Cervical sentinel lymph node biopsy for melanomas of the head and neck and upper thorax

OBJECTIVE

To describe a clinical experience with sentinel lymph node biopsy (SLNB) of head and neck nodal basins for clinical stage I melanomas draining to these areas.

DESIGN

Consecutive clinical case series with a mean follow-up of 10.7 months.

SETTING

University tertiary care referral medical center.

PATIENTS

Seventy patients with clinical stage I cutaneous melanoma who underwent SLNB of cervical and/or parotid lymph node basins.

INTERVENTIONS

Patients underwent same-day preoperative technetium Tc 99m lymphoscintigraphy followed by SLNB using gamma probe and blue dye (66 patients) and blue dye alone (4 patients). Patients with histological evidence of tumor (here in after "positive") according to SLNB results underwent modified cervical completion lymph node dissection, including parotidectomy, as appropriate. Patients without histological evidence of tumor (hereinafter "negative") according to SLNB results were followed up clinically without undergoing completion lymph node dissection.

MAIN OUTCOME MEASURES

The rates of SLNB success, SLNB positivity, completion lymph node dissection positivity, complications, and SLNB false-negative results were determined by clinical follow-up.

RESULTS

Locations of melanomas in the 70 patients were the face (n = 20), neck (n = 14), ear (n = 9), scalp (n = 9), and upper thorax (n = 18). Locations of basins that underwent biopsy (n = 104) were in the cervical (n = 68), parotid (n = 19), and axillary (n = 17) regions. The mean Breslow thickness was 2.1 mm (range, 0.4-12.0 mm). Sentinel lymph node biopsy was successful in 103 basins (99%). The mean number of sentinel lymph nodes per basin was 2.5 (range, 1.0-8.0). Positive sentinel lymph nodes were found in 12 patients (17%) and 15 basins (14%). Sentinel lymph node biopsy results correlated with the American Joint Committee on Cancer tumor stage (P = .05) and a Breslow thickness of 1.23 mm or greater (P = .03). Additional tumor-containing nodes were noted in 5 (42%) of the 12 patients who underwent completion lymph node dissection, and these results correlated with the presence of multiple positive sentinel lymph nodes (P = .01). There were complications in 3 patients (4%) (seromas in 2 patients and temporary spinal accessory nerve paresis in 1 patient). One nodal recurrence in a basin that was negative according to SLNB results (SLNB with blue dye only) was noted (false-negative rate, 2%). The results of SLNB were accurate in 69 patients (99%).

CONCLUSIONS

Sentinel lymph node biopsy using lymphoscintigraphy and blue dye to manage cutaneous melanomas draining to the head and neck nodal areas is reliable and safe. Sentinel lymph node biopsy results correlated with a Breslow thickness of 1.23 mm or greater and the American Joint Committee on Cancer tumor stage. Completion lymph node dissection is recommended after determining positive SLNB results.

Effects of adjuvants on the immune response of staphylococcal alpha toxin and capsular polysaccharide (CPS) in rabbit

This study was performed to isolate a vaccine strain of S. aureus from clinical or subclinical mastitis and to choose the most optimal adjuvant for immune response of alpha toxin and capsular polysaccharide (CPS) of field strain. Of thirty strains of S. aureus isolated from milk of clinical or subclinical mastitis, V112 strain isolated from milk of gangrenous mastitis was used in this vaccine. Twenty one of rabbits were allocated into 5 groups based on adjuvants and immunized twice every 2 weeks for 8 weeks. This vaccine was composed of alpha toxin (10 hemolytic units) and formalinized whole cells (1 x 10(11) cells/ml. Five rabbits received PBS solution as a control group. The highest antibody titers against alpha toxin and CPS were observed in dextran sulfate- and aluminium hydroxide-adjuvant group at 8 weeks after immunization, respectively. These results of the study showed that one adjuvant could not induce strong and long-term immune response of alpha toxin and CPS antigens. Therefore, the use of combined adjuvants in subunit vaccine may be useful and feasible.

