Chemical synthesis of 15-ketosterols and their inhibitions of cholesteryl ester transfer protein

Described herein are the chemical syntheses of 3 beta-hydroxy-5 alpha-cholest-8(14)-en-15-one and 3 beta-hydroxy-5 alpha-cholest-8(14),16-dien-15-one from diosgenin and the examinations of their ability to inhibit the cholesteryl ester transfer protein (CETP). Clemmensen reduction of diosgenin gave cholest-5-ene-3 beta, 16 beta,26-triol. Tosylation of the latter compound gave cholest-5-ene-3 beta,16 beta,26-triol 26-tosylate which, upon reduction with LiAIH4, gave cholest-5-ene-3 beta,16 beta-diol. Hydrogenation-benzoylation of the latter to 5 alpha-cholest-3 beta,16 beta-diol 3 beta-benzoate followed by mesylation-elimination gave 5 alpha-cholest-16-ene-3 beta-ol 3 beta-benzoate. Controlled oxidation of the latter with CrO3-dimethylpyrazole gave 3 beta-hydroxy-5 alpha, 14 alpha-cholest-16-en-15-one 3 beta-benzoate. Oxidation of delta 16-15-one with SeO2 gave 3 beta-hydroxy-5 alpha-cholest-8(14),16-dien-15-one 3 beta-benzoate along with 3 beta-hydroxy-5 alpha, 14 beta-cholest-16-en-15-one 3 beta-benzoate. Selective hydrogenation of the delta 8(14),16-15-ketosteryl ester, followed by base hydrolysis gave 3 beta-hydroxy-5 alpha-cholest-8(14)-en-15-one. Hydrolysis of 3 beta-hydroxy-5 alpha-cholest-8(14),16-dien-15-one 3 beta-benzoate in basic media gave 3 beta-hydroxy-5 alpha-cholest-8(14),16-dien-15-one. The effects of the 15-ketosterols on the CETP activity were studied in vitro by incubating cholesteryl ester donor (HDL), cholesteryl ester acceptor (LDL) and human plasma as a CETP source at 37 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraoperative spinal sonography in the cervical anterior approach

Intraoperative spinal sonography was used during cervical anterior approach procedures for cervical discectomy and osteophytectomy to demonstrate spinal pulsation, the protruded disc or osteophyte, the anterior subarachnoid space, and the spinal cord. Spinal pulsation was recognized in some cases before removal of the disc but the anterior subarachnoid space and spinal cord could not be observed. However, the latter were more clearly observed during removal of the disc and could be seen after total removal of the disc and osteophyte. This method allows confirmation of decompression and pulsation of the spinal cord without cutting and removal of the posterior longitudinal ligament.

Peripheral T-cell lymphoma involving subcutaneous tissue

The peripheral T-cell lymphomas, presumably derived from various immunocompetent peripheral T-cell system components, form a heterogeneous group of non-Hodgkin's lymphomas. We describe two patients with peripheral T-cell lymphoma primarily involving subcutaneous tissue. They presented with multiple subcutaneous nodules. Skin biopsy specimens in both patients demonstrated a lobular subcutaneous infiltrate. The infiltrate consisted of small and medium-sized atypical lymphoid cells. Both patients had a protracted clinical course before they were diagnosed as having malignant lymphoma. We detected latent Epstein-Barr virus infection in the skin lesions of case 2. Latent Epstein-Barr virus infection might be related to the development of this variant of peripheral T-cell lymphoma.

Erythema induratum with pulmonary tuberculosis: report of three cases

Three cases of erythema induratum which occurred in the patients with pulmonary tuberculosis are described. The cutaneous lesions were violaceous, indurated nodules on both lower legs above the malleoli. Histologically, tuberculoid granuloma with caseation necrosis was found in one case; necrotizing vasculitis was the prominent finding in other two cases. The erythema induratum promptly responded to antituberculous therapy. We believe that, in light of these cases, the association between erythema induratum and infection with tubercle bacilli should be re-emphasized.

