Effect of middle hepatic vein reconstruction in living donor liver transplantation using right lobe

BACKGROUND

This study reviewed the impact of middle hepatic vein (MHV) reconstruction on right lobe graft with regard to functional recovery and graft regeneration at 1 week after transplantation.

MATERIALS AND METHODS

From January 1999 to September 2005. 211 adult living donor liver transplantations were performed using the right lobe. The reconstruction of hepatic venous tributaries from segment 5 or segment 8 or both was performed in every cases of sufficient size. The patency of graft vessels was evaluated with computed tomography (CT) angiography on postoperative day 7. We analyzed liver enzymes (aspartate transferase [AST], alanine transferase [ALT] and bilirubin) at 1 week postoperatively and evaluated regeneration activity by CT volumetry at 1 week postoperatively.

RESULTS

Among 211 cases, 182 (86.3%) were reconstructed with interpositional MHV grafts. Among them, 51 cases (51.9%) were patent at 1 week postoperatively. The levels of AST and ALT in patent cases of all patients and small-for-size grafts were lower than among the occlusion cases, albeit not significantly. The mean graft regeneration at 1 week postoperatively among patent cases was 1.75 +/- 0.39 versus 1.64 +/- 0.24 in the occluded cases (P = .111), but among small-for-size grafts, there was a significant difference in graft regeneration between patent versus occluded cases (2.05 +/- 0.50 vs 1.66 +/- 0.17, P = .037).

CONCLUSION

Functional recovery and graft regeneration in small-for-size grafts showed a beneficial effect in patent cases, compared with occluded cases. Our selection criteria for MHV reconstruction must include cases of small-for-size grafts not all cases.

Detection of Donor-Specific Anti-HLA Class I and II Antibodies Using Antibody Monitoring System

The antibody monitoring system (AMS, GTI Inc) is a solid enzyme-linked immunosorbent assay (ELISA) crossmatch test for the detection of immunoglobulin G (IgG) antibody to donor-specific solubilized HLA class I and class II antigens. The objective of this study was to compare the results of the AMS assay with donor-specific anti-HLA IgG antibodies (DS-HLA Abs), as determined by ELISA panel reactive antibody (PRA) and the flow cytometric crossmatch test (FCXM). A total of 107 sera were screened for the presence of HLA Abs by ELISA PRA (LAT-M, One-Lambda Inc), the DS-HLA Abs were determined in 34 serum samples (31.8%) by an ELISA panel (LAT class I and class II, One-Lambda Inc) and FCXM. The FCXM and AMS assays were performed with matched lymphocytes from 56 donors. There was a significant degree of concordance (89.7%) between the two tests (P < .001). The sensitivity, specificity, positive predictive value, and negative predictive value of AMS assay to detect DS-HLA Abs was 88.2%, 94.5%, 88.2%, and 94.5%, respectively. The AMS is a simple, objective test, which has several advantages over the cell-based crossmatch test, such as elimination of non-HLA antibody reactivity, elimination of non-donor-specific antibody reactivity, no need for viable cells, and preparation of the donor's HLA antigens in advance. In summary, this study suggested that AMS may be useful as a supportive crossmatch test or as a monitoring test after transplantation to detect class I or class II DS-HLA Abs.

Development of computational models for the purpose of conducting individual livestock and premises traceback investigations utilizing National Animal Identification System-compliant data