Foreign gene expression by in vivo gene electroporation in the quail testis

To investigate whether or not foreign gene expression is attained in the testis of living Japanese quails, a firefly luciferase reporter gene was transfected by in vivo electroporation (EP), and transcriptional activity of different promoters was compared. In addition, the effect of the Epstein-Barr virus self-replication sequence was also tested. The results showed that luciferase activity in the testis reached almost a plateau value at 50 V. Under this EP condition, no difference was found in transcriptional activity between the simian virus 40 (SV40) and miw promoters. The reporter gene expression in the quail testis was observed over 28 days after in vivo gene EP, although the activity gradually decreased, and the presence of the Epstein-Barr virus self-replication sequence in the SV40 promoter did not significantly prolong the luciferase activity. These results suggest that in vivo gene EP confers strong, though transient, foreign gene expression in the Japanese quail, and it may provide a new powerful approach for studies on transcriptional regulation of genes during proliferation and differentiation of spermatogenic cells in the quail testis.

Audiologic evaluation of neonates with severe hyperbilirubinemia using transiently evoked otoacoustic emissions and auditory brainstem responses

OBJECTIVES

To audiologically clarify the lesion site and to test the reliability of transiently evoked otoacoustic emissions (TEOAEs) in hearing screening of hyperbilirubinemic neonates.

STUDY DESIGN

Eleven neonates with severe hyperbilirubinemia who had exchange transfusion in the neonatal intensive care unit of an academic hospital over a 3-year period were included in this study. They were tested with auditory brainstem response (ABR) and TEOAEs after exchange transfusion during hospitalization or at an immediate follow-up visit after discharge. Follow-up ABR tests were performed when infants showed significant hearing loss.

METHODS

ABR and TEOAE tests were performed on the 11 neonates with severe hyperbilirubinemia after exchange transfusion. Follow-up ABR tests were carried out in 3-month intervals in the four neonates who showed abnormal or no response on initial ABR.

RESULTS

Four neonates showed abnormal or no response and the other seven demonstrated normal response in ABR. All 11 neonates passed TEOAEs. Two neonates showed improvement in auditory function at 3- or 6-month follow-up ABR.

CONCLUSION

The results of this study indicate that the site of lesion in hearing loss caused by hyperbilirubinemia may be at the retrocochlear location while the cochlea remains intact. TEOAEs may have limitations in evaluation of hearing in the neonates with hyperbilirubinemia.

In vivo manipulation of foreign gene expression by steroid administration in the oviduct of laying hens

The experiments described herein were conducted to examine whether or not steroid administration allows in vivo induction of foreign gene expression in the oviduct of laying hens. The chloramphenicol acetyltransferase reporter gene driven by several viral and cellular promoters with or without steroid response elements was transfected by in vivo electroporation. The results indicated that in vivo, as observed in vitro, steroid administration induced transcriptional activities of the promoters with steroid response elements but it did not do so without steroid response elements. Our data implicate, therefore, that in vivo induction of foreign gene expression is possible in the oviduct of laying hens, and that the present in vivo gene transfer approach would serve as a useful tool to elucidate the mechanism of tissue-specific and steroid-induced transcription of chicken egg white genes.

Immunogenicity of alpha-toxin, capsular polysaccharide (CPS) and recombinant fibronectin-binding protein (r-FnBP) of Staphylococcus aureus in rabbit

This study was conducted to evaluate the antibody levels of alpha-toxin, capsular polysaccharides (CPS) and fibronectin-binding protein (FnBP) in rabbits immunized with an experimental vaccine against Staphylococcus aureus and to develop the bovine mastitis subunit vaccine in the future. Enzyme immunoassay was used for detection of IgG antibodies against staphylococcal CPS, alpha-toxin and FnBP. The levels of specific antibodies against CPS, alpha-toxin and FnBP in immunized rabbits were significantly increased after first immunization compared with control animals (p<0.05). Of three antigen used in vaccine, immunogenicity of CPS was relatively lower, compared with those of alpha toxin and fibronectin binding protein. Numbers of S. aureus in blood of immunized groups were lower than those of control group after bacterial challenge. But the bacterial numbers among immunized groups were not significantly different. S. aureus counts in excised organs were significantly lower in all immunized rabbits than in PBS-control group (p<0.05). The present study showed that alpha-toxin, capsular polysaccharide and fibronectin binding protein included in a subunit vaccine were protective.

