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Background and Study Aims: Although abdominal ultrasonography (US) is a good initial screening method for detection of biliary tract disease, we sometimes encounter patients who only have findings of dilatation of the common bile duct (CBD) on US, without specific biliary symptoms or jaundice. This study aimed to evaluate the causes and clinical significance of dilatation of the CBD in patients without biliary symptoms, jaundice, or causative lesions at US., Patients and Methods: A total of 77 patients who had no biliary symptoms and whose internal CBD diameter was more than 7 mm, without definite causative lesions on US, were enrolled. Of these, 49 underwent endoscopic retrograde cholangiopancreatography (ERCP) and 28 underwent follow-up US or computed tomography (CT) instead of ERCP. We excluded patients whose bilirubin level had increased beyond the upper normal level or who had previous history of upper abdominal surgery including cholecystectomy., Results: The ERCP findings were as follows: no lesion in 20 patients (40.8%), juxtapapillary duodenal diverticulum (JDD) in 11 (22.5%), benign stricture in ten (20.4%), distal CBD mass in two (4.1%), choledochal cyst in two (4.1%), anomalous union of the pancreaticobiliary duct (AUPBD) in two (4.1%), and choledochal cyst with AUPBD in two (4.1%). There were no differences in age or in alkaline phosphatase or gamma-glutamyl transpeptidase (GGT) levels between the patients who had causative lesions revealed at ERCP and those who did not. Among the 28 patients who did not undergo ERCP, 12 had returned to normal and eight had no change in CBD diameter on follow-up US. Among eight patients who underwent CT, there were four with normal findings, one with JDD, and three with suspected choledochal cysts., Conclusions: We detected a significant number of causative biliary tract lesions in asymptomatic adults with dilatation of the CBD on routine abdominal US; no laboratory or demographic parameters were useful for discrimination. Further diagnostic study will be helpful for the early diagnosis of biliary tract disease in such patients.

Peliosis hepatis is a rare benign condition that is histologically characterized by multiple cystic blood-filled spaces in the liver. Although the cause is unknown, the condition occurs in association with several diseases or medications. We report a patient who was found to have a lesion with lipiodol accumulation in the liver 2 months after its intraarterial injection. The lesion was diagnosed and treated as a small hepatocellular carcinoma. However, subsequent right hepatic lobectomy and histologic examination confirmed the diagnosis of focal peliosis hepatis.

Goals: To evaluate the clinical significance of enlarged perihepatic lymph nodes in patients with chronic hepatitis B., Background: Enlargement of perihepatic lymph node is a common finding during ultrasonography in patients with chronic hepatitis. Its relation with liver histology and viremia was reported in chronic hepatitis C, but little has been known about its clinical significance in chronic hepatitis B., Study: We evaluated the clinical significance of perihepatic lymphadenopathy in chronic hepatitis B. In 50 patients with biopsy-proven chronic hepatitis B and 15 healthy controls, the perihepatic lymph node volume was evaluated by ultrasonography and its possible correlation with biochemical tests, hepatitis activity index, and hepatitis B viremia was investigated., Results: Perihepatic lymph node was detected in 48 of 50 patients with chronic hepatitis B (volume = 3.4 +/- 2.4 mL) and in two of 15 controls (0.4 mL and 0.6 mL). In chronic hepatitis B, lymph node volume showed a significant correlation with serum aspartate transaminase (r = 0.66), alanine transaminase (r = 0.63), gamma-glutamyl-transpeptidase (r = 0.53), histologic activity index (r = 0.59), and necroinflammatory score (r = 0.59; p < 0.05 for all), but not with fibrosis score and serum hepatitis B viremia., Conclusions: Enlarged perihepatic lymph nodes in chronic hepatitis B can be a good indicator for histologic and biochemical inflammatory activity of the liver, but not for viremia.

Background: Nitric oxide (NO) is synthesized enzymatically from L-arginine by NO synthase, which is measured by inducible NO synthase (iNOS). Helicobacter pylori (H. pylori) infection produces a state of chronic immunostimulation in the gastric epithelium. Infection with cagA+ H. pylori has greater degree of gastric inflammation and epithelial cell damage. Therefore, we compared the levels of iNOS in patients with H. pylori infection in relation to cagA status and H. pylori-related disease., Materials and Methods: One hundred and seven patients, including 51 patients with gastric cancer, 12 patients with gastric ulcer, 18 patients with duodenal ulcer and 26 patients with chronic gastritis, were enrolled in this study. Biopsies from the antrum and body were obtained for histologic examination, culture and reverse transcriptionase-PCR (RT-PCR) for detection of iNOS gene expression. The presence of H. pylori was confirmed by Giemsa staining or culture and the gene expression of cagA in H. pylori isolates was confirmed by PCR., Results: H. pylori infection was detected in 70.1% (75/107) and cagA was detected in 84.8% (28/33). iNOS expression was detected in 49.5% (53/107) and there was no significant difference in iNOS expression according to H. pylori infection nor the cagA status in the gastroduodenal diseases. However, iNOS expression was more frequently detected in gastric cancer than the other H. pylori-related diseases (64.7% vs. 35.7%, p <.05)., Conclusion: Although NO was thought be involved in the gastric carcinogenesis, the level of NO production was not related to H. pylori infection or cagA status.

