Comparison of intravascular ultrasound measurements at the sites of balloon dilatations of femoral arteries with measurements of postmortem gross arterial segments at the same sites

Intravascular ultrasound measurements of arterial cross-sectional area at the site of balloon dilatation are quantitatively accurate and consistent with measurements by digital planimetry. Lumen cross-sectional area determinations are virtually the same and the minor differences in total arterial cross-sectional area are probably related to the dehydration of each specimen, which occurred during the interval between studies. Thus, arterial disruption by balloon angioplasty does not interfere with the quantitative accuracy of intravascular ultrasound measurements.

Physical status and expression of HPV genes in cervical cancers

It is known that E2 protein of oncogenic human papillomavirus (HPV) inhibits the expression of E6 and E7 genes from their major promoters in vitro and suppresses the proliferation of cervical cancer cells. This suggests that the loss of functional E2 gene may provide selective advantages in the development of cervical cancer. Investigation of the relationship between the disruption of HPV-16/18 E2 genes by DNA integration and clinical outcome of cervical cancer may not only help to understand the mechanism of HPV-related cervical carcinogenesis, but may also provide novel management of cervical cancer. It was noted that integrated HPV-16/18 DNA was predominant in most patients with cervical cancers, marking 51 of a total of 68 cases (75%); episomal HPV DNAs were found in 5 cases (7.4%), and finally mixed forms of HPV DNAs with episome and integration were found in 12 cases (17.6%). Whole portions of E2 DNA of HPV-16 could be amplified by PCR in 19 (36.5%) of 52 cases of cervical intraepithelial neoplasia. It was shown that there was not statistically significant association with the different stages, but integrated HPV DNAs were detectable only in the patients with far-advanced stage of cervical cancers, which also means no episomal forms were detected. Episomal forms of HPV DNA were detectable in 14 (25.9%) of 54 squamous cell carcinomas (4 pure episomal forms and 10 mixed forms), whereas only 1 (8.3%) of 12 adenocarcinomas and adenosquamous cell carcinomas contained episomal viral DNA. When HPV DNA forms were compared with initial tumor size, lymphovascular space involvement, and frequency of nodal metastasis, statistically significant relationships were not found. The association of DNA integration with invasive cervical cancers was seen regardless of HPV type; however, there were differences between the integration profiles of HPV-16 and HPV-18 DNA. Of the 51 HPV-16-containing cancers, 36 (70.6%) revealed purely integrated HPV DNA, and another 10 cases (19.6%) displayed both integrated and episomal HPV DNAs. However, 5 (9.8%) cases showed only episomal copies of the HPV-16 genome. In contrast, all 17 HPV-18-containing cancers (5 cases positive for HPV-18 and 12 cases positive for both HPV-16 and -18) revealed only the integrated form of HPV-18 DNA. The expression of E6 and E7 transcripts of HPV-16/18 is uniformly correlated with the physical status of HPV DNAs. HPV E2 mRNAs were constantly expressed in the presence of the intact virus in cases with episome and mixed forms of HPV DNA. In general, amplified signals from HPV E2 RT-PCR are more intensive than those from DNA-PCR in the same patients. It is suggested that RT-PCR is a valuable method to evaluate dynamic expression of the specific gene and seems to be more sensitive than the DNA-PCR method in detecting intact E2 gene because of the gene copy numbers.

Genetic evidence for the multicentric origin of synchronous multiple gastric carcinoma

Multiple gastric cancers, which constitute 4% to 10% of all gastric cancers, occur in older people and are associated with more extensive intestinal metaplasia. With regard to the genesis of multiple gastric cancers, multicentricity (independent origin) rather than multifocality (local or lateral spread of one cancer) has been the favored theory. Conventional morphologic study, however, has not been able to provide convincing evidence in support of multicentricity. The purpose of this study was to verify the multicentric origin of multiple gastric cancers at a genetic level. For this purpose, immunohistochemical and molecular techniques were used to define the mutation pattern of APC, MCC and p53 in multiple lesions of synchronous multiple gastric cancers. The study was based on a total of 30 gastric tumors from 13 patients, including 10 double tumors, 2 triple tumors, and 1 quadruple tumor. Single-strand conformation polymorphism and polymerase chain reaction direct sequencing were carried out for exons 5 to 8 of p53, and loss of heterozygosity was detected on the basis of polymerase chain reaction amplification of polymorphism in exon 10 of MCC and in exon 11 of APC. Twelve of 13 cases showed alteration in one or more genetic markers. Of these, three demonstrated a discordant mutation pattern of p53 in individual lesions, and another two revealed allelic loss of MCC in one lesion and p53 mutation in the other. In six other cases, only one lesion showed alteration of APC, MCC, or p53, and in the remaining case, one lesion carried p53 and MCC mutations and the other carried MCC loss of heterozygosity only. The results of this study showed discordance of the mutation pattern of APC, MCC, and p53 in individual lesions of multiple gastric cancers, providing genetic evidence for a multicentric origin of synchronous multiple gastric carcinomas. Collectively, these findings supported the theory of field cancerization in gastric carcinogenesis.

Modulation of high-voltage activated Ca2+ channels in the rat periaqueductal gray neurons by mu-type opioid agonist

The effect of mu-type opioid receptor agonist, D-Ala2,N-MePhe4,Gly5-ol-enkephalin (DAMGO), on high-voltage-activated (HVA) Ca2+ channels in the dissociated rat periaqueductal gray (PAG) neurons was investigated by the use of nystatin-perforated patch recording mode under voltage-clamp condition. Among 188 PAG neurons tested, the HVA Ca2+ channels of 38 neurons (32%) were inhibited by DAMGO (DAMGO-sensitive cells), and the other 80 neurons (68%) were not affected by DAMGO (DAMGO-insensitive cells). The N-, P-, L-, Q-, and R-type Ca2+ channel components in DAMGO-insensitive cells shared 26.9, 37.1, 22.3, 7.9, and 5.8%, respectively, of the total Ca2+ channel current. The channel components of DAMGO-sensitive cells were 45.6, 25.7, 21.7, 4.6, and 2.4%, respectively. The HVA Ca2+ current of DAMGO-sensitive neurons was inhibited by DAMGO in a concentration-, time-, and voltage-dependent manner. Application of omega-conotoxin-GVIA occluded the inhibitory effect of DAMGO approximately 70%. So, HVA Ca2+ channels inhibited by DAMGO were mainly the N-type Ca2+ channels. The inhibitory effect of DAMGO on HVA Ca2+ channels was prevented almost completely by the pretreatment of pertussis toxin (PTX) for 8-10 h, suggesting that DAMGO modulation on N-type Ca2+ channels in rat PAG neurons is mediated by PTX-sensitive G proteins. These results indicate that mu-type opioid receptor modulates N-type HVA Ca2+ channels via PTX-sensitive G proteins in PAG neurons of rats.

Prognostic significance of pretreatment squamous cell carcinoma antigen and carcinoembryonic antigen in squamous cell carcinoma of the uterine cervix

Sixty-seven patients with squamous cell carcinoma of the uterine cervix (FIGO Stages IB2, IIA, and IIB) were reviewed to evaluate the pretreatment level of squamous cell carcinoma antigen (SCC) and carcinoembryonic antigen (CEA) which may be used to predict a subset of patients with poor prognosis. The rate of pathologic pretreatment serum level of SCC increased significantly in cases with Stage IIB compared to that of Stages IB2 and IIA (50% versus 16.3%). The rate of pathologic pretreatment serum level of CEA did not show any difference between these two groups (29.2% versus 30.2%). The 48-month disease-free survival for patients with pathologic pretreatment serum levels for one or both tumor-associated antigens (TAAs) was 40.0% versus 91.7% for patients with normal levels (log-rank test, P < 0.005) in Stages IB2 and IIA. Patients who had a pathologic pretreatment serum level for one or both TAAs showed higher incidence of lymph node metastasis than patients with normal levels (36.7% versus 10.8%). The patients who had pathologic pretreatment serum levels for both TAAs and lymph node metastasis have the poorest prognosis. The pretreatment serum levels for one or both TAAs make it possible to predict the clinical response to neoadjuvant chemotherapy consisting of cis-platinum (DDP) and 5-fluorouracil (5-FU). Our findings suggest that pretreatment of SCC in conjunction with CEA is a valuable tumor marker to predict the prognosis of squamous cell carcinoma of the uterine cervix and to foresee a clinical response to subsequent neoadjuvant chemotherapy.

