Gastrointestinal stromal tumor solitary distant recurrence in the left brachialis muscle.

Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract that are most commonly found in the stomach. Although GISTs can spread to the liver and peritoneum, metastasis to the skeletal muscle is very rare and only four cases have previously been reported. These cases involved concurrent skeletal metastases of primary GISTs or liver metastases. Here, we report the first case of a distant recurrence in the brachialis muscle after complete remission of an extra-luminal gastric GIST following a wedge resection of the stomach, omental excision, and adjuvant imatinib therapy for one year. Ten months after therapy completion, the patient presented with swelling and tenderness in the left arm. Magnetic resonance imaging revealed a large mass in the brachialis muscle, which showed positivity for c-kit and CD34 upon pathologic examination. This is the first reported case of a solitary distant recurrence of a GIST in the muscle after complete remission had been achieved.

A case of a jejunal ectopic pancreas presenting as obscure gastrointestinal bleeding.

A jejunal ectopic pancreas, where pancreatic tissue is found outside of the usual anatomical location, is a rare submucosal tumor that may cause obscure gastrointestinal (GI) bleeding. After initial negative endoscopic evaluation of the obscure GI bleeding, including colonoscopy and/or upper endoscopy, it is reasonable to proceed with further evaluation of the small bowel. Diagnostic options for the evaluation of the small bowel may include capsule endoscopy, push enteroscopy, or barium contrast small bowel studies. Here, we report a case of obscure GI bleeding caused by a jejunal ectopic pancreas, diagnosed through capsule endoscopy and barium contrast small bowel studies, which was treated successfully with single incision access laparoscopy.

Cavernous hemangioma occurred between the trapezius and splenius capitis muscle.

Hemangiomas are the most common benign tumor of soft tissue. They are frequently seen on the trunk and extremities. In addition, most of them exist at the skin and subcutaneous layer, but fewer than 1% does in the intramuscular layer. For the diagnostic images of the intramuscular cavernous hemangioma, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are used currently. Multiple therapeutic methods are used, but surgical excision is considered as the most ideal treatment. We describe the recurred cavernous hemangioma occurred between the trapezius and splenius capitis muscle. The mass was well demarcated but scattered and infiltrated into the adjacent muscle layer, therefore, extensive resection was unavoidable. When determining a treatment regime for the hemangioma, it is essential to consider the size of the mass, cosmetic and functional aspects of the patient.

Usefulness of SPAIR Image, Fracture Line and the Adjacent Discs Change on Magnetic Resonance Image in the Acute Osteoporotic Compression Fracture.

OBJECTIVE: Osteoporotic compression fracture is an increasing issue in this community and its diagnosis depends on the magnetic resonance images (MRI). Although T1- and T2-weighted images (T1WI and T2WI) have high sensitivity and specificity, the fat suppression technique gives more clear delineation of this abnormalities. Accordingly, we re-evaluated its exact sensitivity and specificity for the imaging diagnosis of osteoporotic compression fractures in our cases. For additional information about the osteoporotic compression fractures, we evaluate the fracture lines, fluid sign and adjacent discs change on the MRI. METHODS: Retrospectively, total 85 patients who had been diagnosed with acute osteoporotic compression fracture were enrolled. They all had been underwent MRI including T1WI, T2WI and T2-Spectral Adiabatic Inversion Recovery (SPAIR) sequence. RESULTS: In this study, the incidence of high signal intensity on T2-SPAIR image was very high (0.9917). The fluid sign was seen in 56.7% on the SPAIR image. The fracture lines were more observed on the T2WI than T1WI (p=0.0062). The adjacent discs change on T2WI and T2-SPAIR image were higher than T1WI (p<0.001). CONCLUSION: For the acute osteoporotic compression fracture, T2-SPAIR image is the most specific sequence of the all sequences. The fluid sign is another suggestive finding when considered other studies. T2WI is more useful to find the fracture line than T1WI. Abnormal signal intensity on the adjacent discs may provide additional information for the acute osteoporotic compression fractures.

Pneumopericardium as a complication of pericardiocentesis.

Pneumopericardium is a rare complication of pericardiocentesis, occurring either as a result of direct pleuro-pericardial communication or a leaky drainage system. Air-fluid level surrounding the heart shadow within the pericardium on a chest X-ray is an early observation at diagnosis. This clinical measurement and process is variable, depending on the hemodynamic status of the patient. The development of a cardiac tamponade is a serious complication, necessitating prompt recognition and treatment. We recently observed a case of pneumopericardium after a therapeutic pericardiocentesis in a 20-year-old man with tuberculous pericardial effusion.

