions. The mean times for each of the above were 3.6, 5.9, and 10 weeks, and the mean cumulative doses of UVA for each of the above were 55.9, 96.8, and 197.9 J/cm2, respectively. The patients tolerated PUVA therapy well without unacceptable side-effects.

CONCLUSIONS

We propose that systemic PUVA using 8-MOP should be investigated further as an alternative treatment for patients with livedoid vasculitis.

Distinct roles for L- and T-type Ca(2+) channels in regulation of atrial ANP release

Atrial secretion of atrial natriuretic peptide (ANP) has been shown to be regulated by atrial workload. Although modulating factors for the secretion of ANP have been reported, the role for intracellular Ca(2+) on the secretion of ANP has been controversial. The purpose of the present study was to define roles for L- and T-type Ca(2+) channels in the regulation of ANP secretion in perfused beating rabbit atria. BAY K 8644 (BAY K) increased atrial stroke volume and pulse pressure. BAY K suppressed ANP secretion and ANP concentration in terms of extracellular fluid (ECF) translocation concomitantly with an increase in atrial dynamics. BAY K shifted the relationship between ANP secretion and ECF translocation downward and rightward. These results indicate that BAY K inhibits myocytic release of ANP. In the continuous presence of BAY K, diltiazem reversed the effects of BAY K. Diltiazem alone increased ANP secretion and ANP concentration along with a decrease in atrial dynamics. Diltiazem shifted relationships between ANP secretion and atrial stroke volume or ECF translocation leftward. The T-type Ca(2+) channel inhibitor mibefradil decreased atrial dynamics. Mibefradil inhibited ANP secretion and ANP concentration in contrast with the L-type Ca(2+) channel inhibitor. These results suggest that activation of L- and T-type Ca(2+) channels elicits opposite effects on atrial myocytic release of ANP.

Detection of epidermal growth factor receptor in the serum of patients with cervical carcinoma

Epidermal growth factor receptor (EGFR) is overexpressed in a variety of malignancies, including breast, lung, gastric, and cervical carcinoma. Its overexpression has been associated with disease progression or poor prognosis in patients with cervical carcinoma. In the present study, the levels of EGFR were determined in serum from 38 patients with cervical carcinoma [invasive or recurrent carcinoma (n = 26) and carcinoma in situ (CIS; n = 12)] and 38 healthy female controls using ELISA. The mean serum level for EGFR in patients with invasive or recurrent carcinoma (165 +/- 60 fmol/ml) was significantly elevated (P < 0.0001) compared with that of healthy controls (66 +/- 17 fmol/ml) and also higher (P = 0.015) than that of patients with CIS (126 +/- 25 fmol/ml). In addition, there was a significant difference in the mean serum levels of EGFR between patients with CIS and healthy controls (P < 0.0001). Thirty-five patients (92%) with cervical carcinoma [invasive or recurrent (n = 24) and CIS (n = 11)] had elevated serum, EGFR levels above the cutoff value of 100 fmol/ml (defined as 2 SD above the mean of the controls). In conclusion, the serum EGFR level was elevated in a significant proportion of patients with cervical carcinoma, and it demonstrated an increasing tendency according to disease progression from normal tissue through CIS to invasive cervical carcinoma. Therefore, it may have a potential usefulness as a biological marker of cervical carcinoma.

Chronic subdural hematoma: evaluation of the clinical significance of postoperative drainage volume

OBJECT

A wide variation in postoperative drainage volumes is observed during treatment of chronic subdural hematoma (CSDH) with twist-drill or burr-hole craniostomy and closed-system drainage. In this study the authors investigate the causes of the variation, the clinical significance thereof, and its influence on treatment outcome.

METHODS

A total of 175 cases were investigated between January 1991 and December 1997. Of these, 145 patients had surgery for CSDH, of whom 30 had bilateral lesions. The cases of CSDH were divided into five subtypes (low-density, isodense, high-density, mixed-density, and layering types) on the basis of the brain computerized tomography (CT) findings. Burr-hole craniostomies with closed-system drainage were performed in all patients and the drainage was maintained for 5 days, during which daily amounts of fluid were measured. The mean drainage volume over 5 days was 320 ml, with the largest volume (413 ml) seen in the low-density type and the smallest (151 ml) in the mixed-density type of CSDH. There were recurrences in six patients (seven instances, 4%). The mixed-density type had the highest recurrence rate (8.6%), whereas there was no recurrence for the low-density type. There were no recurrences in 81 patients in whom the total drainage volumes for 5 days were more than 200 ml, but there were recurrences in six (seven instances) of 94 patients in whom the total drainage volume was less than 200 ml.

CONCLUSIONS

The postoperative drainage volumes varied greatly because of differences in the outer membrane permeability of CSDH, and such variation seems to be related to the findings on the CT scans obtained preoperatively. Patients with CSDH in whom there is less postoperative drainage than expected should be carefully observed, with special attention paid to the possibility of recurrence.

Bone bruises: MR characteristics and histological correlation in the young pig

PURPOSE

To correlate magnetic resonance (MR) signal characteristics of bone bruises with histological findings.

MATERIALS AND METHODS

In 14 tibiae of young pigs, bone bruises were created in the proximal tibial metaphysis. The signal intensity seen on the MR images were correlated with histological findings. The following findings were evaluated: (a) changes of signal intensity on the tibiae; (b) changes of histology on the tibiae; and (c) changes of (a) and (b) on follow-up examinations.