Many of the efforts surrounding the development of the National Animal Identification System have encompassed the identification of livestock production and handling premises as well as individuals or herds of animals, whereas little effort has been directed toward the ultimate goal of animal traceback within 48 h. A mock data set representative of the Colorado cattle population was created for modeling of cattle traceability. Using this data set, algorithms were developed to complete rapid and accurate traceback and traceforward of animals or premises or both. On July 19, 2005, the Colorado Department of Public Health and Environment, in conjunction with the Colorado Department of Agriculture, conducted a test exercise pertaining to homeland security. The exercise team randomly identified animal number 926,583 (of the 2 million total animals) as a potentially infected animal of interest and requested a traceback of this animal. Traceback was accomplished in 215 s, and 540 primary coresident animals were identified. However, due to animal movements, the number of coresidents (animals exposed, directly or indirectly, to the animal of interest) expanded with coresidency level (level 1 = direct contact; level 2 = direct contact with an animal that had direct contact with the animal of interest; level 3 = direct contact with an animal that had contact with an animal that had direct contact with the animal of interest, etc.) to more than 1.2 million coresidents at level 4, and more than 90% of all animals identified as a coresident at some level. In addition to the coresidency results, the premises containing the coresidents were identified and sorted by the number of coresidents. Because of animal movement, all 19,391 premises included in the data set had coresidents at some level. This exercise demonstrated the capability of the developed algorithms to complete rapid traceback and the complexity of the resulting animal traceback output.

AtBAG6, a novel calmodulin-binding protein, induces programmed cell death in yeast and plants

Calmodulin (CaM) influences many cellular processes by interacting with various proteins. Here, we isolated AtBAG6, an Arabidopsis CaM-binding protein that contains a central BCL-2-associated athanogene (BAG) domain. In yeast and plants, overexpression of AtBAG6 induced cell death phenotypes consistent with programmed cell death (PCD). Recombinant AtBAG6 had higher affinity for CaM in the absence of free Ca2 + than in its presence. An IQ motif (IQXXXRGXXXR, where X denotes any amino-acid) was required for Ca2 +-independent CaM complex formation and single amino-acid changes within this motif abrogated both AtBAG6-activated CaM-binding and cell death in yeast and plants. A 134-amino-acid stretch, encompassing both the IQ motif and BAG domain, was sufficient to induce cell death. Agents generating oxygen radicals, which are known to be involved in plant PCD, specifically induced the AtBAG6 transcript. Collectively, these results suggest that AtBAG6 is a stress-upregulated CaM-binding protein involved in plant PCD.

Microstrain fields for cortical bone in uniaxial tension: Optical analysis method

This study employed an optical strain measurement method, called microdisplacements by machine vision photogrammetry (DISMAP), to measure both the global and local strain fields in microtensile specimens of cortical bone subjected to controlled uniaxial tension. The variation of local maximum principal strains was measured within the gauge region of samples as a function of applied tensile stress during testing. High gradients of local strain appeared around microstructural features in stressed bone even while the global strain for the entire gauge region showed a strong linear correlation with increasing tensile stress (r2 = 0.98, p < 0.0001). The highest local strain around micro-structural features in bone was 11.5-79.5 times higher than the global strain.

Microcystic meningiomas: radiological characteristics of 16 cases

BACKGROUND

As a rare subtype of meningioma, only a few reports deal with radiological characteristics of microcystic meningiomas and the problem remains controversial. The authors have analyzed the radiological findings of a series of microcystic meningiomas with a special focus on magnetic resonance images (MRI) and conventional angiography.

METHOD

Sixteen patients of histologically proven microcystic meningiomas were included. Analysis of preoperative MRI including signal intensity characteristics, enhancement patterns and peritumoural edema were performed and correlated with angiographic and histological findings. Peritumoural edema was graded using edema index (EI) which was defined as the ratio of VE/VT.

FINDINGS

The tumours were uniformly visualized as a high-signal mass lesion in T2-weighted images and as a low-signal mass lesion in T1-weighted images regardless of tumour vascularity shown by angiography. T2-weighted images revealed that peritumoural brain edema was severe in 11, moderate in 1, mild in 2 and negligible in 2 patients and this was closely related to the co-existence of irregular tumour marginal enhancement. However, other features failed to distinguish these lesions from other subtypes of meningioma.

CONCLUSIONS

The cases presented demonstrate that characteristic MRI findings suggestive of microcystic meningiomas are; (1) low signal intensity mass in T1- and high signal intensity mass in T2-weighted images; (2) high incidence of peritumoural edema.