The radiographic incidence of bony defects in the lateral lamella of the cribriform plate

The purpose of this study was to evaluate the incidence and radiographic characteristics of bony defects of the lateral lamella of the cribriform plate using a coronal computerised tomography (CT) scan. By retrospectively reviewing the coronal CT scans of 410 sinuses from 205 subjects, the overall incidence and the relationship to the subjects' age and depth of cribriform plate were analysed. Bony defects were identifiable in 59.5% of the sinuses. The incidence of a bony defect was not significantly different between the sinuses of the paediatric age group and the adult group. The sinuses having a deeper cribriform plate showed a higher incidence of bony defects in comparison with the sinuses with a less deep cribriform plate. The high incidence of radiologically detectable bony defects in this region may emphasize the particular risk of this area during endoscopic sinus surgery.

Identification of a gene, SOO1, which complements osmo-sensitivity and defect in in vitro beta1,3-glucan synthase activity in Saccharomyces cerevisiae

The soo1-1 (for suppressor of osmo-sensitivity) mutation results in a temperature-dependent osmo-sensitive phenotype at non-permissive temperature (37 degrees C), makes yeast cells more susceptible to Zymolyase and affects in vitro beta1,3-glucan synthase activity level. Transformation of soo1-1 mutant by SOO1 gene reverses these effects. Nucleotide sequencing of SOO1 revealed that this gene is identical to the recently reported alpha-COP that is involved in the intracellular protein translocation from endoplasmic reticulum to Golgi and vice versa. Although the soo1-1 mutant strain showed osmotically remediable growth at 37 degrees C, SOO1 disruptants could not grow in any culture conditions. Analysis of cell wall fractions revealed that the soo1-1 mutation causes a decrease in in vitro beta1,3-glucan synthase activity, and, thus, a subsequent alteration of the cell wall composition.

Lymph node tumor volumes in patients undergoing sentinel lymph node biopsy for cutaneous melanoma

BACKGROUND

Regional lymph node tumor volumes in patients undergoing sentinel lymph node (SN) biopsy (SNB) for treatment of cutaneous melanoma have not been described. The objectives of this study were to describe the lymph node tumor volumes typically seen in this population and to correlate tumor volumes with tumor thickness and positive SN characteristics.

METHODS

Review of a consecutive series of patients with clinically localized cutaneous melanoma who underwent SNB of nonpalpable regional lymph node basins followed by complete lymphadenectomy (LND) was performed. Multiple lymph node sections from positive SNs and nonsentinel nodes (NSNs) in LND specimens were examined microscopically. Individual tumor deposit diameters were measured using an ocular micrometer. Aggregate tumor volumes were calculated for SN and LND specimens. Tumor volumes and SN and LND positivity rates were correlated with tumor thickness, the number of positive SNs, and the presence of multiple SN tumor deposits.

RESULTS

SNB procedures were performed for 149 melanomas in 189 regional nodal basins. The mean tumor depth was 2.48 mm. The mean number of SNs/basin was 2.1. Thirty-two of 149 SNB procedures (21.5%) revealed a total of 34 nodal basins with at least one positive SN. The median tumor volume in positive SNs was 4.7 mm3 (range, 0.1-3618 mm3; mean, 209 mm3). The median aggregate tumor volume in positive LND specimens was 4.9 mm3 (range, 0.1-3618 mm3; mean, 224 mm3). Six basins (17.6%) contained at least one positive NSN. The regional node aggregate tumor volume correlated weakly with tumor thickness (Pearson's correlation coefficient = .302, P = .0934). NSN positivity was not predicted by tumor thickness, American Joint Committee on Cancer tumor stage, number of positive SNs, or number of metastatic deposits within SNs.

CONCLUSIONS

Most melanoma-positive SNs contain minute tumor volumes. Tumor thickness and patterns of SN metastases may not be predictive of tumor burden or the presence of positive NSNs.