Comparison of Cotrel-Dubousset pedicle screws and hooks in the treatment of idiopathic scoliosis

Eighty-two patients with idiopathic scoliosis were treated by Cotrel-Dubousset instrumentation between 1987 and 1991. Twenty were treated with hooks only, 47 with screws and hooks, and 15 with screws only. The methods were compared and the findings showed that screw fixation can be used in the thoracic spine without neurological complications. The screws provided immediate stability with rigid fixation, together with better correction of frontal, sagittal and rotational deformity. There is less loss of correction, a shorter fusion and less risk of neurological complications because of the placement outside the spinal canal and the rigid fixation in derotation. The technique was simpler and the operating time shorter than with the other methods.

Acquired vitamin D-resistant rickets caused by aggressive osteoblastoma in the pelvis: a case report with ten years' follow-up and review of the literature

Rickets or osteomalacia secondary to tumor in either bone or soft tissue is rare and interesting in that it can be cured after removal of the tumor. The majority of the reported cases occurred in adults older than 30 years, and the most commonly associated types were vascular and fibrous tumors. We present a new case of aggressive osteoblastoma in the ilium, which induced vitamin D-resistant rickets in an 8-year, 9-month-old boy. Radiographs and blood chemistry findings on admission showed typical features of active hypophosphatemic ricketts. He underwent three local excisions of the tumor. At 10-year follow-up, the patient was symptom free but short. When a child has symptoms of rickets that develop relatively later than ordinary vitamin D-resistant rickets, every effort should be made to search out a tumorous lesion before attributing it to a renal origin.

[Status of parasitic infection diagnosed by surgical biopsy in Kwangju and Chollanam-do]

In order to know the species and frequency of human parasitic infection diagnosed by biopsy, 149 cases (0.18%) of parasitic infection were reviewed, which were selected from 80,947 biopsied materials submitted for routine histopathological examination during a period of 10 years from 1980 to 1989 at Department of Pathology, Chonnam National University Hospital. They consisted of 112 cases of cysticercosis, 17 paragonimiasis, 7 clonorchiasis, 4 amebiasis, 1 sparganosis, 1 enterobiasis, 1 anisakiasis, and 1 fascioliasis respectively. Based on morphological preservation of cysticercus, they could be divided into mild (20.2%), moderate (40.4%), and severe (39.4%) degeneration. Except 2 cases biopsied at the lungs, 15 cases of ectopic paragonimiasis were located at abdominal cavity (8 cases) and central nervous system (7 cases). One case of intrahepatic fascioliasis was observed. This is the 13th human fascioliasis reported in Korea. From the above results, the frequency of parasitic infections found in biopsied specimens was on the decrease as the year passed by, but biopsy is very useful diagnostic method on tissue parasites such as cysticercosis and ectopic paragonimiasis.

A case of bullous transient acantholytic dermatosis

We report a case of a bullous variant of transient acantholytic dermatosis in a 59-year-old female. Each bullous lesion lasted several weeks and healed without scarring. The lesions were migratory and recurrent without a cleared period. Histopathologic examination revealed an intraepidermal vesicle low in the epidermis. The lesions cleared after 2 months of isotretinoin therapy.

A comparative study of the cytotoxicity of skin irritants on cultured human oral and skin keratinocytes

The cytotoxicity of irritants on human oral and skin keratinocyte culture models was compared. Keratinocytes were exposed to sodium lauryl sulphate and benzalkonium chloride at concentrations of 10(-4)-10(-7) M for 24 h. Cytotoxicity was evaluated by changes in mitochondrial metabolic activity (MTT assay) and plasma membrane integrity (LDH leakage). Our results showed that oral and skin keratinocytes are equally sensitive to the irritants tested. There were marked similarities in susceptibility between each cell type cultured from six individuals. The immunohistochemical staining pattern of both cell types resembled that of the basal cell. These observations suggest that the skin keratinocyte culture model may be useful in evaluating the cytotoxicity of agents which are irritants on either the skin or oral mucosa.

