Acyl-chain specificity of human milk bile-salt-activated lipase

In order to probe the active-site structure of human milk bile-salt-activated lipase (BAL), the kinetics of the BAL-catalysed reaction were studied using monoesters as substrates. Among the fatty acyl chains, ranging from C8 to C16 of monoacylglycerols in a single equimolar assay mixture, there was a consistent trend of increased reactivity with decreased fatty-acyl-chain length for both the basal and taurocholate-stimulated activities of BAL. In addition, the detection of hydrolysis of long-chain monoacylglycerols in the absence of bile salt indicates that it is possible for the long-chain fatty acid monoester to form an enzyme-substrate complex with the basal form of BAL. I further examined the reaction kinetics of BAL with water-soluble short-chain esters of p-nitrophenol. The results indicated that there is a consistent trend towards a decreased Michaelis-Menten constant with increased acyl-chain length. Therefore it was concluded that the decreased reactivity with increased acyl-chain length of acylglycerols is probably not a consequence of the lowered affinity of the substrate for the enzyme. The fact that butyrate ester has the optimum acyl chain to be a substrate of BAL can be attributed to its acyl-chain length being long enough for interaction with the active centre of BAL and short enough to provide adequate positioning of the ester bond for transition state complex formation. The calculated free energy of BAL catalysis based on the derived kinetic parameters provides additional insight into the effect on the enzyme-substrate interaction of increasing the number of methylene groups in the acyl chain of substrates.

Influence of age on results of resection of hepatocellular carcinoma

One hundred and fifty-eight elective hepatectomies carried out between 1976 and 1989 for hepatocellular carcinoma were classified into three groups according to age: group I (n = 20) under 30 years of age; group II (n = 102) 30 to 60; and group III (n = 36) over 60. The number of operations carried out on patients in group III has increased since 1983, and the types of hepatic resection in the three different age groups were slightly but not significantly different. The incidence of small tumours (diameter less than 5 cm) and associated cirrhosis were relatively low in the younger patients. Postoperative complications developed in 4 patients (20%) in group I, 18 (18%) in group II and 8 (22%) in group III, the main ones being hepatic failure and intraabdominal sepsis. Operative mortality was 4%; one patient (5%) died in group I, 4 (4%) in group II, and 2 (6%) in group III, and the principal causes were hepatic failure and massive haemorrhage. Hepatic resection for hepatocellular carcinoma in most patients over 60 years old was associated with slightly higher operative morbidity and mortality, but the risks were such that we recommend that operation should not be denied to selected patients in this age group.

Bias of maximum likelihood estimator of intraclass correlation

A bias correction was derived for the maximum likelihood estimator (MLE) of the intraclass correlation. The bias consisted of two parts: a correction from MLE to the analysis of variance estimator (ANOVA) and the bias of ANOVA. The total possible bias was always negative and depended upon both the degree of correlation and the design size and balance. The first part of the bias was an exact algebraic expression from MLE to ANOVA, and the corrected estimator by this part was ANOVA. It was also shown that the first correction term was equivalent to Fisher's reciprocal bias correction on hisZ scores. The total possible bias of MLE was large for small and moderate samples. Relative biases were larger for small parametric values and vice versa. To ensure a relative bias less than 10% assuming an intraclass correlation of 0.025, which is not unusual in most of the animal genetic studies, the total number of observations (N) should be not less than 500. From a design point of view, minimum bias occurred atn = 2, the minimum family size possible, underN fixed.

[Efficiency of patient-controlled analgesia versus conventional analgesia in patients after thoracotomy]

The patients received thoracotomy usually suffered from significant severe pain postoperatively, which accompanied with impaired pulmonary function or increased incidences of atelectasis and pneumonia. So adequate analgesia for those patients is indicated. The purpose of this study is to investigate the efficiency of patient-controlled analgesia (PCA) and determine whether it is better than conventional analgesia or not. Twenty-six patients, ASA physical status class I and II, were randomized into two groups: PCA and intramuscular (IM). The effect on pain relief was assessed by a visual analogue pain scale (VAPS) q 4 h postoperatively for two days. Forced vital capacity (FVC) and the questionnaire of nocturnal sleep disturbance by pain were evaluated preoperatively, the first, second postoperative mornings. As result of this study, the patients of PCA group get less pain than IM group after the first and second days of surgery. VAPS values are 3.7 +/- 1.1, 2.8 +/- 0.8 and 6.1 +/- 0.9, 5.3 +/- 1.1 respectively pertaining to PCA and IM groups (p less than 0.05). The patients of IM group get more disturbance of nocturnal sleep than PCA group at initial two nights of postoperation as well (p less than 0.05). It is manifest to look out the significant difference between these two groups in accordance with FVC ratio records of post-surgery vs presurgery at initial two days after surgery on the subject of respiratory function recovery. PCA group are 46.46 +/- 7.29%, 52.25 +/- 8.32% in a condition of more progress on lung function recovery than IM group of 38.13 +/- 10.25%, 42.15 +/- 7.82% (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Change of gastric liquid emptying after highly selective vagotomy and pyloric dilatation for patients with obstructing duodenal ulcer