A new venous conduit utilizing the recipient portal vein branches for segment V in adult partial liver transplantation

Right anterior-medial lobe congestion due to temporary clamping of segment V and/or VIII is common in the operative theater during adult donor right lobe liver transplantation, the most common procedure in our institute. We have used an autogenous saphenous vein conduit to recipient portal vein tributaries in 15 cases, as a "Y-to-I venoplasty" since January 2004. The recipient portal vein is transected 5 mm proximal to its bifurcation and extended to both sides with partial hepatic dissection. The "Y-to-I venoplasty" is made by suture closure of the portal vein transversely to form a tube. The average length is 7.5 cm with a 1.3 cm width. One end of "Y-to-I venoplasty" conduit is anastomosed to the donor segment V branch on the back table. And the other end is anastomosed directly to the IVC via a new window or the middle hepatic vein stump in recipient. The phase distension of the conduit with respiration is noted in the operative field. A 6/15 (40%) patency rate, was observed by CT angiography at the second postoperative week. All-patient conduits showed good flow on serial examinations at the 60th postoperative day. This new venous graft, made of recipient portal vein is a good conduit for segment V decongestion in adult right lobe partial liver transplantation.

Neuropeptide Y immunoreactivity and corticotropin-releasing hormone mRNA level are increased in the hypothalamus of mouse bearing a human oral squamous cell carcinoma

We examined gene expression of corticotropin-releasing hormone and neuropeptide Y level in the hypothalamic paraventricular nucleus of mouse bearing a human oral squamous cell carcinoma. A cell line derived from a human oral squamous cell carcinoma was inoculated into the lower dorsal area of nude mice. Body weight, tumor size and daily food intake were recorded every morning. Mice were sacrificed for corticotropin-releasing hormone mRNA in situ hybridization and neuropeptide Y immunohistochemistry, when the tumor ratio reached to 11-13% of real body weight. The results were compared with the age-matching non-tumor controls injected with saline instead of carcinoma cell. Body weight gain was significantly reduced in tumor bearing mice, however, no compensatory hyperphagia was found, i.e. daily food intake of the tumor mice did not differ from the non-tumor mice. Both neuropeptide Y immunoreactivity and corticotropin-releasing hormone mRNA level were significantly increased in the hypothalamic paraventricular nucleus of tumor mice. These results suggest that a human oral squamous cell carcinoma may induce anorexia, at least partly, via increasing the hypothalamic expression of corticotropin-releasing hormone in the tumor subjects. Additionally, neuropeptide Y-induced feeding appears to be inhibited in this tumor anorexia model, and this may correlate with increased expression of corticotropin-releasing hormone.

Delayed bleeding after gamma knife surgery for meningioma

We report the occurrence of haemorrhage in a meningioma after gamma knife surgery.A 52-year-old woman had undergone gamma knife radiosurgery for a growing meningioma in the left tentorial hiatus three years earlier (A radiation dose of 15 Gy was administered to the margin, with a maximum dose of 30 Gy, Fig. 1a). The size of the mass decreased steadily, and central lucency was seen in the follow-up magnetic resonance images, a usual finding seen after gamma knife surgery (MRI, Fig. 1b). However, a MRI taken at the 30-month follow-up showed the tumour to be swollen, and peritumoural oedema had increased (Fig. 1c). Three years later, apoplectic symptoms occurred, and computed tomography revealed a peritumoural haemorrhage, with oedema (Fig. 1d). An emergency craniotomy was carried out, and the biopsy showed a transitional type of meningioma, with vasculopathy and necrosis. After operation she had a right hemiparesis and a visual defect.

The significance of gemistocytes in astrocytoma

BACKGROUND

A retrospective clinical analysis of astrocytomas which contained a significant proportion of gemistocytes was carried out in order to evaluate their effect on prognosis, and other factors influencing prognosis.

METHOD

From 253 consecutive cases of astrocytic tumours in adults, 25 were selected who had more than 20% gemistocytes in every high-power field examined. 9 of these had anaplasia, the remainder did not. They were divided into two groups according to the proportion of gemistocytes; group A, contained more than 60% gemistocytes, and group B, had between 20 and 60% gemistocytes. TUNEL and immunohistochemical staining for PCNA, p53, Ki-67, bcl-2 were performed in the 20 available cases.

