Overexpression or mutation of the p53 tumor suppressor gene does not occur in malignant ovarian germ cell tumors

BACKGROUND

The p53 tumor suppressor gene has been well studied in epithelial ovarian cancers. However, little is known of the expression of this gene in ovarian germ cell tumors. The authors attempted to investigate whether p53 alterations occurred in this group of tumors.

METHODS

Twenty-two patients with malignant ovarian germ cell tumors were included in this study. Immunohistochemical staining for p53 was performed on paraffin embedded tissue of each case. Single-strand conformation polymorphism analysis of exons 4-9 of the p53 gene was performed on 9 of the 22 tumors where genomic DNAs were obtained from the frozen tissue samples. Three tumors that revealed focal p53 positivity by immunostaining were studied further with direct DNA sequencing.

RESULTS

Overexpression of p53 was not observed in all of the 22 ovarian germ cell tumors; only 3 were found to have nuclear staining in a small fraction of the malignant cells (< 5% in 1 immature teratoma, 5-10% in 2 yolk-sac tumors). Among the nine frozen tumors subjected to single-strand conformation polymorphism analysis, none revealed p53 mutation in exons 4-9. There was no p53 mutation detected by DNA sequencing of the three tumors with focal immunoreactivity.

CONCLUSIONS

Alterations of the p53 tumor suppressor gene may not be associated with the pathogenesis of ovarian germ cell tumors. Instead, genetic changes such as inactivation of other tumor suppressor genes and/or activation of some protooncogenes need to be studied to determine the genetic mechanisms of the tumor development.

Isolated resection of proper caudate lobe for hepatocellular carcinoma in cirrhotic liver: a case report

The caudate lobe of the liver is located between the hepatic hilum and the inferior vena cava. Resection of the caudate lobe alone, without sacrificing other parts of the liver, is a surgical challenge. An isolated resection of proper caudate lobe was accomplished here in a 64-year-old man with hepatocellular carcinoma complicated by liver cirrhosis. The post-operative course was uneventful. The patient remains free of disease two years after operation. The technique used is described to advocate isolated caudate lobectomy for a patient with cirrhosis with a caudate lobe hepatocellular carcinoma.

[Endometrial carcinoma without myometrial invasion]

Between 1974 and 1991, 621 patients with endometrial cancer were treated with hysterectomy without any preoperative treatment. Subsequent pathological examinations revealed that 92 cases had no myometrial invasion. Clinicopathological analysis was carried out in the 92 patients. The results are as follows: 1. Complete surgery was carried out in all cases except one case with intraperitoneal dissemination. The relapse rate in the 91 cases was 2.2% (2/91). The 2 cases with recurrence had grade 1 (G1) and grade 2 (G2) adenocarcinoma and both cases manifested local recurrence. 2. Of 70 cases treated with pelvic lymphadenectomy, two cases (2.9%) with G1 adenocarcinoma exhibited a single node metastasis. The metastatic site was an external iliac lymph node in both cases. Despite the lymph node metastasis, the 2 cases have exhibited no relapse. 3. None of the 92 cases showed any evidence of adnexal metastasis. The positive rate of peritoneal cytology was 13.4% (9/67). Except for one case with peritoneal dissemination who also had positive peritoneal cytology, 8 cases with positive peritoneal cytology have not developed recurrence. This study showed that some endometrial cancer patients without myometrial invasion manifest recurrence, peritoneal dissemination or lymph node metastasis. It is therefore considered that lymphadenectomy and careful follow-up are necessary in every case of endometrial cancer, even in G1 cases without myometrial invasion.

Isolated lateropulsion of the trunk in cerebellar infarct

MRI in a 63-year-old male with isolated lateropulsion of the trunk disclosed an infarct in the inferior portion of the right cerebellar hemisphere, suggesting an end-zone type infarct in the lateral branch of the right posterior inferior cerebellar artery (1PICA) or a borderzone infarct between 1PICA and superior cerebellar artery. A close clinico-topographical relationship between isolated lateropulsion of the trunk and lesion in the territory of 1PICA was demonstrated.