Gastric liquid emptying was studied in duodenal ulcer patients with and without stenosis before highly selective vagotomy (HSV) and 1 week, 3 months, and 1 year after. The test meal consisted of 1 mCi of 99m Technetium-diethylene penta-acetic acid (DTPA) in 500 ml of isotonic saline. The patients were divided into 2 groups: group 1 (16 cases) without clinical stenosis, who underwent HSV alone, served as control; group 2 (14 cases) with mild to moderate stenosis, who underwent HSV and transgastric dilatation to 20 mm in diameter. Before HSV, the stenotic group showed a significantly slower liquid emptying than the nonstenotic. Most of the stenotic group could resume a normal diet quickly after operation, but they still had prolonged liquid emptying. At 3 months, the emptying curve of the stenotic patients had approached that of the preoperative controls without a significant difference, while the nonstenotic patients showed an accelerated initial emptying. Although there was a significant improvement with the appearance of accelerated initial emptying at 1 year, the stenotic group still demonstrated slightly slower emptying than the nonstenotic group. A temporary state of preexistent gastric atony due to chronic outlet obstruction may explain the delayed emptying in the early postoperative period; however, minor residual resistance in the fibrotic, scarred tissue was postulated to be persistent despite dilatation, and responsible for the slower emptying of the stenotic than the nonstenotic group at 1 year.

Structure of human milk bile salt activated lipase

The structure and some functional sites of human milk bile salt activated lipase (BAL) were studied by cDNA cloning and chemical analysis of the enzyme. Eighteen cDNA clones of human BAL were identified from lactating human breast cDNA libraries in lambda gt11 and lambda gt10 with antibody and synthetic oligonucleotides as probes. The sequence of four clones was sufficient to construct a 3018-bp BAL cDNA structure. This sequence codes for an open reading frame of 742 amino acid residues. There is a putative signal sequence of 20 residues which is followed by the amino-terminal sequence of BAL, and the mature BAL contains 722 amino acid residues. The cDNA sequence also contains a 678-base 5'-untranslated sequence, a 97-base 3'-untranslated region, and a 14-base poly(A) tail. The sequence of a 1.8-kbp insert of clone G10-4A differs from that of the other cDNA in that it contains a deletion of 198 bases (1966-2163) corresponding to 66 amino acid residues. By use of BAL cDNA as probe, it was found that the major molecular species of BAL mRNA in human mammary gland HBL-100 cells had a size of 2.9 kb and two minor species had sizes of 3.8 and 5.1 kb by Northern blot analyses. The deduced BAL protein structure contains in the carboxyl-terminal region 16 repeating units of 11 amino acids each. The repeating units have the basic structure Pro-Val-Pro-Pro-Thr-Gly-Asp-Ser-Gly-Ala-Pro with only minor substitutions. The amino acid sequence of human BAL is related to that of pancreatic lysophospholipase, cholesterol esterase, cholinesterase, acetylcholinesterase, and thyroglobulin. Ten of the 14 cyanogen bromide fragments of diisopropyl fluorophosphate inhibited human milk BAL were isolated, determined for N-terminal sequences, analyzed for amino sugars, and tested for some functional properties. These chemical studies established that the active site of human milk BAL is located at serine-194, the N-glycosylation site is present at asparagine-187, the O-glycosylation region is in the 16 repeating units near the C-terminus, and the heparin binding domain is in the N-terminal region. We have also determined the location of disulfide bridges as Cys64-Cys80 and Cys246-Cys257. The cyanogen bromide cleavage and the partial sequencing of CNBr peptides also confirmed the location of methionines in the polypeptide chain as well as the deduced cDNA sequence of BAL.

