Successful multidisciplinary treatment of an endodermal sinus tumor of the pineal region

The case presented is a 17-year-old male patient with a pineal region endodermal sinus tumor manifested by obstructive hydrocephalus and upward gaze limitation. The highly aggressive nature of this rare malignancy was evidenced by spontaneous tumor bleeding. The patient was treated with a cerebrospinal fluid (CSF) shunt and microsurgical tumor excision followed by irradiation and combination chemotherapy consisting of cisplatin, vincristine, methotrexate and bleomycin. The response to therapy was monitored by serial measurements of serum and CSF alpha-fetoprotein level. The patient remains free of any clinical or radiographic evidence of tumor recurrence 38 months after the initial diagnosis. This experience supports the rationale for an aggressive multidisciplinary approach toward this rare and highly malignant neoplasm.

Sequence-independent inhibition of in vitro vascular smooth muscle cell proliferation, migration, and in vivo neointimal formation by phosphorothioate oligodeoxynucleotides

Phosphorothioate oligodeoxynucleotides (PS oligos) are antisense (sequence-specific) inhibitors of vascular smooth muscle cell (SMC) proliferation when targeted against different genes. Recently an aptameric G-quartet inhibitory effect of PS oligos has been demonstrated. To determine whether PS oligos manifest non-G-quartet, non-sequence-specific effects on human aortic SMC, we examined the effects of S-dC28, a 28-mer phosphorothioate cytidine homopolymer, on SMC proliferation induced by several SMC mitogens. S-dC28 significantly inhibited SMC proliferation induced by 10% FBS as well as the mitogens PDGF, bFGF, and EGF without cytotoxicity. Moreover, S-dC28 abrogated PDGF-induced in vitro migration in a modified micro-Boyden chamber. Furthermore, S-dC28 manifested in vivo antiproliferative effects in the rat carotid balloon injury model. S-dC28 suppressed neointimal cross-sectional area by 73% and the intima/media area ratio by 59%. Therefore, PS oligos exert potent non-G-quartet, non-sequence-specific effects on in vitro SMC proliferation and migration as well as in vivo neointimal formation.

Intelligence quotient in childhood acute lymphoblastic leukemia after prophylactic treatment in central nervous system with 18 Gy cranial irradiation and intrathecal methotrexate

The purpose of this study is to evaluate whether central nervous system prophylactic treatment (CNSP) with cranial irradiation therapy (CrRT) 18 Gy and intrathecal methotrexate would decline the intelligence quotient (IQ) scores of children with acute lymphoblastic leukemia (ALL). In protocol TCL 842, children with ALL received CrRT 18 Gy in 12 fractions, and 5 concomitant doses of intrathecal methotrexate 15 mg/m2/dose with 15 mg as the maximum, for CNSP after remission achieved. The first IQ test was performed immediately after CNSP. Those who had no CNS relapse for more than 5 years after CNSP had a second IQ test. For children between 3 and 6 years old, the Stanford-Binet (S-B) IV test was used, and for older children, the Wechsler Intelligence Scale for Children-Revised (WISC-R) was used. Fourteen consecutive children at our hospital were enrolled. There were 7 boys and 7 girls. The age at diagnosis ranged from 3 to 9 years old. Two of them were in the high-risk group, eight in the intermediate-risk group, and four in the standard-risk group. The IQ scores of all patients fell within the average range. In the first IQ tests, the mean IQ score was 104.29 (range 83-124, S.D. 14.55). In the second IQ tests, the mean IQ score was 100.93 (range 85-128, S.D. 11.57). Statistically, there was no significant difference between the first and second IQ scores (paired t-test, two-tailed P = 0.4232; one-tailed P = 0.2116). Our findings suggested that CNSP used in protocol TCL 842 did not reduce IQ scores of children with ALL 5 years after CNSP.

