Neonatal choriocarcinoma of liver

Neonatal choriocarcinoma associated with a seemingly normal gestation is rare. A total of 20 cases of either primary or metastatic choriocarcinoma in infancy have been reported until 1992. We report an additional case of a huge choriocarcinoma of the liver in a 2-month-old boy, who died of tumor hemorrhage. This baby was born to a 19-year-old unmarried mother. The placenta was thought to be normal and was not examined histologically. The liver mass was first noted 2 weeks after birth, and he was admitted because of poor feeding and pallor. Before any therapy was instituted, he died of massive tumor bleeding. Autopsy revealed a huge hemorrhagic tumor mass with massive necrosis in the left lobe of the liver. Several nodular metastases were found only in the lung. The remainder was unremarkable except for bilateral cleft lip and palate. It is presumed that the choriocarcinoma in the liver could be either a primary tumor in the absence of any primary focus in the mother or the infant or a metastatic lesion from an occult choriocarcinoma of the placenta.

Hepatic choriocarcinoma in a neonate: MR appearance

We present the MR findings of hepatic choriocarcinoma in a 2-week-old infant. Two masses of heterogeneous signal intensity were evident; one was an extensive mass on the left side of the liver and the other was a "daughter" nodule in the right lobe. Peripheral portions of the masses were hyperintense on T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI) suggesting subacute hemorrhage. Central portions of the masses were hypointense on T1WI and bright on T2WI. T1-weighted postgadolinium imaging showed peripheral enhancement of both tumor nodules. The infant's mother had normal serum beta-human chorionic gonadotropin levels and pelvic CT.

Synthesis and phosphodiesterase activity of carboxylic acid mimetics of cyclic guanosine 3',5'-monophosphate

Synthetic analogs of the natural product griseolic acid in which a guanine base is substituted for the adenine have been prepared. The best of these compounds inhibits a cyclic guanosine 3',5'-monophosphate (cGMP) phosphodiesterase preparation with an IC50 of 0.34 microM but is a very weak inhibitor of a cyclic adenosine 3',5'-monophosphate (cAMP) phosphodiesterase. An exploration of stereochemistry indicates that the configuration of the carboxylic acids and the ring fusion in the inhibitors is important for potent cGMP PDE inhibition. PDE inhibition is not sensitive to the presence of the 2' or 4' oxygen atoms in the ribose, but inhibition is decreased when the 3' oxygen is removed. A selected group of analogs in which a monocarboxylic acid is present are poor inhibitors. The structure-activity relationship is consistent with the carboxylic acid functionality acting as a mimetic for the phosphate anion in cGMP. This concept is supported by a conformational analysis of two of the inhibitors.

Complete obstruction of the nasolacrimal system. Part I. Treatment with balloon dilation

Fluoroscopically guided balloon dilation in treatment of complete obstruction of the nasolacrimal system was assessed in 39 eyes of 35 patients. All patients had severe epiphora. With nasal endoscopic guidance, a 0.018-inch guide wire was introduced through the superior punctum into the inferior meatus of the nasal cavity and was pulled out through the nasal aperture with a hemostat. A deflated angioplasty balloon catheter was passed retrograde over the guide wire through the inferior meatus until it straddled the stricture. Balloons were dilated with water-soluble contrast medium. No major complications occurred. At 7 days after balloon dilation, epiphora decreased in 22 of 39 eyes; 17 demonstrated complete resolution of severe epiphora, and five showed incomplete resolution. At 2 months, improvement had not been maintained in 10 of the 22 eyes. This technique for treatment of complete obstruction of the nasolacrimal system is simple and safe, but the high failure and recurrence rates in this study are not encouraging.

Complete obstruction of the nasolacrimal system. Part II. Treatment with expandable metallic stents

To evaluate the clinical usefulness of expandable metallic stents for maintenance of the dilated nasolacrimal sac and duct, double stents were implanted under fluoroscopic guidance in seven patients with severe epiphora after failed balloon dacryocystoplasty. Stents were constructed of 0.25-mm stainless steel wire in a cylindrical zigzag configuration of 10 bends. A single stent was 4 mm in diameter when fully expanded and 10 mm long. The stent was placed accurately in all but one patient, in whom a second stent was placed accurately after removal of the dislodged stent with a hemostat under endoscopic guidance. After stent placement, all patients demonstrated complete resolution of epiphora. During follow-up of 4-20 weeks, complete blockage of the stent occurred in one patient. This was treated with intrastent balloon dacryocystoplasty. No stents migrated. Although the long-term validity of this treatment has not been proved, expandable metallic stents seem to be of value in the treatment of complete obstruction of the lacrimal sac and nasolacrimal duct.