Oligodeoxyribozymes that cleave beta-catenin messenger RNA inhibit growth of colon cancer cells via reduction of beta-catenin response transcription.

Abnormal regulation of Wnt/beta-catenin signaling followed by increased levels of the beta-catenin protein have been identified in enhanced cellular proliferation and development of colon polyps and cancers. To inhibit beta-catenin gene expression in colon cancer cells, RNA-cleaving oligodeoxyribozyme (DNAzyme) was employed to destroy the beta-catenin mRNA. We designed a strategy to identify the cleavage sites in beta-catenin RNA with a pool of random sequences from a DNAzyme library and identified four potential DNAzyme-working sites. DNAzymes were constructed for the selected target sites and were tested for the ability to cleave beta-catenin RNA. When introduced into the cells, the selected DNAzymes decreased the expression of beta-catenin significantly as well as its downstream gene, cyclin D1. Additionally, we designed short hairpin RNA that targets the same cleavage site for the selected DNAzyme. The designed short hairpin RNA also inhibited beta-catenin gene expression in colon cancer cells. Our studies show that RNA-cleaving DNAzymes and RNA interference targeted to beta-catenin significantly reduced beta-catenin-dependent gene expression, resulting in inhibition of colon cancer cell growth. These results indicate that the functional antisense oligonucleotides directed against beta-catenin might have potential as a therapeutic intervention to treat colon cancer.

Evaluation of generations 2, 3 and 4 arginine modified PAMAM dendrimers for gene delivery.

It is a matter of concern to develop and design synthetic non-viral gene carriers with high transfection efficiency and low cytotoxicity in gene therapy. Recently, various arginine conjugated dendrimers showed better performance in transfection and greater viability than polyethyleneimine (PEI). In this study, we synthesized and investigated e-PAM-R G2, 3 and 4 which are biodegradable polyamidoamine (PAMAM) dendrimers modified with arginine and compared that with PAMAM-R series containing amide bonds for gene carriers. For plasmid DNA delivery, the transfection efficiency of e-PAM-R G4 was higher than G3 and G2 and similar to PAMAM-R G4 with favorable cell viability. Moreover, they indicated significantly higher suppression of TEL/AML1 protein, maybe due to rapid olidonucleotide (ODNs) release through biodegradability of e-PAM-R. These results suggest that biodegradable and non-toxic e-PAM-R may be useful carriers for the gene including plasmid DNA, antisense ODNs and si-RNA.

Design and kinetic analysis of hammerhead ribozyme and DNAzyme that specifically cleave TEL-AML1 chimeric mRNA.

In order to develop the oligonucleotides to abolish an expression of TEL-AML1 chimeric RNA, which is a genetic aberration that causes the acute lymphoblastic leukemia (ALL), hammerhead ribozymes and deoxyoligoribozymes that can specifically cleave TEL-AML1 fusion RNA were designed. Constructs of the deoxyribozyme with an asymmetric substrate binding arm (Dz26) and the hammerhead ribozyme with a 4nt-bulged substrate binding arm in the stem III (buRz28) were able to cleave TEL-AML1 chimeric RNA specifically at sites close to the junction in vitro, without cleaving the normal TEL and AML1 RNA. Single-turnover kinetic analysis under enzyme-excess condition revealed that the buRz28 is superior to the Dz26 in terms of substrate binding and RNA-cleavage. In conjunction with current progress in a gene-delivery technology, the designed oligonucleotides that specifically cleave the TEL-AML1 chimeric mRNA are hoped to be applicable for the treatment of ALL in vivo.

Replication of an RNA ligase ribozyme under alternating temperature condition.

Self-replication process of the RNA ligase ribozyme molecules was investigated by using the modified RNA ligase ribozyme under alternating temperature condition that enhances turnover rate of the RNA ligation reaction. In our experiment, the RNA ligase ribozyme system mainly undergoes a cross-catalytic replication process, in which two ribozymes catalyze each other's synthesis from a total of four RNA substrates under alternating temperature condition, resulting in time-dependent accumulation of additional copies of the starting ribozymes in a reaction mixture. The present study demonstrates that cross-catalytic replication in nucleic acids system can be efficiently devised under the alternating temperature condition.