Isolation and characterization of an apoA-II-containing lipoprotein (LP-A-II:B complex) from plasma very low density lipoproteins of patients with Tangier disease and type V hyperlipoproteinemia

Previous studies have shown that very low density lipoproteins (VLDL) from patients with Tangier disease are less effective as a substrate for human milk lipoprotein lipase (LPL) than VLDL from normal controls as assessed by measuring the first order rate constant (k1) of triglyceride hydrolysis. Tangier VLDL also has a higher content of apolipoprotein (apo) A-II than normal VLDL. To explore the possible relationship between the relatively high concentration of apoA-II in VLDL and low k1 values, Tangier VLDL were fractionated on an anti-apoA-II immunosorber. The retained fraction contained a newly identified triglyceride-rich lipoprotein characterized by the presence of apolipoproteins A-II, B, C-I, C-II, C-III, D, and E (LP-A-II:B:C:D:E or LP-A-II:B complex), whereas the unretained fraction consisted of previously identified triglyceride-rich apoB-containing lipoproteins free of apoA-II. In VLDL from patients with Tangier disease or type V hyperlipoproteinemia, the LP-A-II:B complex accounted for 70-90% and 25-70% of the total apoB content, respectively. The LP-A-II:B complexes had similar lipid and apolipoprotein composition; they were poor substrates for LPL as indicated by their low k1 values (0.014-0.016 min-1). In contrast, the apoA-II-free lipoproteins present in unretained fractions were effective substrates for LPL with k1 values equal to or greater than 0.0313 min-1. These results indicate that triglyceride-rich lipoproteins consist of several apoB-containing lipoproteins, including the LP-A-II:B complex, and that lipoprotein particles of similar size and density but distinct apolipoprotein composition also possess distinct metabolic properties.

Time of the first urine and the first stool in Chinese newborns

A total of 1,000 consecutive newborns were studied for the time of passage of the first urine and the first stool. Delayed passage (greater than 24 hours) of the first urine was noted in 4% of 920 adequate birth weight infants (birth weight greater than 2,500 grams) and 3.8% of 80 low birth weight infants (birth weight less than or equal to 2,500 grams). Whereas, delayed passage of the first stool was noted in 2.0% of adequate birth weight infants and 11.3% of low birth weight infants. By the age of 48 hours, all infants had passed their first urine, while, 99.9% of adequate birth weight infants and 97.5% of low birth weight infants had passed their first stool. There was significant difference in the gestational age, birth weight, presence of respiratory distress syndrome and delay in the first enteral feeding between the delayed and nondelayed stool passage groups.

[Etiology of intestinal obstruction--4 years' experience]

In order to find out the etiological patterns of intestinal obstruction, we reviewed 1205 cases diagnosed as intestinal obstruction at our hospital. The operative findings, locations of obstruction and pathological results were analyzed among 707 cases who were operated on. The most common cause of colon obstruction was tumor (78.7%). The etiologies of small intestinal obstruction were: adhesions, 47.4%; hernia, 22.1%; tumor, 11.8%; intussusception, 8.8%; foreign bodies, 3.7%; and miscellaneous causes, 6.2%. In the patients older than 40 years, the most common causes of intestinal obstruction were adhesion and malignancy, in contrast to hernia and intussusception that were commonly found in children. The mean age of the patients with colon obstruction was older than those with small bowel obstruction, 55.7 +/- 21. vs 39.4 +/- 17.3 (P less than 0.001). Of the patients with previous abdominal surgery, adhesions caused the obstruction in up to 60.5%. Among the 102 cases who had been operated for abdominal malignancy, the cause of intestinal obstruction was due to recurrent tumor in 78 patients (76.4%). Of patients without previous abdominal surgery, the etiologies of intestinal obstruction were: incarcerated hernia, 36.7%; tumor, 21.1%; intussusception, 15.6%; and adhesion, 13.8%. The incidence of strangulation obstruction was 25.7%, of which the major causes were adhesions, 51.7%; and hernia. 43.0%. We concluded that the most common cause of colon obstruction was tumor. The two most common causes of small intestinal obstruction were adhesions and hernia. Age and past history of abdominal surgery can much help for the differential diagnosis.