FINDINGS

The median follow-up period was 46 months. There were 14 recurrences, with a median time to recurrence of 15 months. Thirteen repeat operations were performed in nine cases, and two cases showed recurring malignant transformation. The overall median survival time following diagnosis was 73 months and the 5-year survival rate was 52%. There were no significant differences in median survival between groups A and B with different proportions of gemistocytes. On the other hand the median survival of the gemistocytic astrocytomas with anaplasia was 25 months, compared with 158 months for those without anaplasia (p=0.0005). The significant impact of anaplasia on survival persisted in both groups. There were no significant differences in immunohistochemical staining between the two groups, with the exception of staining for Ki-67 (means of the two groups: group A 1.40; group B 2.50).

CONCLUSIONS

It is suggested that the proportion of gemistocytes does not itself affect prognosis.

Stereotactic biopsy for intracranial lesions: reliability and its impact on the planning of treatment

BACKGROUND

The authors present a retrospective analysis of 308 computed tomography (CT)-guided stereotactic biopsies in 300 patients in order to evaluate the reliability and efficacy of the stereotactic biopsy for intracranial lesions.

METHOD

All patients were suffering from undetermined intracranial lesions and treated at Seoul National University Hospital between January 1993 and December 1999. Age ranged from three to 79 years (mean 41); the male to female ratio was 180:120. All patients underwent CT-guided stereotactic biopsy for the histological verification and/or evacuation of the cyst using Riechert-Mundinger stereotactic system.

FINDINGS

Histological diagnosis was made in 275 patients (diagnostic yield 91.7%). Diagnostic yield was better in group with frozen section examination during the stereotactic procedure than the group without it (p=0.01). Neoplastic lesions were more likely to be diagnosed in stereotactic biopsy than non-neoplastic lesions (p=0.02). Among 30 patients who underwent craniotomy after the stereotactic biopsy, the histological diagnoses after the craniotomy were identical to those of the stereotactic biopsy in 29 patients (diagnostic accuracy 96.7%). Two patients died within seven days after the stereotactic biopsy (mortality 0.6%). The postoperative new neurological deficit or aggravation of the neurological status was found in 19 patients, including transient cases of seven patients (permanent morbidity rate 3.9%). Histologically malignant gliomas and deeply-located lesions were the significant risk factors for the development of complications. In 148 cases, histological diagnosis of the stereotactic biopsy was different from the preoperative clinical diagnosis. Among these cases, the treatment plan was changed after stereotactic biopsy in 81 cases.

CONCLUSIONS

Stereotactic biopsy for intracranial lesions is a reliable and relatively safe procedure. It is also a very efficacious method especially in patients who need histological confirmation for the treatment.

Soil temperature and egg mass formation by Meloidogyne arenaria on oriental melon (Cucumis melo L.)

Abstract

Egg masses of Meloidogyne arenaria race 2 were observed on the second planting of oriental melon by the time of its first harvest under glasshouse conditions in Korea. Time and degree-days above 5°C (DD5) for egg mass formation after April were about 24.5 days and 500 DD5. Higher mean soil temperature shortened the days required for egg mass formation. A threshold temperature for degree-days accumulation of 12.2°C was selected on the basis of lowest coefficient of variation among data sets of time to egg mass formation. We propose the use of DD12.2 for predicting the time to egg mass formation of M. arenaria under these glasshouse conditions.

Radiosurgery of intracranial cavernous malformations

BACKGROUND

The efficacy of radiosurgery in cases of surgically high risk symptomatic cavernous malformations (CMs) for reducing haemorrhagic risk and for seizure control has not been clearly documented and the radiation-induced complications of radiosurgery remain problematic. The authors present a retrospective clinical analysis of 22 cases of CMs treated by radiosurgery.