One of the major limitations of curative resection in patients with pancreatic cancer is local tumor extension to the mesenteric vessels. Thus, the purposes of our study were to assess the clinical value of contrast-enhanced spiral computed tomography (CT) in predicting the resectability and survival of patients with pancreatic cancer with suspicious vascular invasion and to assess the influence of curative resection on the survival of these patients. We enrolled 40 patients with pancreatic cancer who were suspected of having an involvement of the adjacent large vessels and who subsequently underwent operation with curative intent in the study. Resectability and survival were correlated with CT findings such as segment length, degree of encasement, and type and number of vessels involved. The survival rate was compared between the curative and palliative resection groups, and survival rate was compared between the resected and unresected groups. Of the 40 patients with adenocarcinoma of the pancreas, 14 had curative resections and 26 had palliative resections. The probability of curative resection was higher in patients with segment lengths less than 2 cm, as compared with segment lengths more than 2 cm. However, there was no difference in survival between the two groups. There were no differences in resectability and survival according to the degree of encasement and type and number of vessels involved. There was no difference in survival between the curative and palliative resection groups. There was no difference in survival between the resected and unresected groups. A survival benefit was not achieved by curative resection in patients with pancreatic cancer with vascular invasion. Therefore, it would be better to avoid aggressive surgery in patients with pancreatic cancer with vascular invasion.

Background: The clinicopathological and biological significance of the expression of iNOS in pancreatic cancer remains unclear. The goal of this study was to determine the possible roles and clinical significance of iNOS expression in pancreatic cancer., Methods: Seventy-two pancreatic adenocarcinoma tissue specimens were obtained by surgical resection. We investigated the immunohistochemical expression of iNOS in 72 patients with pancreatic cancer with respect to variable clinicopathological characteristics, proliferation activity (assessed by Ki-67 expression), apoptosis (assessed by TUNEL stain), and microvessel density (assessed by CD34 expression; angiogenesis)., Results: Immunohistochemical investigations demonstrated immunolabeling of tumor cells with anti-iNOS antibody. Positivity for iNOS was observed in 48/72 (66.7%). The expression of iNOS protein did not correlate with age, bilirubin, tumor marker, location, size, AJCC stage, differentiation, distant metastasis, or patient survival. No significant association was found between iNOS expression and proliferation or microvessel density in pancreatic cancer. Apoptotic index (AI) of positive iNOS expressions were significantly higher than negative expression (p < 0.001)., Conclusion: Inducible nitric oxide synthase (iNOS) is expressed by human pancreatic cancer, and its presence is positively correlated with apoptosis of cancer cells that could provide the basis for the development of therapeutic strategies in human pancreatic cancer.

The Drosophila eye disc is a sac of single layer epithelium with two opposing sides, the peripodial membrane (PM) and the disc proper (DP). Retinal morphogenesis is organized by Notch signaling at the dorsoventral (DV) boundary in the DP. Functions of the PM in coordinating growth and patterning of the DP are unknown. We show that the secreted proteins, Hedgehog, Wingless, and Decapentaplegic, are expressed in the PM, yet they control DP expression of Notch ligands, Delta and Serrate. Peripodial clones expressing Hedgehog induce Serrate in the DP while loss of peripodial Hedgehog disrupts disc growth. Furthermore, PM cells extend cellular processes to the DP. Therefore, peripodial signaling is critical for eye pattern formation and may be mediated by peripodial processes.

Purpose: Biofeedback is an effective therapy for a majority of patients with anismus. However, a significant proportion of patients still failed to respond to biofeedback, and little has been known about the factors that predict response to biofeedback. We evaluated the factors associated with poor response to biofeedback., Methods: Biofeedback therapy was offered to 45 patients with anismus with decreased bowel frequency (less than three times per week) and normal colonic transit time. Any differences in demographics, symptoms, and parameters of anorectal physiologic tests were sought between responders (in whom bowel frequency increased up to three times or more per week after biofeedback) and nonresponders (in whom bowel frequency remained less than three times per week)., Results: Thirty-one patients (68.9 percent) responded to biofeedback and 14 patients (31.1 percent) did not. Anal canal length was longer in nonresponders than in responders (4.53 +/- 0.5 vs. 4.08 +/- 0.56 cm; P = 0.02), and rectal maximum tolerable volume was larger in nonresponders than in responders. (361 +/- 87 vs. 302 +/- 69 ml; P = 0.02). Anal canal length and rectal maximum tolerable volume showed significant differences between responders and nonresponders on multivariate analysis (P = 0.027 and P = 0.034, respectively)., Conclusions: This study showed that a long anal canal and increased rectal maximum tolerable volume are associated with poor short-term response to biofeedback for patients with anismus with decreased bowel frequency and normal colonic transit time.

Recently, the concept of gastric hypersensitivity was introduced as an important factor in the pathophysiology of functional dyspepsia (FD), but it is unclear which symptoms can predict the presence of gastric hypersensitivity. Therefore, we evaluated the relationship between common symptoms of FD and various parameters measured by gastric barostat in FD patients. Gastric barostat tests were performed in 64 FD patients and 20 healthy control subjects without gastrointestinal symptoms. Individual symptoms such as early satiety, postprandial fullness, sense of delayed emptying, nausea, vomiting, and epigastric soreness were collected and graded as mild to severe. Basal tone, gastric compliance, and postprandial receptive relaxation were similar in controls and patients, the threshold of abdominal discomfort was lower in FD patients than in controls (8.9 +/- 3.6 mm Hg and 14.5 +/- 3.7 mm Hg, respectively, P < 0.05). However, there were no significant differences in the threshold of abdominal discomfort according to the severity of individual symptoms. In conclusion, a simple evaluation of individual symptoms could not predict the presence of gastric hypersensitivity.

To evaluate the role of gastric hypersensitivity and the relationship between gastric hypersensitivity and delayed gastric emptying in Korean functional dyspepsia (FD) patients, the authors performed gastric barostat and gastric emptying scintigraphy in 64 FD patients and compared these results with those of control subjects. Basal tones and gastric compliance were similar in control subjects and patients. However, threshold of abdominal discomfort was lower in FD patients than in control subjects (8.9 +/- 3.6 mmHg and 14.5 +/- 3.7 mmHg respectively; p < 0.05). Twenty-four of 64 patients (37.5%) experienced abdominal discomfort at a pressure less than 7 mmHg above minimal distending pressure (corresponding to the 95th percentile of normal values). Half time of solid-phase gastric emptying in patients and control subjects was not significantly different. Twenty-three of 64 patients (35.9%) had delayed gastric emptying compared with control subjects (normal ranges were mean +/- two standard deviations in control subjects). Thresholds of abdominal discomfort were not significantly different in patients with and without delayed gastric emptying (9.3 +/- 4.0 mL/mmHg vs. 8.6 +/- 3.3 mL/mmHg). There were also no significant differences in the proportion of patients with delayed gastric emptying between patients with and without gastric hypersensitivity. In conclusion, gastric hypersensitivity plays an important role in FD, and the presence of gastric hypersensitivity was not related to the presence of delayed gastric emptying.