RESULTS

We observed three types of injuries on T1-weighted images: focal or diffuse low signal, normal signal and linear low signal intensities. Severe hemorrhagic areas showed low signal intensities on all sequences of MR imaging. Fast spin-echo (FSE) T2-weighted images showed a more distinct low signal intensity than T1-weighted images. FSE short tau inversion recovery (STIR) and FSE fat saturated (FSE-FS) T2-weighted images showed similar signal intensities with FSE T2-weighted images. FS T1-weighted enhanced images showed low signal intensities with variable enhancements. Upon histological examination, hemorrhages and edemas were prominent at the subcortical areas of the contusion sites. The areas of dense, low signal intensities in all imaging sequences showed signs of severe hemorrhage. The areas of diffuse low signal and enhanced areas showed mixed areas of hemorrhages and edemas. Follow-up MR imaging showed evolution of the processes of hemorrhages and edemas with fatty marrow changes.

CONCLUSIONS

MR imaging can depict changes in the bone marrow resulting from direct injury to the bone. MR imaging is a useful tool for evaluating the evolution of bone bruises.

Delivery of total parenteral nutrition (TPN) via umbilical catheterization: development of a piglet model to investigate therapies to improve gastrointestinal structure and enzyme activity during TPN

Nutritional support of preterm infants by total parental nutrition (TPN) is common; however, TPN compromises intestinal structure and enzyme activity. Our goal was to develop a piglet model to assess the effect of limited enteral stimulation with formula and insulin-like growth factor-I (IGF-I) on intestinal morphology and enzyme activity. A nutritionally complete TPN solution was infused for 7 days and piglets were gavaged twice daily with 4 ml sterile water, formula, or formula containing 1,000 micrograms/l IGF-I. Litter mate piglets fed formula served as orally fed controls. On day 7, body weights and plasma hormone profiles of TPN and orally fed piglets were similar. However, intestinal weight, jejunal and ileal villus height and surface area, and mucosal lactase and sucrase activity of TPN piglets was reduced by approximately 50%. No effect of limited enteral stimulation or IGF-I was observed likely due to the small volume of formula administered enterally, which resulted in a low dose of IGF-I (4.3 micrograms IGF-I/kg/day).

Galactosylated chitosan-graft-dextran as hepatocyte-targeting DNA carrier

Lactobionic acid bearing galactose group was coupled with chitosan for liver specificity, and dextran was grafted to galactosylated chitosan (GC) for stability in water. Compared to the GC/DNA complex, the stability of the galactosylated chitosan-graft-dextran (GCD)/DNA complex could be enhanced. The particle size of the GCD/DNA complexes decreased as the charge ratio of GCD to DNA increased. Conformational change of DNA did not occur after complex formation with GCD compared with the conformation of DNA itself. The GCD/DNA complexes were only transfected into Chang liver cells and that of Hep G2 having asialoglycoprotein receptors (ASGR), indicative of specific interaction of ASGRs on cells and galactose ligands on chitosan.

Investigation of three doses of oral insulin-like growth factor-I on jejunal lactase phlorizin hydrolase activity and gene expression and enterocyte proliferation and migration in piglets

In a previous study, oral IGF-I at 65 nM increased lactase phlorizin hydrolase (LPH) activity and villus height in piglets, however, the mechanisms were unknown. Herein, the response to a range of doses of IGF-I was investigated and we hypothesized that LPH and villus height would respond to oral IGF-I in a dose-dependent manner. Two 14-d experiments were conducted using cesarean-derived piglets. In experiment 1, piglets (n = 28) were fed formula containing 0, 33, 65, or 131 nmol/L (0, 0.25, 0.5, or 1.0 mg/L) recombinant human IGF-I. In experiment 2, 5'-bromodeoxyuridine was administered to piglets fed formula alone (n = 4) or containing 131 nmol/L IGF-I (n = 4). IGF-I did not affect body weight gain or intestinal weight or length. Jejunal villus height and LPH activity were significantly greater in piglets fed 131 nmol IGF-I/L than control piglets. Villus height and lactase activity in piglets fed the 33 and 65 nmol/L IGF-I doses were similar and intermediate between control and 131 nmol IGF-I/L. Jejunal mRNA expression and LPH polypeptide abundance were investigated in piglets receiving 0 or 131 nmol/L IGF-I. Steady state LPH mRNA abundance was significantly higher (p < 0.05) in IGF-I-treated piglets. The relative abundance of proLPH(h) was not significantly increased (p = 0.06) by IGF-I treatment. Mucosal DNA content and DNA synthesis were greater in piglets receiving 131 nmol IGF-I/L than control, however, enterocyte migration and mucosal protein content were unaffected. Thus, oral IGF-I increased jejunal LPH activity and LPH mRNA abundance and stimulated intestinal cell hyperplasia in normal piglets.

Detection and characterization of a type IIA secretory phospholipase A2 inhibitory protein in human amniotic fluid

Two types of phospholipase A2 (PLA2) inhibitory protein (PLIP-I, PLIP-II) were detected and isolated from human amniotic fluid by Sephacryl S300 gel filtration chromatography. The lower molecular weight-fraction (PLIP-II) was further purified by Sephadex G75 gel filtration and analyzed by SDS-PAGE. Its molecular weight was estimated to be approximately 18 kDa, and it was sensitive to heat treatment. Inhibition of phospholipase A2 (sPLA2 type IIA) by PLIP-II occurred in a dose-dependent manner (IC50 about 0.82/microm), and the effect was stronger on sPLA2 IIA than on pancreatic sPLA2 (IC50 about 3.11 microL). The ratio of the inhibitions of the sPLA2 IIA by PLIP-II remained consistent over an entire range of substrate concentrations. Furthermore, addition of excess Ca2+ at concentrations of up to 10 mm did not antagonize the inhibitory activity of PLIP-II.