Preserved vasodilatory response to nitroglycerin in saphenous vein bypass grafts

BACKGROUND

Uncertainty exists regarding the effects of nitroglycerin on atherosclerotic segments of coronary arteries, and information on vasoreactivity of saphenous vein bypass grafts is sparse. Intravascular ultrasound enables identification of atherosclerosis in angiographically normal segments and allows continuous determination of alterations in cross-sectional lumen areas.

METHODS AND RESULTS

Patients with documented coronary atherosclerosis were studied. Vessel morphology and lumen area at baseline and after 100 to 200 micrograms nitroglycerin were assessed at 10-second intervals for 60 seconds in vessel segments without angiographically apparent lesions. Coronary artery saphenous vein bypass grafts from 11 patients were compared with native coronary arteries in 16 different patients. Atherosclerosis was present in all vessel segments studied. There was a rapid increase in lumen area compared with baseline after intravascular nitroglycerin in both native coronary arteries and saphenous vein bypass grafts. Maximum lumen area dilatation was 19.6 +/- 12.2% in saphenous vein bypass grafts and 19.7 +/- 13.1% in native coronary arteries. An earlier peak response in saphenous vein bypass grafts (34.5 +/- 6.9 seconds) compared with native coronary arteries (44.7 +/- 8.5 seconds; P = .003) was found. Vessel wall area remained constant during vasodilation, but there was a significant reduction in measured wall thickness (P = .034).

CONCLUSIONS

In patients with documented coronary artery disease, intravascular ultrasound reveals substantial atherosclerosis in angiographically normal vessel segments. In these vessel segments, both native coronary arteries and saphenous vein bypass grafts exhibit prompt vasodilation with the intravascular administration of nitroglycerin. The vasodilatory capacity in response to nitroglycerin seems to be preserved in transposed, denervated, and devascularized saphenous veins.

Correspondence of aortic valve area determination from transesophageal echocardiography, transthoracic echocardiography, and cardiac catheterization

The correspondence of aortic valve area measurements from transesophageal echocardiography, transthoracic echocardiography, and cardiac catheterization was determined in 100 patients with severe aortic stenosis (aortic valve area < or = 0.75 cm2), moderate aortic stenosis (aortic valve area > 0.75 to < or = 1.2 cm2), mild aortic stenosis (aortic valve area > 1.2 to < or = 2.0 cm2), and nonstenotic aortic valves (aortic valve area > 2.0 cm2). Because high correlation does not require high agreement, data were assessed by analysis of agreement. Aortic valve areas determined by transthoracic echocardiography (1.43 +/- 0.76 cm2), transesophageal echocardiography (1.40 +/- 0.79 cm2), and cardiac catheterization (1.47 +/- 0.82 cm2) were similar. Correlations between methods were excellent (r values = 0.96). "Limits of agreement" between the three comparisons did not differ significantly. Similar levels of agreement when comparing these independent methods for determining the aortic valve area indicate that direct planimetry by transesophageal echocardiography, the continuity equation with transthoracic echocardiography, and the Gorlin formula are equally accurate and may be used interchangeably. Clinically important discrepancies between methods are uncommon and are readily settled by adding a third method.

Primary intramedullary spinal cord primitive neuroectodermal tumor with intracranial seeding in an infant

Primary spinal cord primitive neuroectodermal tumor (PNET) is a rare entity. In all 13 cases have been reported in the literature, including 3 with intracranial seeding. A 3-month-old girl with involvement of the spinal cord below the mid-thoracic level is described. The brain MRI revealed findings indicative of seeding along the intracranial subarachnoid space. Biopsy, duraplasty and removal of laminotomy flap were done. In spite of a good response to the first cycle of postoperative "8-drugs-in-a-day' chemotherapy, further treatment was refused. She died 21 days after the onset of leg weakness, which reveals the rapid progression of untreated cases. To our knowledge, this is the first case of spinal cord PNET with parenchymal involvement that has been described in an infant.

A designer's polymer as an oral drug carrier (tablet) with pseudo-zero-order release kinetics

A new synthetic polymeric material has been investigated as an oral controlled-release system. The water soluble polymer consists of a non-cross-linked, ionic polymer possessing sulfonate functional groups: poly(sulfopropyl methacrylate potassium-co- methyl methacrylate) (PSPMK/MMA). Drug-resin complexes were obtained by preparing an aqueous solution of the polymer to which propranolol HCl as a model drug was added. Using either dextrose or microcrystalline cellulose as a tablet binder did not cause any problems in fabricating a compact drug-resinate tablet. The release of propranolol HCl from drug-resinate tablets (2.5 mm x 9.0 mm, 10% dextrose) was pseudo-zero-order kinetics from the beginning to the end for over 21 h. This was due to the greater contribution of drug release from the edge of the tablets. However, zero-order release tablets were obtained by increasing the radius to thickness ratio of the tablet to greater than 3.13. A mathematical model describing release kinetics from drug-resinate tablets predicted the effects of drug loading and the physical dimensions of the tablets by a heterogeneous dissociation/erosion-controlled mechanism. As the content of dextrose in the tablets increased, the dissociation/erosion rate constant (K0) increased due to the greater influx of water into the tablets along with counterions. As expected, the release rate was decreased as the stirring rate decreased from 100 to 50 rpm, resulting in the dissociation/erosion rate constant of 2.62-2.04 mg/cm2h, respectively. Therefore, this system has been proven to release drugs independent of the pH of simulated gastric/intestinal fluids (1.2 and 7.5) as well as the compression force of the tablet, which ranged from 1500 to 4400 lbs.

Modulation of glycine-induced chloride current in acutely dissociated rat periaqueductal gray neurons by mu-opioid agonist DAGO

Effect of a mu-opioid agonist (D-Ala2,N-MePhe4,Gly5-ol-enkephalin, DAGO), on glycine (Gly)-induced chloride current (IGly) was investigated in the periaqueductal gray (PAG) neurons acutely dissociated 1-2-week-old Wistar rats by the use of nystatin-perforated patch recording configuration under voltage-clamp condition. At a holding potential (VH) of -40 mV, DAGO caused a sustained potentiation of IGly at the low concentrations (10(-6)-10(-5) M) but reduced slightly the Gly response at the high concentration (10(-4) M). The reversal potential of IGly was equal to the Cl- equilibrium potential (ECl) and was not changed in the presence of 10(-6) M DAGO. The 10(-5) M Gly response was inhibited by the simultaneous treatment of forskolin and 3-isobutyl-1-methylxanthine (IBMX). H-89, a protein kinase A (PKA) inhibitor, increased the 10(-5) M Gly response but had little effect on the 10(-4) M Gly response. DAGO increased 10(-5) M Gly response in the presence of forskolin and IBMX but, not more than in the absence of forskolin and IBMX. The 10(-5) M Gly response augumented by DAGO was not affected by adding H-89. The present results suggest that the glycine-induced chloride current is cAMP dependent and is inhibited by PKA, and that the potentiation of the glycine response by DAGO is also cAMP dependent and is due to the inhibition of PKA as that of H-89. We conclude that the potentiation of glycine response by DAGO is mediated by an inhibition of cAMP-dependent PKA in the PAG neurons.

Effect of BQ-123 and tissue plasminogen activator on vasospasm after subarachnoid hemorrhage in monkeys

BACKGROUND AND PURPOSE

We aimed to determine the effect of intracisternal administration of an endothelin-A receptor antagonist (BQ-123) against vasospasm in a monkey model and to determine whether this drug would have adverse interactions with intracisternal tissue plasminogen activator (TPA).

METHODS

Thirty-three monkeys were randomly allocated to undergo baseline cerebral angiography, creation of right subarachnoid hemorrhage (SAH), and intracisternal delivery of (1) placebo (n = 10); (2) low-dose BQ-123 (5 mg/kg per day, n = 7); (3) high-dose BQ-123 (10 mg/kg per day, n = 9); or (4) BQ-123 10 mg/kg per day plus TPA 1 mg every 12 hours for three doses (n = 7). Angiography was repeated after 7 days, and animals were killed. Vasospasm was assessed by comparisons of angiograms within groups across time by paired t test and by comparisons across groups at each time by ANOVA.