Acute leukemias with unusual immunophenotypes

Over a two-year period, immunophenotypic patterns of 266 acute leukemia cases were analyzed using a panel of tests including TdT, SmIg and 9 surface antigens by the immunofluorescence stains for the assessment of the incidence and grade of phenotypic ambiguity (lineage infidelity) and the possible clinical significance of unusual immunophenotypes. Immunophenotypes were classified into four groups according to the degree of ectopic antigen expression. We classified as Group A (91.7%, 244 of 266 cases) those expressing conventional pattern without ectopic antigen. Group B (3.0%, 8 of 266 cases) was defined to have at least two lineage specific markers and single ectopic antigen. Such a "low grade deviation" did not prevent a definite immunodiagnosis. Group C (4.2%, 11 of 266 cases) revealed a promiscuous coexpression of markers related to different lineages, including two cases (0.8%, 2 cases) of biphenotypic leukemia. Group D (1.1%, 3 cases) included unclassifiable immunophenotypes with no antigen or HLA-DR only expression. Both patients with biphenotypic leukemia and one patient with unclassifiable immunophenotypes failed to respond to induction chemotherapy, suggesting a poor prognosis in these patients. The incidence of acute myelogenous leukemia (AML) cases with one or more ectopic surface antigens was 10 (8.1%) of the 124 AML cases. Ectopic antigen expression was seen in 5 (4%) of the 125 B-lineage acute lymphoblastic leukemia (ALL) cases and 3 (25%) of the 12 T-ALL cases. It is concluded that nearly 95% of cases of acute leukemia cases can be diagnosed accurately with immunophenotyping alone including patients with a mild degree of deviation from expected antigenic patterns.(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence for essential histidine and cysteine residues in calcium/calmodulin-sensitive cyclic nucleotide phosphodiesterase

Ca/calmodulin-sensitive cyclic nucleotide phosphodiesterase (CaM-PDE) is an important enzyme regulating cGMP levels and relaxation of vascular smooth muscle. This modification study was conducted mostly with bovine brain CaM-PDE to identify essential functional groups involved in catalysis. The effect of pH on Vmax/Km indicates two essential residues with pKa values of 6.4 and 8.2. Diethyl pyrocarbonate (DEP), a histidine-modifying agent, inhibits CaM-PDE with a second-order rate constant of 130 M-1 min-1 at pH 7.0 and 30 degrees C. Activity is restored by NH2OH. The pH dependence of inactivation reveals that the essential residue modified by DEP has an apparent pKa of 6.5. The difference spectrum of the intact and DEP-treated enzyme shows a maximum between 230 and 240 nm, suggesting formation of carbethoxy derivatives of histidine. The enzyme is also inactivated by N-ethylmaleimide (NEM) and 5,5'-dithiobis-(2-nitrobenzoic acid), both sulfhydryl-modifying agents, with the latter effect reversed by dithiothreitol, which suggests inactivation resulting from modification of cysteine residue(s). Partial inactivation of the enzyme by DEP or NEM results in an apparent decrease in the Vmax without a change in the Km or the extent of CaM stimulation. The rate of inactivation by DEP is greater in the presence than in the absence of Ca/CaM. A substrate analogue, Br-cGMP, and the competitive inhibitor 3-isobutyl-1-methylxanthine partially protect the enzyme against inactivation by DEP or NEM, suggesting that the modification of histidine and cysteine residues occurs at or near the active site. DEP also inactivated porcine brain CaM-PDE.(ABSTRACT TRUNCATED AT 250 WORDS)