Experimental model of posttraumatic syringomyelia: the role of adhesive arachnoiditis in syrinx formation

An experimental model was devised to elucidate the role of spinal blockade in posttraumatic syringomyelia. Thirty-eight Japanese White rabbits, each weighing about 3 kg, were used in this study. The animals were divided into four groups: in Group 1, eight animals received traumatic injury only; in Group 2, 12 animals received traumatic injury following injection of 100 mg kaolin suspended in 1 cc normal saline solution into the subarachnoid space at the site of trauma; in Group 3, nine animals received traumatic injury following injection of 200 mg kaolin in 1 cc normal saline solution into the subarachnoid space at the site of trauma; and in Group 4, nine animals without traumatic injury received an injection of 200 mg kaolin in 1 cc normal saline solution into the subarachnoid space. The subjective criteria for syrinx formation were the presence of a definite round cyst having a smooth margin and an upper or lower extension of more than 2 cm from the injured site. Syrinx formation was seen in 12.5% (one of eight rabbits) in Group 1, 41.7% (five of 12 animals) in Group 2, 55.5% (five of nine rabbits) in Group 3 and 0% (none of nine animals) in Group 4 (p < 0.05). There was a tendency for the combined trauma/kaolin injection groups to be more prone to develop a syrinx. In the kaolin injection only group (Group 4), no animal showed a definite cyst or an extending cavity during the experimental period. The results suggest that kaolin enhances the extension of multiple small cavities that have already formed at the time of initial injury. The difference between the frequency of syrinx formation and the time of survival was statistically significant well beyond the 0.05% level. The overall difference, relating to the frequency of syrinx development, group, and duration of survival, was also statistically significant. In summary, subarachnoid block secondary to adhesive arachnoiditis is important in initiating the extension of the syringomyelia cavity.

Black heel with atypical melanocytic hyperplasia

Two cases with a black pigmented patch on the heel are reported. Biopsy specimens showed that atypical melanocytic hyperplasia was confined to the epidermis despite the lesion being present for a long time. The diagnosis of atypical melanocytic hyperplasia should be considered in the differential diagnosis of the black heel.

Hwa-byung. A community study of Korean Americans

One hundred nine Korean American community subjects were interviewed regarding their experiences with hwa-byung (HB), a Korean folk illness label commonly used by Koreans with a myriad of physiological and psychological complaints. During these interviews, standard instruments were also used to assess their depressive and somatic symptoms. The results indicated that a relatively high proportion (12%) of the subjects labeled themselves as having suffered from HB. While no apparent sociodemographic differences were found between HB and non-HB subjects, significantly more HB subjects fulfilled the diagnosis of DSM-III major depression and also had previous diagnoses of depression. The HB subjects also had significantly higher scores for the total, depressive, and somatic subscales and 16 of the 20 individual items of the Center for Epidemiologic Studies-Depression Scale. These data confirm previous observations of substantial overlap between HB and DSM-III major depression among Koreans and Korean Americans, and suggest that HB may be a culturally patterned way of expression for Koreans experiencing major depression and related conditions. The clinical and theoretical implications of these findings are also discussed.

Pigmented nail with atypical melanocytic hyperplasia

We report two cases showing black discoloration of the thumb nail which were histologically found to be acral lentiginous melanoma (ALM) in situ. A pigmented subungual lesion is more frequently malignant than benign and it is generally believed that diagnosis of subungual melanoma during the radial-growth phase is very difficult. Our cases are particularly interesting because atypical melanocytic hyperplasia was confined to the epidermis despite the lesion being present for a long time.