Transthoracic endoscopic sympathectomy for primary palmar hyperhidrosis in children

Primary palmar hyperhidrosis often starts in childhood. It usually causes academic and social disabling at the age children begin primary school. This study included 65 children (44 girls and 21 boys, mean age 13.5 years) who underwent one-stage bilateral transthoracic endoscopic sympathectomy. The proper sympathetic segment was visualized in almost all cases and electrocautery ablation was performed. The immediate postoperative course was uneventful in all cases and no major morbidity was encountered. Horner's syndrome did not occur in any case. All patients were discharged the day of surgery or after an overnight stay. The duration of follow-up was from 6 months to 3 years. Although compensatory sweating was found in 40% of the patients, long-term satisfaction was reported in 63 cases (96%). This procedure is effective, simple, and is recommended as the method of choice for surgical treatment of severe upper extremity hyperhidrosis in children.

Group B streptococcal cellulitis of perineum and lower abdomen: report of one case

This report describes a 4-week-old female baby with disseminated group B streptococcus (GBS) infection. The illness began as a swelling with violaceous hue of perineum and lower abdomen, a manifestation that may be falsely attributed to a traumatic injury. GBS septicemia, meningitis and cellulitis of lower abdomen was confirmed by cultures. This case illustrated an unusual presentation of GBS infection as cellulitis of lower abdomen. The presence of concurrent septicemia and meningitis in this case indicated that a more extensive diagnostic work-up and a more aggressive therapeutic approach are needed for young infants with cellulitis.

Epoxidation of trans-4-hydroxy-2-nonenal by fatty acid hydroperoxides and hydrogen peroxide

In this study, we reported that fatty acid hydroperoxides and hydrogen peroxide are capable of epoxidizing 4-hydroxy-2-nonenal, a lipid peroxidation product, to the mutagenic epoxide. The evidence of its formation is provided (i) by trapping with [8-3H]deoxyadenosine for the formation of 7-(1',2'-dihydroxyheptyl)-1,N6-ethenodeoxyadenosine as a pair of diastereomers, (ii) by derivatization with (2,4-dinitrophenyl)hydrazine in acidic methanol, and (iii) by comparing its 1H-nuclear magnetic resonance and mass spectra to those of the authentic standard. After incubating 4-hydroxy-2-nonenal with 9- or 13-linoleic acid hydroperoxide at 37 degrees C for 24 h, the epoxide was produced in 13.4% or 12.5% yield, and with hydrogen peroxide, the yield was 21.5%. In the presence of fatty acid (linoleic acid, gamma-linolenic acid, or arachidonic acid) and lipoxygenase, the epoxide of 4-hydroxy-2-nonenal was formed in 15.3%, 7.2%, or 6.2% yield, respectively. The xanthine/xanthine oxidase/superoxide dismutase system generated the epoxide in 1.2% yield. These yields are estimated on the basis of a standard curve obtained from reactions of deoxyadenosine and epoxide. These results show that 4-hydroxy-2-nonenal is epoxidized by biological oxidants, suggesting a plausible endogenous pathway for the in vivo formation of etheno adducts.

On the consistency of a physical mapping method to reconstruct a chromosome in vitro

During recent years considerable effort has been invested in creating physical maps for a variety of organisms as part of the Human Genome Project and in creating various methods for physical mapping. The statistical consistency of a physical mapping method to reconstruct a chromosome, however, has not been investigated. In this paper, we first establish that a model of physical mapping by binary fingerprinting of DNA fragments is identifiable using the key assumption-for a large randomly generated recombinant DNA library, there exists a staircase of DNA fragments across the chromosomal region of interest. Then we briefly introduce epi-convergence theory of variational analysis and transform the physical mapping problem into a constrained stochastic optimization problem. By doing so, we prove epi-convergence of the physical mapping model and epi-convergence of the physical mapping method. Combining the identifiability of our physical mapping model and the epi-convergence of a physical mapping method, finally we establish strong consistency of a physical mapping method.