RESULTS

Significant clot remained in the basal cisterns in all groups except those receiving TPA, in whom complete clot clearance was noted. Comparisons of angiograms at baseline and after 7 days showed significant vasospasm of the right middle cerebral artery in animals receiving placebo (mean +/- SEM reduction in diameter, 36 +/- 7%; P < .05) and low- and high-dose BQ-123 (16 +/- 4% and 18 +/- 7%, respectively). Animals that received TPA did not develop significant right cerebral artery vasospasm. Comparisons of arterial diameters at day 7 revealed significant variance in right middle cerebral artery diameter, with animals in the placebo group having significantly more and animals in the TPA group having significantly less vasospasm than the BQ-123 groups. Histopathological examination of the brains did not show inflammation or pathological change in animals that received BQ-123 or BQ-123 plus TPA.

CONCLUSIONS

Intracisternal TPA was efficacious against vasospasm in monkeys. Combination therapy with TPA and BQ-123 was not associated with reduction in efficacy of either drug or with evidence of toxicity.

Transcutaneous ultrasound augments lysis of arterial thrombi in vivo

BACKGROUND

External ultrasound has a synergistic effect on thrombus disruption with thrombolytic agents in vitro. We hypothesized that transcutaneous ultrasound could augment thrombolysis in vivo.

METHOD AND RESULTS

Thrombus formation was induced electrically in 48 pairs of iliofemoral arteries of 24 rabbits; arterial occlusions were documented angiographically. In 17 of 24 rabbits, 25000 units/kg streptokinase was then administered intravenously. The pairs of iliofemoral arteries were randomized to receive ultrasound treatment or no ultrasound treatment. Low-frequency (26 kHz) ultrasound (continuous wave, 18 W/cm2) was applied transcutaneously over the area of occlusion. In 7 of 24 rabbits, 14 thrombotically occluded iliofemoral arteries were exposed to ultrasound alone without streptokinase. The results were evaluated through the use of angiography (TIMI grade flow) and histopathology. After 30 +/- 10 minutes of activated sonication combined with intravenous streptokinase, 10 of 17 iliofemoral arteries (59%) treated with transcutaneous ultrasound were widely patent angiographically, with TIMI grade 3 flow. Histologically, the patent arteries had only minimal focal moral thrombus. The angiographic patency rate was significantly lower in the control groups: 1 of 17 arteries (6%) treated with streptokinase alone (P = .0012) and 1 of 14 arteries (7%) treated with ultrasound alone (P = .0036).

CONCLUSIONS

In vivo transcutaneous ultrasound significantly augments lysis of thrombi with streptokinase in rabbit iliofemoral arteries.

Effect of hormone replacement therapy on lipoprotein(a) and lipid levels in postmenopausal women. Influence of various progestogens and duration of therapy

BACKGROUND

Estrogen replacement therapy in postmenopausal women reduces the risk of coronary artery disease. One of the possible mechanisms of this effect is the modification of lipid profiles. However, there is controversy concerning the effects on lipoprotein(a) [Lp (a)] and lipid levels of progestogens administered with estrogen.

METHODS

Five hundred fifty-one postmenopausal women were divided into 5 groups: group 1, 0.625 mg of conjugated equine estrogen (CEE) (n = 140); group 2, 0.625 mg of CEE plus 5 mg of medroxyprogesterone acetate (MPA) (n = 97); group 3, 0.625 mg of CEE plus 10 mg of MPA (n = 109); group 4, 2 mg of estradiol valerate plus 0.5 mg of norgestrel (n = 134); and group 5, control (n = 71). The Lp(a) and lipid levels were measured before and 2, 6, and 12 months after hormone replacement therapy.

RESULTS

Estrogen replacement therapy for 12 months lowered the Lp(a) level by 37.1%. The addition of progestogen attenuated the Lp(a)-lowering effect of estrogen. The high-density lipoprotein cholesterol (HDL-C) level was markedly increased in group 1 (16.5%), was moderately increased in groups 2 (10.8%) and 3 (11.3%), and was not changed in group 4. The low-density lipoprotein cholesterol level was decreased by 10.9% to 17.6% in all the treatment groups. Estrogen replacement therapy for 2, 6, and 12 months raised the HDL-C level by 7.2%, 17.4%, and 17.8%, respectively. In the group with combined estradiol plus norgestrel therapy, the HDL-C level was decreased after 2 months and was not changed after 6 and 12 months. The groups that received CEE plus MPA showed intermediate effects between the group that received CEE only and the group that received estradiol plus norgestrel.

CONCLUSIONS

Combined estrogen and progestogen therapy may have effects on the heart different from those of estrogen therapy alone because of adverse impact of progestogens on Lp(a) and HDL-C levels. The effects of progesterones were dependent on the androgenic potency of progestogen and the duration of therapy.

Contribution of inadequate compensatory enlargement to development of human coronary artery stenosis: an in vivo intravascular ultrasound study

OBJECTIVES

This intravascular ultrasound study sought to examine to what extent native coronary artery stenosis is accompanied by vessel wall thickening or inadequate compensatory enlargement (relative vessel constriction), or both.

BACKGROUND

In human femoral arteries, inadequate compensatory enlargement is reported to be a paradoxic mechanism for the development of severe arterial lumen narrowing. However, it is unclear in human coronary arteries whether inadequate compensatory enlargement contributes to the development of critical arterial stenosis.

METHODS

Thirty-five primary coronary artery lesions from 30 patients (19 men, 11 women; mean [+/- SD] age 65 +/- 13 years) were imaged by intravascular ultrasound. The vessel cross-sectional area and lumen area were measured, and the wall area (vessel cross-sectional area minus lumen area) was calculated at the lesion site and at the proximal and distal reference sites. We defined compensatory enlargement to be present when the vessel cross-sectional area at the lesion site was larger than that at the proximal reference site, inadequate compensatory enlargement when the vessel cross-sectional area at the lesion site was smaller than that at the distal reference site and intermediate remodeling when the vessel cross-sectional area at the lesion site was intermediate between the two reference sites.

RESULTS

Compensatory enlargement was observed in 19 (54%) of 35 lesions, inadequate compensatory enlargement in 9 (26%) of 35 and intermediate remodeling in 7 (20%) of 35. In the inadequate compensatory enlargement group, reduction of the vessel cross-sectional area contributed to 39% of lumen reduction.

CONCLUSIONS

Compensatory enlargement commonly (54%) occurs at stenotic coronary lesions. However inadequate compensatory enlargement results in a substantial amount (39%) of the lumen area reduction in 26% of primary coronary artery lesions.

Hemolysate inhibits L-type Ca2+ channels in rat basilar smooth muscle cells

Erythrocyte lysate increases intracellular Ca2+ ([Ca2+]i) and contracts cerebral arteries in vitro and has been suggested to be the cause for cerebral vasospasm. We investigated the effect of hemolysate on L-type Ca2+ channels directly by using patch clamp techniques in freshly isolated single smooth muscle cells from rat basilar artery. Patch clamp studies revealed a whole-cell current which resembles the L-type Ca2+ current reported by others. Hemolysate reduced the amplitude of the L-type Ca2+ channel current. The effect of hemolysate was reversible by washout and repeatable. Hemolysate was separated into two fractions by using filter membranes. The fraction > 1 kDa which contains oxyhemoglobin and other proteins mimicked the effect of hemolysate, while the fraction < 1 kDa and ATP were without effect. We conclude that hemolysate does not increase [Ca2+]i by activation of L-type Ca2+ channel.

Changes in Lp(a) lipoprotein and lipid levels after cessation of female sex hormone production and estrogen replacement therapy

OBJECTIVE

To investigate the serial changes in Lp(a) lipoprotein levels with the loss of female sex hormones by surgical menopause and with estrogen replacement therapy in the same woman.

