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Abstract: Vascular endothelial growth factor-C (VEGF-C) and its receptor, vascular endothelial growth factor receptor-3 (VEGFR-3), have been implicated as important factors in the formation of lymphatic vessels, but its role in osteosarcomas has not yet been fully investigated. This study aims to define the expression of VEGF-C and VEGFR-3 in primary and metastatic osteosarcomas and their relationship to various clinicopathologic parameters. Thirty-three primary osteosarcomas and two pulmonary metastatic samples were immunostained for VEGF-C and VEGFR-3. In addition, VEGF-C and vascular endothelial growth factor-D (VEGF-D) mRNA expression levels in three different human osteosarcoma cell lines and control fibroblasts were evaluated by real-time quantitative polymerase chain reaction (PCR). Both VEGF-C and VEGFR-3 were expressed mainly in the cytoplasm of the tumor cells. Of the 35 patients with osteosarcoma, 16 patients (45.7%) showed strong positive reaction with VEGF-C. Four cases (11.4%) were negative, and 15 cases (42.9%) showed weak immunoreactivity. For VEGFR-3, 12 patients (34.3%) showed strong positive reaction. Fifteen cases (42.9%) were negative, and eight cases (22.8%) showed weak immunoreactivity. A significant, positive correlation (Rs=0.42, p=0.01) was found between the expression of VEGF-C and VEGFR-3 in osteosarcomas. The expression of VEGF-C was significantly associated with the osteoblastic subtype and high histologic grade in osteosarcomas. However, the expression of VEGF-C showed no significant correlation with the presence of metastasis. Expression of VEGFR-3 was not related to any clinicopathologic features analyzed. Two of the three osteosarcoma cell lines tested showed amplification of VEGF-C mRNA compared with control cells. No amplification of VEGF-D was noted in these cell lines. Our data suggest that VEGF-C and its receptor are expressed in osteosarcomas. Although the level of VEGF-C was high, it does not seem to have a direct influence on tumor metastasis in osteosarcomas. [Copyright &y& Elsevier]

Abstract: The objective of our study was to estimate the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after abdominoplevic CT. A total of 104 patients initially underwent abdominopelvic CT before appendix US due to acute abdominal pain. All CT examinations were evaluated retrospectively for the presence of acute appendicitis. The findings of appendix on CT were classified into five categories (definite appendicitis, probably appendicitis, equivocal CT findings for diagnosis of appendicitis, probably not appendicitis, and normal looking appendix). Appendix US images and their radiologic reports were also evaluated retrospectively. Then, CT and US findings were correlated with clinical or pathologic diagnosis. Three all patients with definite appendicitis initially on CT again showed US findings of appendicitis. In the 32 patients of probably appendicitis on CT, US showed normal looking appendix in seven patients (21.8%, 7 of 32) who improved with medical treatment and discharged. In the 16 patients of equivocal CT findings for diagnosis of appendicitis, US showed appendicitis in seven patients (43.8%, 7 of 16) and normal looking appendix in nine patients. In the 12 patients of probably not appendicitis on CT, US showed acute appendicitis in two patients (16.7%, 2 of 12). In the 41 patients of normal looking appendix on CT, US showed acute appendicitis in five patients (12.2%, 5 of 41). US reevaluation enables us to avoid misdiagnosis of appendicitis on CT and improve diagnostic accuracy of acute appendicitis. [Copyright &y& Elsevier]

Abstract: Purpose: To compare the in vivo gastric injury observed during radiofrequency (RF) ablation of the liver abutting the stomach before and after the intragastric administration of chilled saline. Materials and methods: Twenty RF ablation zones were created in the livers of 10 pigs with a 1-cm-exposed active tip of an internally cooled electrode under ultrasound guidance for 10min. Ten RF ablation zones were created before (non-saline group) and after (saline group) the intragastric administration of approximately 1000mL of chilled saline, and 20 RF ablation zones were made in the posterior part of the left lobe abutting the stomach. The frequency and severity of the thermal injury observed in the stomach of the two groups were compared histologically. Results: All the resected gastric specimens showed thermal injuries of varying degrees of severity. The largest diameter of the gastric injury was significantly smaller in the saline group (mean 1.5cm; range 1.3–1.8cm) than in the non-saline group (mean 2.1cm; range 1.8–2.4cm) (p =0.000). The saline group showed significantly less thermal injury to the muscular layer of the gastric wall by the histopathology (p =0.033). Conclusions: The intragastric administration of chilled saline might be a useful technique for reducing the severity of gastric injury during RF ablation of the liver abutting the stomach. [Copyright &y& Elsevier]

