Analysis of the rat clusterin gene promoter and cyclic AMP-regulated mRNA stability in testicular cells

Clusterin, also known as SGP-2 or TRPM-2, is expressed in the male reproductive tissues at different levels. The genomic structure of the rat clusterin gene was recently reported by our laboratory and others. In this study, we have determined the promoter responsible for the basal expression of the rat clusterin gene in testicular cells by analyzing the transient expression of the bacterial chloramphenicol acetyl transferase (CAT) reporter gene in MA-10 cells driven by different segments of the 5'-flanking region and the first intron of the clusterin gene. The region required for maximal basal expression was identified at -266 to +54. Addition of DNA fragments of the rat clusterin gene from -1298 to -266 bp, or from +54 to +1153 to (-266/+54)CAT resulted in a 87% decrease in CAT activity, suggesting the presence of inhibitory DNA elements in both the 5'-flanking region and the first intron. When DNA fragment in the first intron, +1153 to +2874, was included, CAT activity in the (-266/+2874)CAT construct increased to 70% of the clusterin promoter (-266/+54)CAT, indicating that stimulatory DNA elements may be present in this region of the first intron. Treatment of MA-10 cells with cyclic AMP (cAMP) neither decreased CAT activity driven by any of the clusterin/CAT chimeric plasmids examined in transient transfection studies, nor reduced the synthesis of nuclear clusterin RNA in nuclear run-on assays, indicating that the reduction of clusterin mRNA levels by cAMP previously reported in our laboratory is not exerted at the transcriptional level. Furthermore, addition of transcriptional or translational inhibitors (actinomycin D and cycloheximide respectively) abolished the cAMP effect observed in MA-10 cells. In summary, we have demonstrated that the basal transcription of the rat clusterin gene in testicular cells is under the control of both positive and negative regulatory sequences at the 5'-flanking region as well as in the first intron. The reduction of clusterin mRNA after exposure of MA-10 cells to cAMP is not due to a decrease in its transcriptional activity, but rather to an increase in the degradation of this mRNA through synthesis of a destabilizing protein(s) and its mRNA.

Postoperative morbidity and mortality of pancreaticoduodenectomy for periampullary cancer

OBJECTIVE

To find out factors that may influence the mortality after Whipple's operation, whether duct to mucosa anastomosis is better than classic "dunking" pancreaticojejunostomy and whether age over 70 is a contraindication for this procedure.

DESIGN

Prospectively randomised study.

SETTING

Teaching hospital, Taiwan, R.O.C.

PATIENTS

93 patients with periampullary cancer undergoing Whipple's operation were randomly divided into two groups. Forty-six with periampullary cancer underwent invaginating pancreaticojejunostomy, and 47 patients underwent duct to mucosa anastomosis for reconstruction.

MAIN OUTCOME MEASURES

Mortality and morbidity were compared between two groups.

RESULTS

The over all mortality was 8% (7/93). An albumin concentration of less than 30 g/L before operation and operative blood loss influenced the surgical mortality both in the univariate and multivariate analysis. Age over 70 years was not a factor. Patients with duct to mucosa anastomoses had a leak rate of 4% (2/47), morbidity of 21% (10/47) and mortality of 6% (3/47). Patients with an invaginated pancreaticojejunostomy had a leak rate of 15% (7/46), morbidity of 33% (15/46), and mortality of 9% (4/46). The need for total parenteral nutrition in the invaginated group (33%) was statistically greater than in the other group (11%) (p = 0.01).

CONCLUSIONS

The morbidity and mortality of pancreaticoduodenectomy for periampullary cancer although slightly greater for patients over the age of 70 are acceptable. The factors that may influence the mortality are an albumin concentration of less then 30 g/L and the amount of blood lost during operation. The duct to mucosa anastomosis is a safe procedure, which has a lower leak rate and less need for total parenteral nutrition than pancreaticojejunostomy.