Lymphoscintigraphy with sentinel lymph node biopsy in cutaneous Merkel cell carcinoma

Merkel cell carcinoma (MCC) is a rare cutaneous malignancy characterized by an aggressive clinical behavior with high rates of locoregional and systemic recurrence. Regional disease and distant metastases are associated with poor prognosis. Despite a predisposition of MCC to spread via the lymphatics, prophylactic lymph node dissection in the absence of clinically apparent lymph node involvement is controversial. The value of lymphoscintigraphy in cutaneous melanoma is established in lesions with ambiguous lymphatic drainage patterns. When used with sentinel lymph node biopsy (SLNB), it can identify subjects with occult regional node metastasis. The authors present 2 patients with MCC who underwent regional node staging with lymphoscintigraphy-directed SLNB. Both patients had sentinel nodes that were positive for metastatic disease. In patients with MCC, minimally invasive regional node staging SLNB may be useful in limiting the sequelae of routine lymphadenectomies. Whether early identification and treatment of patients with occult regional node disease can influence survival in MCC is not known.

Presurgical evaluation and surgical outcome of temporal lobe epilepsy

The authors analyzed 22 patients younger than 18 years of age with temporal lobe epilepsy (TLE) treated surgically. Patients underwent a comprehensive presurgical evaluation, including video-electroencephalogram. Fifty-five percent had a history of febrile seizures. Eighty-two percent had auraes and most exhibited oroalimentary and gestural automatisms. Contralateral dystonic posturing was present in 36% and postictal dysphasia in 54% of patients with left-sided resections. Cranial magnetic resonance imaging (MRI) was abnormal in 59% of patients. MRI revealed changes consistent with mesial temporal sclerosis in 8 (47%) of 17 patients without lesions. Fluorodeoxyglucose-positron emission tomography (PET) scans revealed ipsilateral temporal hypometabolism (PET-TH) in 12 (85.7%) of 14 patients. The intracarotid amobarbital procedure revealed impaired memory of the epileptogenic side in 59% of patients. Seventeen patients underwent en-bloc resections and five lesionectomies and resection of the epileptogenic area. There was no surgical morbidity or mortality. Forty-three percent had hippocampal sclerosis, 28.5% gliosis, 14% low-grade tumors, 9.5% cavernous angiomas, and 5% had no pathologic findings. Follow-up (6 months to 12 years) was available for 21 patients; 76% became seizure free, 19% had rare seizures, and 5% had a worthwhile improvement. TLE can be safely treated surgically in younger patients with excellent results. The clinical manifestations were similar to adult patients. PET-TH was present even at a younger age, suggesting that the focal functional deficits appear early in patients with medically refractory TLE, which may help in the early identification of these patients.

Determination of free acetaldehyde in total blood for investigating the effect of aspartate on metabolism of alcohol in mice

To explore the effect of sodium L-aspartate monohydrate (aspartate) as a NAD+ regenerating agent for acetaldehyde in alcohol metabolism, a simple HPLC method has been developed for the measurement of free acetaldehyde in total mice blood digested with alcohol and aspartate. The blood samples were collected in EDTA Vacutainer tubes, and treated with 2,4-dinitrophenylhydrazine (DNP hydrazine) reagent in total blood. Acetaldehyde DNP hydrazone was extracted from total blood and analyzed by HPLC using an Ultrasphere ODS column. The compounds were separated using acetonitrile-water (50:50, v/v) as mobile phase and detected at 356 nm. The detection limit for acetaldehyde DNP hydrazone was 0.1 ppm. A blank determination was carried out for each analysis and subtracted from the results. The amount of acetaldehyde in blood has been determined as a function of time lapse after sole alcohol administration and aspartate ingestion followed by alcohol administration, respectively. This comparative analysis demonstrates that the ingestion of aspartate before the administration of alcohol dramatically decreases the aldehyde level in blood, and aspartate may be utilized as a prospective antagonist for acceleration of ethanol metabolism and prevention of acetaldehyde toxicity.

Gene gun-mediated in vivo analysis of tissue-specific repression of gene transcription driven by the chicken ovalbumin promoter in the liver and oviduct of laying hens

In order to search tissue-specific elements in the 5'-upstream promoter region, gene gun was used to transfect in vivo plasmid DNAs with varying lengths of truncated ovalbumin promoter fused to the CAT reporter gene to the oviduct and liver of laying hens. The results indicated that in the oviduct, consistently high reporter gene expression was observed irrespective of the length of the truncated ovalbumin gene promoters, whereas in the liver the ovalbumin promoter extending from -3200 to +8 bp suppressed substantially the reporter gene expression compared with consistently high gene expression obtained by the ovalbumin promoters from -2800 to +8 bp or shorter length. It was concluded, therefore, that a tissue-specific silencer-like element might reside most likely in the ovalbumin gene promoter region between -3200 and -2800 bp which represses the ovalbumin gene transcription in the liver, but not in the oviduct of laying hens.