T-cell lymphokines, interleukin-4 and gamma interferon, modulate the induction of vascular smooth muscle cell tissue plasminogen activator and migration by serum and platelet-derived growth factor

Platelet-derived growth factor (PDGF)-induced smooth muscle cell (SMC) fibrinolysis is necessary for SMC migration. In order to determine whether the T-cell lymphokines interleukin-4 (IL-4) and gamma interferon (gamma-IFN) affect SMC fibrinolysis and migration, we examined the effects of human recombinant IL-4 and gamma-IFN on human aortic SMC tissue-type plasminogen activator (TPA), urokinase-type plasminogen activator (UPA), and plasminogen activator inhibitor type-1 (PAI-1) antigen production, as determined by enzyme-linked immunosorbent assays. Although IL-4 had no direct effect on SMC TPA antigen, IL-4 potentiated SMC TPA antigen levels and activity in conditioned media and cellular lysates in media containing 2% fetal bovine serum but did not change UPA or PAI-1 production. gamma-IFN attenuated IL-4 augmentation of SMC TPA antigen production in conditioned media, although gamma-IFN itself had no direct effects on SMC TPA and PAI-1 antigen production. IL-4 augmented PDGF induction of SMC TPA antigen. gamma-IFN inhibited PDGF induction of SMC TPA antigen and IL-4 potentiation of this process. gamma-IFN diminished the promigratory effects of both IL-4 and PDGF on in vitro SMC migration. Tranexamic acid, a plasmin inhibitor, abrogated the stimulation of SMC migration by IL-4. Therefore, IL-4 and gamma-IFN modulate the induction of SMC TPA and SMC migration by 2% fetal bovine serum and PDGF.

[Distant metastasis after irradiation alone in carcinoma of the uterine cervix--the patterns and results]

From 1988 to May, 1992, there were 286 patients with pathology-proved carcinoma of the uterine cervix referred to Chang Gung Memorial Hospital, Kaohsiung to receive definite radiotherapy. Sixty-one (21%) patients were found to develop distant metastasis after radiotherapy for at least 2 years follow-up. By FIGO stage, the incidence of distant metastasis was as follows: I :2/39, II a:1/19, II b:20/118, III :34/101, IV a: 4/9. Eighty-five percent patients (52/61) began to develop distant metastasis within the first 2 years after radiotherapy. Twenty-three patients developed single organ metastasis, and 38 patients developed multiple organ metastasis. Lymph nodes (38 patients), lung (28 patients), bone (27 patients), and abdomen (20 patients) were the common sites of distant metastasis. Lymph nodes metastasis occurred most often at supraclavicular lymph nodes (15 patients), para-aortic lymph nodes (18 patients), and inguinal lymph nodes (5 patients). Spine (23 patients), especially the lumbar spine (20 patients) was the most common site of bony metastasis. Abdominal metastasis occurred in abdominal cavity (15 patients) or liver (5 patients). The incidence of metastasis within the first two years after radiotherapy was lung: 75% (21/28), bone: 62% (18/29), left supraclavicular lymph nodes: 60% (9/15), para-aortic lymph nodes: 72% (13/18), intra-abdominal cavity: 86% (13/15), liver: 66% (2/3), brain: 0% (0/4). The 2-year actuarial survival rate for the 61 patients after developing distant metastasis was 14%, with a median survival time of 6.4 months. There was no significant difference in survival when comparing patients with single organ metastasis and with multiple organ metastasis (p > 0.05), or patients with distant metastasis alone and with distant metastasis combined with local recurrence (p > 0.05). Otherwise, after distant metastasis twenty-three patients receiving chemotherapy or radiotherapy had a significantly higher 2-year survival rate than 38 patients receiving supportive care only after distant metastasis (34% vs. 2.4%, p < 0.05).

Peduncular hallucinosis following microvascular decompression for trigeminal neuralgia: report of a case

Peduncular hallucinosis usually presents as a visual disorder and is often a genuine hallucination associated with mesencephalic lesions. A 62-year-old woman with trigeminal neuralgia underwent microvascular decompression for facial pain through a lateral suboccipital approach. The pain completely disappeared after surgery, but a visual hallucination developed on the second postoperative day and continued for 5 days. Magnetic resonance imaging confirmed the lesions around the mesencephalon.