Purpose: Tuberculous pleurisy is the most frequent extrapulmonary manifestation of tuberculosis. In spite of adequate treatment, pleural fibrosis is a common complication, but the mechanism has not been elucidated. This study is to determine whether epithelial to mesenchymal transition (EMT) of mesothelial cells occurs in tuberculous pleurisy., Materials and Methods: Normal pleural mesothelial cells, isolated from irrigation fluids during operations for primary spontaneous pneumothorax, were characterized by immunofluorescence and reverse transcription polymerase chain reaction (RT-PCR). These cells were treated in vitro with various cytokines, which were produced in the effluents of tuberculous pleurisy. The isolated cells from the effluents of tuberculous pleurisy were analyzed by immunofluorescence and RT-PCR analysis., Results: The isolated cells from the irrigation fluid of primary spontaneous pneumothorax had epithelial characteristics. These cells, with transforming growth factor-β1 and/or interleukin-1β treatment, underwent phenotypic transition from epithelial to mesenchymal cells, with the loss of epithelial morphology and reduction in cytokeratin and E-cadherin expression. Effluent analysis from tuberculous pleurisy using immunofluorescence and RT-PCR demonstrated two phenotypes that showed mesenchymal characteristics and both epithelial & mesencymal characteristics., Conclusion: Our results suggest that pleural mesothelial cells in tuberculous pleurisy have been implicated in pleural fibrosis through EMT.

Objective: The purpose of this study was to assess the diagnostic performance of CT in the detection of intestinal ischemia associated with small-bowel obstruction using the maximal attenuation of a region of interest (ROI)., Materials and Methods: Abdominal CT scans of 60 patients with small-bowel obstruction were retrospectively reviewed. The reference standard of the clinicopathologic groups was classified into four categories: no bowel necrosis, mucosal-submucosal necrosis, superficial muscle necrosis, and transmural necrosis. The viability of the small bowel on CT was evaluated by visual assessment using five categories (i.e., definitely intestinal ischemia, probably intestinal ischemia, possibly intestinal ischemia, equivocal CT results, and no intestinal ischemia) and by measurement of the maximal attenuation of an ROI at selected obstructed small-bowel loops on contrast-enhanced and unenhanced CT scans. Diagnostic performances were evaluated by one-way analysis of variance and receiver operating characteristic (ROC) curve analysis., Results: The sensitivity, specificity, positive and negative predictive values, and accuracy of visual assessment for intestinal ischemia were 91.7% (33/36), 66.7% (16/24), 80.5% (33/41), 84.2% (16/19), and 81.7% (49/60), respectively. The maximal attenuation of the ROIs on contrast-enhanced CT and the subtraction value between the maximal attenuation on contrast-enhanced CT and that on unenhanced CT scans at selected bowel were significantly different according to clinicopathologic group (p < 0.001). The area under the ROC curve of the maximal attenuation subtraction values between contrast-enhanced and unenhanced CT scans (0.995) was higher than that of visual assessment (0.908) for the detection of intestinal ischemia., Conclusion: The quantification of bowel wall enhancement using the maximal attenuation of an ROI was a reliable and useful method for the diagnosis of intestinal ischemia and showed good correlation with pathology results.

Intramucosal Helicobacter pylori (H. pylori) has been described in biopsy tissues and culture systems. However, the association of intramucosal H. pylori with histopathologic features has not been evaluated. The purpose of this study is to investigate the relationship between intramucosal H. pylori and inflammatory reactions in H. pylori infection. In 113 randomly selected human gastric biopsies and 20 murine stomachs, which were inoculated with SSI every day for a week, immunohistochemical analysis for intramucosal H. pylori was done and correlated with histologic parameters. Electron microscopic examination was done on murine stomachs. H. pylori infection was present in 104 gastric biopsies and 17 murine stomachs. Intraepithelial immunopositivity for H. pylori was detected in 27 of 104 (26%) biopsies and in 11 of 17 (65%) murine stomachs. Lamina proprial immunopositivity for H. pylori was present in 51 of 104 (48%) biopsies. Neutrophil-associated immunopositivity for H. pylori was observed in 22 of 90 (24%) biopsies with H. pylori chronic active gastritis. Lamina proprial and neutrophil-associated immunopositivity for H. pylori correlated significantly with the density of H. pylori and the grade of acute inflammatory reaction in H. pylori gastritis. Intramucosal location of H. pylori itself or its antigen is closely associated with acute inflammatory reactions and may play an important role in establishing a persistent infection in chronic H. pylori gastritis. Furthermore, lamina proprial and/or neutrophil-associated H. pylori appears to be more important than intraepithelial H. pylori in acute inflammatory reactions of H. pylori gastritis.