Cloning and phylogenetic analysis of chitin synthase genes from the insect pathogenic fungus, Metarhizium anisopliae var. anisopliae

Degenerated PCR primers were used to amplify chitin synthase genes from genomic DNA of Metarhizium anisopliae var. anisopliae. Through cloning and sequencing of approximately 600-bp fragments amplified by PCR, we found three genes encoding different types of chitin synthases, designated MaCHS1, MaCHS2, and MaCHS3. Southern blot analysis performed on genomic DNA showed that each of the chitin synthases MaCHS1, MaCHS2, and MaCHS3 is encoded by a single copy gene. Alignment of their deduced amino acid sequences with those of other euascomycetes separated the sequences into three distinct classes. MaCHS1 was identified as a gene for class I chitin synthase, MaCHS2 for class II, and MaCHS3 for class III. The UPGMA dendrogram and phylogenetic tree of the deduced amino acid sequences revealed the taxonomic and evolutionary position of Metarhizium anisopliae var. anisopliae.

Synthesis of human erythropoietin in vivo in the oviduct of laying hens by localized in vivo gene transfer using electroporation

In order to synthesize human erythropoietin protein in the oviduct of laying hens, localized in vivo gene transfer was attempted by using electroporation. In Experiment 1, transcriptional activities were compared by using four viral and cellular promoters, i.e., the 1.35-kbp long ovalbumin promoter, SV40 early promoter, Rous sarcoma virus long terminal repeat (RSV LTR), and the miw promoter, which is a hybrid of RSV LTR and chicken beta-actin promoter. These promoters were fused immediately upstream to the chloramphenicol acetyltransferase reporter gene. The results of chloramphenicol acetyltransferase activity showed that the miw promoter was the strongest, followed by SV40, RSV LTR, and the ovalbumin promoter in decreasing order. The intensity of the miw promoter was 250 times as high as that of the ovalbumin promoter. In Experiment 2, plasmid DNA containing the human erythropoietin gene, driven either by the ovalbumin promoter or the miw promoter, was transfected in vivo, and the production of human erythropoietin protein was detected by ELISA. The results indicated that the synthesis of human erythropoietin protein was attained in the chicken oviduct, and its concentration was higher when driven by the miw promoter than the ovalbumin promoter.

In vivo electroporation: a powerful and convenient means of nonviral gene transfer to tissues of living animals (Review)

Although in vivo electroporation is currently an unfamiliar nonviral means of gene transfer, accounting for only about 1% of total studies related to in vivo gene transfer and gene therapy, it may be extensively used for experimental and therapeutic purposes in the near future. Like other nonviral methods, in vivo electroporation has a variety of advantages over viral vectors as: any types of cells and tissues in theory could become a target, handling is easy and quickly done within a matter of second, repeated administration of DNA is possible, no immunogenicity is expected, and there is no constraints on amounts and sizes of DNA to be used. Gene transfer efficiency of in vivo electroporation was found to be equivalent to or even superior to that of in vivo lipofection, gene gun and direct DNA injection methods. Although gene expression exerted is transient and foreign genes are likely to be present in an episomal form when transferred by in vivo electroporation, foreign gene products could be detected for more than 1 month depending on tissues and DNA constructs used. Gene expression generated by in vivo electroporation could be controlled to a certain extent in a tissue- or cell-specific manner, and be induced as intended. Perhaps better appraisal of in vivo electroporation as a nonviral gene transfer method should be brought forth in the future after more detailed analyses.