PATIENTS AND METHODS

Forty-four premenopausal women who underwent a transabdominal hysterectomy (TAH) because of benign gynecological disorders were divided into two groups: women who underwent a TAH and unilateral salpingo-oophorectomy (n=31) and women who underwent a TAH and bilateral salpingo-oophorectomy (n=13). In the group of women who underwent a TAH and bilateral salpingo-oophorectomy, 0.625 mg of conjugated equine estrogen was given daily 2 months after the operation. The levels of Lp(a) lipoprotein and lipids were measured before and at 2 and 4 months after the operation.

RESULTS

In the group of women who underwent a TAH and bilateral salpingo-oophorectomy, the mean (+/-SD) concentration of Lp(a) lipoprotein was increased by 24.5% from 0.48+/-0.47 mmol/L (18.4+/-18.3 mg/dL) to 0.59+/-0.54 mmol/L (22.9+/-21.0 mg/dL) after 2 months (P<.05), and it was reduced by 30.6% to 0.41+/-0.51 mmol/L (15.9+/-20.1 mg/dL)(P<.005) with therapy with conjugated equine estrogen (Premarin). The Lp(a) lipoprotein levels were not changed in the group of women who underwent a TAH and unilateral salpingo-oophorectomy. In the group of women who underwent a TAH and bilateral salpingo-oophorectomy, the high density lipoprotein cholesterol level showed a trend of increase after 2 months from 1.45+/-0.48 mmol/L (56.1+/-18.5 mg/dL) to 1.58+/-0.309 mmol/L (61.2+/-15.1 mg/dL) without statistical significance, and it revealed a significant elevation to 1.76+/-0.43 mmol/L (68.2+/-16.8 mg/dL) with therapy with conjugated equine estrogen (Premarin) compared with that of the basal level (P<.05).

CONCLUSIONS

tHE Lp(a) lipoprotein levels appear to be closely associated with female sex hormones. This association might play a pivotal role in postmenopausal increases of atherosclerotic diseases and cardioprotective effect of estrogen in postmenopausal women.

Presence of oncogenic HPV DNAs in cervical carcinoma tissues and pelvic lymph nodes associating with proliferating cell nuclear antigen expression

The presence of oncogenic HPV DNAs (HPV-16/18) in cervical carcinomas and their normal and metastatic pelvic lymph nodes and the expression patterns of proliferating cell nuclear antigen (PCNA) in cervical carcinomas were retrospectively studied to elucidate the possible roles of them in malignant transformation and progression of the disease. HPV-16/18 DNAs were detected by polymerase chain reaction using HPV E6 type-specific primers in 79 patients with cervical cancer. 31 patients who had pelvic lymph node metastasis (group I) and 48 patients without pelvic lymph node metastasis (group II) who were proven by pathologic examination of surgical specimens. HPV-16 or -18 DNAs were detectable in cervical carcinoma tissues in 60 patients from 79 cervical cancer patients (75.9%; HPV-16 was 67.1% and HPV-18 was 8.9%). HPV DNAs were amplified from metastatic pelvic lymph nodes in 13 patients of group I (42%) and from nonmetastatic lymph nodes in 7 group I patients (22.5%). Recurrence was identified in 9 group I patients (29.0%) in 3 years of follow-up. HPV DNAs were amplified from nonmetastatic lymph nodes in 11 group II patients (22.9%). Two group II patients, who had HPV-16 DNA by PCR in nonmetastatic nodes, were recurrent. PCNA was overexpressed in 66.7% of HPV-16- or -18-positive cervical cancers and 16.7% of HPV-16- or -18-negative cervical cancers. However, the expression levels of PCNA in cervical cancers were not influenced by the presence of oncogenic HPV DNA or pathologic metastasis in the pelvic lymph nodes. In conclusion, HPV DNA could be amplified from some metastatic and nonmetastatic pelvic lymph nodes and the detectability of oncogenic HPV DNA in pelvic lymph nodes may represent the poor outcome in the treatment of disease. The expression of PCNA protein which was associated with presence of oncogenic HPV DNAs in cervical cancers, suggesting activation of S phase of cell cycle, may contribute to the malignant progression by HPV-16 or -18.

Absence of focal compensatory enlargement or constriction in diseased human coronary saphenous vein bypass grafts. An intravascular ultrasound study

BACKGROUND

No in vivo data are available on the occurrence of compensatory enlargement or vessel constriction in diseased human coronary saphenous vein bypass grafts (SVBGs). The aim of this intravascular ultrasound (IVUS) study was to examine to what extent lumen reduction is accompanied by (1) vessel wall thickening and (2) arterial wall constriction in SVBGs.

METHODS AND RESULTS

We used IVUS to examine 43 SVBGs from 42 patients (32 men, 10 women; mean age, 72 +/- 5 years) 8 to 23 (11 +/- 4) years after SVBG. IVUS images were obtained with a 3.5F monorail ultrasound catheter with a 30-MHz frequency and were analyzed at the lesion site, the reference site, and an intermediate site. The lumen area was significantly (P < .01) decreased; the vessel wall area (SVBG cross-sectional area minus lumen area) and the plaque area (area within the external elastic lamina minus lumen area) were significantly (P < .01) increased from the reference site through the lesion site. However, SVBG cross-sectional area was the same at these three sites (24.0 +/- 8.1 versus 24.4 +/- 8.6 versus 24.5 +/- 8.6 mm2, P = NS), and the external elastic lamina area was also quite constant in each vessel (17.8 +/- 6.0 versus 17.7 +/- 6.4 versus 17.6 +/- 6.2 mm2, P = NS).

CONCLUSIONS

These in vivo IVUS data from human coronary SVBGs demonstrate that (1) no focal compensatory enlargement or vessel constriction occurred in stenotic segments compared with the reference segments and that (2) the absence of focal compensatory enlargement appears to be a potentially important factor in the progression of stenoses in coronary SVBGs.

Maternal blood C-reactive protein, white blood cell count, and temperature in preterm labor: a comparison with amniotic fluid white blood cell count

OBJECTIVE

To compare the diagnostic and prognostic performance of maternal blood C-reactive protein, white blood cell count (WBC), and temperature with that of amniotic fluid (AF) WBC in preterm labor.

METHODS

One hundred two women with preterm labor and intact membranes were studied. Maternal blood was collected to measure C-reactive protein concentration and WBC, and maternal temperature was also measured. Amniotic fluid obtained by amniocentesis was cultured and WBC determined. Receiver operating characteristic curve, logistic regression, and survival techniques were used for analysis.

RESULTS

Patients with acute histologic chorioamnionitis had significantly higher median C-reactive protein concentration, WBC, temperature, and AF WBC than patients without this lesion (P < .05). Receiver operating characteristic curve and survival analysis demonstrated that an elevated C-reactive protein, WBC, or AF WBC was strongly associated with the likelihood of histologic chorioamnionitis, shorter interval to delivery, clinical chorioamnionitis, and neonatal morbidity (P < .05 for each). Of all the tests, AF WBC was the best independent predictor of a positive AF culture (odds ratio [OR] 16.8), interval to delivery (hazard ratio 5.7), clinical chorioamnionitis (OR 15.2), neonatal sepsis (OR 16.8), and significant neonatal complications (OR 7.4), after other confounding variables were adjusted (P < .05 for each).

CONCLUSION

An elevated C-reactive protein, WBC, or AF WBC identified patients with intrauterine infection and adverse perinatal outcomes. Amniotic fluid WBC was a better independent predictor of these outcomes than C-reactive protein, WBC, or temperature.

Effects of prolonged glucose infusion on insulin secretion, clearance, and action in normal subjects

It was the aim of this study to determine whether prolonged hyperglycemia can produce "glucose toxicity" in normal human subjects. To this end, plasma glucose was clamped at approximately 5, approximately 8.8, and approximately 12.6 mM for 68 h in healthy volunteers. Rates of insulin secretion (by deconvolution of plasma C-peptide) and rates of insulin clearance [area under curve (AUC) 24 h insulin secretion/AUC 24 h insulin] were determined. Pre- and posthyperglycemia glucose turnover was measured (with [6,6-2H2]glucose) during euglycemic-hyperinsulinemic clamping to assess peripheral (muscle) and hepatic insulin action. Hyperglycemia (approximately 12.6 mM) for 68 h was associated with significant reductions in rates of insulin secretion (-35%, P < 0.05), insulin clearance (-57%, P < 0.05), glucose infusion rates needed to maintain hyperglycemia (-36%, P < 0.05), and insulin-stimulated glucose uptake (-55%, P < 0.01). No significant changes were seen during approximately 8.8 mM hyperglycemia or during euglycemia. These data showed that 12.6 mM hyperglycemia, but not 8.8 mM hyperglycemia or euglycemia, was associated with reduced insulin secretion, insulin clearance, and peripheral (muscle) insulin action. We concluded that 1) in normal subjects, desensitization to glucose involving beta-cells and muscle developed at plasma glucose concentrations between approximately 9 and approximately 12 mM, and 2) these effects were partially compensated for by a decrease in insulin clearance.