[Population structure and dynamics: the population matrix]

"This article shows an alternative way of presenting population data. The population matrix, constructed as an important part in the process of compiling socio-demographic accounts, demonstrates the close connection between stock and flow data, bringing both types of data consistently together." Official data for the Netherlands are used to illustrate the concept. (SUMMARY IN ENG)

C-terminal domain of apolipoprotein CII as both activator and competitive inhibitor of lipoprotein lipase

In this study we have prepared peptides of the C-terminal domain of apolipoprotein CII (ApoCII) by a solid-peptide-synthesis technique and demonstrated that the C-terminal tetrapeptide, Lys-Gly-Glu-Glu, represents an inhibitor of lipoprotein lipase. The tetrapeptide not only inhibits the basal activity of lipoprotein lipase, but also blocks the activation effect of native ApoCII. The lengthening of this tetrapeptide resulted in a corresponding increase in affinity for lipoprotein lipase. This suggested that amino acids other than those of the C-terminal tetrapeptide also contribute to the binding affinity of ApoCII for lipoprotein lipase. On the basis of an essential requirement of the ApoCII terminal domain for binding to lipoprotein lipase, we suggest that the initial interaction of ApoCII, mediated via the C-terminal tetrapeptide, promotes the proper alignment of ApoCII with lipoprotein lipase, followed by the weak interaction of the ApoCII activator domain with the lipoprotein lipase activator site, enhancing the lipolysis process.

[Transfusion-induced severe allergic reaction--report of one case]

Recently, improved cross-matching techniques have reduced the frequency of adverse reactions of blood transfusion less the 2%, but allergic reactions (non-hemolytic) occur in about 3% of patients receiving properly typed and crossmatched blood. Allergic reactions to blood or drugs administered during anesthesia represent an unpredictable and occasionally life-threatening event. When a severe allergic reaction develops, an aggressive and prompt treatment, including intravenous epinephrine, is necessary to minimize morbidity and mortality. We experienced a case of intraoperative shock due to blood transfusion. The case manifested with hypotension, tachycardia, cutaneous rash and bronchospasm during blood transfusion and then the aggressive treatment was given to resume normal vital signs. The rest of anesthesia and surgery as well as the recovery was uneventful and the patient was discharged on the 18th postoperative day.

Acylglycerol reactivity and reaction mechanism of bovine milk lipoprotein lipase

The sequential lipolysis of trioleoylglycerol and the triacylglycerols of very-low-density lipoprotein by bovine milk lipoprotein lipase can be described by the consecutive reactions: (formula: see text) where k'1, k'2 and k'3 are apparent first-order rate constants. The values of these rate constants dictate several conclusions concerning the reaction mechanism of this enzyme. The significant differences in the k'1, k'2 and k'3 values for trioleoylglycerol substrate imply that cleavage of the acyl-enzyme intermediate is not the rate-limiting step of the overall lipolysis reaction. This conclusion is further supported by the lack of an effect of hydroxylamine on the reaction rate. In addition, the observed isotope effect of k1 (H2O): k1(D2O) of 1.32 with trioleoylglycerol substrate suggests that the acyl-enzyme formation may contribute to the rate-limiting step of the lipoprotein-lipase-catalyzed reaction. In the presence of excess bovine serum albumin, the transfer of fatty acid product from the enzyme to albumin must be fast, since the k'1 values are not dependent on albumin concentration. When albumin is not in excess, the reaction is retarded and the study of reaction kinetics demonstrates negligible reaction after the available albumin is saturated.

Repeated bowel resections for eosinophilic gastroenteritis with obstruction and perforation. Case report

A 60-year-old man underwent two operations in 10 months for eosinophilic gastroenteritis. Segmental resection of the jejunum was initially carried out for the obstructing lesion. A second jejunal resection was required for perforation 10 months later in spite of treatment with steroids.

Adipogenesis in a murine bone marrow stromal cell line capable of supporting B lineage lymphocyte growth and proliferation: biochemical and molecular characterization

Recent advances in long-term bone marrow (BM) culture techniques have allowed investigators to dissect cellular components responsible for lympho hematopoiesis. Consequently, a number of "stromal" cell clones have been developed which are capable of supporting B lineage lymphocyte growth and proliferation in vitro by direct cell-cell interactions and the release of cytokines. While much work has focused on the support function of these cells, questions remain regarding their own differentiation potential. We have examined adipogenesis in the cloned BM stromal cell, BMS2. The presence of hydrocortisone, methylisobutylxanthine, or 30% fetal calf serum each accelerated adipocyte differentiation. This process was accompanied by the accumulation of triglycerides and cholesterol esters along with the induction of adipocyte-specific enzymes. Likewise, the steady-state level of mRNA transcripts increased for genes related to lipid metabolism. However, the pattern of mRNA expression in BMS2 adipocytes differed from that of a well-established, pre-adipocyte cell line, 3T3-L1, with respect to the following genes: glycerol phosphate dehydrogenase, CAAT/enhancer binding protein and angiotensinogen. Adipocyte BMS2 cells retailed the ability to support stromal cell-dependent B lineage lymphocytes in methylcellulose assays. The adipocytes continued to express macrophage-colony-stimulating factor mRNA constitutively and interleukin 6 mRNA in an inducible manner, similar to the BMS2 pre-adipocytes. Together, these data document a close developmental relationship between a specialized fibroblasts and adipocytes in the BM and suggest that adipocyte stromal cells may play an active role in lympho-hematopoiesis.