Serum responsiveness of the rat PCNA promoter

Expression of proliferating cell nuclear antigen (PCNA) gene is growth-regulated. The growth dependence of the rat PCNA gene promoter activity was investigated. Cultured cells were transfected with the promoter containing plasmid and recovered for 48 h in serum-free medium to become quiescent. Cells were then cultured in serum-containing medium and harvested at certain intervals after serum-stimulation, and the promoter-directed chloramphenicol acetyltransferase activities in cell extracts were measured. The promoter used in this study contained sequences between -693 and +125 in relation to the transcription initiation site. The promoter activity was found to be serum-responsive. However, the serum-responsiveness of the promoter became less obvious when the amount of the promoter increased; meanwhile, the promoter became active in the control unstimulated (or quiescent) cells. It was suspected that the dosage effect was due to the titration of the negative regulatory factor in quiescent cells. The titration experiment with a reporterless construct as competitor for regulatory factors showed that the excess of promoter molecules reduced the promoter activity in serum-stimulated cells, while causing a transiently increase of promoter activity in quiescent cells. Based on these results, it is postulated that the serum-responsiveness of the rat PCNA promoter is controlled by both negative and positive regulatory factors. Consistent with this proposition, promoter binding proteins of 105 and 114 kDa were identified only in serum-stimulated and quiescent cells, respectively, in addition to several other promoter binding proteins (ranging from 76 to 110 kDa) which were seen in both serum-stimulated and quiescent cells.

[Pharmacokinetic analysis of platinum in the continuous CDDP-CBDCA treatment; its relation to the changes of blood biochemistry]

Seven patients with recurrent gynecological malignancies (2 cervical, 2 endometrial, 3 ovarian) treated with CDDP at the initial chemotherapy were studied for the pharmacokinetic analysis of platinum (Pt) and changes of blood biochemistry in the continuous CDDP-CBDCA infusion therapy. All the patients were indwelled of the total parenteral nutrition catheter. A balloon type infuser (Baxter Inc., multiday type) was connected with the catheter and the drugs were infused continuously through it. CBDCA was infused continuously from day 1 through day 5 at a daily dose of 60 mg/m2, followed by continuous CDDP infusion from day 6 through day 30 at a daily dose of 2.5 mg/m2. All the patients received 3 courses of the treatment. The area under the [Pt]-time curve (AUC) of filterable Pt was as high as 60.98 +/- 8.20 mg.hr/ml (mean +/- SE), and that of total Pt 691.48 +/- 93.61 mg.hr/ml. However, the Cmax of filterable Pt was as low as around 400 ng/ml during day 1 to 6, and around 20 ng/ml during day 7 to day 30. As to the toxicity, only slight myelosuppression but no renal and gastrointestinal toxicity were observed in this therapy. The quality of life of the patients received this treatment were maintained well throughout of the therapy. Responders were evaluated as 1 CR, 2 PR, 2 NC and 1 PD. These data indicated that high AUC but low Cmax of filterable Pt by continuous CDDP-CBDCA therapy resulted in less toxicity. Further investigation was warranted to evaluate the efficacy of continuous CDDP-CBDCA therapy.

Single-pulse degenerate-cross-phase modulation in a single-mode optical fiber

Using a single ultrashort optical pulse propagating through a short nonbirefringent single-mode optical fiber, we have observed degenerate-cross-phase modulation of the two orthogonal circularly polarized components of the pulse. The spectral broadening of the two polarization components in the single laser pulse is attributed to self-phase modulation (SPM), degenerate-cross-phase modulation (DXPM), and interference between SPM and DXPM.