METHODS

Twenty-two patients with symptomatic CMs were treated by linear accelerator (LINAC) radiosurgery or Gamma knife (GK) between 1995 and 1998. Medical records including radiological investigations were carefully reviewed to the last follow-up. The mean age of the patients was 34.1 years (12-56) and the male to female ratio was 12:10. Twenty patients reported at least one episode of bleeding and four had undergone microsurgery before radiosurgery. The remaining two patients presented with seizure without evidence of recent haemorrhage. In 16 cases, the CMs were deep-seated, and the others were located in the cerebral hemispheres; four were located at an eloquent area. LINAC radiosurgery using computed tomography scan was performed in 11 cases until May 1997, after which GK radiosurgery using magnetic resonance (MR) image was performed in 11 cases. The volume of the lesion ranged from 0.09 cc to 4.8 cc (mean 1.42 cc) and the mean marginal dose was 16.1 Gy (8-24). The median follow-up period after radiosurgery was 38.3 months (21-67). The rate of haemorrhage, seizure, and neurological deterioration following radiosurgery was analyzed, and the rate of haemorrhage was compared to that seen in natural course reports.

FINDINGS

There was one case of haemorrhage during the follow-up period and the seizure was well controlled with anticonvulsants. In the group with prior haemorrhage, the bleeding rate of cavernous malformation after radiosurgery (1.55%/year) was lower than that of pre-radiosurgical period (35.5%/year, t=1.296, P=0.04). Six patients showed neurological deterioration following radiosurgery, however, the neurological deficits persisted in only two of the patients with LINAC. The radiosurgical modality (LINAC vs. GK) showed a possible correlation to radiation induced neurological deficits (P=0.06). On the MR images at the last follow-up, the lesion was decreased in eleven patients, increased in one, and no change was found in 10 cases. The T2 weighted MR images revealed a perilesional high signal change in nine patients. This signal change was not statistically related to lesion size (P=0.236), location (P=0.658), nor radiation dose (P=0.363), but was dependent on the treatment modality (P=0.02). New-enhancing lesion and a new cyst were each found in one case, respectively, during the follow-up.

INTERPRETATION

Radiosurgery may be a good alternative option for treatment of surgically high risk CMs. However, the optimal radiosurgical technique, dose adjustment, and proper delineation of the mass are prerequisites. Radiosurgery induced complications are still problematic and post-radiosurgery MR image changes need to be further elucidated.

Relationship between crop losses and initial population densities of Meloidogyne arenaria in winter-grown oriental melon in Korea

To determine the economic threshold level, oriental melon (Cucumis melo L. cv. Geumssaragi-euncheon) grafted on Shintozoa (Cucurbita maxima x Cu. moschata) was planted in plots (2 x 3 m) under a plastic film in February with a range of initial population densities (Pi) of Meloidogyne arenaria. The relationships of early, late, and total yield to Pi measured in September and January were adequately described by both linear regression and the Seinhorst damage model. Initial nematode densities in September in excess of 14 second-stage juveniles (J2)/100 cm(3) soil caused losses in total yields that exceeded the economic threshold and indicate the need for fosthiazate nematicide treatment at current costs. Differences in yield-loss relationships to Pi between early- and late-season harvests enhance the resolution of the management decision and suggest approaches for optimizing returns. Determination of population levels for advisory purposes can be based on assay samples taken several months before planting, which allows time for implementation of management procedures. We introduce (i) an amendment of the economic threshold definition to reflect efficacy of the nematode management procedure under consideration, and (ii) the concept of profit limit as the nematode population at which net returns from the system will become negative.

Cerebral germinoma with hemiatrophy of the brain: report of three cases

BACKGROUND

The authors report three cases of cerebral germinoma that occurred in young adults with unusual presentation.

METHOD

All three patients presented with hemiparesis and were treated at Seoul National University. A histological diagnosis of germinoma was made by a stereotactic biopsy in all three cases.

FINDINGS

Magnetic resonance (MR) images showed that their tumors were located in the internal capsule and thalamus, and were associated with ipsilateral cerebral hemisphere and brain stem atrophy. The hemiparesis slowly progressed and this was accompanied by a haemorrhagic cyst in each patient.

