LONG‐TERM FOLLOW UP OF PATIENTS WITH SMALL GASTROINTESTINAL STROMAL TUMORS IN THE STOMACH USING ENDOSCOPIC ULTRASONOGRAPHY‐GUIDED FINE‐NEEDLE ASPIRATION BIOPSY

Background: Gastrointestinal stromal tumors (GIST) are one of the most common mesenchymal tumors of the gastrointestinal tract. GIST are defined by positive immunohistochemical staining for KIT or CD34 and thus are generally diagnosed after surgery. Because small GIST are rarely diagnosed before surgery, the clinical course of these small tumors is not clear. The aim of the present study was to follow changes in size and configuration of small GIST that were pathologically confirmed using endoscopic ultrasonography‐guided fine‐needle aspiration biopsy (EUS‐FNAB). Methods: Between July 1997 and December 2003, 16 tumors in 16 patients (10 men and 6 women) with an immunohistochemical diagnosis of GIST were regularly followed in our hospital. The median patient age when EUS‐FNAB was performed was 62 years (range 26–82 years) and the median follow‐up period was 4.9 years (range 0.5–9.6 years). Results: Fourteen tumors showed no remarkable changes in size and shape during follow up compared with the initial diagnosis. Two tumors enlarged: one tumor approximately doubled its diameter in 8 years and the other tumor increased from 1.8 cm at diagnosis to up to 10 cm after only 2 years. Doubling time of the latter tumor was calculated as 3.1 months. Conclusions: We conclude that EUS‐FNAB might be a good modality for final diagnosis of GIST without surgery, and that GIST without rapid growth on follow up can be endoscopically followed.     

Development of a Novel Scale to Assess Life Fulfilment as Part of the Further Refinement of a Quality-of-Life Model for Epilepsy

Summary: We have been involved in developing a health-related quality-of-life model for use as an outcome measure in epilepsy. As part of the further development of this model, we have developed a measure of life fulfilment. This scale is based on methods previously described by Krupinski in 1980. The value of Krupinski's approach is the opportunity for patients to weight the numerous aspects of their quality of life and assess the discrepancy between their actual and desired circumstances. The life fulfilment scale has been shown to be reliable (α= 0.7) and valid. The scale is currently being applied to several clinical studies in epilepsy. We believe that the scale provides a valuable contribution to our health-related quality-of-life model.     

The pathogenesis of rat virus infection in infant and juvenile rats after oronasal inoculation

Summary The pathogenesis of rat virus (RV) infection was studied in random-bred Sprague-Dawley rats after oronasal inoculation of a recent RV isolate designated RV-Yale (RV-Y). RV-Y was pathogenic for rats inoculated as infants (2 days) whereas rats inoculated as juveniles (4 weeks) had asymptomatic infection and no lesions. Rats inoculated as infants developed pantropic infection accompanied by hepatic necrosis, granuloprival cerebellar hypoplasia and hemorrhagic encephalopathy. Virological and serological studies showed that virus could persist in inoculated rats for at least 35 days and for at least 28 days after seroconversion was first detected. Immuno-histochemical results indicated that RV-Y infects tissues conducive to virus excretion including kidney and lung. RV-Y also was found in genital tissues of some rats. Athymic juvenile rats inoculated intraperitoneally with RV-Y had a poor humoral immune response and harbored infectious virus for at least 3 weeks, whereas infection in euthymic control rats was detected for 1 week. These studies indicate that RV-Y can persists in the presence of humoral immunity and suggest that transmission of infection could occur for a substantial period after seroconversion. They also suggest that immunodeficient rats have increased susceptibility to persistent infection.     