A partially purified beta-glucosidase from Bifidobacterium adolescentis converts cycasin to a mutagenic compound

beta-Glucosidase was extracted from sonicated Bifidobacterium adolescentis Int-57 and partially purified by Sepharose CL-6B gel-filtration and DEAE-cellulose ion-exchange chromatography. The partially purified enzyme was confirmed to convert cycasin to a mutagen in the Ames and SOS chromotests. beta-Glucosidase negative strains were unable to activate cycasin mutagenically.

A controlled trial of the effect of the 5-lipoxygenase inhibitor, zileuton, on lung inflammation produced by segmental antigen challenge in human beings

BACKGROUND

Segmental antigen challenge (SAC) and bronchoalveolar lavage (BAL) have been proven useful for investigating IgE-mediated lung inflammation in volunteers with allergies.

OBJECTIVE

This model was used to evaluate the pulmonary antiinflammatory effects of an experimental 5-lipoxygenase inhibitor (zileuton) in subjects allergic to ragweed. We hypothesized that decreased generation of leukotrienes by inhibition of the 5-lipoxygenase pathway of arachidonic acid metabolism would diminish the subsequent inflammatory response resulting from antigen challenge.

METHODS

Ten subjects with allergies received zileuton or placebo, 600 mg administered orally four times a day for 8 days, and then underwent bronchoscopy, BAL of a control segment, and SAC in the contralateral lung followed by BAL of the challenged segment 24 hours later in a double-blind, placebo-controlled, crossover protocol. Urinary excretion of leukotriene E4 induced by antigen challenge plus total and differential cell counts and the amount of total protein, albumin, urea, and eosinophil cationic protein in BAL fluid were determined.

RESULTS

A significant inhibition of leukotriene production (approximately 86%) was observed in subjects receiving zileuton. In addition, there was a statistically significant increase in eosinophils after antigen challenge (0.6 +/- 0.2 x 10(4) eosinophils/ml increasing to 49.0 +/- 25.0 x 10(4) in subjects receiving placebo, whereas the influx of eosinophils in subjects receiving zileuton was not statistically different from baseline (1.1 +/- 0.7 x 10(4) eosinophils/ml increasing to 16.5 +/- 4.1 x 10(4); analysis of variance for repeated measures with post hoc comparisons).

CONCLUSIONS

Treatment with zileuton altered the inflammatory response after antigen challenge. Products of the 5-lipoxygenase pathway appear to be important in recruiting eosinophils to the lung after SAC.

Proliferating cell nuclear antigen expression in Wilms' tumor: a comparative study of pre- and post-chemotherapy specimens

A total of 36 Wilms' tumors were immunohistochemically analyzed for proliferative (proliferating cell nuclear antigen-labeling) index (PI) with special reference to the effect of preoperative chemotherapy on the proliferative potential of tumors and differences in PI according to the histologic components (epithelial, blastemal and stromal). The cases were divided into two groups according to the status of chemotherapy at the time of surgical removal of the tumors. In group I (n = 12, cases with pre-operative chemotherapy), the mean PI +/- s.d. values of epithelial, blastemal and stromal types were 19.5 (n = 1), 10.1 +/- 5.28 (n = 8), and 16.2 +/- 13.49 (n = 3), respectively, and in group II (n = 24, cases without preoperative chemotherapy), 45.2 +/- 15.41 (n = 3), 28.5 +/- 16.92 (n = 10), and 23.2 +/- 4.45 (n = 2), respectively. The cases with mixed histology in group II (n = 9) had comparable PI values for each histologic component. The mean PI +/- s.d. was 12.1 +/- 7.76 in group I and 31.9 +/- 15.95 in group II. The PI value of group II was significantly higher than that of group I (P < 0.001). Alterations in the PI value following chemotherapy implied that the interpretation of tumor histology following chemotherapy should be more prudent because alteration of the PI, which reflects the proliferative potential of tumor cells, suggests modified biology of viable cells in pretreated cases as a consequence of chemotherapy.

Combination therapy with interferon-gamma and interleukin-2 for the treatment of metastatic melanoma

The toxicity and clinical response to treatment with the combination of interferon-gamma (IFN-gamma) and interleukin-2 (IL-2) in patients with metastatic melanoma was evaluated. From May 1993 through February 1994, 20 patients were treated with 24 courses of IFN-gamma with or without IL-2. A 7-day course of subcutaneous IFN-gamma alone was administered to cohorts of two or three patients each at doses of 0.1, 0.2, or 0.3 mg/m2. Thirteen patients received escalating doses of IFN-gamma between 0.2 and 0.5 mg/m2 followed by the intravenous (i.v.) administration of IL-2 (720,000 IU/kg) given three times a day. A treatment course consisted of two cycles (maximum of 15 doses of IL-2 per cycle) separated by a 10-day interval. Five additional patients were treated with five courses of IFN-gamma, IL-2, and tumor-infiltrating lymphocytes (TILs). All patients treated had the diagnosis of metastatic melanoma. The maximal tolerated dose of subcutaneous IFN-gamma was established at 0.3 mg/m2 with dose-limiting hepatotoxicity. Immunohistochemistry analyses showed detectable upregulation of MHC class I alleles in one (8%) of 12 patients. Two of 20 patients who received the combination of IFN-gamma and IL-2 had responses, one partial and one complete response. The duration of response was 7 months for the partial response and 12 months for the complete response. IFN-gamma was tolerated with minimal side effects of nausea, vomiting, malaise, and decreased hematopoiesis. No increased toxicities were found with the combination treatment, as compared with IL-2 alone. One death occurred on the third day of treatment with IFN-gamma alone from hemorrhage into brain metastases. There were no responders in the five patients who received the combination treatment of TIL, IL-2, and IFN-gamma. From these findings, we conclude that further studies looking at this combination treatment are not warranted.

Benzastatins A, B, C, and D: new free radical scavengers from Streptomyces nitrosporeus 30643. I. Taxonomy, fermentation, isolation, physico-chemical properties and biological activities

In the course of screening for free radical scavengers, rare metabolites, benzastatins A and B having aminobenzamide skeleton and benzastatins C and D having tetrahydroquinoline skeleton, were isolated from the culture broth of streptomyces nitrosporeus 30643. They showed inhibitory activity against lipid peroxidation in rat liver microsomes. In the cell assay, benzastatins C and D inhibited glutamate toxicity in N18-RE-105 cells with EC50 values of 2.0 and 5.4 microM, respectively.

Cytotoxic benzyl dihydroflavonols from Cudrania tricuspidata

Three new dihydroflavonols, gericudranins A-C were isolated from the stem bark of Cudrania tricuspidata. They were identified as 6,8-di-p-hydroxybenzyltaxifolin, 8-p-hydroxybenzyltaxifolin and 6-p-hydroxybenzyltaxifolin, respectively, by means of spectral studies. These compounds were cytotoxic to human tumor cell lines, such as CRL 1579 (skin), LOX-IMVI (skin), MOLT-4F (leukemia), KM12 (colon) and UO-31 (renal) in culture, with ED50 values of 2.7-31.3 micrograms ml-1.