Morphologic and biomechanical study of avascular necrosis of the femoral head

Radiologic review and uniaxial compression tests of 1 cm3 cubes of avascular and subjacent portions of 64 femoral heads of 51 patients with idiopathic avascular necrosis of the femoral head were performed to determine the morphologic and biomechanical changes with progression of the disease. Cases were divided into three groups according to the simple radiographic findings: group I (precollapse), group II (collapse), and group III (advanced collapse with secondary degenerative arthritis). Fourteen group I, 36 group II, and 14 group III specimens were identified. In addition to the simple radiographs, 16 magnetic resonance images were reviewed. In group I, there was no significant difference of yield and maximum stress, and modulus of elasticity between avascular and subjacent portions below the reactive rim. In group II, the above parameters showed lower values in the avascular portion than in the subjacent portion (P less than .05). In group III, maximum stress of the avascular portion showed significantly higher value than that of the subjacent region (P less than .05). In groups II and III, a major crack was observed in the subchondral area in 14 specimens and in the deep avascular and reactive junction in 36 specimens. Bone densitometry data suggested higher mineral content indicative of more sclerosis in the deep crack group. These findings might suggest that different biomechanical properties in the subchondral crack group and interface crack group might contribute to varieties in clinical manifestations. Later sclerotic changes and aspherical collapse of the femoral head might play a large role in the development of secondary degenerative arthritis of the hip joint.

A survival study of surgically treated lung cancer in Korea. Lung Cancer Surgical Study Group

Survival rate over a 5-year period were studied in a series of 658 proven primary lung cancer patients treated by thoracic surgeons at 8 institutes during the period from 1976 to 1987 in Korea. The study was designed as a multi-center cooperative work for the statistical analysis of the followup result. Clinical data of age, sex, morbidity, and staging of the tumor were assessed in 540 patients to evaluate their 5-year survival rates. Eventually, 405 resectable patients were analyzed by stage, cell type, surgical procedure, and TNM status. The 5-year actuarial survival rates by stage in the resectable group were: stage I 39.7%, II 30.6% III A 16.3%, III B 6.7%, and IV 0%. The 5-year survival rates by cell type were: squamous cell 31.9%, adenocarcinoma 21.2%, large cell 11%, and small cell 6%. The survival rates by surgical procedures were: lobectomy 30.7% and pneumonectomy 25.7%. The survival rates by TNM status in the operable group were: T1 34.7%, T2 26.8%, T3 7.5%, T4 5%; N1 23%, N2 10%, N3 3%; MO 21%, and M1 0%, respectively. The overall actuarial 5-year survival rate in the group of 405 resectable patients was 25.9%.

Immunohistochemical study on the antigenicity of each organ structure of Clonorchis sinensis

An immunohistochemical study was performed to demonstrate comparative antigenicity of each body structure of the liver fluke, Clonorchis sinensis, such as the digestive tract, reproductive organs, excretory system, tegument and suckers. Indirect immunoperoxidase technique was applied, using formalin-fixed and paraffin-embedded sections of C. sinensis as the antigen. Pooled cat sera obtained 10 weeks after an experimental infection with C. sinensis and peroxidase-conjugated goat anti-cat IgG were used as the primary and secondary antibodies, respectively. The intensity of immunohistochemical stain was very sensitive upon the titers of the primary and secondary antibodies, and their optimum dilutions were found to be 1:1,000-1:2,000 and 1:1,000, respectively. The intestinal epithelial cells, intestinal content and excretory bladder showed strong positive coloring reactions even at lower titer (1:2,000) of the primary antibody, whereas the uterine wall and eggs, vitelline glands, and male reproductive organs showed only weak positive reactions despite an increase in the antibody titer (1:1,000). On the other hand, the suckers, tegument, subtegumental cells and other parenchyma portions did not reveal any positive immunoperoxidase reaction at the same antibody titers. From the above results, it is highly suggested that the most potent antigenicity of C. sinensis occur from their excretory-secretory substances originated from the digestive and excretory organs.

Angioblastoma (Nakagawa)--is it the same as tufted angioma?

Four children affected by intradermal vascular proliferations are presented. The clinicopathological findings closely resemble those of cases described as angioblastoma, a familiar entity in the Japanese literature. Some people suggest that angioblastoma is the same as the tufted angioma described by Wilson-Jones. We found localized hyperhidrosis in two of our patients. Proliferation of eccrine glands near the tumour lobule was a consistent finding in the biopsy specimens from these four patients. In one patient, some of the vascular tufts were replaced by mucinous material. These findings have not been mentioned in previous reports of tufted angioma.