Epidemiological study of head injuries in central Taiwan

BACKGROUND

Head injury plays a major role in emergency neurosurgery and is the leading cause of neurosurgical mortality at Taichung Veterans General Hospital. Statistical data show that a similar condition exists in other teaching hospitals in the central Taiwan area, which includes more than one-quarter of the entire population and has more than one-third of the total land of Taiwan. A clinical statistical survey of head injuries in this area may provide a better understanding of the realistic situation in Taiwan. Reports on head injuries in Taipei City, Taipei area, and Hualian County are also cited for comparison.

METHODS

The present study is based on a cooperative investigation of head injuries by 18 teaching hospitals in central Taiwan from July 1991 to June 1993. All patients received a neurological examination including the Glasgow coma scale (GCS), with recording by 20 Board-certified neurosurgeons.

RESULTS

The 7050 cases collected included 5322 hospitalized cases, 1694 cases seen in the Emergency Room, and 34 deaths on arrival. The leading cause of head injuries was traffic accidents (5354 cases, 76.3%). Motorcycles contributed to the highest number of cases (3661, 68.4%); and trains contributed to the lowest number (8, 0.1%). Helmets were used in only 5.2% of 3503 motorcycle accidents. Based on the patients' or families' description in 4835 cases, the leading cause of the accident was careless driving (1180 cases, 24.4%). The 1088 cases of severe head injury were classified with a score less than 8 by the GCS; 498 of them died, or an 86.6% mortality (575 cases).

CONCLUSIONS

Traffic accidents are the leading cause of head injuries, and motorcycles contribute to the major part of it in central Taiwan. Similar conclusions can be drawn for other areas including Taipei City, Taipei area, and Hualian County.

[Time course changes in bone metabolic markers after menopause--a cross-sectional study]

To clarify the clinical significance of the measurement of bone metabolic markers in postmenopausal subjects, a cross-sectional study of 546 healthy women (215 premenopausal, 164 bilateral oophorectomized and 167 natural menopausal) was conducted. All the subjects had their lumbar bone (L2-4 mineral density measured by means of DEXA. Bone metabolic markers (bone formation markers: serum alkaline phosphatase, osteocalcin and intact osteocalcin; bone resorption markers: urine excretion of hydroxyproline, pyridinoline and deoxypyridinoline) were also evaluated. After dividing the subjects according to the length of time after menopause, the time course changes in the Z-score values for bone metabolic markers were calculated. A triphasic pattern of lumbar bone loss was seen: there was a rapid phase in the first 5 years after menopause, a plateau phase in the second 5 years and a slow phase beginning 10 years menopause. The changes in bone metabolic markers coincided closely with the rapid phase of bone loss. In the plateau and slow phases, there were no markers which significant changed greatly. One possible clinical application of bone metabolic markers is in assessing the results of treatment for postmenopausal osteoporosis.

Assessment of bone density in the distal radius with computer assisted X-ray densitometry (CXD)

A modified and improved radiographic absorptiometry of the distal radius which enables on-site analysis, called computer assisted X-ray densitometry (CXD), was evaluated from the viewpoint of quality assessment. Its precision and the correlation with dual energy X-ray absorptiometry (DXA) was evaluated in 12 volunteers (mean age 44.7 years). The profile of CXD-measured radial bone mineral density (RBMD) from 142 subjects (75 premenopausal and 67 postmenopausal women, mean ages 44.9 and 50.6 years, respectively) were compared with previous data by other methodologies of bone mineral analysis. The intra-assay coefficient of variation (CV) was 0.617%, the inter-assay CV was 2.064%, and the inter-observer CV was 0.673%. The correlation between CXD-measured RBMD and DXA-measured RBMD was of statistical significance (r2 = 0.733, P < 0.01). The correlation of CXD-measured RBMD with age, height or weight corresponded well with previous reports. CXD-measured RBMD and DXA-measured vertebral bone mineral density (VBMD) also had a significant positive correlation, but their correlation was not so close (r2 = 0.149, P < 0.01). The discriminative ability of osteoporosis by CXD was of acceptable level (odd's ratio = 5.72, P < 0.05), when assessed by comparison with bone dystrophy score (BDS) on the plain vertebral radiogram. Although some problems remain in technical standardization, CXD could be an easy, inexpensive, and widely applicable alternative of non-weight bearing cancellous bone densitometry.