Patterns of bcl-2 expression in placenta

A total of 39 placentas, whose gestational ages ranged from 8 to 41 weeks, were analyzed for bcl-2 expression using immunohistochemistry and immunoblotting. Immunohistochemically, both intracytoplasmic and nuclear expression of bcl-2 was observed in villous and extravillous trophoblasts, villous mesenchymal cells and capillary endothelial cells, villous macrophages, intermediate trophoblasts, amnionic epithelium, and even in decidua and endometrial glandular epithelium in early gestational periods. The degree of expression significantly decreased in the placentas after the gestational period of 32 weeks which coincides with the declining phase of placental increase. On immunoblotting lysates of 10(4) cells from single cell suspensions of fresh placentas, bcl-2 was detected in the placentas of 22 and 33 gestational weeks, but it was negligible or absent in three term placentas. The results of the present study suggest two possible implications on the role of bcl-2 in placenta: 1) it may be a type of proliferation or maturation-related marker, especially of trophoblasts, which show decreased expression along with terminal differentiation and maturation, and 2) because the primary role of bcl-2 is the inhibition of programmed cell death (PCD), the decrease in placental bcl-2 around term may be a parturition-associated biological change.

Antibacterial substance produced by Streptococcus faecium under anaerobic culture

A facultative anaerobe isolated from Korean domestic soil produced an antibacterial substance under strict anaerobic conditions. Based on the morphological and biochemical tests, and cellular fatty acid profiles, the anaerobe was identified as Streptococcus faecium. An antimicrobial compound produced from the S. faecium was identified as 3,7,12-trihydroxy-24-cholanic acid methylester on the basis of its physico-chemical analysis. This substance had potent antibacterial activities against a test organism harboring multiple antibiotic resistance markers, and a variety of pathogenic bacteria. The isolated S. faecium produced lactic acid as well as the antibiotic compound under the anaerobic conditions.

The value of Helicobacter pylori IgG antibody in estimating the severity of gastritis in children

A serologic test for antibodies is useful for diagnosis of Helicobacter pylori(H.pylori) infection in children. We evaluated the reliability of H.pylori IgG antibody titer in grading the severity of infection in children. We surveyed the sero-prevalence of H.pylori infection in 300 healthy school children (13 to 15 years old). Thirty-four percent(102 of 300 children) were sero-positive for H.pylori. Of the 102 sero-positive children, 70 underwent gastroscopic examination. Ninety percent of sero-positive children(63 of 70 children) were proven to be H.pylori infected. All children with H.pylori infection had histologically proven gastritis, and its severity did not correlate with the IgG antibody titer. Although a serologic test is useful to identify H.pylori infection in children, it can not predict the severity of H.pylori associated gastritis.

An immunohistochemical analysis of mdr-1 and bcl-2 expressions in neuroblastoma

Among the differentiation-related changes in neuroblastoma are expressions of mdr-1 and bcl-2, which may be potentially related to the resistance to anticancer chemotherapy. In the present study, the authors performed an immunohistochemical analysis of mdr-1 and bcl-2 expressions in 30 neuroblastomas using monoclonal anti-P-glycoprotein(mdr-1 product) antibody and monoclonal anti-bcl-2 antibody to investigate the significance of their expression. The overall incidence of mdr-1 and bcl-2 expressions were 53.3% (16/30) and 93.3% (28/30), respectively. The expressions of mdr-1 and bcl-2 didn't seem to be related to the status of preoperative chemotherapy or stage of disease. The expression of mdr-1 was closely related to the differentiation of tumor cells (p < 0.01), especially to the neuronal differentiation. The bcl-2 expression was so common that it seemed to be indigenous to this neoplasm. The overall findings suggested that the expression of mdr-1 is one of the differentiation markers, while bcl-2 expression may partly explain the reasons for the relatively poor prognosis of neuroblastoma by the resistance to anticancer chemotherapy, which is a major therapeutic tool for this peculiar neoplasm.

Intracranial tuberculoma: comparison of MR with pathologic findings

PURPOSE

To compare the MR signal intensity patterns and enhancement pattern of intracranial tuberculomas with their histopathologic features.

METHODS

MR images of six patients with surgically proved intracranial tuberculoma were reviewed retrospectively and were compared with histologic findings of the resected specimen. Detailed histologic examination was performed to look for the extent and characteristics of caseation necrosis, fibrosis, and inflammatory cellular infiltrates at each area of different signal intensities and at the enhancing areas on MR. Signal intensities for T1- and T2-weighted images were compared with normal gray matter.

RESULTS

On T1-weighted images, the granulomas showed a slightly hyperintense rim surrounded by a complete or partial rim of slight hypointensity and central isointensity or mixed isointensity and hyperintensity in five patients and homogeneous isointensity in one patient. Histologically, the zone of central isointensity or mixed intensity corresponded to caseation necrosis plus adjacent cellular infiltrates. The hyperintense and hypointense rims corresponded to the layers of collagenous fiber and the layers of the inflammatory cellular infiltrates, respectively. On T2-weighted images, the entire portion of the granuloma showed slightly heterogeneous isointensity or hypointensity with small markedly hypointense foci in five patients, and a hyperintense center surrounded by a hypointense rim in one patient. Histologic layers were not discriminated on T2-weighted images. On postcontrast T1-weighted images, there were single or multiple conglomerate ring enhancements within a tuberculoma in all six patients, corresponding to the layers of both collagenous and inflammatory cells.

CONCLUSION

Combination of the described signal intensity patterns and conglomerate ringlike enhancing appearance of the lesion is characteristic of tuberculoma, and may play an important role in differentiating intracranial tuberculomas from other ring-enhancing brain lesions.

Bcl-2 expression in neuroblastoma is differentially regulated by differentiation inducers

Neuroblastoma is characterized by differentiation in vivo and in vitro, and the process is known to be associated with changes in various gene expressions, among which is the bcl-2 gene whose major function may be potentially involved in the resistance to anticancer chemotherapy. We investigated the changing patterns of bcl-2 expression in neuroblastoma cell lines according to differentiation to assess whether the expression patterns can be differentially modulated by different types of differentiation inducers. Differentiation was induced in two neuroblastoma cell lines [SK-N-SH, SK-N-BE(2)] using all-trans-retinoic acid, gamma-interferon and EHS laminin, respectively. The levels of expression of bcl-2 were analysed before and after differentiation using immunoblotting and subsequent densitometry. The expression patterns of bcl-2 differed according to the type of differentiation inducers. Its expression increased when treated with retinoic acid and EHS laminin along with neuronal differentiation, while differentiation with gamma-interferon treatment was associated with decreased bcl-2 expression. Decreased expression of bcl-2 despite neuronal differentiation induced by gamma-interferon was thought to be important in that a certain differentiation pathway without increased drug resistance-related factor expression exists, which in turn has implications for the clinical application of gamma-interferon, combined with chemotherapy.

Prospective, randomized, double-blind trial of BQ-123 and bosentan for prevention of vasospasm following subarachnoid hemorrhage in monkeys

Thirty-one monkeys were randomly divided into three groups to undergo baseline cerebral angiography followed by induction of subarachnoid hemorrhage by placement of autologous blood clot along the right-sided arteries of the anterior circle of Willis (Day 0). The monkeys were then given drug vehicle or one of two endothelin (ET) antagonists, BQ-123 (6 mg/kg/day) or bosentan (5 mg/kg/day) intracisternally. The BQ-123 was administered by continuous infusion from a subcutaneous pump and the bosentan was given by twice-daily injections into an Ommaya reservoir in the subcutaneous space with a catheter along the right middle cerebral artery (MCA). Seven days later (Day 7), angiography was repeated and the animals were killed. Comparison of arterial diameters shown on angiograms between Day 0 and Day 7 groups given placebo and bosentan showed significant reductions in the diameters of the right intradural internal carotid (28% +/- 6% and 30% +/- 6%, respectively, paired t-test, p < 0.05), anterior cerebral artery (29% +/- 8% and 32% +/- 6% respectively +/- 6%, respectively) and MCA (34% +/- 6% and 46% +/- 4%, respectively). Animals injected with BQ-123 had significant narrowing of the right extradural internal carotid artery (7% +/- 6%) and the basilar artery (11% +/- 3%), but not of the right MCA. Comparison of arterial diameters between groups at Day 7 showed significant variance in the right extradural internal carotid, both intradural internal carotid, right middle cerebral, and left anterior cerebral arteries; the animals injected with BQ-123 developed significantly less arterial narrowing these those receiving bosentan and placebo. Bosentan was not detected in the cerebrospinal fluid aspirated from the cisterna magna on Day 7, whereas BQ-123 was detected in two animals. We can infer from these results that BQ-123 prevents vasospasm following subarachnoid hemorrhage in monkeys, that further investigations of ET antagonists are warranted, and that ET may be an important pathophysiological mediator of vasospasm. The lack of efficacy of bosentan may be related to inadequate cerebrospinal fluid levels obtained by administration twice-daily through an Ommaya reservoir.