Immune complexes in early arthritis. L Detection of immune complexes before rheumatoid arthritis is definite

Fifty-three patients with early arthritis were studied longitudinally for up to 3 years. During this time, 24 developed sufficient features for definite rheumatoid arthritis (RA) to be diagnosed. The other (arthralgia patients) differed from the RA patients as, in the majority, C-reactive protein and ESR were normal and anti-nuclear antibodies or rheumatoid factors were rarely found. Moreover, in time their signs and symptoms improved or disappeared. Circulating immune complexes were detected in both groups of patients by the platelet aggregation test whereas complexes detected by abnormal Clq-binding activity were found mainly in the RA patients. Platelet-aggregating complexes were usually present in the first samples studied and disappeared in the arthralgia patients with recovery from their symptoms. In the RA patients, Clq-binding complexes appeared simultaneously or later than platelet-aggregating complexes but both tests were positive several months before RA could be diagnosed. These results suggest that immune complexes are one of the first immunological abnormalities to appear in patients with arthritis. Although the constituent antigen and antibody of complexes detected by either test are unknown, their possible nature is discussed.     

Transmissible ileal hyperplasia of hamsters. II. Ultrastructure.

The ultrastructure of developing ileal lesions was characterized in weanling hamsters with experimentally induced transmissible ileal hyperplasia (TIH). The primary lesion was mucosal hyperplasia with progressive replacement of mature villus columnar absorptive cells by undifferentiated crypt-type cells. The undifferentiated, mitotically active cells expanded onto villus walls from their normal location in crypts by Day 10 and reached villus tips by Day 14. Aggregates of slightly curved, 0.3 X 1.5 mu, rod-shaped bacteria were detected in the apical cytoplasm of crypt epithelium by Day ;. They replicated intracellularly and accumulated in progressively greater numbers in hyperplastic cells. Active penetration of cells by intralumenal bacteria was not seen. The appearance and distribution of TIH-associated antigen, demonstrated by indirect immunofluorescence, was identical to that observed for intracellular bacteria. Hyperplastic, bacteria-laden crypt epithelium penetrated adjacent supporting tissues. Dilated crypts with flattened epithelium ruptured and released organisms into surrounding tissues. Pyogranulomatous inflammation began at 17 to 25 days and preceded or accompanied penetration of the muscle layers by expanding crypts. Macrophages and neutrophils in inflammatory lesions contained many phagocytized bacteria. In some advanced lesions mature, bacteria-free absorptive cells and goblet cells reappeared. These observations support the hypothesis that intestinal bacteria cause TIH.     

Expression of a novel combination of fast and slow troponin T isoforms in rabbit extraocular muscles

Summary The properties of extraocular muscles (EOMs) are quite different from those of the trunk and limb. Here we show that there is a novel pattern of troponin T (TnT) expression in EOMs which most likely contributes to the fine control of ocular movement and may reflect their innervation by cranial motoneurons. Three regions of the muscle were analysed to distinguish the TnT isoforms present in the fast singly-innervated fibres from those in the multiply-innervated fibres. More than 95% of the TnT in the singly-innervated fibres is TnT_3f, which exhibits the most graded response to changes in calcium concentration during activation (Schachatet al., J. molec. Biol. 198, 551–4). In multiply-innervated fibres, which exhibit tonic contractures, the slow troponin T TnT_2s is expressed. While neither TnT_3f nor TnT_2s is unique to EOM, this pattern is unusual in two respects: first, both TnT_3f and TnT_2s are minor components of the trunk and limb musculature, and second, most muscles express several fast and both slow TnT species. Although EOM occupies a highly specialized physiological niche, its unusual physiology is not reflected in the presence of new TnT isoforms but in the expression of a different ratio of the known species of TnT.     

A pilot study of erythrocyte choline flux and content in affective disorders

Choline influx and choline content were measured in healthy volunteers (N = 36), patients with unipolar affective disorder (N = 28), and bipolar patients before and during treatment with lithium (N = 14, N = 13 respectively). Erythrocyte choline content was not found to be significantly elevated in any of the groups studied, except in patients taking lithium. Choline influx into the erythrocytes of healthy controls was found to decrease with increasing age, while choline influx into lithiated erythrocytes increased with increasing age in patients. An inverse relationship between erythrocyte choline influx and content was found to exist only in the erythrocytes of elderly healthy volunteers (greater than or equal to 60 years old).