Atypical and unusual calcifications of the heart and great vessels: imaging findings

Cardiovascular calcifications in the thorax may be clinically significant and may prove extremely valuable diagnostically. The typical appearance and location of common cardiovascular calcifications have been well described [1, 2]. We present a series of radiologic findings in patients with atypical and unusual cardiovascular calcifications in the thorax.

Rapid detection of -alpha 4.2 deletion of alpha-thalassemia-2 by polymerase chain reaction

We sequenced part of the X boxes of alpha-thalassemia-1 of Southeast Asia type (- -SEA) with -alpha 4.2, -alpha 3.7, -alpha G-Taichung, and alpha CS alpha. We found the X box of -alpha 3.7 belonged to the X box of alpha 2 globin gene and the X box of alpha CS alpha contained X boxes of both alpha 1 and alpha 2 globin gene, whereas the X box of -alpha 4.2 and -alpha G-Taichung was a hybrid of X boxes of alpha 2 and alpha 1 globin gene. We also found there are two types of -alpha 4.2 deletion; type 1 is a common type of -alpha 4.2 deletion and type 2 is linkage to -alpha G-Taichung. We used a combination of two methods, the amplification refractory mutation system (ARMS) and the amplified created restriction sites (ACRS), to amplify the hybrids of X boxes specifically. The upstream primer for X box of alpha 2 globin gene was designed following the standard ARMS procedure to amplify the X segment of the alpha-globin gene. The downstream primer was designed according to the ACRS method to check the specificity of PCR products. Using this approach, we can diagnose the different types of -alpha 4.2 deletion. This kind of approach can also be used to amplify the specific region from the cluster of highly homologous genes.

[Calcitonin physiologically regulates the postmenopausal bone loss and possibly inhibits the bone loss in fast losers]

To study the correlation between the basal serum calcitonin level and L2-4 bone mineral density (BMD), a cross sectional study of 384 healthy subjects (106 premenopausal, 88 perimenopausal and 109 postmenopausal subjects) and a longitudinal study of 42 oophorectomized subjects were conducted. A positive correlation was found in perimenopause (r = 0.219, p = 0.040) but not in premenopause (r = 0.069, p = 0.4898) and postmenopause (r = 0.141, p = 0.0554) in a cross sectional study. The percent reduction in L2-4BMD compared to the baseline also correlated with preoperative calcitonin levels at 6 months after oophorectomy (r = 0.333, p = 0.0442), but not significantly at 12 months (r = 0.224, p = 0.27). These data suggest that the basal calcitonin level correlates to L2-4BMD only at perimenopause or in the early postoophorectomized period when bone turnover is accelerated and bone resorption seems to be faster than bone formation. In addition the premenopausal basal calcitonin level may be an indicator of the fast loser after menopause.

[Basic aspects of bone metabolic markers]

Bone formation and bone resorption are altered in most metabolic bone diseases. Recent advances in measurement of bone metabolic markers arrows as the non-invasive investigation of bone metabolic balance. The rate of formation or degradation of the bone matrix can be assessed by the measurement of bone specific proteins and it's degradative products. Among the posturated products, osteocalcin, carboxy-terminal propeptide of type I collagen (PICP) are considered to be more specific indices to know the osteoplastic function. On the other hand, pyridinoline or deoxypyridinoline in urine strongly reflects bone resorption rate. However some criticisms still exist in the evaluation of serum or urinary levels of bone metabolic markers, especially in formation markers. In adults, bone formation marker such as osteocalcin negatively correlated with their bone mineral density. On the other hand, in children, osteocalcin positively correlated with height velocity. Therefore we have to pay special attention to dysfunction of osteoblast, such as retarded calcification in evaluation of serum level of bone formation markers.