Genotype distribution and comparison of the putative envelope region of hepatitis C virus from Korean patients

Comparative nucleotide sequence studies of the genomes of hepatitis C virus (HCV) revealed that there are at least 6 different genotypes of HCV. The prevalence of HCV genotypes among the patients with liver diseases in Korea was investigated using the polymerase chain reaction (PCR) for the NS5 region. In the 75 HCV RNA positive samples, two genotypes, type 1b and type 2a, were the major causative agents which accounted for 60% and 33% of infections respectively, while 7% could not be assigned a genotype by the methods used. The nucleotide sequences of cDNAs encoding the putative envelope proteins from 10 type 1b and 5 type 2a genotype samples were analyzed. Approximately 31-42% of the nucleotide sequences of type 1b samples examined differed from those of different genotypes. In the case of type 2a samples, 36-42% of the nucleotide sequences differed from those of different genotypes. The diversities of the amino acid sequences were the same or greater than those of the nucleotide sequences. Two hypervariable regions (HVR1 and HVR2) were recognized in both HCV genomes of genotypes 1b and 2a. However, the sequence divergence within the HVR2 region of genotype 2a was less than that of genotype 1b.

Compressed donut-shaped tablets with zero-order release kinetics

PURPOSE

Simple uncoated compressed tablets with a central hole (donut-shape) are proposed to provide a constant drug release over a long period of time (> 20 hrs). The effect of hole size and drug solubility on the release kinetics is investigated.

METHODS

The donut-shaped polyethylene oxide (PEO, Mw = 4 x 10(6)) tablets (600 mg and 12 mm diameter) are bored with a drill bit (3/32", 7/64", 1/8", and 5/32").

RESULTS

The release of theophylline from the donut-shaped tablets is zero order (80-90% release) before rapidly decreasing. As the hole size is increased from 7/64" to 5/32", the release rate increases and the release time is shortened. However, the release of theophylline from the donut-shaped tablet with a hole size of 3/32" follows the same anomalous release profile from a tablet without a hole. As drug solubility increases, the duration of linear drug release is shortened to 65-70% release followed by a severe tailing at the later stage of the release.

CONCLUSIONS

Donut-shaped PEO tablets with a hole provide zero-order release kinetics because the effect of the releasing surface area on the release kinetics is reduced.

Insights into IgE-mediated lung inflammation derived from a study employing a 5-lipoxygenase inhibitor

We have recently reported that the 5-lipoxygenase (5-LO) inhibitor, zileuton, alters lung inflammation produced by segmental antigen challenge in ragweed-allergic human subjects. Specifically, zileuton inhibited the urinary excretion of leukotriene E4 produced by antigen challenge, and the significant increase in bronchoalveolar lavage (BAL) eosinophils observed in subjects on placebo was not seen in subjects on zileuton. In this manuscript, we report additional data obtained during that study which provide information about mechanisms important during IgE-mediated inflammatory reactions in the lung. Three different areas are addressed: 1) the time to recovery of the lung from an IgE-mediated inflammatory response; 2) mechanisms related to the generation of cyclooxygenase products in the lung after antigen challenge and the effect of 5-LO inhibition on the production of cyclooxygenase metabolites; and 3) mechanisms responsible for the production of peptide leukotrienes in the lung and lung injury (as shown by albumin influx into the alveolar air space) 24 h after antigen challenge. We observed the following: 1) a significant BAL eosinophilia and basophilia remained 31 days (range 21-48) after segmental antigen challenge and bronchoalveolar lavage; 2) a decreased quantity of BAL cyclooxygenase products, as well as lipoxygenase products, in the presence of 5-LO inhibition; and 3) correlative analyses which suggest that while eosinophils appear most important for the production of peptide leukotrienes and lung injury 24 h after antigen challenge in subjects taking placebo, other effector mechanisms, perhaps those involving basophils and the initial mast cell triggering event, appear to gain in importance when the IgE-mediated inflammatory reaction is blunted by 5-LO inhibition.

Spindle cell hemangioendothelioma--a case report

Spindle cell hemangioendothelioma is a rare vascular tumor which is presented with subcutaneous nodules and follows a benign indolent course but has a recurrent tendency, and is histologically resembling a cavernous hemangioma and Kaposi's sarcoma. We present a case of spindle cell hemangioendothelioma possessing clinical aggressiveness with painful bony erosion, histologic pleomorphism and mitoses. A 20-year-old man presented with a recurrent painful mass on the left ankle. The mass was dark brown and firm with irregular margins and measured 1.5 cm in diameter, which affected and eroded the underlying medial malleolus of the left tibia. Microscopically, the tumor was composed of cavernous endothelial-lined blood spaces and spindle cellular areas mimicking Kaposi's sarcoma. The spindle cells intermingled with plump epithelioid cells and showed a moderate degree of pleomorphism with occasional mitoses. Immunohistochemically, the spindle cells were focally positive for factor VIII-associated antigen and vimentin, and negative for S-100 protein, desmin, and epithelial membrane antigen.

NS3-4A of hepatitis C virus is a chymotrypsin-like protease

The polyprotein encoded by a single open reading frame of hepatitis C virus (HCV) is processed by host- and virus-encoded proteases. The viral protease NS3 is responsible for the cleavage of at least four sites (NS3/4A, NS4A/4B, NS4B/5A, and NS5A/5B junctions) in the nonstructural protein region. To characterize the protease function of NS3 and NS4 on various target sites, efficient cis- and trans-cleavage assay systems were developed by using in vitro transcription and translation. Deletion of the C-terminal two-thirds from NS3 in an NS3-NS4A-4B polypeptide (NS3 delta C-4A-4B) hampered cleavage of the NS3/4A junction but not that of the NS4A/4B junction. As a consequence, expression of NS3 delta C-4A-4B containing an internal deletion of NS3 results in an NS3 delta C-4A fusion protein. NS3 delta C-4A shows very efficient and specific trans-cleavage activity at NS4A/4B, NS4B/5A, and NS5A/5B junctions. In addition, the biochemical properties of HCV NS3 delta C-4A were further elucidated by adding known protease inhibitors in trans-cleavage reactions. The HCV protease NS3-4A is inhibited by chymotrypsin-specific inhibitors N-tosyl-L-phenylalanine chloromethyl ketone (TPCK), chymostatin, and Pefabloc SC but not by trypsin-like protease inhibitors antipain, leupeptin, and N-alpha-p-tosyl-L-lysine chloromethyl ketone (TLCK) or by the protease inhibitors E-64, bestatin, pepstatin, and phosphoramidon. This finding strongly suggests that HCV protease NS3-4A is a chymotrypsin-like serine protease.

Sequence and diversity of rabbit T-cell receptor gamma chain genes

The nucleotide sequences of one constant (C), six variable (V), and two joining (J) gene segments coding for the rabbit T-cell receptor gamma chain (Tcrg) were determined by directly sequencing fragments amplified by the cassette-ligation mediated polymerase chain reaction. The Tcrg-C gene segment did not encode a cysteine residue for connection to the Tcr delta chain in the connecting region, and two variant forms of the Tcrg-C gene segment were generated by alternative splicing, like the human Tcrg-C2 gene. Five of six rabbit Tcrg-V gene segments belonged to the same family and displayed similarity to five productive human Tcrg-V1 family genes as well as the mouse Tcrg-V5 gene. The remaining rabbit Tcrg-V gene segment displayed similarity to the human Tcrg-V3 gene. Both rabbit Tcrg-J gene segments displayed similarity to the human Tcrg-J2.1 and 2.3, respectively. These findings suggested that the genomic organization of rabbit Tcrg genes is more similar to that of human than of mouse Tcrg genes.