Ultrasound-guided fine-needle aspiration biopsy of lung cancers

One hundred eighty-eight patients with 191 lung cancers were collected retrospectively to evaluate the diagnostic results and to determine the accuracy of cytologic diagnoses obtained from ultrasound-guided fine-needle aspiration biopsy (US-guided FNAB), and to discuss the necessity of large-bore tissue core needle biopsy. All 188 patients underwent US-guided FNAB, and 20 patients with 21 lung tumors also underwent US-guided tissue-core needle biopsy. Using US-guided FNAB alone, the positive cytologic results and correct cytologic diagnoses were 91% (174 of 191) and 71% (37 of 52). If both US-guided FNAB and selected US-guided tissue core needle biopsy (n = 21) were evaluated, the positive cytologic or histologic results and correct cytologic or histologic diagnoses were 94% (180 of 191) and 80% (45 of 57), respectively. Analyzing the disagreement between the cytologic results and histologic diagnoses (n = 15), we found that the disagreement usually occurred in the specimens with poorly differentiated carcinomas (nonspecific cell type) (53% [8 of 15]); of these, two patients (13% [2 of 15], small cell carcinoma) would have a change in treatment. The complications of US-guided FNAB were pneumothorax (n = 3), hemoptysis (n = 1), hemothorax (n = 1), and suspected tract metastasis (n = 1). We conclude that US-guided FNAB has a high diagnostic yield in lung cancers, and US-guided tissue core needle biopsy is only necessary in patients whose cytologic results are negative or who have poorly differentiated carcinomas.

Case report: paucity of interlobular bile ducts in Chinese children

Sixteen Chinese children with cholestasis since early infancy were diagnosed to have paucity of interlobular bile ducts (PILBD) or its equivalent. Twelve children belonged to the syndromic group of PILBD and four children belonged to the non-syndromic group. A definite histological diagnosis of bile duct paucity was established in only two children (aged 4 and 9 months) during the first percutaneous needle biopsy. In the remaining 14 children a varying degree of bile duct destruction was evident in the follow up percutaneous or wedge liver biopsies. The evolving changes were characterized by inflammatory infiltration near or at the ductal wall, the presence of dysmorphic ductules, the degeneration of ductal epithelia and a progressive decrease of interlobular bile ducts. Of 10 children who underwent laparotomy for definite diagnosis, kasai operation was performed in two of them. In the syndromic PILBD group, all children, including two paired siblings, had at least three of five major clinical features. Hypoplasia of the extrahepatic biliary tree was found in five children and atresia of the extrahepatic bile duct was found in one. Three of six children studied were shown, by polymerase chain reaction, to have cytomegalovirus infection in the liver. This study demonstrates that bile duct paucity is a result of progressive bile duct destruction. A definitive diagnosis is difficult to make in early infancy. Thus, the careful evaluation of extrahepatic features in cholestatic children and follow-up liver biopsies are indicated. Although the pathogenetic mechanism of PILBD is unknown, bile duct destruction is the common pathway leading to paucity of bile ducts irrespective of syndromic or non-syndromic types.

Paediatric liver transplantation: a 10 year experience in Taiwan

Between March 1984 and August 1994, 13 orthotopic liver transplantations were performed in 13 patients < or = 25 years of age. The indications included Wilson's disease (n = 7), biliary atresia (n = 4), choledochal cyst (n = 1) and hepatitis C cirrhosis (n = 1). Technical variants included full-size (n = 11), reduced-size (n = 1) and living-related (n = 1) liver transplantation. These recent technical innovations have offered an expanded donor pool for earlier transplantation, shorter waiting times and excellent quality grafts. Surgical complications occurred in six patients; all required additional surgery. Biliary complications were encountered more commonly in our earlier patients. Our actuarial patient and graft survival rate is 92% at 2 years. The long-term follow-up of our liver-transplanted Wilson's disease patients provides confirmatory evidence that orthotopic liver transplantation cures the underlying metabolic defect with complete normalization of biochemical abnormalities of copper metabolism, reversal of neurological impairments and the disappearance of Kayser-Fleischer corneal rings. The high rate of patient survival and excellent rehabilitation indicate that with prudent clinical judgement, liver transplantation can be achieved with an acceptable rate of morbidity, mortality and cost in a setting where manpower and donor organs are very limited.