INTERPRETATION

Clinical diagnosis was not easy because of the unusual clinical presentations and atypical MR imaging findings. It is suggested that cerebral germinoma should be included in the differential diagnosis of a haemorrhagic mass which is associated with cerebral atrophy in the thalamus, basal ganglia, or internal capsule, especially in adolescents or young adults.

Activation of caspase-8 during N-(4-hydroxyphenyl)retinamide-induced apoptosis in Fas-defective hepatoma cells

We observed that N-(4-hydroxyphenyl)retinamide (4HPR), a chemopreventive and chemotherapeutic agent, effectively induced apoptosis in hepatoma cells. Interestingly, Fas-negative (Hep 3B and PLC/PRF/5) hepatoma cells were shown to be more susceptible to apoptosis induced by 4HPR than were Fas-positive (Hep G2 and SK-HEP-1) hepatoma cells. Thus, we explored the mechanisms underlying 4HPR-induced apoptosis in Fas-defective hepatoma cells. Hep 3B cells stably expressing the dominant-negative Fas-associated death domain (dnFADD) showed no alteration in 4HPR drug susceptibility, but when stably expressing E1B19K, Crm A, or dominant-negative FLICE (dnFLICE), Hep 3B cells were resistant, suggesting that 4HPR-induced apoptosis was mediated by caspase-8 activation. Furthermore, apoptosis could be completely blocked by Z-VAD-FMK (a general caspase inhibitor) or by IETD-CHO (a caspase-8 inhibitor), but was only partially blocked by Ac-DEVD-CMK (a caspase-3 inhibitor), by N-acetyl-L-cysteine (NAC) (an antioxidant), by N-acetyl-leucyl-leucyl-norleucinal (ALLN) (a calpain inhibitor I), or by Z-LEHD-FMK (a caspase-9 inhibitor). Time-sequence analysis of the induction of apoptosis by 4HPR revealed that an initial caspase-8 activation was followed by late mitochondrial cytochrome c release and minor caspase-9 activation, which suggested that caspase-8 activation is the primary upstream regulatory point. Activation of Bid or induction of proapoptotic Bax was not observed during apoptosis. In contrast, Bcl-xL expression was decreased during 4HPR-induced apoptosis. Taken together, these results indicate that 4HPR may be a potential chemotherapeutic drug, which is able to induce apoptosis in Fas-defective hepatoma cells through caspase-8 activation.

Effects of dextromethorphan on nocturnal behavior and brain c-Fos expression in adolescent rats

Dextromethorphan, an antitussive widely available over-the-counter, is abused, mostly by teenagers at high doses. In our previous report, a high dose of dextromethorphan activated the midbrain dopamine neurons of adolescent rats. In the present study, we performed c-Fos immunohistochemistry in the dopaminergic terminal regions of adolescent rat brain after the intraperitoneal administration of dextromethorphan at different doses (0, 10, 20, and 40 mg/kg), and also examined the effects on nocturnal behavior. The results showed that dextromethorphan increased c-Fos expression dose dependently in the anterior cingulate cortex, caudate putamen, nucleus accumbens, and central amygdala. Significant ataxia occurred and both locomotor and rearing activity decreased immediately after the dextromethorphan injection. We conclude that the neurons in the reward pathway of the adolescent rat brain appear to be activated by a single injection of dextromethorphan, and that activation of this pathway by dextromethorphan may correlate with the behavioral effects and abuse potential of the drug.

Childhood meningioma: unusual location, atypical radiological findings, and favorable treatment outcome

OBJECTS

To investigate the characteristics of childhood meningioma, especially, locations, radiological findings, pathological features (including proliferative potential) and outcome, 11 children with meningiomas were retrospectively analyzed.