Objective: We evaluated the relationship between Helicobacter pylori (H. pylori) infection and gastric sensitivity to distention or gastric emptying rate to define the role of H. pylori in the pathogenesis of functional dyspepsia., Methods: Gastric barostat, gastric emptying scintigraphy, and 13C urea breath test were performed in 34 consecutive patients with functional dyspepsia., Results: Between H. pylori-positive and -negative patients with functional dyspepsia, there were no significant differences in basal tone (57.2 +/- 15.0 ml vs 66.8 +/- 18.3 ml), compliance (41.0 +/- 11.2 ml/mm Hg vs 38.2 +/- 11.8 ml/mm Hg), threshold of first sense (3.6 +/- 2.7 mm Hg vs 2.3 +/- 1.5 mm Hg), threshold of abdominal discomfort (9.4 +/- 4.0 mm Hg vs 7.3 +/- 1.9 mm Hg), and postprandial receptive relaxation (115.4 +/- 89.7 ml vs 99.0 +/- 88.7 ml), measured by gastric barostat. Half gastric emptying time (88.6 +/- 24.5 min vs 91.4 +/- 21.6 min) and retention rate at 120 min (32.8 +/- 17.8% vs 41.9 +/- 20.1%) were also similar between the two groups., Conclusion: H. pylori infection was not associated with gastric hypersensitivity to distention or delayed gastric emptying.

Background: Cardiovascular disease is a major health issue in Hong Kong. We conducted a screening program to assess the 10-year risk for the population and to assess the potential benefit of large-scale screening in Hong Kong., Method: A local screening program for cardiovascular risk was carried out in a health service network with a total of 17,716 participants. Retrospective data analysis for the prevalence and distribution of the various risk factors was performed. The data were then applied to calculate the 10-year risk of each individual, according to the European Task Force coronary risk chart., Results: Of the participants, 54.2% had total cholesterol levels > 5.2 mmol/l; 28.7% had body mass index > 25 kg/m2; 18.5% were hypertensive; 15.1% were smokers; and 3.7% had diabetes mellitus. There were 35.5% of the screened population who had at least two risk factors and 10.9% had at least three risk factors. A total of 9049 individuals satisfied the criteria for the European Task Force guidelines and were selected for 10-year cardiovascular risk analysis. We calculated that 68.0% of the male population had at least 10% risk and 41.5% had at least 20% risk of developing a coronary heart event within 10 years. Among women, 48.2% of the population carried at least 10% risk and 2.8% carried at least 20% risk., Conclusion: The calculated 10-year risk of the population, particularly for men, is significant. Our study demonstrated that mass screening is feasible, and has the benefit of early identification of high-risk individuals, which could be a reasonable strategy for cost-effective medicine.

Polarization of epithelial cells depends on a hierarchical process whereby specific membrane-associated proteins become targeted to specialized membrane domains. Here, we describe a novel Drosophila protein, Discs Lost (DLT), that plays a crucial role in the polarization of embryonic epithelia during cellular blastoderm formation. At subsequent stages of development, DLT interacts with the apical determinant Crumbs (CRB) and the laterally localized protein Neurexin IV (NRX IV). Mutations in dlt or double-stranded RNA interference lead to aberrant localization of CRB and NRX IV and cause a concomitant loss of epithelial cell polarity. Hence, DLT is required to establish and maintain cell polarity and participates in different molecular complexes that define apical and lateral membrane domains.

An early event in Drosophila eye development is the division of the eye disc into dorsoventral domains. The dorsoventral pattern is displayed in the adult compound eye as a distinct mirror symmetry across the dorsoventral midline or equator. The dorsoventral axis is also implicated in organizing early development of the eye, as retinal differentiation is initiated at the posterior dorsoventral midline. Here we show that Fringe is expressed specifically in the ventral half of the undifferentiated eye disc, thus creating a dorsoventral boundary. Ectopic Fringe borders that are generated by clones of fringe cells can reverse the planar polarity of photoreceptor clusters, indicating that the Fringe boundary is crucial for the induction of mirror symmetry. Lack of a Fringe boundary disrupts equatorial expression of Notch signalling proteins and causes a complete failure of eye development. Our results indicate that the formation of the Fringe boundary and subsequent Notch signalling at the equator are essential for organizing mirror symmetry and eye morphogenesis.

The Drosophila notum, the dorsal body wall of the thorax, is subdivided genetically into longitudinal domains (Calleja, M., Moreno, E., Pelaz, S. and Morata, G. (1996) Science 274, 252-255). Two homeobox genes clustered in the iroquois complex, araucan and caupolican, regulate proneural genes and are required for development of sensory bristles in the lateral notum (Gomez-Skarmeta, J. L., del Corral, R. D., de la Calle-Mustienes, E., Ferres-Marco, D. and Modolell, J. (1996) Cell 85, 95-105). An iroquois-related homeobox gene, mirror, was recently isolated and is localized close to the iroquois complex region (McNeil, H., Yang, C.-H., Brodsky, M., Ungos, J. and Simon, M. A. (1997) Genes and Development 11, 1073-1082; this study). We show that mirror is required for the formation of the alula and a subset of sensory bristles in the lateral domain of the notum. Genetic analysis suggests that mirror and the other iroquois genes interact to form the alula as well as the sensory organs. Based on similarities between mirror and the iroquois genes in their genetic map positions, expression, protein structure and function, mirror is considered a new member of the iroquois complex and is involved in prepatterning sensory precursor cells in the lateral notum.