Clinical experience in 20 hepatic resections for peripheral cholangiocarcinoma

During the 10-year period from 1978 to 1987, hepatic resections were performed on 20 patients with peripheral cholangiocarcinoma (PCC). Nine of these patients were men and 11 were women (mean age, 48.5 years). Among them, 80% had intrahepatic stones with recurrent cholangitis. The 20 patients were subdivided into the following three groups: Group I (12 patients with surgery for PCC); Group II (4 patients with surgery for chronic cholangitis [but the final pathologic diagnosis confirmed PCC]); and Group III (4 patients with surgery for space-occupying liver lesions). No early postoperative mortality was noticed. The few complications that occurred were related to surgery for hepatolithiasis. Postoperative wound infection was the most common complication. The overall mean survival time was 20.5 months. Four patients survived for more than 3 years; one was even alive for more than 5 years after surgery.

Response of bone marrow stromal cells to adipogenic antagonists

Adipocytes constitute a major part of the bone marrow stroma in vivo and may play an active role in lymphohematopoiesis. Earlier studies had shown that the bone marrow stromal cell clone BMS2 was capable of adipocyte differentiation in vitro, in addition to its well-defined ability to support B lymphopoiesis. We now demonstrate that the process of adipogenesis in this functional bone marrow stromal cell clone can be inhibited by the cytokines interleukin-1 alpha, tumor necrosis factor, and transforming growth factor beta. Exposure of preadipocyte BMS2 cells to these agents blocked the induction of adipocyte differentiation as assessed by morphologic criteria and analysis of the neutral lipid content. Both interleukin-1 alpha and tumor necrosis factor elicited a rapid transient elevation in the steady-state mRNA levels of c-fos, c-jun, and JE. When added to differentiated adipocytes, the three cytokines continued to act as adipogenic antagonists. This was indicated by concentration- and time-dependent decreases in the activity of an adipocyte-specific enzyme, lipoprotein lipase. These changes in enzyme activity correlated directly with a decrease in steady-state levels of lipoprotein lipase mRNA. Another RNA marker of adipocyte differentiation (adipsin) was less influenced by the adipogenic antagonists. This may reflect the longer half-life of this mRNA transcript compared with those of lipoprotein lipase. Our results dramatically demonstrate that the differentiation state of bone marrow stromal cells can be modulated by exogenous factors in vitro. It is also the first report that transformation growth factor beta regulates the activity of lipoprotein lipase. These data suggest potential physiologic actions for these cytokines in vivo within the overall context of lymphohematopoiesis.

Intraoperative fiberoptic choledochoscopy for malignant biliary tract obstruction

A prospective study to determine the safety and effectiveness of intraoperative fiberoptic choledochoscopy in the management of malignant obstruction of the biliary tree was conducted in 44 patients. There were 12 patients with cancer of the pancreatic head, 9 with adenocarcinoma of the distal common bile duct, 4 with adenocarcinoma of the ampulla of Vater, 8 with cholangiocarcinoma of the common hepatic duct, 9 with intrahepatic bile duct carcinoma, and 2 with hepatocellular carcinoma. Five patients with intrahepatic bile duct carcinoma and two with hepatocellular carcinoma were found during a search for intrahepatic duct stones in patients with recurrent cholangitis. In nine patients with bile duct carcinoma (seven extrahepatic and two intrahepatic), histopathological diagnosis was made at operative endoscopy. Treatment strategy was altered in seven patients based on findings at operative choledochoscopy. Complications were few with no mortality. Intraoperative fiberoptic choledochoscopy was safe and useful in the management of malignant obstruction of the biliary tree.