RESULTS

Unusual location, large size, frequent calcification, and cyst formation were characteristic radiological findings. Gross total resection was achieved in 8 patients, and there was recurrence in 2. Gamma knife radiosurgery was performed on residual and recurrent tumors. MIB-1 indices tended to be high in large tumors. Nine patients had a Karnofsky Performance Scale of more than 70 during the follow-up period of 10 months to 19.5 years. Surgical treatment rendered 4 of 5 epileptic patients seizure free. The childhood meningiomas examined had unusual locations, atypical radiological findings, and various proliferative potentials.

CONCLUSIONS

Complete resection is the treatment of choice. Gamma knife radiosurgery can be a good alternative for residual tumors and small recurrent tumors. The outcome of childhood meningiomas is good after surgery.

Dextromethorphan increases tyrosine hydroxylase mRNA in the mesencephalon of adolescent rats

Dextromethorphan (DM), an antitussive widely available in over-the-counter, has been abused mostly in teenage groups at high doses. To examine effects of DM on the reward pathway, we injected a high dose of DM (40 mg/kg; intraperitoneally) into the adolescent rat and measured tyrosine hydroxylase (TH) mRNA by in situ hybridization in the ventral tegmental area (VTA) and the substantia nigra (SN). Remarkable increases in the level of TH mRNA were observed in the VTA and SN 2 h after DM injection. Stereotyped behavior and ataxia increased, and rearing decreased by DM administration. These results suggest that DM-induced increase in TH mRNA expression in mesencephalon contribute to the reinforcing property and the behavioral effects of DM.

Expression profile of nine novel genes differentially expressed in hepatitis B virus-associated hepatocellular carcinomas

Chronic hepatitis B virus (HBV) infection is known to be one of the major causes in the development of hepatocellular carcinoma (HCC), although the biomolecular mechanism(s) involved remain unclear. To identify the cellular gene(s) involved in HBV-associated hepatocarcinogenesis, we used the mRNA differential display method and examined three paired tumor and nontumor tissues, all of which had chromosomally integrated HBV-DNA through chronic infection. Using 240 different combinations of three one-base anchored oligo-dT primers and 80 arbitrary 13-mers, genes decreased or increased in expression more than twofold between each tumor tissue and its paired nontumor tissue were identified. Twenty-nine known genes and four novel genes were differentially over-expressed in the HCC tumor tissues. In contrast, 27 known genes and five novel genes were under-expressed in those tumor tissues. The nucleotide sequences of the nine novel gene fragments were determined and their expression patterns were examined in 40 HCC samples. HA61T2, PT18, HG63T1, and HG57T1 were preferentially over-expressed in 32 cases (80%, P<0.001), 24 cases (60%), 23 cases (57.5%) and 22 cases (55%) of the 40 tumor tissues, respectively. There was an increased frequency of HG57T1 over-expression in HCC patients with HBV-positive serology and low serum alpha-feto protein (AFP) levels (P<0.05). DNT10, PT8, PT19, ENT25 and HA6T4 were under-expressed in 26 cases (65%), 23 cases (57.5%), 21 cases (53%), 20 cases (50%) and 18 cases (45%) of the 40 tumor samples, respectively. There was a strong correlation of DNT10 under-expression with high serum AFP level in HCC patients, irrespective of HBV serology (P<0.01). HA6T4 was preferentially under-expressed in HCC tumors in patients with HBV-positive serology and high serum AFP levels (P<0.05). Thus, the functional analyses of the known and novel genes identified in this study should prove valuable to further understand the mechanism(s) of hepatocarcinogenesis.

Expression of cyclooxygenase-2 (COX-2) in hepatocellular carcinoma and growth inhibition of hepatoma cell lines by a COX-2 inhibitor, NS-398