In human in-vitro fertilization (IVF)-embryo transfer, the in-vitro culture environment differs from in-vivo conditions in that the oxygen concentration is higher, and in such conditions the mouse embryos show a higher concentration of reactive oxygen species (ROS) in simple culture media. ROS are believed to cause damage to cell membranes and DNA fragmentation in somatic cells. This study was conducted to ascertain the level of H2O2 concentration within embryos and the morphological features of cell damage induced by H2O2. A total of 62 human oocytes and embryos (31 fragmented, 15 non-fragmented embryos, 16 unfertilized oocytes) was obtained from the IVF-embryo transfer programme. The relative intensity of H2O2 concentrations within embryos was measured using 2',7'-dichlorodihydrofluorescein diacetate by Quanti cell 500 fluorescence imaging and DNA fragmentation was observed with transmission electron microscopy and an in-situ apoptosis detection kit. The H2O2 concentrations were significantly higher in fragmented embryos (72.21 +/- 9.62, mean +/- SEM) compared to non-fragmented embryos (31.30 +/- 3.50, P < 0.05) and unfertilized oocytes (30.75 +/- 2.67, P < 0.05). Apoptosis was observed only in fragmented embryos, and was absent in non-fragmented embryos. Electron microscopic findings confirmed apoptotic bodies and cytoplasmic condensation in the fragmented blastomeres. We conclude that there is a direct relationship between increased H2O2 concentration and apoptosis, and that further studies should be undertaken to confirm these findings.

Objectives: The pathogenesis of nonalcoholic fatty liver in non-obese persons is poorly understood. We aimed to elucidate whether hyperinsulinemia and glucose intolerance are associated with development of fatty liver in patients with normal body weight., Methods: Forty-seven patients with fatty liver were divided into non-obese (n = 25) and obese groups (n = 22) according to age adjusted body mass index. Inclusion criteria were as follows: (1) elevated transaminase levels during more than 3 months of follow up period, (2) no detectable HBsAg or anti-HCV in the serum, (3) alcohol consumption less than 40 gm/week, (4) no use of potential hepatotoxic drugs within 3 months and (4) sonographic evidence of fatty liver(moderate to severe degree). Baseline insulin levels and oral glucose tolerance test using 75gm of glucose were performed and the results were compared in each group of patients., Results: Mean baseline insulin levels were elevated in both groups above the reference value, 9.3 +/- 3.5 microU/L in non-obese group and 9.9 +/- 3.5 microU/L in obese group (p = 0.26). Seventeen of non-obese patients (68%) had elevated basal insulin level and 16 of obese patients (73%) had elevated basal insulin level (p = 0.39). In oral glucose tolerance test, there was no difference in glucose level between non-obese and obese groups from O minute to 180 minutes (p > 0.05). Eleven patients from the non-obese group (44%) and 8 patients from the obese group (36%) had either impaired glucose tolerance or diabetes (p = 0.29)., Conclusion: Our data suggest that hyperinsulinemia and glucose intolerance may play a role in the pathogenesis of fatty liver in patients with normal body weight as well as in patients with obesity.

Femoral anteversion is the inclination of the femoral neck axis with reference to the tangent plane of the distal femur. For estimating femoral anteversion, following three major parameters are required; the neck axis, the long axis, the knee axis. Conventional methods on the basis of 2D images are ambiguous to determine these major axes. As the femur has a complex 3 dimensional structure, the 3 dimensional model should be applied for accurate and reliable measurement of femoral anteversion. In this paper, we model femur and define three parameters. The neck axis is defined from the femoral head and neck model. The long axis is determined from the cylindrical model of the femoral shaft. The knee axis is also determined from the model of femoral condyles. According to the definition of the femoral anteversion, the femoral anteversion is efficiently estimated from these models. 30 specimens were tested by conventional 2D imaging method, 3D imaging method which was developed by authors and the new 3D modelling method. The study provides accurate, fast and human factor free measurement for femoral anteversion.

In an effort to develop transgenic plants resistant to diphenyl ether herbicides, we introduced the protoporphyrinogen oxidase (EC 1.3.3.4) gene of Bacillus subtilis into tobacco plants. The results from a Northern analysis and leaf disc assay indicate that the expression of the B. subtilis protoporphyrinogen oxidase gene under the cauliflower mosaic virus 35S promoter generated resistance to the diphenyl ether herbicide, oxyfluorfen, in transgenic tobacco plants.

To study the genetic variation of the HIV-1 strains prevalent in South Korea, we analyzed the nef sequences derived from 46 HIV-1-positive individuals living in various geographic regions in Korea. Phylogenetic analysis revealed four subtypes of HIV-1: A (3 patients), B (41 patients), D (1 patient), and a type that could not be clearly classified to any known subtype (1 patient). Thirty-five of the 41 Korean subtype B isolates formed a distinct monophyletic clade that is not related to any of the international sequences from the Los Alamos Database or GenBank as of June 1997. Indeed, the presence of unique conserved sequences was identified among the Korean isolates in this Korean subtype B group. The variations in the nucleotide sequences of a majority (32 of 35) subtype B samples within the Korean clade were 1.9% to 8.8%, and amino acid sequences varied from 3.9% to 15.5%. These results suggest that HIV-1 strains currently present in South Korea might have originated from a few sources or might be developing through a certain selective pressure. This is the first report on the molecular nature of the HIV-1 infection present in South Korea.