A protease inhibitor of the serpin family is a major protein in carp perimeningeal fluid: I. Protein purification and characterization

Two isoforms of a protease inhibitor of the serpin family (p62) have been purified from bighead carp perimeningeal fluid. Both isoforms migrate with an apparent molecular mass of 62 kDa on reducing and nonreducing sodium dodecyl sulfate-polyacrylamide gels. Both proteins inhibited the activities of bovine trypsin, bovine chymotrypsin, and porcine pancreatic elastase. They also formed complexes with these proteases that were resistant to sodium dodecyl sulfate treatment. p62 exists in the extracts of all tissues examined, including brain, head kidney, kidney, liver, muscle, ovary, pituitary, and spleen. It is also present in serum, ovarian fluid, and milt as well as perimeningeal fluid. The protease inhibitor is a glycoprotein, and its carbohydrate moiety could be removed by endoglycosidase F. Because p62 resembles mammalian alpha 1-antitrypsin in many aspects, it is likely a fish equivalent of alpha 1-antitrypsin.

Use of Tc-99m HMPAO brain SPECT to evaluate cerebral collateral circulation during Matas test

Five patients with traumatic carotid-cavernous fistulae and two patients with internal carotid artery aneurysms inside the cavernous sinus are presented. A quantitative method was used for the evaluation of brain collateral circulation in the anterior and middle cerebral artery territories by using Tc-99m HMPAO SPECT before and during the Matas test. It affords a more reliable quantitative measurement of reduced activity than conventional carotid angiography during the Matas test. In this study, a reduction of radioactivity of less than 15% during the Matas test did not reveal any postoperative neurological deficit after a carotid artery trapping procedure. This noninvasive method seems to be useful to determine the appropriate surgical treatment.

Use of a single lumen endotracheal tube and continuous CO2 insufflation in transthoracic endoscopic sympathectomy

BACKGROUND

Transthoracic endoscopic sympathectomy (TES) is an accepted standard surgical treatment for palmar hyperhidrosis. For anesthetic management, a double lumen endobronchial tube is usually used to deflate the lung on the operative side. Recently we have applied continuous insufflation of carbon dioxide (CO2) into the pleural cavity to merely compress one lung while ventilating both lungs with a conventional single lumen endotracheal tube.

METHODS

We have studied 45 patients (ASA I and II) who underwent bilateral TES, Thirty-three were ventilated by single lumen tube and the other 12 by double lumen endobronchial tube with one lung ventilation. In both groups I and II, CO2 was insufflated slowly through the scope to a intrapleural pressure of 20 cm H2O. Both lungs were ventilated with peak pressure of less than 20 cmH2O at tidal volume of 5-12 ml/kg at 10-16 beats/min.

RESULTS

In these patients, no CO2 retention was noted. Oxygenation and cardiovascular stability were maintained and there were no complications. In the double lumen series, we found that oxygen saturation was less uniform and less stable than those in the single lumen series.

CONCLUSIONS

It is concluded that the use of single lumen endotracheal tube with continuous insufflation of CO2 in TES is easy, simple and safe.

An altered spectrum of herpes simplex virus mutations mediated by an antimutator DNA polymerase

The mutation spectrum attributable to an antimutator DNA polymerase in a eukaryotic cell was examined. Drug-resistant thymidine kinase (tk) mutants derived from both a wild-type (wt) strain, KOS and an antimutator DNA polymerase (pol) mutant, PAAr5, of herpes simplex virus (HSV), were isolated, and the mutated tk genes were characterized at the sequence level. While both transition and frameshift mutations were found in the mutated tk genes derived from the wt KOS Pol, all the PAAr5-mediated mutants analyzed were frameshift mutations. These results imply that the wt HSV Pol is less faithful than the antimutator enzyme, at least in part, because of its propensity to mediate transition mutations.

Kluver-Bucy syndrome: report of a case with nasopharyngeal cancer after irradiation and chemotherapy

A case of Kluver-Bucy syndrome associated with delayed cerebral necrosis after radiation therapy and chemotherapy is reported. The patient--a 51-year-old man who was a victim of nasopharyngeal cancer--developed a complex behavioral disturbance consisting of visual agnosia, alteration of sexual behavior, strong oral tendency, placidity, memory deficit and speech disturbance one year after two courses of irradiation and chemotherapy. Brain computed tomography disclosed bilateral temporal hypodensity with edema. The patient expired from cachexia three months later. The clinical picture fulfilled the criteria of Kluver-Bucy syndrome. It should be emphasized that this syndrome may occur after irradiation and chemotherapy in patients with nasopharyngeal cancer.