Changes of lactate dehydrogenase and its isoenzyme activity in renal diseases

Analysis of the five different serum isoenzymes of lactate dehydrogenase (LDH) is of great value in the differential diagnosis of various diseases. In order to investigate the changes of serum LDH isoenzymes in several renal diseases, 44 patients with Korean hemorrhagic fever, 10 patients with chronic renal failure, 10 patients with nephrotic syndrome, and 15 healthy subjects were studied. The isoenzymes of LDH were determined by the Helena LDH isoenzyme electrophoresis procedure. LDH1 was 22.3 +/- 2.8, LDH2 29.4 +/- 5.1, LDH3 20.8 +/- 4.5, LDH4 9.0 +/- 2.7 and LDH5 8.8 +/- 3.2 mU/ml in healthy subjects. In patients in the oliguric stage of Korean hemorrhagic fever, LDH1 was 63.4 +/- 28.5, LDH2 99.7 +/- 40.7, LDH3 107.5 +/- 39.0, LDH4 41.9 +/- 32.8 and LDH5 37.2 +/- 26.3 mU/ml, while LDH1 was 23.8 +/- 11.7, LDH2 38.9 +/- 14.6, LDH3 36.0 +/- 18.7, LDH4 13.8 +/- 13.0 and LDH5 12.7 +/- 7.6 mU/ml in nonoliguric patients. In patients with chronic renal failure LDH1 was 33.2 +/- 10.8, LDH2 41.9 +/- 13.3, LDH3 27.7 +/- 8.5, LDH4 12.1 +/- 6.2 and LDH5 12.3 +/- 5.8 mU/ml. In patients with nephrotic syndrome, LDH1 was 25.1 +/- 4.3, LDH2 33.5 +/- 4.9, LDH3 23.1 +/- 6.2, LDH4 8.4 +/- 3.7 and LDH5 8.4 +/- 3.4 mU/ml. In summary, LDH3 activity was elevated in the oliguric stage of Korean hemorrhagic fever and LDH2 was elevated in chronic renal failure; those values were correlated with the BUN level.

Lobulated intradermal nevus. Report of three cases

We report the cases of three patients with lobulated intradermal nevi. Biopsy specimens showed similar findings, that is, fatty infiltration within nests of nevus cells, neuroid differentiation of nevus cells, and dermal fibrosis. Our cases probably represent an unusual form of regressing melanocytic nevus.

Immunohistochemical study of melanocytic nevus and malignant melanoma with monoclonal antibodies against S-100 subunits

Immunohistochemical localization of S-100 protein alpha and beta subunits in the cells of melanocytic nevi and malignant melanomas was studied by using monoclonal antibodies directed against each subunit. Although polyclonal anti-S-100 reactivities have been demonstrated uniformly in all nevus cells and melanoma cells, monoclonal anti-S-100 alpha and anti-S-100 beta reactivities were either absent or rarely found in ordinary junctional nevi or junctional nests of ordinary compound nevi. However, in the junctional nests of dysplastic junctional nevi and junctional components of dysplastic compound nevi, monoclonal anti-S-100 alpha reactivity become more frequent, whereas monoclonal anti-S-100 beta reactivity remains negative. In the superficial variety of melanomas such as superficial spreading melanoma and lentigo maligna melanoma, monoclonal anti-S-100 beta is nonreactive until vertical growth or invasiveness begins. Most nodular melanomas are positively stained with both monoclonal anti-S-100 alpha and anti-S-100 beta. It is suggested that monoclonal anti-S-100 alpha can be an indicator of active junctional nevus of melanocytic nevi and the reactivity with monoclonal anti-S-100 beta may be related to vertical progression of superficial spreading melanomas and lentigo maligna melanomas.