Evaluation of particulate Bioglass in a rabbit radius ostectomy model

Osseous defects and fractures may require supplimentation to support and promote healing. Bioglass (BG) may be a useful therapeutic for these conditions. Therefore, we executed a study to determine whether particulate BG could promote healing of 20-mm unilateral ostectomies in the radius of rabbits. Ostectomies were either treated with BG or remained untreated in the control (CTL) group. At 4 and 8 weeks post-treatment, ostectomies were assessed histomorphometrically and biomechanically. New bone formation was more intense contiguous to the host bone for both BG and CTL than centrally, yet BG animals displayed active mineralization throughout the ostectomy. The amount of bone within BG-filled defects was greater than CTLs at 4 weeks, whereas, at 8 weeks there was no difference. Biomechanically, the BG-treated limbs required more torque to break than did CTL limbs at 4 weeks; however differences were not significantly different. By 8 weeks, the BG-treated and CTLs, had comparable strength. Bioglass may be a useful therapy to produce the early phase of osseous repair. However, improvements in handling properties of the particles will be needed to enhance efficacy.

Detection of thyroid remnant/metastasis without stunning: an ongoing dilemma

The use of 131I doses of several mCi for scans can stun the thyrocytes and thyroid cancer cells, whereas the usual dose (300 microCi) of 123I does not. We compared the diagnostic accuracy of the 123I (300 microCi) scans and that of 131I (3-10 mCi) scans in 155 patients. The diagnostic accuracy of a 123I scan in detecting functioning thyroid remnant/metastasis was 89.5% (77/86 scans) and that of a 131I scan was 92.9% (39/42) in 6 week-postoperative patients (p = 0.750). For radioablation therapy follow-up patients, the diagnostic accuracy of 123I in determining presence or absence of functioning remnant or metastasis was 69.4% (25/36) and that of 131I was 92.5% (49/53) with a p value of 0.079. The success rates for complete ablation of functioning tissue after radioiodine therapy administered after diagnostic 123I and after 131I were 72% (34/47) and 56% (24/43), respectively, with a p value of 0.125. Our study indicates the following: 1) for the first postoperative evaluation, the diagnostic accuracy of the 123I scan was essentially equal to that of the 131I scan, and the success rate of radioablation therapy appears to be better than 123I scan; and 2) for postablation follow-up surveys, the 131I scan appears to be better but carries the risk of stunning the functioning cells.

Estrogen receptor is not primarily responsible for altered responsiveness of ovalbumin mRNA induction in the oviduct from genetically selected high- and low-albumen chicken lines

The role of estrogen receptor on ovalbumin mRNA induction by steroid hormones was investigated in primary cultures of oviduct cells from estrogen-stimulated immature chicks of genetically selected high- and low-albumen egg laying lines (H- and L-lines). In experiment 1, the extent of ovalbumin mRNA induction and changes in estrogen and progesterone receptors were compared between the oviduct cells from H- and L-lines with or without steroid hormones in the culture medium. In experiment 2, the effect of estrogen receptor gene transfection on the induction of ovalbumin mRNA was studied in the oviduct cells from the L-line chicks. The results showed a close correlation of the changes in ovalbumin mRNA with the numbers of nuclear and total estrogen receptors in the oviduct cells but not with the numbers of nuclear and total progesterone receptors. Estrogen receptor gene transfection induced ovalbumin mRNA to a moderate extent in the absence of the steroid hormones. To our surprise, however, estrogen receptor gene transfection apparently suppressed the ovalbumin mRNA responsiveness to estrogen to a considerable extent. It was concluded, therefore, that the extent of estrogen receptor expression might not be primarily responsible for the differences in responsiveness to steroid hormones of oviduct cells from genetically selected H- and L-line chickens.

Comparative study of interictal PET and ictal SPECT in complex partial seizures

OBJECTIVE

To compare the sensitivity of ictal 99mTc-HMPAO single photon emission computed tomography (SPECT) with interictal 18F-fluoro-deoxyglucose positron emission tomography (PET) in localization of the epileptogenic focus in patients with medically intractable complex partial seizures (MI-CPS).

MATERIAL AND METHODS

Retrospective analysis was performed on patients with MI-CPS who underwent anterior temporal lobectomy from January 1993 onwards when PET became available to us for clinical studies at the Indiana University Medical Center. There were 38 female and 29 male patients (total = 67) with MI-CPS, 10 to 55.5 years of age (mean 31) and duration of their epilepsy from 1-46 years (mean 21). Interictal PET was evaluated for evidence of focal hypometabolism and ictal SPECT for focal perfusion abnormality (hyperperfusion or hypoperfusion) by visual analysis.