[Bone metabolic markers in osteoporosis]

Since osteoporosis has been defined as "state of low bone mass", the bone mineral measurement has been utilized as a golden standard. However some limitations in bone mineral measurement such as expensive machine, very small extent in bone mineral change and/or required long term observation to detect significant change in bone mass, are prohibited extensive use. On the other hand, recent advances in the measurement of bone metabolic markers arrows us to utilize in the diagnosis of osteoporosis as well as in the monitoring of drug efficacy for osteoporosis. Especially in the monitoring of osteoporosis under some treatment, the magnitude of the change in bone metabolic markers are about 10 times higher than that in bone mineral density. Therefore, the measurement of bone metabolic markers may be utilized more widely in the clinical field of not only osteoporosis but also the other metabolic bone diseases in near future.

Combined assay of serum levels of CA125 and CA19-9 in endometrial carcinoma

Serum levels of CA125 and CA19-9 were examined in 225 cases with endometrial carcinoma before treatment and 32 cases with recurrent endometrial carcinoma. The positive rates in the 225 cases were 27.1% for CA125, 24.0% for CA19-9, and 38.7% for the combined assay. The serum levels of both CA125 and CA19-9 significantly increased with surgical staging. The presence of lymph node metastasis and extrauterine spread exhibited a marked influence on the serum levels of both CA125 and CA19-9. Myometrial invasion and vessel permeation also increased serum levels of CA125, whereas peritoneal cytology and adnexal metastasis exhibited no influence on CA125 levels or CA19-9 levels. Twenty-five of 33 cases who showed either more than 100 U/ml of CA125 level or more than 100 U/ml of CA19-9 level were classified as surgical stage III or IV. The combined assay demonstrated a 71.9% positive rate at the time of detection of the recurrence (65.6% for CA125, 43.7% for CA19-9). In 34.4% of the 32 recurrent cases, elevated levels of the tumor markers were the first sign of recurrence. These data indicate that the use of CA19-9 in combination with CA125 is noteworthy in the management of patients with endometrial carcinoma.

[Recurrent endometrial cancer after complete surgery]

Between 1974 and 1991, 576 patients with endometrial cancer were treated with complete surgery. 1. The overall relapse rate was 14.4%. No recurrence was observed in surgical stage Ia, whereas 56.8% relapse was noted in stage IIIc. 2. The relapse rate in cases with adenocarcinoma was 13.0%. The relapse rate increased with poorer differentiation. Five of 6 cases with serous adenocarcinoma developed recurrence. 3. Myometrial invasion, size of tumor, vessel permeation, cervical involvement, adnexal metastasis and lymph node metastasis were significant factors for relapse. 4. Distant recurrence was noted in 63.9% of recurrent cases and 28.9% developed pelvic recurrence. The most common recurrent sites were lung, peritoneal cavity, and para-aortic lymph node in distant relapse and vaginal vault and parametrium in pelvic relapse. 5. The time to relapse ranged between 106 days and 5,518 days after complete surgery. Thirty one point three % of the recurrent cases manifested relapse within the first year, 60.2% within 2 years and 93.9% within 5 years. The mean time to relapse was 561 days. It was concluded that adjuvant therapy for cases with adnexal metastasis, lymph node metastasis, cervical involvement, adenocarcinoma (G3), and serous adenocarcinoma should be established urgently.

Pulmonary thrombosis in a 10-year-old child with minimal change disease and nephrotic syndrome. A clinical, radiologic, and pathologic correlation with literature review

The nephrotic syndrome has long been recognized as a hypercoagulable state. Arterial thrombosis is a rare complication of the syndrome. Diuretics and steroids, standard treatment for exacerbations, have been implicated as contributing to the development of arterial thrombosis. The authors present the pathologic, clinical, and radiologic findings of a patient with nephrotic syndrome and minimal change disease. The patient died of pulmonary thrombosis while on high-dose steroid therapy for an acute exacerbation of proteinuria following a recent hospital admission for chest pain and dyspnea.

Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study

PURPOSE

To determine the sensitivity, specificity, and positive and negative predictive values of chest radiographic findings in patients suspected of having acute pulmonary embolism (PE).

MATERIALS AND METHODS

Chest radiographs of 1,063 patients with suspected PE were reviewed. PE was confirmed angiographically in 383 patients and excluded in 680 patients.

RESULTS

The chest radiograph was interpreted as normal in only 12% of patients with PE. The most common chest radiographic finding in patients with PE was atelectasis and/or parenchymal areas of increased opacity; however, the prevalence was not significantly different from that in patients without PE. Oligemia (the Westermark sign), prominent central pulmonary artery (the Fleischner sign), pleural-based area of increased opacity (the Hampton hump), vascular redistribution, pleural effusion, elevated diaphragm, and enlarged hilum were also poor predictors of PE.

CONCLUSION

Although chest radiographs are essential in the investigation of suspected PE, their main value is to exclude diagnoses that clinically mimic PE and to aid in the interpretation of the ventilation-perfusion scan.

Activation of peritoneal macrophages in patients with gynecological malignancies by sizofiran and recombinant interferon-gamma

We investigated the influence of the combined use of sizofiran, a beta-1,3-glucan and a recombinant interferon-gamma (rIFN-gamma) upon biological activities of peritoneal macrophages (M phi). The number of peritoneal M phi and the production of cytokines (interleukin-1 beta, interferon-gamma and tumor necrosis factor) was increased by the combined treatment. Fully activated peritoneal M phi based on the increased number of elongated pseudopods were observed by electromicroscope. Sizofiran seems to assure a sufficient supply of M phi to kill tumor cells in the peritoneal cavity and co-administered rIFN-gamma seems to directly stimulate the accumulated M phi in addition to its direct cytotoxicity against tumor cells. This combination therapy may be a step to the prevention of the recurrence of gynecological malignancies including ovarian cancer, after a negative second-look laparotomy.

[75 infantile palsy children treated with acupuncture, acupressure and functional training]

In treating infantile cerebral palsy (CP), 75 CP children were treated with a comprehensive meridian therapy including scalp and body acupuncture, acu-point injection and auriculo-point stimulation, supplemented with acu-pressure and massage, and functional training. A minimum of 10 times of treatment within twenty days, and a maximum of 120 times within a year was performed. The effect of the treatment was evaluated by appraising the children's performance of physical exercise and their social adaptability. The intelligence quotient (IQ) of 30 sick children that had been treated for 60 times (6 courses) was compared prior to and after treatment. It indicates that the treatment yielded a very positive improvement in the children's physical capability and an increase of their intelligence.

[Increase in CDDP therapeutic index by lower concentration and longer infusion time--home chemotherapy for ovarian cancer]

Twenty-two patients with ovarian cancer stage III and IV received combination chemotherapy with CDDP, adriamycin (ADM) and cyclophosphamide (CPM), and were studied for response and side-effects. Patients were divided into two groups according to the following CDDP infusion schedules. (CAP 1) CDDP 7mg/sqm/8 hrs/saline 500 ml/d1-d10, ADM 35 mg/sqm/d1, CPM 350 mg/sqm/d1: 8 cases; (CAP 2) CDDP 70 mg/sqm/2 hrs/d1, ADM 35 mg/sqm/d1, CPM 350 mg/sqm/d1: 14 cases. The overall response rate (CR + PR) was 62.5% in CAP 1, and 50% in CAP 2 (on statistical difference: NS). The 3-year survival rate was 54.7% in CAP 1 and 38.5% in CAP 2 (NS). Side effects of nausea, vomiting and nephrotoxicities were remarkably reduced in CAP 1. These data suggest that lower concentration and longer infusion time of CDDP administration increases the therapeutic index. This infusion schedule is suitable for chemotherapy at home or on an outpatient clinic basis, especially in patients with ovarian cancer.