Characterization of latex allergens and correlation of serum IgE/IgG antibody ratio with clinical symptoms

Enzyme-linked immunosorbent assay (ELISA) was used to study latex-specific IgE and IgG. Levels of these immunoglobulins were correlated with latex allergy severity. Total protein content and relative immunoreactivity of 12 different brands of disposable gloves were compared. Specific latex proteins were extracted and characterized by immunoblotting. Blots revealed that the major latex allergen, reactive with both IgE and IgG, was a 34 KD component. Protein content varied among brands of gloves but correlated with immunoreactivity (R = 0.683; P < 0.017). The ratio of IgE/IgG correlated positively with symptom severity (R = 0.689; P < 0.001) and was useful to predict the severity of latex allergy.

Radiation-induced malignant fibrous histiocytoma in patients with nasopharyngeal carcinoma

OBJECTIVE

To evaluate the prevalence, 15-year cumulative incidence, time interval, and prognosis of radiation-induced malignant fibrous histiocytoma of the head and neck in long-term survivors of nasopharyngeal carcinoma.

DESIGN

Cohort.

SETTING

Tertiary care hospital.

PATIENTS

Eight long-term survivors of nasopharyngeal carcinoma with malignant fibrous histiocytoma in the maxillary sinus or nasal cavity.

MAIN OUTCOME MEASUREMENT

Survival of postirradiation malignant fibrous histiocytoma in patients with nasopharyngeal carcinoma.

RESULTS

The prevalence of radiation-induced malignant fibrous histiocytoma in long-term survivors of nasopharyngeal carcinoma was 0.38%. The 15-year cumulative incidence was 2.2%. Most tumors occurred in the maxillary sinus and were characterized by spindle-shaped tumor cells with plump nuclei arranged in a whorl or storiform pattern in a fibrous stroma. The mean interval between malignant fibrous histiocytoma and nasopharyngeal carcinoma was 121 months. Local recurrence developed in all cases within 9 months after surgery. Six patients died of disease without distant metastasis within 30 months. Two patients were alive with disease for 20 and 32 months, respectively.

CONCLUSIONS

Radiation-induced malignant fibrous histiocytoma in the head and neck region in long-term survivors of nasopharyngeal carcinoma is rare. It takes a long time to occur after irradiation and is locally invasive with poor prognosis.

Simultaneous characterization of glutathione S-transferase M1 and T1 polymorphisms by polymerase chain reaction in American whites and blacks

Human glutathione S-transferase (GST) M1 and T1 enzymes exhibit genetic polymorphism, with a percentage of normal individuals exhibiting a homozygous deletion of the relevant genes. We established a differential polymerase chain reaction (PCR) technique to simultaneously characterize inactivating mutations responsible for the null alleles of GSTM1 and GSTT1. Primers for GSTM1,GSTT1,and for beta-globin (as a positive control) were used to simultaneously amplify all three gene products from leukocyte DNA from 416 normal healthy human volunteers. Identical GSTM1 and CSTT1 genotypes were obtained using nine samples processed either separately or simultaneously for GSTM1 and GSTT1. The frequency of the null genotype for GSTM1 was higher in whites (114/213 or 53.5% vs 56/203 or 27.6%, p < 0.001) and for GSTT1 was higher in blacks (49/203 or 24.1% vs 32/213 or 15.0%, p = 0.019). The observed frequency of the 'double null' genotype for both GSTM1 and GSTT1 was not significantly different from that predicted if both polymorphisms were independent (p = 0.102) and did not differ by race (p = 0.120) or sex (p = 0.800). There was a higher frequency of the GSTM1 null genotype among females than males (92/202 or 45.5% vs 78/214 or 36.4%, p = 0.049). These results demonstrate that this PCR method is a simple and reliable tool to simultaneously characterize both GSTM1 and GSTT1 null genotypes.

[Cardiac arrest during transurethral resection of the prostate]

Due to the development of anesthetic drugs and techniques, and the progress of monitor system. The rate of cardiac arrest during anesthesia has declined during the last decades. We report two cases of sudden cardiac arrest which happened during transurethral resection of the prostate, and discuss the mechanism, treatment, and the methods of prevention.