To develop an antiviral agent and virus-resistant plants, a cDNA clone encoding Phytolacca insularis antiviral protein (PIP) was isolated from a cDNA library constructed with poly(A)+ RNA purified from leaves of P. insularis. The PIP cDNA contains an open reading frame encoding 307 amino acids. The deduced amino acid sequence includes a putative signal sequence of 22 amino acids at the N-terminus. The amino acid sequence of PIP shares 84% homology with that of the pokeweed antiviral protein (PAP). In addition, the mature PIP exhibits the conserved putative active site found in other ribosome-inactivating proteins (RIPs). Recombinant PIP (rPIP) synthesized in Escherichia coli inhibits protein synthesis in vitro in rabbit reticulocyte lysate through the N-glycosidase activity in a similar manner with other RIPs. Local lesion assays with purified rPIP revealed that it inhibits infection of various viruses to plants. Transgenic potato plants expressing the PIP cDNA under the control of the cauliflower mosaic virus 35S promoter are resistant to viruses, such as potato virus X, potato virus Y, and potato leafroll virus. These results suggest that the PIP cDNA could be used for the development of an antiviral agent and transgenic plants resistant against a broad spectrum of plant viruses infecting through both mechanical and aphid transmission.

This is a summary of the research topics, of current interest, relating to digestive disease in Korea. This review is based on the subjects of the papers that were accepted for presentation at the 34th Annual Meeting of the Korean Society of Gastroenterology and the 39th Semiannual Meeting of the Korean Society of Gastrointestinal Endoscopy held November 22-24, 1995, in Seoul. The most popular topics were on Helicobacter pylori infection. These included experimental papers on the pathogenesis of bacteria-associated gastritis and the duodenal ulcer. Recently, the increase in the number of papers published on the motility of the gastrointestinal and pancreaticobiliary tracts is quite remarkable. Molecular genetic works on oncogenesis using cultured tumour cell lines, on the enzyme expression in the biopsied mucosal cells of the small intestine, and on the various expressions of viral genomes in the hepatocytes are among these recent topics of research. Clinical works, such as therapeutic endoscopy in malignant diseases and therapeutic trials in the hepatitis virus-associated chronic liver diseases are also popular topics.

Objectives: We compared the ability of preoperative abdominal computed tomography (CT) with that of preoperative abdominal ultrasonography (US) in predicting the extent of tumor growth and the curative resectability of gastric cancer., Methods: Abdominal CT and US were done in 95 patients with gastric adeno-carcinoma. The radiologic findings were prospectively compared with surgical and pathologic findings., Results: The sensitivities of abdominal CT and US in detecting the perigastric lymph node involvement were 26.6% and 20%, respectively. The sensitivity of abdominal CT in predicting the pancreatic invasion (60%) was better than that of abdominal US (20%). However, there were 6 false positive diagnosis of pancreatic invasion by abdominal CT; in contrast, there was no false positive diagnosis of pancreatic invasion by abdominal US. Of 95 patients who underwent surgical exploration, 14 were found to have unresectable tumors because of extragastric organ involvement and distant metastases. Abdominal CT falsely predicted 8 of 14 cases in which curative gastric resection was impossible as resectable. Moreover, abdominal CT falsely predicted 5 of 81 cases in which curative gastric resection was possible as unresectable. Abdominal US falsely predicted 12 of 14 cases in which curative surgery was impossible as resectable., Conclusion: Preoperative abdominal Ct and US did not accurately predict the tumor extent and the curative resectability of the gastric cancer. Especially, abdominal CT finding of pancreatic invasion by gastric cancer should not be a contraindication for surgical exploration.

We analyzed the incidence, clinical features, and the long-term sequelae of arthropathy in 84 patients with Behçet's disease. After a mean disease duration of 44.7 months, 59 patients (70%) had at least 1 episode of arthropathy. Of these, arthropathy was present at the time of diagnosis in the majority of patients (75%). In the remainder, arthropathy developed 4 to 80 months (mean 29) after the diagnosis of Behçet's disease. Female patients were significantly more likely to have arthropathy than male patients (89 versus 56%, p = 0.006). The pattern of involvement was oligoarticular in 75%, monoarticular in 23%, and polyarticular in 2% of these patients. The most commonly involved site was the knee, followed by the ankle and the wrist. Radiologic examination of the involved site was normal in 80% of the patients. After a mean duration of arthropathy of 43.2 months, by the American College of Rheumatology (ACR) criteria, the functional class of the arthropathy was I-II in 88%, and III-IV in 12%. In conclusion arthropathy is a fairly common manifestation in patients with Behçet's disease, but crippling arthritis is relatively rare.

Intraductal papillary neoplasm associated with mucinous ductal ectasia is an uncommon cystic disease of the pancreas. This tumor is characterized by the multilocular cyst lined by mucin producing cells with variable degrees of atypia and ductal ectasia. In addition, this tumor has a favorable prognosis in contrast to other mucinous cystic tumor of the pancreas. Reports on intraductal mucin producing tumor are quite limited and most of them are found in Japanese literature. We report a case of intraductal papillary adenocarcinoma with marked dilatation of the pancreatic duct filled with mucin in a 72-year-old female patient.

In each facet of the Drosophila compound eye, a cluster of photoreceptor cells assumes an asymmetric trapezoidal pattern. These clusters have opposite orientations above and below an equator, showing global dorsoventral mirror symmetry. However, in the mutant spiny legs, the polarization of each cluster appears to be random, so that no equator is evident. The apparent lack of an equator suggests that spiny legs+ may be involved in the establishment of global dorsoventral identity that might be essential for proper polarization of the photoreceptor clusters. Alternatively, a global dorsoventral pattern could be present, but spiny legs+ may be required for local polarization of individual clusters. Using an enhancer trap strain in which white+ gene expression is restricted to the dorsal field, we show that white+ expression in spiny legs correctly respects dorsoventral position even in facets with inappropriate polarizations; the dorsoventral boundary is indeed present, whereas the mechanism for polarization is perturbed. It is suggested that the boundary is established before the action of spiny legs+ by an independent mechanism.