Cyclooxygenase-2 (COX-2) has been suggested to be associated with carcinogenesis. In hepatocellular carcinoma (HCC), the expression pattern of COX-2 protein has been well correlated with the differentiation grade, suggesting that abnormal COX-2 expression plays an important role in hepatocarcinogenesis. We investigated the expression pattern and clinical significance of COX-2 in HCC tissues. In addition, we evaluated the efficacy of a selective COX-2 inhibitor, NS-398, in three hepatoma cell lines. Thirty-six HCC tissues, 15 hepatoma cell lines, 1 colorectal cell line (HT-29), and 1 fibroblast cell line (SV80) were included in the study. We evaluated serological tests and histological and radiological evaluations of HCC tissues. Immunohistochemical staining for COX-2 was performed on 36 HCC tissues and 17 cancer cell lines. A cell viability assay for growth inhibition of NS-398 in five cell lines was performed. Immunohistochemically, all six well-differentiated HCCs were positive, whereas 83% (10 of 12) of the poorly differentiated HCCs were negative. There was no significant relationship between the intensity of COX-2 expression and the level of alpha-fetoprotein, tumor size, presence of portal vein thrombosis, tumor capsule and metastasis, Tumor-Node-Metastasis staging, and growth types (P > 0.05). According to the cell viability assay, NS-398 suppressed the growth of all cell lines, independent of the degree of COX-2 expression. The inhibitory effect on each cell line was identified in 10 microM NS-398 and was significantly strong in 100 microM NS-398. All cell lines exhibited apoptosis, which was identified by 4'-6-diamidino-2-phenylindole staining. In conclusion, COX-2 may be a determinant of the differentiation grade of HCC, and the inhibition of COX-2 can induce growth suppression of hepatoma cell lines via induction of apoptosis.

Subdiaphragmatic vagotomy induces NADPH diaphorase in the rat dorsal motor nucleus of the vagus

Axotomy of the vagal motor neurons by cervical vagotomy induces NADPH diaphorase staining due to increased nitric oxide synthase expression in both the rat dorsal motor nucleus and nucleus ambiguous; furthermore, cerical vagotomy leads to cell death of the dorsal motor nucleus cells. Subdiaphragmatic vagotomy axotomizes the vagal motor cells further from the brainstem than cervical vagotomy, and cuts the fibers running only to the abdominal viscera. Here we report that subdiaphragmatic vagotomy is sufficient to induce NADPH diaphorase staining in the dorsal motor nucleus but does not induce staining in the nucleus ambiguus. Because the neurons of the dorsal motor nucleus do not undergo cell death after subdiaphragmatic vagotomy and are able to re-enervate the gut, the increased nitric oxide synthase expression after distal axotomy may be related more to regeneration than degeneration.

Postoperative spinal seeding of craniopharyngioma. Case report

The authors present a case of postoperative spinal seeding of papillary craniopharyngioma. This 27-year-old man who had previously undergone subtotal removal of a suprasellar craniopharyngioma was admitted because of low-back and right leg pain. Results of neurological examination showed a limitation in straight-leg raising in the right side with no sensorimotor changes. Magnetic resonance imaging of the lumbar spine demonstrated multiple enhanced intradural extramedullary masses causing spinal cord compression. Pathological examination of the tumor tissue obtained via laminectomy revealed papillary craniopharyngioma, which had the same histological features as those of the previous suprasellar tumor. Several ectopic recurrences of craniopharyngioma have been reported; however, the authors believe that this is the first published report of the spinal seeding of craniopharyngioma.

The Department of Neurosurgery at Seoul National University: past, present, and future

The Department of Neurosurgery at Seoul National University College of Medicine is one of the oldest neurosurgical departments in Korea, and it is a center of academic leadership in neurosurgery. In September 1957, the department was established by Bo Sung Sim, and it has produced many leaders of neurosurgery in Korea. Chairmen Bo Sung Sim, Kil Soo Choi, Dae Hee Han, and Byung-Kyu Cho each brought special skills and talents to the development of the department. The current and fifth chair, Hyun Jib Kim, assumed the chairmanship in July 2000. The department comprises 11 full-time faculty members, 5 fellows, and 14 residents. More than 1,700 neurosurgical procedures are performed annually in four operating theaters. A gamma knife was installed in 1997, and approximately 200 gamma knife procedures are performed each year. In addition to clinical activities, research and education for graduate and postgraduate students are also particular strengths of the department. This article traces the clinical, academic, and scientific development of the department, its present activities, and its future direction.