Expression of Epstein-Barr virus in carcinomas of major salivary glands: a strong association with lymphoepithelioma-like carcinoma

To elucidate the role of Epstein-Barr virus (EBV) in salivary gland carcinomas, 56 cases of carcinomas of major salivary glands were investigated. These included 14 mucoepidermoid carcinomas, 13 adenoid cystic carcinomas, seven malignant mixed tumors, four adenocarcinomas, four salivary duct carcinomas, two acinic cell carcinomas, two undifferentiated carcinomas without lymphoid stroma, seven lymphoepithelioma-like carcinomas (LELCs), two squamous cell carcinomas, and one small cell carcinoma. EBV transcripts were examined by in situ hybridization using digoxigenin-labeled oligonucleotide antisense probe for EBV-encoded RNA 1 (EBER1) on formalin-fixed paraffin-embedded tissue sections. EBER1 was detected in the malignant epithelial cells in all seven cases of LELC, but not in any of the other carcinomas and the neighboring normal salivary gland tissue. Because all the EBV-negative cases showed satisfactory labeling with the poly d(T) probe, the negative reaction with EBER1 was unlikely to be caused by poor RNA preservation in the tissues. The seven cases of LELC, which were histologically indistinguishable from undifferentiated nasopharyngeal carcinoma (NPC), had a disease-free 4-year survival rate of 85.7%. The results suggest that LELC of the salivary gland in Taiwanese Chinese may share similar EBV-related pathogenesis with that of NPC.

Use of enzyme-linked immunosorbent assay and radioimmunoassay to determine serum and urine dexamethasone concentrations in thoroughbreds after intravenous administration of the steroid

OBJECTIVE

To develop a simple and sensitive ELISA for detection of dexamethasone in horse serum and urine.

SAMPLE POPULATION

Blood and urine samples from 3 thoroughbred mares.

PROCEDURE

A dexamethasone oxime was prepared and conjugated to hemocyanin, bovine serum albumin and to horseradish peroxidase. One- and two-step double-antibody ELISA methods, as well as a radioimmunoassay method, were performed. The one-step ELISA was used to test urine from 3 Thoroughbred mares injected with 5 mg of dexamethasone, IV.

RESULTS

The ELISA could detect dexamethasone in the range of 0.01 to 50 ng/ml, with intra- and interassay variations of 8.92 and 9.42%, respectively. Serum dexamethasone concentration reached a peak of 20 to 35 ng/ml 15 minutes after steroid administration and decreased to 1 ng/ml in 2.5 hours. Urine dexamethasone concentration 18 to 50 ng/ml 1 to 2 hours after drug administration and decreased to 1 ng/ml at 10 hours.

CONCLUSION

The developed assay is sensitive as well as simple for detecting dexamethasone in horse serum and urine, and is comparable to radioimmunoassay.

CLINICAL RELEVANCE

This method can be useful for screening samples from racehorses, because it is sensitive and does not require sample preparation or sophisticated equipment.

Etiology of lymphadenopathy in patients with AIDS in Taiwan

From 1986 to 1995, we retrospectively reviewed the records of 40 of 125 patients (32.0%) with acquired immunodeficiency syndrome (AIDS) who presented with extrainguinal lymphadenopathy. Most of the patients had an advanced stage of HIV infection with a mean CD4 lymphocyte count of 44/mm3. AIDS-defining opportunistic infections and malignancies were present in most patients and the neck region was the most common site of involvement. The etiology of lymphadenopathy was established in 26 patients. Tuberculous lymphadenitis was the most common cause, followed by lymphadenopathic Kaposi's sarcoma, benign reactive hyperplasia, cryptococcal lymphadenitis and disseminated Mycobacterium avium complex infection. Characteristic histopathologic findings were detected in 19 patients and 7 had presumptive tuberculous infections. The remaining 14 patients had no definitive etiology for their lymphadenopathy. As the causes are variable and the number of HIV/AIDS cases is increasing in Taiwan, more patients with lymphadenopathy, especially in the early stages of HIV infection will be encountered. Therefore, it is essential that diagnostic histopathologic and microbiologic studies be performed for appropriate and timely treatment.

Inter-observer variability of portal hemodynamics measured by Doppler ultrasound on three different locations of portal vein

Doppler ultrasound is a noninvasive modality for portal hemodynamic study. However, inter-observer variability has been observed. This study has investigated ways to produce less inter-observer variability. Doppler ultrasound portal vein hemodynamic studies were carried out by three well-trained specialists on 20 healthy hospital staff members. The intra-hepatic, first branch, right portal vein, the hilar portal vein, and the extra-hepatic portal vein were chosen for study. With respect to the diameter of portal veins, a significant inter-observer variability was found for the first branch right portal vein and the extra-hepatic portal vein, but not for the hilar portal vein. For maximal portal vein velocity studies, inter-observer variability was not found at any location. A significant failure rate was noted for the measurement of extra-hepatic portal vein velocity. Only 8 volunteers had complete data from all of the three investigators. A significant variability was also noted for the average velocity of extra-hepatic portal vein. We conclude that Doppler ultrasound hemodynamic studies of the hilar portal vein has the most acceptable inter-observer variability and thus should be used for longitudinal portal hemodynamic studies.