We investigated the performance of a double-antigen sandwich recombinant enzyme immunoassay (EIA; Abbott Laboratories, North Chicago, Ill.) and compared it with that of a synthetic-peptide-based EIA (Biochem Immunosystems, Montreal, Quebec, Canada) for the detection of human immunodeficiency type 1 (HIV-1) and HIV-2 antibodies in 2,321 clinical serum samples. The results of both EIA methods and Western blot (immunoblot) were in agreement for 1,046 HIV-1 and 10 HIV-2 specimens from a panel of known positives. From a prospective panel of 1,085 specimens, 38 proved to be positive by both EIAs and Western blot, 3 were positive by the recombinant EIA only, and 9 were positive by the peptide EIA only, for calculated specificities of 99.71 and 99.04%, respectively. Of 180 specimens from a seroconversion panel collected from 77 patients, the results for 170 were in agreement by all antibody testing methods and 10 were found to be repeat reactive for HIV antibodies by the recombinant EIA only. All 10 were initial specimens of seroconverting patients; 7 were also reactive for HIV p24 antigen. An examination of four of these sera by radioimmunoprecipitation assay showed gp120 and gp160 bands in each. Analysis of the anti-Env antibody class in three of these samples showed that one consisted of immunoglobulin M (IgM) only and two contained both IgG and IgM antibodies. Although both EIA procedures were sensitive and specific in the detection of antibodies to HIV-1 and HIV-2 and both were capable of detecting early antibodies, the recombinant assay was more sensitive for antibody detection during early seroconversion.

Recent analyses have shed light on the roles of genes involved in early events of eye cell determination and the spatiotemporal control of differentiation within the eye field. These genes function at sequential steps in the programming, initiation, or progression of differentiation, highlighting an elegant orchestration of gene activities to achieve this striking developmental event. Progress has been made in the study of the coordination between cell cycle control and cell differentiation, as well as in the genetic control of morphogenetic movements within the developing eye disc.

One hundred thirty-one strains of Streptococcus pneumoniae isolated from clinical specimens between January 1991 and April 1993 were serotyped and tested for susceptibility to 10 antimicrobials by the agar dilution method. Five serotypes (6A, 6B, 14, 19F, and 23F) accounted for 67% of all isolates. Seventy percent of isolates were not susceptible to penicillin, exhibiting either intermediate resistance (37%) or high-level resistance (33%); 82% of isolates from children and 59% of those from normally sterile body fluids were resistant to penicillin. A significantly increased rate of penicillin resistance (P < .01, Fisher's exact or chi 2 test) was associated with hospitalization, an age of < or = 15 years, ongoing antimicrobial therapy at the time of isolation of the organism, nosocomial acquisition, and several specific serotypes (6, 14, 19F, and 23F). No penicillin-resistant strain showed beta-lactamase activity. Various proportions of the penicillin-resistant strains also displayed resistance to cefaclor (89%), cefotaxime (82%), chloramphenicol (65%), erythromycin (52%), and ciprofloxacin (15%), but none was resistant to teicoplanin or vancomycin. The prevalence of pneumococcal resistance documented in Korea in this study is among the highest figures published to date.

The authors conducted a retrospective review of 234 bone scans of stomach cancer patients who had been diagnosed at the Seoul National University Hospital. In 106 of the 234 cases (45.3%), there were abnormal bone scan results, suggestive of bone metastases. The most common site of bone metastases was the spine, followed by the ribs, pelvis, femur, and skull. These sites were similar to those known for other malignant diseases. The incidence of bone metastases increased according to the duration of disease, especially within 12 months after diagnosis in patients with stage III gastric cancer. The incidence of bone metastases increased as the clinical stage increased. However, the incidence of metastases did not relate to gastric cancer pathologic type. The authors found 6 cases of "superscan" in the 234 bone scans (2.6%). The bone scan findings correlated positively with the level of serum alkaline phosphatase.

The Drosophila eye consists of a reiterative hexagonal array of photoreceptor cell clusters, the ommatidia. During normal morphogenesis, the clusters in the dorsal or ventral halves of the disc rotate 90 degrees in opposite directions, forming mirror images across a dorsoventral equator. In the mutant nemo (nmo), there is an initial turning of approximately 45 degrees, but further rotation is blocked. Genetic mosaic analysis indicates that the nmo gene acts upon each cluster as a whole; normal nmo function in one or more photoreceptor cells appears to be sufficient to induce full rotation. The nmo gene sequence encodes a serine/threonine protein kinase homolog, suggesting that the kinase is required to initiate the second step of rotation. In another mutant, roulette, excessive rotation through varying angles occurs in many ommatidia. This defect is suppressed by nmo, indicating that nmo acts upstream in a rotation-regulating pathway.

The efficacy of the proton pump inhibitor omeprazole, 20 mg every morning, was compared with that of the H2-receptor antagonist ranitidine, 150 mg every morning and at bedtime, in a double-blind randomized parallel group study in 250 patients with gastric or prepyloric ulcers. At both 4 and 8 weeks, significantly more patients had healed ulcers in the omeprazole group than the ranitidine group, whether the results were analysed on a per-protocol or an intention-to-treat basis. At 4 weeks, 74% of patients in the omeprazole group were healed compared with 51% in the ranitidine group (P = 0.001), and at 8 weeks the corresponding values were 99 and 82% (P = 0.001, per-protocol cohort). Omeprazole treatment and small ulcer size significantly increased the probability of healing, but smoking had no significant effect. Patients in the omeprazole group had significantly fewer occurrences of daytime epigastric pain during the first 4 weeks than the ranitidine group (P = 0.0037), as shown by their diary cards. Both treatments were well tolerated.

