Expression of differential nitric oxide synthase isoforms in human normal gastric mucosa and gastric cancer tissue

The present study investigated the expression and distribution of three isoforms of nitric oxide synthase (NOS) in different anatomical regions of the human stomach and in gastric neoplastic tissues by immunohistochemistry using specific antibodies. Intracellular localization of individual isoenzymes of NOS was detected in normal gastric mucosa. Gastric cancer tissues had a marked reduction of all three NOS isoforms expression. The expression of the endothelial NOS, neuronal NOS and inducible NOS in the tumor tissue was significantly lower than in normal gastric mucosa (P = 0.01, P = 0.02, P < 0.01, respectively). In the tumor tissue the expression of inducible NOS was significantly lower than the expression of both constitutive forms of NOS (P < 0.01). There was a tendency to higher expression of both constitutive forms of NOS in earlier stages T2 of the tumor compared to advanced T4 tumor. In contrast, the expression of inducible NOS was higher than in the advanced T4 tumor than in the earlier stages T2 of the tumor. The mapping of the expression of endothelial NOS, neuronal NOS and inducible NOS in human stomach showed higher expression of NOS isoforms in the distal third than in the proximal third of the stomach (P = 0.03, P = 0.04, P = 0.01, respectively). We conclude that there is greater expression of NOS in the stomach corpus and in antrum than in the proximal third of the normal human stomach mirroring the anatomical predilection of common pathological changes in this part of the human stomach. Furthermore, there was loss of the expression of individual isoenzymes in gastric neoplasms.      

Langerhans' cell histiocytosis with thyroid involvement masquerading as thyroid carcinoma

A 28-year-old woman was admitted to our Hospital with a chief complaint of progressive gingival swelling and loosening of teeth over about a year. According to past history, she had received total thyroidectomy 2 years previously due to thyromegaly. The thyroidectomy specimen was at first interpreted as 'poorly differentiated carcinoma of the thyroid'. One year ago, she began to be aware of gingival swelling and loosening of teeth. A gum biopsy was taken and the pathologic features were similar to her 'thyroid carcinoma'. Subsequent investigations, including immunohistochemical stain, showed the gum was heavily infiltrated with histiocyte-like Langerhans' cells which were positive for S-100 protein. Ultrastructural examination of the cells under electron microscope revealed many typical intra-cytoplasmic Birbeck granules. Langerhans' cell histiocytosis was diagnosed. Langerhans' cell histiocytosis with thyroid involvement is extremely rare and may run a relatively indolent course. Even on a retrospective examination, it may easily be confused with poorly differentiated carcinoma of the thyroid. We suspect that this error may have been made on other occasions and that the occurrence of this condition may be underreported.      

HIV infection in haemophilia--a European cohort

Ten haemophilia centres in northern Europe have pooled data on 202 haemophilic children who were infected with HIV between 1979 and 1986. All cases were under 16 years of age on 1 July 1985. The age at infection ranged from 1-15 years. Thirty seven cases (18%) had progressed to AIDS by 1 July 1991 and 15 of these have died. Persistent generalised lymphadenopathy has been noted in 102 patients of whom 18 (17%) have developed AIDS. Twenty three of the remaining patients (23%) have not. CD4+ T cell counts have fallen steadily. Of 36 patients who have had shingles since seroconversion, 19 (53%) had counts below 0.2 x 10(9)/l. Thirty five out of 145 patients without shingles (24%) had similar values. The mean IgA concentration in patients with CD4+ T cell counts above 0.5 x 10(9)/l was 2.38 g/l, between 0.2 and 0.5 was 3.07 g/l, and in those with CD4+ T cell counts below 0.2 x 10(9)/l the mean IgA concentration was 4.58 g/l. Treatment patterns have altered between 1989 and 1991, with increased use of zidovudine in patients without AIDS and a marked increase in primary prophylaxis against pneumocystis pneumonia. This has been associated with a decline in the incidence of pneumocystis as an indicator disease in new AIDS cases from 56% in 1989 to 20% in 1991. These observations indicate that persistent generalised lymphadenopathy does not worsen the outlook, but shingles does. Rising IgA concentrations are markers for disease progression. Modern prophylactic regimens are delaying the onset of indicator disease, but CD4 values continue to fall steadily.     

Obstructed right pulmonary venous drainage and ipsilateral lung hypoplasia.

A case of right lung hypoplasia and dyspnea, presented at our institution for cardiac evaluation, is described. Clinical evaluation and instrumental findings of normally connected but completely obstructed right pulmonary venous drainage have led us to diagnose an exceptional variant of subtotal cor triatriatum. Differential diagnosis was mainly carried out between pulmonary venous anomalies and drainage obstructions. Symptom relief was obtained with surgical excision of the atrial dividing membrane.     

Nystagmus testing in intoxicated individuals.

BACKGROUND: Law enforcement officers routinely conduct psychophysical tests to determine if an impaired driver may be intoxicated or in need of medical assistance. Testing includes assessment of eye movements, using the Horizontal Gaze Nystagmus (HGN) and Vertical Gaze Nystagmus (VGN) tests, which are conducted at roadside by patrol officers. These tests previously have been validated when the subject is placed in a standing posture with head upright. However, certain conditions require that the subject be tested while seated or supine. Under these conditions, Positional Alcohol Nystagmus (PAN) could be induced and mistaken for HGN or VGN. METHODS: The study was conducted at law enforcement training academy alcohol workshops in the Pacific Northwest. Ninety-six volunteer drinkers were tested when sober and three times after drinking alcohol by 40 volunteer officers experienced in administering the tests. Blood alcohol concentration (BAC) was measured objectively with a calibrated breath analysis instrument each time a subject was tested. RESULTS: The number of eye movement signs observed during the HGN test at any posture increases with increasing BAC. The presence of VGN at any test posture occurs only in the presence of signs of HGN and only at high levels of impairment. PAN was most often observed at BACs of 0.08% and higher, but was never confused with the observation of HGN or VGN, regardless of test posture. CONCLUSIONS: The HGN test administered in the standing, seated, and supine postures is able to discriminate impairment at criterion BACs of 0.08% and 0.10%. The VGN test can identify high levels of impairment at any test posture. Therefore, these tests can be used by an officer to determine if a driver is impaired, regardless of whether the driver is standing, seated, or supine.