Incidence estimation of thyroid cancer among Koreans

The medical records of inpatients with diagnoses of either ICD-9 193(malignant neoplasm of the thyroid gland) or 226(benign neoplasm of the thyroid gland) in the claims sent in by medical care institutions throughout the country, to the Korea Medical Insurance Corporation (KMIC) during the period from January 1, 1986 to December 31, 1987 were abstracted. These records were abstracted in order to identify and confirm new cases of thyroid cancer among the beneficiaries of the KMIC. Using these data, the incidence rate of thyroid cancer among Koreans was estimated as of July 1, 1986 through June 30, 1987. The crude rates were estimated to be 0.76(95% Cl: 0.63-0.87) and 3.87(95% Cl: 3.60-4.14) per 100,000 in males and females, respectively, and the cumulative rates for the age spans 0-64 and 0-74 in males were 0.06% and 1.10%, respectively. In females, those were equally 0.35%. The age-adjusted rate for the world population was 0.93 per 100,000 in males, which is one of the lowest levels in the world. However, the adjusted rate in females was 3.96 per 100,000, which is an average level and very similar to that of the Chinese in Singapore and Shanghai. A similar tendency was shown in the case of the truncated rates for the age group of 35-64, which was 1.91 per 100,000 in males and 8.82 per 100,000 in females.

Incidence estimation of stomach cancer among Koreans

A series of incidence estimation studies of cancers among Koreans through a nationwide survey has been undertaken by authors since 1988. The medical records were studied of inpatients with diagnoses of either ICD-9 151 (malignant neoplasm of the stomach), or 197 (secondary malignant neoplasm of the respiratory and digestive systems), or 211 (benign neoplasm of other parts of the digestive system) in claims sent in by medical care institutions throughout the country to the Korea Medical Insurance Corporation (KMIC) during the period from January 1, 1986 to December 31, 1987. These records were abstracted in order to identify and confirm the new cases of stomach cancer among the beneficiaries of the KMIC, which covers about 10% of whole Korean population. Using these data from the KMIC, the incidence patterns of stomach cancer among Koreans were estimated as of July 1, 1986 to June 30, 1987. The crude incidence rates of stomach cancer among Koreans are estimated to be 36.2 (95% tonfidence interval; 35.3-36.9) and 21.0 (95% CI; 20.3-21.6) per 100,000 in males and females, respectively. The cumulative rates for age spans 0-64 and 0-74 are 3.8% and 7.3% in males, respectively. In females they are 1.8% and 3.0%. The adjusted rates for the world population are 57.9 in males and 25.1 in females, which are similar to those of Shanghai, China '78-'82 but lower than those of Osaka, Japan. The truncated rates for ages 35-64 years, however, are 108.3 in males and 49.1 in females, which may be the highest in the world. Among Koreans in Korea, an increased risk of stomach cancer in this age group is the notable finding. Incidence patterns of stomach cancer by age, sex, and area, which are the first report in Korea, are analyzed and presented.

Magnetic resonance imaging diagnosis of an intracranial metastasis of adenocarcinoma of the prostate: case report

Adenocarcinoma of the prostate is the second most common cancer of American males over age fifty. However, the reported instances of cerebral metastases have been exceedingly rare and are usually diagnosed at postmortem. This report describes an unusual case of brain metastasis from an occult adenocarcinoma of the prostate confirmed by craniotomy and tumor resection.

Incidence rate of hepatitis B: results of a record linkage study among healthy Korean males

A stable, liver disease-free cohort of 369,725 was reconstructed as of 1984 for the study of hepatitis B virus seromarkers and liver diseases. The cohort consisted of male beneficiaries of the Korea Medical Insurance Corporation (KMIC) over 30 years of age and living nationwide. Subjects who were both negatives for HBsAg and anti-HBs (N = 274,037) were selected for incidence of hepatitis B. Data on test results of HBsAg and anti-HBs in 1984 and on hepatitis B occurrence during 1985-1986 were collected from the files of the KMIC. Linkage was done between these two data sets to measure the incidence rate through a longitudinal observation of the male population. Correction against misclassification error and duplicate claims was done by a sample survey and verification procedures. The incidence rate of hepatitis B was 17.13 per 100,000 person-years for acute viral hepatitis B and 15.74 for chronic hepatitis B, respectively. An increasing age-dependent pattern for acute hepatitis B was not so prominent in this population. However, the incidence rate of chronic hepatitis B steadily increased with age. The relative risk, estimated by a log-linear model for rate and constant hazard, was significantly higher in the over-60 age group than in the others. The incidence rate in the lower socioeconomic class was higher than in the others, although statistically not significant.