[The treatment of esophagojejunal anastomotic stricture after total gastrectomy]

From December 1983 through December 1988, 200 cases of total gastrectomy were performed in Chang Gung Memorial Hospital. The esophagojejunostomy was performed with EEA staplers in 196 cases, and with hand suture in 4 cases. Twelve cases developed anastomotic stricture after the operation. All of these 12 anastomoses were done with EEA 28 mm staplers. Four of the 12 patients received no further treatment either because the symptoms were mild or because of development of carcinomatosis. Six patients received endoscopic YAG laser treatment, only 2 had good results. Four Patients received balloon dilatation, 2 of them had good results, 4 patients received surgical intervention after failure of the balloon dilatation or YAG laser treatment. Of the 4 patients who underwent surgery, the thoracoabdominal approach was used in 3, and a thoracotomy in 1. Three patients received side to side esophagojejunostomy to bypass the stricture site. In the remaining patient, stricture was excised and a new end to end anastomosis was done with hand sutures. All of these 4 patients had good results after the operation. There are many possible mechanisms of the development of anastomotic stricture. Anastomotic leakage, technical error, lack of mucosa-to-mucosa apposition, size of the EEA stapler and tissue ischemia all have been regarded as the possible causes of anastomotic stricture. Once the esophagojejunal anastomosis stricture occurs, treatment should be done to relieve dysphagia. From the results of our patients, endoscopic YAG laser is not a satisfactory treatment for anastomotic stricture.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatic resection in 120 patients with hepatocellular carcinoma

During the 11-year period from 1977 through 1987, hepatic resections were carried out in 120 patients with hepatocellular carcinoma (HCC). Twenty-five had HCCs smaller than 5 cm in diameter. There were 97 male and 23 female patients, with an average age of 51.5 years. Among them, 45.8% had liver cirrhosis and 80.8% were positive for hepatitis B surface antigen. Fourteen with ruptured HCCs underwent hepatic resection to control the intra-abdominal hemorrhage. Operative mortality within one month after surgery was 4.1%. The postoperative course was complicated by pleural effusion in 5.8%, subphrenic abscess in 2.5%, postoperative bleeding in 1.6%, hepatic failure in 1.6%, and bile leakage in 0.8% of the patients. The overall five-year survival rate in this series was 25.9%, while survival for the last five years was better (42.3% vs 11.9% for patients treated between 1977 and 1982). The cumulative survival rate had no relation to tumor rupture or liver cirrhosis. The group of patients with smaller tumors (diameter, less than 5 cm) or without vascular invasion by tumor had better survival.

Inhibition of lipoprotein lipase by the receptor-binding domain of apolipoprotein E

A synthetic peptide (residues 139-153) corresponding to the receptor-binding domain of apolipoprotein E (ApoE) was tested for lipoprotein lipase (LPL) inhibitory properties. In systems using both natural and synthetic substrates, inhibition of LPL was observed. Using the synthetic substrate, 50% inhibition was observed at 50 microM while high concentrations completely inhibited LPL activity. These studies suggest an additional functional role for the receptor-binding domain of ApoE-modulation of LPL activity.

[The determination of Cu and Zn levels in the serum and gastric juice of patients with gastric cancer]

The serum copper and zinc Levels of 35 cases of gastric cancer were measured pre- and postoperatively, and Cu and Zn Levels in their gastric juice were also determined Preoperatively. The results Showed that serum copper Levels (SCL) and Cu/Zn ratios of patients with gastric cancer were significantly higher, while serum zinc levels (SZL) lower than those of the control. In addition, SCL of patients with gastric cancer elevated progressively as the cancer advanced. After resection of the tumor, SCL and Cu/Zn ratio declined and SZL elevated again. The Cu and Zn levels in the gastric juice, of benign gastric lesions showed more marked elevation and gastric cancer patients had higher Zn level than those in the normal controls.

Elevation of liver diacylglycerols and molecular species of diacylglycerols in rats fed a lipogenic diet