Drug release from compressed hydrophilic POLYOX-WSR tablets

Drug release from compressed tablets manufactured with a powder mixture of poly(ethylene oxide) (PEO), a drug, and magnesium stearate is presented. Several factors such as molecular weight, drug loading, drug solubility, the pH of the dissolution medium, and stirring rate are investigated. The drug release from the high molecular weight PEO tablets (MW = 2 x 10(6) and 4 x 10(6)) is governed by the swelling of the polymer rather than by the erosion of the polymer, leading to anomalous release kinetics. However, the drug release from the low molecular weight PEO (MW = 0.9 x 10(6)) is controlled primarily by the swelling/erosion of the polymer, resulting in front synchronization and a constant release rate. It is observed that drug loading and drug solubility do not influence the release of drugs from low molecular weight PEO tablets. The pH of the dissolution medium and the stirring rate do not affect the drug release regardless of the molecular weight of the PEO.

Amniotic fluid interleukin-6: a sensitive test for antenatal diagnosis of acute inflammatory lesions of preterm placenta and prediction of perinatal morbidity

OBJECTIVE

Our purpose was to determine whether amniotic fluid concentrations of interleukin-6 are of value in the antenatal diagnosis of acute inflammatory lesions (histologic chorioamnionitis) of preterm placenta and in the prediction of perinatal morbidity and mortality.

STUDY DESIGN

The relation among placental histologic findings, perinatal outcome, and amniotic fluid interleukin-6 concentrations was examined in 50 consecutive patients who delivered preterm neonates within 72 hours after amniocentesis. Interleukin-6 was determined by enzyme-linked immunosorbent assays. Receiver-operator characteristic curve was used for analysis.

RESULTS

Patients with acute histologic chorioamnionitis had significantly higher median amniotic fluid interleukin-6 concentrations than patients without histologic chorioamnionitis (median 70.8 ng/ml, range 0.7 to 499.2 ng/ml vs median 2.9 ng/ml, range 0.8 to 16.0 ng/ml, respectively; p < 0.00001). An amniotic fluid interleukin-6 concentration > 17 ng/ml had a sensitivity of 79% (23/29) and a specificity of 100% (21/21) in the diagnosis of acute histologic chorioamnionitis and a sensitivity of 69% (18/26) and a specificity of 79% (19/24) in the prediction of significant neonatal morbidity (defined as neonatal sepsis, respiratory distress syndrome, pneumonia, intraventricular hemorrhage, bronchopulmonary dysplasia, or necrotizing enterocolitis) and mortality. These sensitivities were significantly higher than those of amniotic fluid culture (79% vs 38%, p < 0.005; 69% vs 27%, p < 0.01, respectively).

CONCLUSIONS

Amniotic fluid interleukin-6 is a sensitive test for the prospective diagnosis of acute histologic chorioamnionitis and the identification of neonates at risk for significant morbidity and mortality.

Variable-region sequences for T-cell receptor-gamma and -delta chains of rabbit killer cell lines against Shope carcinoma cells

A rabbit gamma delta killer T-cell line against Shope carcinoma cells was established from peripheral blood lymphocytes (PBL) of a human T-lymphotropic virus type I (HTLV-I)-infected rabbit bearing Shope papilloma and carcinoma. Southern hybridization analysis of this cell line with an HTLV-I probe showed that the cell line contained multiple clones of HTLV-I-transformed cells, and three sublines with different integration patterns of the HTLV-1 genome were isolated by cloning of the cell line. In all these sublines T-cell receptor (TCR)-gamma and -delta genes were rearranged and expressed. A PCR-based analysis of the expression of variable (V) genes showed that the killer cell line preferentially expressed V gamma 1.1 and V delta 1 genes, whereas V gamma 2 and V delta 1 genes were dominantly expressed in normal PBL. Analysis of the junctional sequences of TCR-gamma and -delta genes which dictate the fine specificities of epitope recognition revealed that all three sublines expressed V gamma 1.1/V delta 1 genes without the nucleotide diversity at the V-J junctions.

Detection of 17p loss in gastric carcinoma using polymerase chain reaction

BACKGROUND

The loss of heterozygosity (LOH) of 17p has been previously studied with conventional Southern blot-restriction fragment length polymorphism analysis, but the relatively low informativity was an obstacle to extensive analysis. To overcome this problem and to investigate the significance of 17p LOH in gastric carcinoma, we employed polymerase chain reaction and subsequent silver staining of DNA.

EXPERIMENTAL DESIGN

LOH of p53 gene and D17S5 locus on 17p was analyzed using polymerase reaction; the relationships between 17p LOH and conventional clinicopathologic parameters were evaluated.

RESULTS

The LOH of p53 gene and D17S5 was found in 36.5% (23 out of 63) and 63.3% (38 out of 60) informative cases, respectively. There was no significant correlation between LOH of these two loci, whereas the frequency of the D17S5 locus was significantly higher (p < 0.01), which suggested that there may be another putative tumor suppressor gene between the two loci or distal to D17S5. The LOH of p53 gene and D17S5 locus was not significantly associated with abnormal p53 expression, depth of invasion, histologic type of the tumor (Lauren's classification), or the status of lymph node metastasis.

CONCLUSIONS

The polymerase chain reaction and silver staining of DNA seemed to be a simple and excellent method for the evaluation of chromosomal allelic loss. The 17p LOH was frequently found in gastric carcinoma, but specific association with conventional clinicopathologic parameters was not found.

Short-term follow-up of stereotactic Gamma Knife radiosurgery in epilepsy

The efficacy of stereotactic Gamma Knife radiosurgery (STGKRS) for epilepsy was assessed in 9 patients followed up for more than 1 year. The mean duration of seizures was 9 years (range 1-22 years). In all 9 patients the epilepsy was classified as medically intractable. MRI showed nonprogressive focal cerebral lesions of less than 2.0 cm in size with or without calcification. After STGKRS, 8 patients had an excellent result (seizure free, single seizure episode, or auras only). In 2 of these patients antiepileptic drug therapy could be discontinued. One patient had no worthwhile improvement. Neither the anatomic distribution of the lesion on neuroimaging study nor extracranial EEG-recorded epileptiform activity appeared to be significant determinants of outcome. Radiation-induced edema did not seem to affect the outcome of seizure control. This preliminary report indicates that, in selected patients with medically intractable seizures associated with a focal cerebral lesion, STGKRS may be effective in controlling or greatly reducing the seizures.

Cystic intrapulmonary lymphangioma: HRCT findings

We report a rare case of cystic intrapulmonary lymphangioma involving the left lung, which presented with pneumothorax and respiratory distress in a 6-month-old infant. Chest radiographs showed a multicystic lesion in the left lung mimicking the features of congenital cystic adenomatoid malformation of the lung. The lesion appeared on high-resolution CT (HRCT) as a multiseptate, air-filled cystic lesion in the left hilar area. Associated HRCT findings were thickening of interlobular septa and bronchovascular bundles in the left lung and the presence of peripheral pulmonary vessels within cystic lesions in the apex of the left lung. HRCT findings correlated well with histopathologic findings. We suggest that these associated findings may be helpful in distinguishing this condition from other cystic lung diseases and that this entity should be included in the differential diagnosis of multicystic lung lesions.

Varied expression of major histocompatibility complex and oncogenes in Shope carcinoma cell lines derived from a single tumor

The cellular gene expression was compared in four Shope carcinoma cell lines, which were derived from a single tumor and possess various potentials for differentiation and tumorigenicity. The E6 and E7 transforming genes of cottontail rabbit papillomavirus were expressed in all these cell lines, highest level of expression being in the most tumorigenic and undifferentiated cell line, where the major histocompatibility complex (MHC) class I expression was the lowest. The MHC class II antigen, which is not expressed on normal epithelial cells, was detected in all the cell lines, but hardly, if at all, on the surface of these cells. The surface expression of the MHC class II antigen could not be induced by the culture supernatant of phytohaemagglutinin-stimulated splenocytes, which increased the surface expression level of the MHC class I antigen of the same cells. These findings suggest that the aberrant expression of the MHC class II antigen in these cells could not be implicated in the immune response against tumors. The c-fos, c-myc and c-H-ras oncogenes were variably expressed in these cell lines, but there was no correlation with tumorigenicity.