Role of Cyclooxygenase-2 (COX-2) and Peroxisome Proliferator-Activated Receptor (PPAR) in Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: Gastric cancer is still the most frequently diagnosed malignancy in Korea. It has been reported that COX-2 and PPAR are involved in multi-step gastric carcinogenesis. The aim of the present study was to examine the expression of COX-2 and PPAR in gastric cancer. METHODS: A total of 75 subjects including 45 patients with gastric cancer and 30 controls were enrolled. All subjects underwent upper gastrointestinal endoscopic examination with tissue collection. mRNA extraction from the tissues and real-time PCR for COX-2, PPAR-delta, and PPAR-gamma were performed. Gastric mucosal concentration of PGE2, which is a final product of COX-2, and 15d-PGJ2, which is a ligand of PPAR-gamma, were measured by the enzyme immunoassay method. RESULTS: COX-2 mRNA expression was significantly higher in both early gastric cancer tissues (EGC, 8.32 +/- 4.84 micro gram/micro L, p<0.005) and advanced gastric cancer tissues (AGC, 8.16 +/- 2.67 micro gram/micro L, p<0.001) than in non-cancerous tissues of controls (3.46 +/- 1.72 micro gram/micro L). There was no significant difference of PPAR-delta and PPAR-gamma mRNA expression between gastric cancer tissues and controls. Mucosal PGE2 concentration was significantly higher in both EGC tissues (5.31 +/- 0.49 micro gram/mg protein, p<0.001) and AGC tissues (5.46 +/- 0.54 micro gram/mg protein, p<0.001) than in non-cancerous tissues of controls (4.22 +/- 0.8 micro gram/mg protein). There was no significant difference of 15d-PGJ2 concentration between gastric cancer tissues and controls. CONCLUSIONS: COX-2 overexpression and increased PGE2 concentration in gastric tissues may play an important role in gastric carcinogenesis. However, the role of PPAR (delta and gamma) and 15d-PGJ2 in gastric carcinogenesis is uncertain. Further studies are needed.

Efficacy of Infect ion Control Strategie sfor Vancomycin: Resistant Enterococci in a Tertiary Care Hospital / 감염

BACKGROUND: Vancomycin-resistant enterococci (VRE) have become one of the important nosocomial pathogens. VRE infections are difficult to treat because few antibiotics are effective currently. Since 1998, VRE have been increasingly isolated in a tertiary care hospital with 1253 beds in Korea. To prevent endemic stage of VRE in the hospital, early intervention with intensive infection control strategies was implemented and the efficacy was evaluated. METHODS: Infection control team monitored VREisolated patients prospectively for 8 months (Mar-Oct, 2000). Infection control strategies including contact precaution of patients were applied for the first three months (the 1st phase :Mar~May). Rectal cultures were done to identify rectal colonization of VRE from all of the VRE-isolated patients and from their roommates. Health care workers' (HCW) hands and environments related with VRE patients were cultured to identify contaminations or colonizations. More intensive infection control strategies including strict isolation of patients were applied for the following 5 months (the 2nd phase : Jun~Oct). Pulsed field gel electrophoresis (PFGE) was done to document genetic relatedness of isolated VRE. RESULTS: Total 26 strains of VRE were isolated from 26 patients during study period. Isolation of VRE had decreased from 1.78 cases per 10,000 patients-days before the study to 1.49 cases during the 1st phase (P=0.4) and to 0.75 cases during the 2nd phase (P=0.02). Rectal colonization rate for VRE isolated patients was 40.9% (9/22); for roommates, 17.1% (12/70). Contamination rate of HCW's hands was 2.3 % (4/ 172) and environmental contamination rate was 8.4% (38/455). Six different PFGE patterns were identified with 43 isolates and 67.6% (29/43) showed the same PFGE patterns. CONCLUSIONS: It was supposed that single clonal epidemic strain had been probably transmitted between the patients, the environments, and the HCW's hands in the hospital. Intensive VRE infection control strategies including strict isolation were very effective to decrease the VRE isolation rate.

A Case of Lumbar Vertebral Osteomyelitis Caused by Aspergillus fumigatus / 감염

Aspergillus fumigatus is the most common pathogen causing invasive aspergillosis. Although invasive aspergillosis mainly involves lung, brain, and sinus, Aspergillus fumigatus osteomyelitis of the spine has been reported very rarely. We experienced a case of vertebral Aspergillus osteomyelitis and report it with a review. A 70-year-old women was admitted due to progressive lower back pain, which had begun 1 month before admission. Although she had diabetes and hypertension, no other underlying disease or immune dysfunction was found. MRI of spine showed severely destroyeded lumbar spines. Debridement and bone graft was done for correction of unstable spine, and Aspergillus fumigatus was grown from surgical specimen. Amphotericin B was given up to total 2 g, and was switched to oral itraconazole maintenance therapy. She is well until now, 120 days after operation. On the other hand, anthracofibrosis due to Mycobacterium tuberculosis was found through bronchoscopic study, which was done because of atelectasis in left lower lobe of lung. Therefore she was treated with anti-tuberculous agents also.

Pulmonary Lymphangiomatosis / 결핵

Pulmonary lymphangiomatosis is a very rare pulmonary lesion with an aggressive potential that occurs mainly in newborns, infants and young children of both sexes. It is characterized by pulmonary abnormalities of lymphatic system, showing an increased number of complex anastomosing lymphatic channels in the pleura, in the subpleural interlobular septa, and along the bronchovascular lymphatic route and uniformly fatal. We report a case of lymphangiomatosis behaving like lymphangioleiomyomatosis in a 26-year-old woman.