We have identified a set of retinal basal glia, designated RBG cells, in the axon layer of the developing Drosophila eye disc. In vivo pulse labeling with bromodeoxyuridine shows that these cells originate in the optic stalk and migrate into the disc. In mutants lacking photoreceptor axons, RBG cells accumulate in the optic stalk, but do not invade the disc. The association of RBG cells with photoreceptor axons, their origin in the optic stalk, and their migration into the retina are in common with the behavior of astrocytes in the developing mammalian retina.

CEA-79 is a murine IgG2a type monoclonal antibody (MoAb) generated using purified CEA from culture supernatants of a human colon cancer cell line, LS174T. The association constant and immunoreactivity of the I-131 labeled CEA-79 ranged from 2.0 to 3.2 x 10(9) l/mole, and from 54 to 74%, respectively. The purpose of this study was to evaluate the feasibility of radioimmunoscintigraphy employing MoAb CEA-79 in patients with advanced gastrointestinal carcinomas. Two mgs of MoAb CEA-79 was labeled with 111 MBq (3 mCi) of I-131, and infused intravenously in 6 stomach cancer and 16 colon cancer patients. Out of 6 patients with stomach cancer, immunoscintigraphy was able to detect the tumors in 4 cases. However, immunoscintigraphy found out tumors in all patients with colon cancer. Moreover, 1 patient with stomach cancer and 2 patients with colon cancer showed increased uptake of MoAb in the tumor lesions despite normal serum levels of CEA. We could conclude that this antibody has a potential as a new imaging agent for the diagnosis of gastrointestinal carcinoma.

Gastric cancer has been recognized as an extracolonic manifestation in patients with familial adenomatous polyposis (FAP). In Korea, gastric cancer is the most common malignant neoplasm. In a recent survey, we collected data from 72 Korean patients with FAP. Among them, three (4.2 percent) were found to have associated gastric cancer. This incidence of gastric cancer in our series is much higher than the previous reports from Japan and other countries. The expected cumulative incidence of gastric cancer among these 72 patients was 0.44, which gives the standardized incidence ratio of 6.9 (95 percent CI, 1.4-20.1). This difference in incidence of gastric cancer was statistically significant (P less than 0.05), which implies that patients with FAP are at significantly higher risk of developing gastric cancer compared with the general population in Korea. These findings confirm an increased risk of gastric cancer in FAP patients, even in a region where gastric cancer is highly prevalent.

The intestinal lesion of Behçet's colitis shows aphthoid or punched-out ulceration. However, the diagnosis of Behçet's colitis should be based on the presence of other stigmata of Behçet's syndrome, since these morphological characteristics are not pathognomonic by themselves. Furthermore, the stigmata of Behçet's syndrome could appear simultaneously or separately with intervals of several months to years. Besides, when a physician first meets patients with intestinal ulcerations of aphthoid or punched-out shape, if they do not have any stigma of Behçet's syndrome, the physician has some difficulty in making a diagnosis of Behçet's colitis. The purpose of this retrospective study was to investigate the followings: 1) The upgrade in clinical type of Behçet's colitis with the advance of time. 2) What portion of the patients with aphthoid or punched-out ulcerations, but without any other clinical feature of Behçet's syndrome, could be diagnosed as Behçet's colitis with the advance of time? During the mean follow-up period of 38.2 months, 4 (22.2%) out of 18 patients with Behçet's colitis upgraded their clinical types. In the nonspecific ileocolitis group, who had no major stigma of Behçet's syndrome on their initial visit, 3 (30%) out of 10 patients were subsequently diagnosed as Behçet's colitis during the mean follow-up period of 33.3 months. From these results, we could conclude that in possible or suspicious cases of Behçet's colitis, a more confident diagnosis could be made by close observations for new developments of major stigma of Behçet's syndrome. Even in cases of nonspecific ileocolitis, the diagnosis of Behçet's colitis could be made in a significant number of cases as time goes by.

Amebic colitis is a disease revealing diverse clinical manifestations and endoscopic gross features and often confused with other types of colitis. In case of misdiagnosis as an idiopathic inflammatory bowel disease or delayed recognition of intestinal amebiasis, an undesirable outcome may occur resulting from erroneous administration of steroids or delayed antiamebic treatment. To demonstrate the pitfalls in the diagnosis and treatment of intestinal amebiasis, 3 cases of amebic colitis with atypical clinical manifestations are presented in this paper. In conclusion, despite the low sensitivities of routine stool examination for parasite and histopathologic confirmation in biopsy specimen, every effort must be made to find amebic trophozoites either in fresh stool or biopsy specimens for prompt and correct diagnosis of amebic colitis when we manage patients with chronic intestinal ulcerations, even though their clinical course and endoscopic findings are not typical of amebiasis. Moreover, following initial successful anti-amebic therapy, more careful clinical, endoscopical, and parasitological follow-up should be done for the early detection of recurrence.

The Drosophila mutant turnip was initially isolated based on poor learning performance (Quinn, W.G., Sziber, P.P., and Booker, R. (1979) Nature 277, 212-214). Here we show that turnip is dramatically reduced in protein kinase C (PKC) activity. In addition, turnip flies are deficient in phosphorylation of a 76-kDa head membrane protein (hereafter pp76) which is a major substrate for protein kinase C in homogenates of wild-type flies. Reduced PKC activity, defective pp76 phosphorylation, and most of turnip's learning deficiency co-map genetically to a region on the X-chromosome, 18A5-18D1-2, spanned by the deletion Df(1)JA27. Apparently turnip+ is not a structural gene for PKC because Drosophila PKC genes map elsewhere in the genome. Our results suggest that turnip gene product is required for activation of PKC and that PKC plays a role in associative learning in Drosophila.