Variations of the left and middle hepatic veins: application in living related hepatic transplantation

The anatomic variations of the middle hepatic vein (MHV) and left hepatic vein (LHV) in 200 patients with normal liver function were analyzed using ultrasonography to clarify the feasibility of resecting the left lobe or left lateral segment in living subjects for living related hepatic transplantation (LRHT). The MHV and LHV form a common trunk in 70% of cases but drain independently into the inferior vena cava (IVC) in 30%. In 7% of cases, the left median vein (LMV) drains into the MHV, in 32% of cases the anterior superior segmental vein (ASSV) that drains segment 8 flows into the MHV. The distance between the two confluence points (LHV flows into MHV or IVC and LMV flows into the MHV) ranged from 0.3 cm to 2.5 cm with an average of 0.75 cm. The diameter of the LMV at the point that flows into MHV ranged from 0.3 cm to 0.9 cm. with an average of 0.61 cm. The distance from the IVC to the confluence of the MHV and LHV ranged from 0 cm to 3.5 cm with an average of 1.5 cm in those cases whose MHV and LHV presented as common trunks. Preoperative delineation of this complex venous anatomy is of paramount importance because the hepatic veins have to be transected in the cutting plane of the liver. The location of this plane is determined by the optimal graft volume required, and both the graft and the remnant liver have to retain perfect function. The venous anatomy would change the cutting plane in the living donor and the surgical method of anastomosis for the recipient.

Induction of 8-hydroxydeoxyguanosine in DNA by chromium(III) plus hydrogen peroxide and its prevention by scavengers

The capability of Cr(III) to induce DNA lesions generated by oxidative damage was investigated in this study by examining the formation of 8-hydroxydeoxyguanosine (8-OHdG) in calf thymus DNA by CrCl3 and/or H2O2 in 10 mM phosphate buffer. In the presence of 0.5 mM H2O2, the formation of 8-OHdG markedly increased with increasing CrCl3 concentration. In contrast, H2O2 or CrCl3 alone did not cause any increase in 8-OHdG level above background. The amount of 8-OHdG induced by CrCl3 plus H2O2 was time dependent; its generation increased linearly over an incubation period of 90 min. The formation of 8-OHdG was unfavorable in an acidic solution (pH < 6); the highest level of 8-OHdG was observed at pH 7-8. Scavengers of reactive oxygen species markedly inhibited the formation of 8-OHdG by CrCl3 plus H2O2; the inhibition effect was sodium azide > D-mannitol > Tris-HCl at an equal concentration. The induction of 8-OHdG by CrCl3 plus H2O2 remained unchanged in D2O. Moreover, an addition of catalase (2.2 U/ml) to the reaction mixture completely inhibited the formation of 8-OHdG by CrCl3/H2O2, whereas only 22% of that formation was inhibited by superoxide dismutase (11 U/ml). A large amount of bovine serum albumin (1.1 mg/ml) could reduce the formation of 8-OHdG by CrCl3 plus H2O2, thereby implying that Cr(III)-mediated DNA-protein crosslinks are unfavorable for 8-OHdG formation. Furthermore, ascorbate could prevent the formation of 8-OHdG by CrCl3 plus H2O2; the extent of prevention increased with increasing ascorbate concentration (10 microM-3 mM). Thus, ascorbate acts as a free radical scavenger in the CrCl3/H2O2 system. The above findings suggest that Cr(III)/H2O2 could generate oxidative damage to DNA, possibly through a Fenton-like reaction, i.e. Cr(III)+H2O2-->Cr(IV)+.OH+OH-. This study also indicates that Cr(III), previously considered as the ultimate kinetically stable species of Cr(VI) metabolites, is capable of inducing carcinogenic lesions through interaction with a cellular oxygen species.