RESULTS

Both ictal SPECT and interictal FDG-PET studies were obtained in 36 patients with MI-CPS. PET showed definite hypometabolism in 30 and questionable hypometabolism in an additional two patients. Ictal SPECT correctly localized the seizure focus in 27 patients by demonstrating ictal hyperperfusion whereas in one the hyperperfusion was falsely localized. In an additional seven patients the ictal SPECT provided probable localization by demonstrating ictal hypoperfusion in the appropriate temporal lobe. The sensitivity of ictal SPECT and interictal PET was 34/36 and 32/36, respectively, the difference was not statistically significant (chi 2y = 0.18, DF = 1, P = 0.67). In six of the 36 patients the two tests were complementary to each other in providing localizing information.

CONCLUSION

Ictal SPECT and interictal PET are equally sensitive and reliable techniques in localizing the epileptogenic focus in patients with MI-CPS. They play a critical role in providing localization in MRI negative patients allowing surgical resection to be undertaken in many without additional invasive electrographic monitoring.

Cloning and characterization of chitin synthase gene fragments from Penicillium chrysogenum

DNA fragments homologous to chitin synthase were amplified from the genomic DNA of Penicillium chrysogenum by PCR. Cloning and sequencing of the PCR-amplified fragments led to the identification of four different genes, designated PcCHS1, PcCHS2, PcCHS3, and PcCHS4. By comparison of the deduced amino acid sequences, PcCHS1 was identified as a gene for class I chitin synthase, PcCHS2 and PcCHS3 were for class II, and PcCHS4 was for class III. Among these only PcCHS4 includes an intervening sequence of 56 bp. The analysis of the deduced amino acid sequences revealed a close evolutionary relationship between Penicillium and ascomycetous fungi.

Quantification of intrahepatic portosystemic shunting after placement of a transjugular intrahepatic portosystemic shunt

PURPOSE

To quantify portosystemic shunting and hepatic portal perfusion after placement of a transjugular intrahepatic portosystemic shunt (TIPS).

MATERIALS AND METHODS

Technetium-99m macroaggregated albumin (MAA) was injected directly into the portal veins of nine asymptomatic patients 3 months after TIPS placement. Portosystemic shunting was quantified by comparing counts in the lungs with those in the liver. One cirrhotic patient and one healthy patient who received portal MAA injections were used as controls.

RESULTS

No portosystemic shunting was found in the healthy patient. In the cirrhotic control patient, 77% of the injected activity was in the lungs. Patients with portosystemic shunts had even more activity in the lungs. Even stenotic shunts diverted greater than 80% of portal blood flow systemically. Flow through the TIPS ranged from 84% to 100% (average, 93%); these fractions of flow correlated inversely with portosystemic pressure gradients.

CONCLUSION

Cirrhotic livers may divert much of the portal blood systemically before TIPS placement. Afterward, this proportion rises, and most portal flow is diverted into the pulmonary circulation.

Modulation of transcriptional activity of the chicken ovalbumin gene promoter in primary cultures of chicken oviduct cells: effects of putative regulatory elements in the 5'-flanking region

With primary cultures of chicken oviduct cells, we tested functional roles in the ovalbumin gene transcription of NF-1 like factor binding element, half estrogen-response-element direct repeat, and chicken ovalbumin upstream promoter residing in the 5'-flanking region of the chicken ovalbumin gene. The three putative regulatory elements were fused upstream to the chloramphencol acetyltransferase reporter gene driven by the chicken ovalbumin gene promoters, and transient gene expression was measured in primary cultured oviduct cells. The results indicated that neither the NF1 binding element nor the ovalbumin upstream promoter showed any enhancer-like activity. In addition, although the half estrogen response element direct repeat enhanced transcriptional activity of the ovalbumin gene promoter, it completely deprived the ovalbumin promoter of estrogen dependency. We concluded, therefore, that the biological significance of these three putative regulatory elements in the homologous chicken oviduct cell system might be different from those previously reported in heterologous systems.