The concentration of diacylglycerols in rat liver was measured by a newly developed procedure that entailed a) freeze-clamping of the liver in situ, b) lipid extraction with dimyristoylglycerol as an internal standard, c) thin-layer chromatography, and d) gas-liquid chromatography. Molecular species of diacylglycerol and total diacylglycerols were quantified. The average level of diacylglycerol in livers of chow-fed rats was 102 micrograms/g wet wt, equivalent to about 180 nmol/g wet wt. A high-carbohydrate fat-free diet, known to increase the rate of fatty acid synthesis, greatly increased the liver diacylglycerol concentration relative to the level observed in rats fed laboratory chow. Diacylglycerol molecular species that contained 16-carbon fatty acids were most markedly elevated. Liver triacylglycerol, free cholesterol, and esterified cholesterol were concurrently increased. Molecular species of triacylglycerols and cholesteryl esters that contained 16-carbon fatty acids were elevated to the greatest degree. The concentrations of total triacylglycerol and cholesteryl esters exhibited a high correlation in the livers of all animals studied, suggesting their coexistence in metabolic pools, predominantly the cores of lipid droplets and newly assembled very low density lipoprotein particles. The correlation of liver diacylglycerol and triacylglycerol contents in the chow-fed rats suggests that the diacylglycerol concentration may be a rate-determining factor in triacylglycerol synthesis when diacylglycerol levels are in the observed range of 70-150 micrograms/g wet wt. In conclusion, when the rates of fatty acid synthesis and hence triacylglycerol synthesis are increased in the liver, the steady state concentrations of diacylglycerols are also elevated.(ABSTRACT TRUNCATED AT 400 WORDS)

Intrahepatic stones associated with cholangiocarcinoma

Twenty cases of cholangiocarcinoma associated with hepatolithiasis were treated surgically. The incidence of cholangiocarcinoma associated with hepatolithiasis was 2.4%. Surgical procedures included common bile duct exploration after intraoperative choledochofiberoscopy in 20, with hepatic resection in nine. Overall survival was 8 months, with a range of 3-40 months. The hepatectomy group seemed to have a better prognosis. Accurate preoperative diagnosis of intrahepatic bile duct carcinoma associated with intrahepatic stones is difficult. All 20 patients in this series had surgery for recurrent cholangitis due to intrahepatic stones. From a retrospective review, it became apparent that early diagnosis can be obtained from the following: 1) detection of a hyperechoic mass in the liver parenchyma during abdominal ultrasonography, 2) a scintigraphic defect near the hilum, 3) filling defects or obliteration of intrahepatic ducts in ERCP or PTC, 4) gross appearance of the liver during surgery revealed a nodular tumor mass or an atrophic, fibrotic liver, and 5) intraoperative choledochoscopic findings which showed an intraluminal tumor or infiltrative lesion.

Bile-salt-activated lipase: effect on kitten growth rate

Because of the presence of bile-salt-activated lipase in cat milk, the dependence of the kitten on bile-salt-activated lipase is anticipated for milk fat absorption. To test this hypothesis, we initiated a feeding experiment comparing the growth rate of kittens fed with formula with those fed with formula and supplemented with purified human milk bile-salt-activated lipase. The results indicated that the kittens fed formula with supplemental enzyme had a growth rate twice that of kittens fed with formula alone. This study also indicated that the kitten can be utilized as an animal model in the investigation of the functional role of bile-salt-activated lipase. In this study we also performed the partial characterization of cat milk protein and fat.

Purification of carboxyl ester lipase from human pancreas and the amino acid sequence of the N-terminal region

A procedure for the purification of carboxyl ester lipase from human pancreas has been developed. The determined N-terminal 10 amino acid residues of the purified enzyme, NH2-Ala-Lys-Leu-Gly-Ala-Val-Tyr-Thr-Glu-Gly, was identical to the terminal of human milk bile salt-activated lipase. The human pancreatic carboxyl ester lipase has an apparent molecular weight slightly smaller than that of human milk bile salt-activated lipase (105,000 vs 125,000) as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Thus, it is possible that the human pancreatic carboxyl ester lipase and human milk bile salt-activated lipase could be produced by the same gene by a different splice or post-translational modification. Alternatively, they could simply be the products of two closely related but separate genes.

Surgical treatment for spontaneous rupture of hepatocellular carcinoma

Twenty-seven patients with spontaneous rupture of hepatocellular carcinoma (HCC) underwent surgical treatment during the past ten years. The indications for emergent laparotomy were hemoperitoneum in 14 and unspecified peritonitis in 13. Twelve were found to have noncirrhotic HCC. The incidence of associated cirrhosis was 55.56 per cent. Surgical procedures included hepatic resection in 14, hepatic arterial ligation in six and packing, suture and electrocauterization in seven. Seven died within one month postoperatively, a surgical mortality rate of 28 per cent. Recently, palliative resection has been used more frequently. The group of patients who underwent resection have a better prognosis.

