Early Prophylactic Gastrectomy for the Management of Gastric Adenomatous Proximal Polyposis Syndrome (GAPPS).

Background: Gastric adenomatous proximal polyposis syndrome (GAPPS) is a recently described, rare, autosomal dominant condition characterized by the extensive involvement of the proximal stomach with hundreds of heterogeneous fundic gland polyps with antral and duodenal sparing. GAPPS is caused by a point mutation of the APC gene promoter 1B and is associated with a risk of malignant transformation, distant metastasis, and death. There are no surveillance, screening, or treatment guidelines for managing GAPPS. The few reported cases have been variably managed with endoscopic surveillance or prophylactic gastrectomy. However, there is no consensus on the optimal management approach. Summary: In this case series, we review the relevant literature on GAPPS and present two siblings who underwent early prophylactic total gastrectomies with good outcomes. Conclusion: Due to the poor correlation between the endoscopic findings on sampled polyps and the risk of harboring invasive gastric cancer, patients with GAPPS should be strongly considered for early prophylactic total gastrectomies in the absence of prohibitive comorbidities.

Clastogenic effects of defined numbers of 3.2 MeV alpha particles on individual CHO-K1 cells.

Research to determine the effects of defined numbers of alpha particles on individual mammalian cells is helpful in understanding risks associated with exposure to radon. This paper reports the first biological data generated using the single-particle/single-cell irradiation system developed at Pacific Northwest Laboratory. Using this apparatus, CHO-K1 cells were exposed to controlled numbers of 3.2 MeV alpha particles, and biological responses of individual cells to these irradiations were quantified. Chromosomal damage, measured by the induction of micronuclei, was evaluated after no, one, two, three or five particle traversals. Exposures of up to five alpha particles had no influence on the total numbers of cells recovered for scoring. With increased numbers of alpha particles there was a decrease in the ratio of binucleated to mononucleated cells of 3.5%/hit, suggesting that alpha particles induced dose-dependent mitotic delay. A linear hit-response relationship was observed for micronucleus induction: Micronuclei/binucleated cell = 0.013 +/- 0.036 + (0.08 +/- 0.013) x D, where D is the number of particles. When the estimated dose per alpha-particle traversal was related to the frequency of induced micronuclei, the amount of chromosomal damage per unit dose was found to be similar to that resulting from exposures to alpha particles from other types of sources. Approximately 72% of the cells exposed to five alpha particles yield no micronuclei, suggesting the potential for differential sensitivity in the cell population. Additional studies are needed to control biological variables such as stage of the cell cycle and physical parameters to ensure that each cell scored received the same number of nuclear traversals.

The role of dose rate in the induction of micronuclei in deep-lung fibroblasts in vivo after exposure to cobalt-60 gamma rays.

To evaluate the influence of low-dose-rate exposures on biological damage, it is necessary to have cells that can be maintained in the same stage of the cell cycle for long periods. Normal rat lung fibroblasts represent a stable cell type with a slow turnover rate in vivo. These cells can be stimulated to divide by placing them in tissue culture. Therefore, a constant cell population can be exposed over a protracted time and stimulated to divide, and the cytogenetic damage can be evaluated at the first cell division after exposure. By placing rats at different distances from a 60Co source, they were exposed to graded doses of gamma rays--0.0, 3.9, 7.4 and 11.3 Gy--protracted over either 4 or 67 h. Fibroblasts were isolated from the lung and cultured for 24 h; after cytochalasin B was added, the cells were cultured for an additional 69 to 72 h. The percentage binucleated cells in fibroblasts of animals exposed for 4 or 67 h was 47.1 +/- 4.3 and 62.1 +/- 3.9. There was no influence of dose on the percentage binucleated cells, but the fraction of cells that divided at 67 h was significantly higher (P < 0.05) than observed at 4 h. Cells were scored for micronuclei on coded slides. The dose-response data from animals exposed for 4 and 67 h were fitted to the following linear dose-response relationships, where D = dose; micronuclei/binucleated cell = 0.02 +/- 0.03 + 2.38 +/- 0.44 x 10(-2) D, and micronuclei/binucleated cell = 0.01 +/- 0.06 + 1.01 +/- 0.10 x 10(-2) D, respectively. The r2 values for the two curves were 0.67 and 0.91, indicating the goodness of fit for the data for the 4- and 67-h treatments. The slopes were different from zero and each other at the P < 0.05 level of significance. The effectiveness of the 60Co exposure decreased as the dose rate decreased. At dose rates below 0.17 Gy/h, the effectiveness remained constant over the range of doses and dose rates used. Comparing the slope of the dose response for the lowest exposure rate to that from information published previously, the dose-rate effectiveness factor was 6.14 +/- 0.65 for the induction of micronuclei in deep-lung fibroblasts.(ABSTRACT TRUNCATED AT 400 WORDS)