Formation of etheno adducts in reactions of enals via autoxidation

4-Hydroxy-2-nonenal (HNE) and crotonaldehyde (CA) are alpha,beta-unsaturated aldehydes (enals) produced by lipid peroxidation. Previous studies have shown that enals form tricyclic propano adducts with purine nucleosides. When epoxidized by tert-butyl hydroperoxide, enals yield the more reactive epoxy aldehydes which are capable of modifying adenine and guanine in DNA by forming etheno adducts. The epoxides are considerably more mutagenic and tumorigenic than the parent aldehydes. In this study, we found that, in addition to the propano adducts, etheno adducts are detected upon incubation of enals with deoxyadenosine (dAdo) or deoxyguanosine (dGuo) at 37 degrees C (pH 7.4). When carried out under oxygen-enriched atmosphere, the reaction of HNE with dAdo yielded 1,N6-ethenodeoxyadenosine (1,N6-EdAdo) and 7-(1',2'-dihydroxyheptyl)-1,N6-EdA in 0.03% and 0.48% yield. The reaction with dG gave 0.19% 1,N2-ethenodeoxyguanosine (1,N2-EdGuo) and 0.79% 7-(1',2'-dihydroxyheptyl)-1,N2-EdGuo. In the case of CA, the reaction with dAdo produced 7-(1'-hydroxyethyl)-1,N6-EdAdo in 0.67% yield, while the reaction with dGuo yielded 0.34% 1,N2-EdGuo and 0.97% 7-(1'-hydroxyethyl)-1,N2-EdGuo, respectively. When the above reactions were carried out under nitrogen, yields of etheno adducts were significantly reduced. These results provide evidence for a pathway by which the etheno adducts may be formed by enals via autoxidation.

Arsenic-related Bowen's disease and paraquat-related skin cancerous lesions show no detectable ras and p53 gene alterations

We have investigated point mutations of codons 12, 13, and 61 in H-, K-, and N-ras oncogenes as well as p53 tumour suppressor gene exon 5 through exon 9 by PCR-SSCP analysis in 26 skin biopsy tissues from 16 arsenic-related Bowen's disease patients and 6 skin samples from 4 paraquat manufacturing workers. No mutation was found. These results are different from findings with UV associated skin cancers. Interestingly, a silent change at codon 27 of H-ras in one allele was detected in all 4 paraquat manufacturing workers and in 2 of 16 arsenic-related Bowen's disease patients. It is likely that the molecular mechanisms involved in arsenic and paraquat induced skin cancers differ from sunlight-related skin malignancies.

Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis

OBJECTIVE

Transthoracic endoscopic electrocauterization of the sympathetic chain for palmar hyperhidrosis is presented.

DESIGN

A retrospective study of 180 patients during a 2-year period was carried out. The duration of follow-up was from 2 to 12 months.

SETTING

General community, referral center, and hospitalized care.

PATIENTS

This study was carried out in 180 patients (116 female and 64 male). The age distribution was between 13 and 43 years (mean age, 21.6 years). They complained of palmar hyperhidrosis without other underlying diseases.

INTERVENTIONS

One-stage bilateral surgery except for three patients with unilateral pleural adhesions.

MAIN OUTCOME MEASURES

Patients were interviewed 1 week after surgery and then they were contacted by a questionnaire about improvement of hyperhidrosis and complications.

RESULTS

This procedure shows a success rate in 98% of the patients. No pneumothorax requiring a chest tube drainage and no Horner's syndrome were recorded. The most common side effect was compensatory sweating in 70% of these patients.

CONCLUSION

This procedure is effective, simple, and requires only an overnight study. It is recommended as the method of choice for surgical treatment of upper extremity hyperhidrosis.