A 38-year-old man was admitted with a high fever, sore throat, and right upper quadrant pain. Nine months before his admission, he had undergone right hemicolectomy under the impression of intestinal lymphoma. But there had been no evidence of lymphoma on microscopic examination. Under the postoperative diagnosis of inflammatory bowel disease, corticosteroid therapy was tried without response. On the follow-up colonoscopic examination, an ovoid ulcer, with convergence of the surrounding mucosal folds at the descending colon and an irregularly shaped ulcer at the ileocolic anastomotic site, were found. The colonoscopic diagnosis was Behcet's colitis. After pathologic slides of biopsy and surgical specimens obtained from the palatine tonsil and colon were reviewed, the diagnosis of polymorphic reticulosis was made. The patient received anticancer chemotherapy, including cyclophophamide and glucocorticosteroid. To date, colonic involvement of polymorphic reticulosis has not been reported. Because of the similarity of the colonoscopic findings to those of Behcet's colitis, polymorphic reticulosis should be included in the differential diagnosis of inflammatory bowel disease. We assume that this is the first case of polymorphic reticulosis involving the colon with characteristic colonoscopic findings.

The healing efficacy of omeprazole was assessed in 57 Korean patients with endoscopically-proven gastric (GU) and/or prepyloric (PPU) ulcers of at least 5 mm diameter. Fifty-three patients presented with GU, two with PPU and two with both types of ulcer. The maximum ulcer diameter was 5-10 mm in 27 patients and greater than 10 mm in 30 patients. All patients received 20 mg of omeprazole each morning for 4-8 weeks depending on ulcer healing. Ulcer healing rates were comparable using both 'intention to treat' (IT) and 'per protocol' (PP) analyses. Following the IT approach 82% (47 of 57) of patients were healed at 4 weeks and 98% (56 of 57) at 8 weeks. Following the PP approach, the corresponding healing rates were 83% (44 of 53) and 98% (55 of 56), respectively. Smoking was found to have a significant effect on ulcer healing at 4 weeks (P = 0.03), with 96% (26 of 27) of non/occasional smokers healed versus only 69% (18 of 26) of daily/heavy smokers. Ulcer size did not have a significant effect on healing, however. Ulcer symptoms, reported by all patients at entry, disappeared rapidly after commencement of omeprazole therapy. Only four patients reported mild symptoms at 4 weeks and no symptoms were reported at 8 weeks. No clinically significant changes in haematology or clinical chemistry (other than a rise in leucocytes in one patient) and no serious adverse events were observed. In conclusion, omeprazole 20 mg each morning was found to be safe and highly effective for treatment of gastric and prepyloric ulcer in Korean patients, producing a 98% healing rate. Symptom relief was rapid and the drug was well tolerated.

The effect of dietary fat, energy restriction, and exercise on N-nitrosomethylurea (NMU:CAS:684-93-5)-induced mammary tumorigenesis in female F344 rats was investigated. Rats were fed the NIH-07 diet until N-nitrosomethylurea administration on Day 50 of age, when they were transferred to six treatment groups. Three sedentary groups were fed either high-fat (20%, w/w), medium-fat (10%), or low-fat (5%) diets ad libitum (HFAL, MFAL, LFAL, respectively); two sedentary groups were fed high fat and medium fat diets restricted to 75% of the food consumed by their ad libitum counterparts (HFR, MFR), and one group was fed a HFAL diet but allowed free access to an activity wheel (HFEX). Tumor yields among the three ad libitum sedentary groups were significantly greater in the HFAL and MFAL groups when compared to the LFAL group. Dietary restriction reduced tumor yields by more than 90% of ad libitum controls regardless of fat intake. Voluntary exercise reduced tumor yields and delayed time of tumor appearance in HFEX animals to levels similar to those found in LFAL animals. Animals with voluntary access to exercise wheels averaged between 1.03 and 2.85 miles/day, consumed more food (+18%), and exhibited greater weight gain (+13%) than their sedentary counterparts. Restricted animals exhibited significantly decreased body weight gains (-15%) compared to their ad libitum counterparts, but no differences in weight gains were detected among the HFAL, MFAL, and LFAL groups, despite widely varying amounts of fat intake. Body composition studies indicated that body fat content was not influenced by the quantity of fat consumed in the diet, but was significantly reduced by caloric restriction (-20 to 26%) and exercise (-20%). While the precise mechanisms underlying the tumor-promoting effects of HFAL diets and the antipromoting effects of energy restriction and exercise remain to be elucidated, available evidence suggests that these effects are not due to alterations in energy homeostasis per se, but may instead be exerted indirectly, and perhaps independently via endocrine, paracrine, or neurohormonal mechanisms.

Two lymphocytoid cell lines have been established from a patient with the Lesch-Nyhan syndrome. The cells are deficient in hypoxanthine-guanine phosphoribosyltransferase, as demonstrated by their failure to incorporate [H(3)]hypoxanthine and by their inability to grow in medium in which they were nutritionally dependent upon exogenous hypoxanthine. This represents the first establishment of presumptively permanent human lymphocytoid cell lines that are deficient in a specific enzyme.

The chromosomes of leucocytes cultured from the peripheral blood of 49 primitive Yanomama Indians of Venezuela were studied to determine the types and frequencies of aberrations in a human population not exposed to the same exogenous agents as civilized man. In all but one instance, 100 cells per individual were scored. In 13 cases, we found one or more cells with multiple complex breaks and rearrangements, represented by tetracentric, tricentric, and numerous dicentric chromosomes. From the standpoint of chromosomal damage, these cells are among the most abnormal cells yet described in vivo in man, and were not seen in the controls. There was also a higher than expected frequency of cells with an isolated structural aberration in both Indians and controls. This may be the result of a 24- to 48-hour delay in the initiation of culture. The cause of the more extensive damage to some cells remains to be determined.

Immunoglobulin production was studied in established lines of normal human lymphocytes. Three lines which produced both immunoglobulin G and immunoglobulin M were cloned. Among the 25 immunoglobulin-producing clones, 23 produced both classes of immunoglobulins. These findings suggest that the phenomenon of genic exclusion does not hold for immunoglobulin production in lymphocytoid cells in culture.