Effects of selective inhibitors on cyclic nucleotide phosphodiesterases of rabbit aorta

In this study three forms of cyclic nucleotide phosphodiesterase (PDE) isolated from rabbit aorta were pharmacologically characterized, and the consequence of selective inhibition of calmodulin-stimulated PDE (CaM-PDE) and cGMP specific PDE (cG-PDE) was evaluated using PDE inhibitors. The cG-PDE (F1) was selectively inhibited by M&B 22948 (IC50 = 0.5 microM) and dipyridamole (IC50 = 7 microM). The cAMP-PDE (cA-PDE, F3) was inhibited more effectively by the cA-PDE inhibitor milrinone than by other PDE inhibitors. The cA-PDE preparation appeared to contain both cG-inhibited PDE and cG-insensitive PDE based on an additive inhibition of the activity by milrinone and SQ 65442, respective inhibitors of these enzymes. Vinpocetine, 8-methoxymethyl isobutylmethylxanthine (8-MeOMeMIX) and M&B 22948 effectively inhibited CaM-PDE (F2). Vinpocetine was a more selective inhibitor of CaM-PDE than M&B 22948 or 8-MeOMeMIX. CaM-PDEs isolated from rabbit aorta and bovine brain exhibited a similar sensitivity to these inhibitors. Seventy-two percent of the cGMP-hydrolyzing activity of this rabbit aortic CaM-PDE preparation was immunoadsorbed to monoclonal antibody (ACC-1) against CaM bound to brain CaM-PDE. Vinpocetine, 8-MeOMeMIX and M&B 22948 at concentrations (30 and 100 microM) which inhibit CaM-PDE greater than 60% increased cGMP but not cAMP levels in l-norepinephrine (NE) preincubated rabbit aortic slices. At concentrations selectively inhibiting cG-PDE, dipyridamole and M&B 22948 increased cGMP levels in untreated slices but failed to increase cGMP levels significantly in NE-treated slices. By contrast, vinpocetine failed to increase cGMP significantly in untreated slices, although it increased cGMP levels in NE or KCl preincubated slices. These data indicate that, in activated (precontracted) aorta, CaM-PDE is a major enzyme, whereas in untreated aorta cG-PDE is a predominant enzyme for the hydrolysis of cGMP. This study also shows a usefulness of selective inhibitors in identifying different forms of PDE and similar drug sensitivities and immunoadsorption of aortic and brain CaM-PDEs by a monoclonal antibody.

Percutaneous transcatheteral biliary biopsy (PTBB)--a report of two cases

In two patients with obstructive jaundice, percutaneous transhepatic cholangiography (PTC) and percutaneous transhepatic biliary drainage (PTBD) were performed. During PTBD, the percutaneous transcatheteral biliary biopsy (PTBB) with the biopsy forceps of the gastrofiberscope was performed through the biliary stent catheter. Biopsy specimens were successfully obtained and histopathologic findings were satisfactory in both cases.

Combining the detachable balloon technique and surgery in imaging carotid cavernous fistulae

Among 143 carotid cavernous fistulae, 10 cases could not be successfully treated by standard endovascular techniques alone; some form of surgical assistance was required. The circumstances included incomplete closure of the fistula while the internal carotid artery was occluded, failure to occlude the fistula after both arterial and venous endovascular approaches, hairpin loop of the cervical portion of the internal carotid artery, failure of previous trapping procedures, and failure to cure spontaneous carotid cavernous fistulae of the dural type after embolization of the external carotid feeders. These ten patients were cured by combining a surgical procedure and an interventional technique.