Kinetics of acylglycerol sequential hydrolysis by human milk bile salt activated lipase and effect of taurocholate as fatty acid acceptor

The simplest reaction scheme for the conversion of trioleoylglycerol to glycerol catalyzed by human milk bile salt activated lipase can be described by consecutive first-order reactions: triacylglycerol k1----diacylglycerol k2----monoacylglycerol k3----glycerol. In these equations, k1, k2, and k3 represent the pseudo-first-order rate constants for the indicated reactions. The results from this study show that although the relative ratio of k2/k1 or k3/k1 may change somewhat, depending on the reaction conditions, the enzyme has a reactivity with the order of dioleoylglycerol greater than trioleoylglycerol greater than monooleoylglycerol. The incomplete equilibration of the intermediary diacylglycerol and monoacylglycerol with the bulk of the substrate during sequential lipolysis of triacylglycerol provides a means for their efficient lipolysis and minimizes the effect of partial acylglycerol as competitive substrates for intact triacylglycerol lipolysis. Taurocholate functions both as an activator of the enzyme and also as fatty acid acceptor to relieve product inhibition. In the presence of sufficient taurocholate, bovine serum albumin is no longer required as a fatty acid acceptor for the in vitro lipolysis.

Effect of atherogenic diet on lipoprotein lipase activity in cynomolgus monkeys

Cynomolgus monkeys (Macaca fascicularis) fed monkey chow (n = 10) had a mean +/- SD post-heparin plasma lipoprotein lipase (LPL) activity level (14.7 +/- 5.5 units/ml) similar to that found in human beings (15.7 +/- 3.9 units/ml). However, the hepatic triglyceride lipase (H-TGL) in these monkeys was extremely low (0.5 +/- 0.3 units/ml) when compared with that in human beings (10.9 +/- 4.3 units/ml). The consumption of isocaloric atherogenic diets (0.2 mg cholesterol/Cal) with either saturated (P/S = 0.34) or polyunsaturated (P/S = 2.2) fat led to increased LPL activity levels (27.6 +/- 6.5 and 28.8 +/- 16.1 units/ml, respectively) and the accumulation of plasma low density lipoprotein cholesterol (LDL-C). The results indicate that cholesterol-containing atherogenic diets with either primarily saturated or polyunsaturated fat have similar potential for the increase of LPL activity. However, it is not clear whether the high dietary cholesterol content represents an obligatory component for the increase of LPL. We speculate that the high level of LPL in cynomolgus monkeys when fed a cholesterol-rich, high fat diet could be a contributing factor to the accumulation of excessive plasma LDL-C.

Studies on the mechanism of hypertriglyceridemia in Tangier disease. Determination of plasma lipolytic activities, k1 values and apolipoprotein composition of the major lipoprotein density classes

Mechanisms responsible for hypertriglyceridemia in Tangier disease were elucidated by an analysis of the plasma post-heparin lipolytic activities and the structural and metabolic properties of very low (VLDL) and low (LDL) density lipoproteins. The levels of lipoprotein lipase activity in six Tangier patients were significantly lower (P less than 0.001) than in 40 control subjects (8.1 +/- 3.3 (+/- S.D.) vs. 14.1 +/- 3.7 units/ml). In contrast, the levels of hepatic triacylglycerol lipase were higher (P less than 0.01) than in normal controls (14.4 +/- 3.9 vs. 9.3 +/- 4.0 units/ml). Because kinetic parameters such as Km or Vmax cannot be obtained with naturally occurring triacylglycerol-rich lipoproteins, the pseudo-first-order rate constant (k1) of triacylglycerol hydrolysis was used to assess the effectiveness of triacylglycerol-rich lipoproteins as substrates for lipoprotein lipase. The k1 values for Tangier VLDL (k1 = 0.017 +/- 0.002 min-1) were significantly lower (P less than 0.001) than the k1 values (0.036 +/- 0.008 min-1) for control VLDL. Both the Tangier and control LDL2 are similar in their resistance to the action of lipoprotein lipase, as shown by their low k1 values (0.002 +/- 0.001 and 0.001 +/- 0.001 min-1, respectively). The major compositional difference between the lipoproteins of Tangier disease and normal subjects was a significant increase in the percent content of apolipoprotein A-II in all lipoprotein particles with d less than 1.063 g/ml, with the greatest increase occurring in VLDL and the lowest in LDL2. These results were interpreted as indicating that, in Tangier disease, there is a lower reactivity of VLDL with lipoprotein lipase which may in part be attributed to the abnormal apolipoprotein composition. This finding, in conjunction with the reduced levels of lipoprotein lipase activity, may explain the hypertriglyceridemia in Tangier disease.