A 32P-postlabeling method for simultaneous detection and quantification of exocyclic etheno and propano adducts in DNA

A 32P-postlabeling method is described that specifically detects and quantifies the 1,N2-propanodeoxyguanosine adducts derived from acrolein (AdG) and crotonaldehyde (CdG) and 1,N2-ethenodeoxyguanosine (EdG) in DNA. These exocyclic adducts are potential DNA lesions caused by exposure to enals as environmental pollutants and as endogenous compounds. This method was developed with the use of the synthetic adduct standards of these exocyclic adducts. The assay relies on HPLC for adduct enrichment prior to labeling and for quantitation and identification after labeling. The labeling efficiencies of adducts at the 1 fmol level ranged from 74 to 96%, whereas they were only 49-60% at the 100 fmol level. This method can detect as low as 0.2 fmol of adduct and allows the detection and quantitative determination of stereoisomers of AdG and CdG. The method was validated by using a sample of enzyme digests of 180 micrograms calf thymus DNA spiked with 25 or 75 fmol of adducts, which is equivalent to 5 or 15 adducts in 10(8) nucleotides. The recovery rates of these adducts in DNA ranged from 30 to 90% at the 25 fmol level and 21 to 55% at the 75 fmol level. Similar to the labeling efficiency, a greater recovery was observed with a lower amount of adduct in DNA. Overall, this method allows the simultaneous identification and quantification of exocyclic adducts AdG, CdG and EdG in DNA. Therefore, it provides a potential tool for studies of the in vivo formation of exocyclic adducts.

Sympatholytic effect of captopril in regression of cardiovascular remodeling in spontaneously hypertensive rats

Fifty-eight spontaneously hypertensive rats (SHR) at 12 wk of age were divided into 3 groups: A) captopril (Cap) 20 mg.kg-1.d-1; B) clonidine (Clo) 30 micrograms.kg-1.d-1; C) Clo 30 micrograms.kg-1.d-1 + Cap 20 mg.kg-1.d-1 orally for 24 wk. Concomitant administration of Cap and Clo did not result in more lowering of the systolic blood pressure (SBP) than that by Cap alone. Regression of left ventricular hypertrophy (LVH) were remarkable in Groups A and C, but not to the extent in that of WKY. No significant difference between these two groups was found. Cap alone resulted in a greater decrease of myocardial norepinephrine (NE) than that of Groups B and C. The wall/lumen ratio and the number of smooth muscle cell (SMC) layers of renal artery decreased in Groups A and C, but little difference was found between them. It seemed that combined blockade of renin-angiotensin-aldosterone (RAA) system and sympathetic nervous system (SNS) did not produce more significant BP reduction and reversal of cardiovascular remodeling than Cap alone did. The sympathetic inhibitory effect of angiotensin converting enzyme inhibitor (ACEI) was not enhanced by sympatholytic treatment.

Formation of the acrolein-derived 1,N2-propanodeoxyguanosine adducts in DNA upon reaction with 3-(N-carbethoxy-N-nitrosamino)propionaldehyde

3-(Methylnitrosamino)propionaldehyde (MNPA) is a carcinogenic nitrosamine formed by nitrosation of arecoline, a major alkaloid in areca nut which is a constituent of betel quid. While DNA adducts of its analogue, 3-(methylnitrosamino)propionitrile, have been characterized, little is known about the structures of DNA adducts by MNPA. In this paper, we report that the acrolein-derived 1,N2-propanoguanine adducts are formed upon incubating deoxyguanosine or DNA with 3-(N-carbethoxy-N-nitrosamino)propionaldehyde, a stable carbamate precursor of the metabolically activated MNPA. The identities of these adducts were confirmed by HPLC co-migration, by their NMR and UV spectra, and by chemical properties as compared with those of the synthetic standards. Analogous results were obtained from the reaction of the carbamate with calf thymus DNA. Upon acid or enzyme hydrolysis of the carbamate-modified DNA, acrolein-guanine adducts were detected, and the levels were quantitated. Again, the identities of the adducts were verified by co-chromatography with the standards, by UV spectroscopy, or by the ring-opening with NaOH/NaBH4. Consistent with its ability to modify DNA, the carbamate was found to be mutagenic in Salmonella tester strains. These results show that acrolein is a likely metabolite from the activation of MNPA and that the formation of 1,N2-propanoguanine adducts may contribute to the mutagenicity of the carbamate of MNPA.