Effects of BRL 34915, a putative K channel opener, on transmembrane 45Ca movements in rabbit aortic smooth muscle

The effects of BRL 34915, a putative K channel opener, on transmembrane Ca2+ movements were studied in isolated rabbit aortic strips, using the 45Ca flux techniques. BRL 34915 (1 and 10 microM) inhibited the contraction and Ca entry in response to norepinephrine (NE) and angiotensin II, each at 0.3 microM. BRL 34915 differed from Na nitroprusside in that it demonstrated little or no inhibition on the contraction and 45Ca efflux provoked by NE in Ca2+-free buffer, suggesting that the effect of BRL 34915 on intracellular Ca release plays a minor role in inhibiting the vasoconstrictor responses to receptor agonists. Moreover, BRL 34915 (100 microM) did not stimulate cyclic GMP formation in rabbit aortic slices. BRL 34915 (10 microM) failed to inhibit the vascular responses to KCl (20 and 40 mM). Tetraethylammonium (20 mM), a K channel blocker, abolished the vasorelaxant action of BRL 34915 against NE. However, Na nitroprusside inhibition of NE contraction was similarly affected. It is concluded that reduction of Ca entry appears to be the predominant mechanism mediating the inhibitory effect of BRL 34915 on the contractile responses to vasoconstrictor stimuli.

Comparative effects of vinpocetine and 8-Br-cyclic GMP on the contraction and 45Ca-fluxes in the rabbit aorta

Vinpocetine is a highly specific inhibitor of calmodulin-dependent phosphodiesterase (CaM-PDE) with an IC50 of 19 microM and produces a significant accumulation of cyclic GMP but not cyclic AMP in rabbit aorta. In isolated rabbit aortic strips, vinpocetine (0.01 and 0.1 mM) inhibited the contraction and 45Ca uptake due to both phenylephrine (1 microM) and KCl (40 mM), whereas 8-Br-cyclic GMP (0.1-1mM) selectively impaired phenylephrine-induced responses. Furthermore, the KCl-stimulated 45Ca efflux in normal Ca2+ buffer, which reflects elevated cytosolic Ca2+, was greatly diminished by vinpocetine but not by 8-Br-cyclic GMP. However, phenylephrine-induced 45Ca efflux and contraction in Ca2+-free buffer, which reflect Ca2+ release from intracellular sites, were similarly inhibited by both vinpocetine and 8-Br-cyclic GMP. The results suggest that vinpocetine may effect vasodilatation through blockade of the slow channel and selective inhibition of CaM-PDE in the vascular smooth muscle.

Congenital odontoid aplasia and posterior circulation stroke in childhood

Head trauma and vigorous physical activity were followed by delayed-onset posterior circulation stroke in a 5-year-old boy with odontoid aplasia and C1-C2 subluxation. Angiography demonstrated vertebral artery narrowing and occlusion of the left anterior-inferior cerebellar and posterior cerebral arteries. Odontoid aplasia and other atlantoaxial dislocations are treatable causes of posterior circulation insufficiency in childhood; these defects may be overlooked without appropriate radiographic study of the cervical spine using flexion-extension views.

Indications for treatment and classification of 132 carotid-cavernous fistulas

Classification of carotid-cavernous fistulas (CCFs) into the four types described by Barrow allows the surgeon to choose the optimal therapy for each patient. Type A patients have fast flow fistulas that are manifest by a direct connection between the internal carotid arterial siphon and the cavernous sinus through a single tear in the arterial wall. The best therapy is obliteration of the connection by a detachable balloon. Ninety-two of 95 traumatic CCFs were treated in this fashion. Direct surgical exposure of the cervical or cavernous internal carotid artery (ICA) was necessary in the remaining 3 patients, who had undergone unsuccessful surgical trapping. Three ruptured cavernous aneurysms and 2 spontaneous CCFs also had Type A connections. Other carotid-cavernous fistulas are slow flow, spontaneous dural arteriovenous malformations (AVMs) that have been classified into B, C, and D types on the basis of arterial supply. Occlusion of the ICA is not a logical choice in the treatment of dural AVMs that occur in the elderly, are relatively benign, and are often bilateral. Type B are rare and are fed by meningeal branches of the ICA only. We have not seen this type of dural fistula in our series. Type C are supplied by feeders from the external carotid only and can almost always be obliterated successfully by embolizing the external carotid artery (ECA) branches. There are 4 Type C cases in this series of 37 spontaneous CCFs. All occurred in patients less than 30 years of age and were shunts between the middle meningeal artery and the cavernous sinus.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of carotid cavernous fistulae or cavernous aneurysms associated with a persistent trigeminal artery: report of three cases

One case of traumatic carotid cavernous fistula and two cases of cavernous aneurysm associated with a persistent trigeminal artery are reported. Since a significant rate of infarctions or hemorrhages in the vertebrobasilar territory is associated with PTA, we prefer to permanently occlude the PTA during treatment of a carotid cavernous fistula or a cavernous aneurysm if the trigeminal artery can be sacrificed without jeopardizing the basilar circulation. These three patients were cured without complications. The internal carotid artery could be preserved in only one case.

A case of congenital factor V deficiency

A case of Factor V deficiency, the first case in Korea, is reported in a 9-year-old boy whose plasma concentration of Factor V was 6%. He complained of easy bruisability, prolonged bleeding from the mouth after minor trauma and hemarthrosis and flexion contracture of the right knee. His parents are heterozygous (maternal Factor V concentration 52%, paternal 40%).

Angiotensin converting enzyme inhibitory activity of SCH 33844 (spirapril) in rats, dogs and monkeys

SCH 33844 is a new non-sulfhydryl-containing angiotensin converting enzyme (ACE) inhibitor. SCH 33844 diacid inhibited hydrolysis of the synthetic substrate hippuryl-histidyl-leucine by rabbit lung ACE in vitro with an IC50 (concentration inhibiting enzyme by 50%) of 0.81 nM. The ester was 83 times less active. Intravenous administration of SCH 33844 and its diacid inhibited pressor responses to angiotensin I (AI) in anesthetized rats with calculated ID50's of 16 and 8 micrograms/kg, respectively. Oral administration of SCH 33844 (0.03-1 mg/kg) inhibited AI pressor responses in conscious rats with a duration of 24 hr at the highest dose. The diacid was inactive. Intravenous administration of SCH 33844 (100-1000 micrograms/kg) or its diacid (30 micrograms/kg) to anesthetized dogs inhibited AI pressor activity and potentiated the depressor response to bradykinin. SCH 33844 inhibited AI responses in conscious dogs following oral administration of 0.3-3 mg/kg. Oral administration of SCH 33844 (1 mg/kg) to conscious monkeys inhibited AI pressor responses for the 4 hr duration of study. In conclusion, SCH 33844 is a potent, orally effective ACE inhibitor in rats, dogs and monkeys.

Antihypertensive, hemodynamic and autonomic profile of a new angiotensin converting enzyme inhibitor, SCH 33844 (spirapril)

SCH 33844 is a new, potent and long-acting inhibitor of angiotensin converting enzyme (ACE). Antihypertensive, hemodynamic and autonomic actions of SCH 33844 were examined in the present series of experiments. Oral administration of 0.3-30 mg/kg reduced blood pressure of spontaneously hypertensive rats. The magnitude of the response was significantly enhanced by pretreatment of the animals with hydrochlorothiazide. Blood pressure remained significantly depressed 24 hr following doses of 3 and 10 mg/kg. Administration of SCH 33844 (3 mg/kg) twice daily to nonpretreated rats or once daily to diuretic-pretreated animals for 5 days resulted in a progressive decrease in blood pressure. The compound did not reduce blood pressure in nephrectomized rats demonstrating the dependence of its action on renal renin. SCH 33844 (1-10 mg/kg orally) also produced dose-related decreases in pressure in diuretic-pretreated conscious normotensive dogs. However, only a small fall in pressure occurred in non-pretreated dogs. Hemodynamic actions were examined in anesthetized dogs. SCH 33844 (1 mg/kg i.v.) reduced blood pressure, increased cardiac output and caused a large fall in peripheral resistance. Autonomic actions were assessed in pithed rats. The compound (10 mg/kg orally) tended to decrease pressor responses to sympathetic activation and to i.v. norepinephrine. This profile is probably due, at least in part, to vasorelaxation following suppression of angiotensin II generation. In conclusion, SCH 33844 is a potent, long-lasting antihypertensive agent which reduces peripheral vascular resistance and possesses only slight autonomic effects.