Showing papers in "National Medical Journal of China in 1994"

Effect of BN52021 on platelet activating factor induced aggregation of psoriatic polymorphonuclear neutrophils

Abstract: We investigated the aggregation of PMN from 20 psoriasis patients (PP) and 12 health persons (HP) to PAF and the effect of PAF antagonist BN 52021 on the aggregation. PAF induced a dose dependent aggregative response of polymorphonuclear neutrophils (PMN) from PP and HP. The aggregative responses of PMN from PP to lower concentrations of PAF were increased (P < 0.05) and to higher concentrations of PAF were not different to that of PMN from HP. BN 52021 could time- and dose-dependently inhibit the aggregation of PMN from PP and HP to PAF, and their IC50 was 1.3 x 10(-6) mol and 1.2 x 10(-6) mol respectively. It is suggested that PAF and PMN play an important pathophysiological role in the development of psoriasis, and application of PAF antagonists may be a new and effective approach to the management of psoriasis.

The effect of iron deficiency anemia on the auditory brainstem response in infant

Abstract: Our study attempts to explore the mechanism by which iron deficiency anemia (IDA) affects the brain function of infants. We made auditory brainstem response (ABR) test for 48 IDA infants and 30 normal control infants, aged 6-36 months and reexamined ABR in 4 IDA infants after three months iron therapy. 26 cases of abnormal ABR among 48 IDA infants were found, it took 54.2% of total IDA infants. IDA led mainly to peripheral impairments of auditory system and rarely to brainstem. There was a direct relationship between the severity of IDA and the degree of abnormality of the ABR in infants. The threshold of ABR in IDA infants was significantly higher than that of in control group. It suggests that IDA infants have listening comprehensive difficulty as a result of impairment in high frequency hearing. After follow-up of 4 IDA infants, it was found that the impairment of auditory system could be reversible after prompt correcting of IDA. This observation has important significance for child health in the future.

Measurement of cervical canal sagittal diameter in Chinese males with cervical spondylotic myelopathy

Abstract: BACKGROUND Cervical canal encroachment can be properly assessed from lateral cervical radiographs either by defining its magnification rate or by a ratio-method. Data of the latter obtained from Chinese males with cervical myelopathy were compared with the data of general population in different age groups. METHODS A total of 200 Chinese males were included in this study. Half of them had undergone decompressive procedures for cervical myelopathy, while the remaining 100 cases were volunteers. Sagittal diameters of cervical canal and vertebra were measured from C3 to C6 on lateral cervical radiographs, while ratios (Torg-Pavlov's ratios) of the two reflected the extent of sagittal canal encroachment. Cut-off values and discriminant rates of these parameters in different age groups were obtained by discriminant analysis. The tube-to-film distance was set as 40 inches. RESULTS In myelopathic group (age or = 55 y/o), the ratios were 0.76 +/- 0.09, 0.71 +/- 0.10, 0.73 +/- 0.11, and 0.76 +/- 0.11; while in control group (age > or = 55 y/o), the ratios were 0.93 +/- 0.10, 0.89 +/- 0.09, 0.88 +/- 0.11, and 0.91 +/- 0.12 respectively. The cutoff values and their discriminant rates are also presented. CONCLUSIONS The differences of canal sagittal diameter as well as Torg-Pavlov ratio between myelopathic and control group of Chinese males in individual age group were statistically significant. It is concluded that congenitally narrow cervical canal is a major predisposing factor to cervical spondylotic myelopathy.

Prediction of the development of neonatal hyperbilirubinemia in ABO incompatibility

Abstract: Background ABO incompatibility is now the most common cause of isoimmune hemolytic disease of the newborn here. Although hemolytic disease because of ABO incompatibility is clinically milder than that from Rh incompatibility, severe hemolysis occasionally occurs, and some cases require exchange transfusion. It is desirable to assess the accuracy of a group of tests to predict the development of neonatal hyperbilirubinemia in ABO incompatibility. Then, early treatment is available for minimizing the frequency of exchange transfusion. Methods Eighty-eight healthy full-term newborn infants born to blood group 0 mothers were studied and divided into four groups. Each baby weighed 2.5 Kg or more, had no evidence of G-6-PD deficiency. Group 1 consisted of 29 blood group A or B infants with hyperbilirubinemia (serum bilirubin levels > or = 15 mg/dl) and/or icterus praecox. Group 2 consisted of 24 blood group A or B infants without hyperbilirubinemia (serum bilirubin levels Results A total of 18 (62.1%) mothers had IgG anti-A or anti-B titers > or = 512X in Group 1. The majority of mothers (91.5%) in Group 2, 3 and 4 had anti-A or anti-B titers or = 4 mg/dl, whereas none in the other groups had cord bilirubin levels > or = 4 mg/dl. Conclusions ABO incompatible newborn infants with maternal IgG anti-A or anti-B titers > or = 512X, cord bilirubin levels > or = 4 mg/dl or positive direct Coombs' test of the cord blood represent a "high risk" category, and should be placed in hospital where frequent re-evaluation and appropriate therapy are available.

Detection of plus and minus strand hepatitis C virus RNA in peripheral blood mononuclear cells and spermatid

Abstract: Plus and minus strands of HCV RNA in plasma, peripheral blood mononuclear cells (PBMC), sperm and spermatid of 8 patients with chronic hepatitis C were tested by the method of PCR to find out whether HCV exists and duplicates in extrahepatic cells or not. Plus HCV RNA was detected in all the plasma samples, but no minus HCV RNA was detected. Plus strand HCV RNA was detected in 5 of 8 PBMC samples and minus strand in 2 of the 5 samples. Three of 5 male chronic hepatitis C patients were willing to cooperate and offer their sperm for detection. In the patients, no minus but plus strand HCV RNA was detected in both supernatant of sperm and spermatid. HCV RNA was not detected in the last washing solution for spermatid. The results suggest that: (1). Probably, only plus HCV RNA exists in plasma; (2). HCV exists and probably duplicates in PBMC; (3). HCV exists in sperm. The possibility of transmission of hepatitis C by sexual intercourse is really existent. But, HCV probably don't duplicate in spermatid.

Effect of caffeine on the levels of brain serotonin and catecholamine in the genetically obese mice.

Abstract: BACKGROUND: Most obesities are known low in sympathetic activity, and brain neurotransmitters may play roles in the defective exhibitions of obesity. Caffeine, a stimulant, which can prompt lipolysis, has been applied on the therapy of obesity. Although the interactive combinations between caffeine and certain neurotransmitters has been appreciated recently, but its regulatory mechanisms are still obscure. This study investigated the effect of caffeine on the body fat deposition, and its interactions with brain serotonin and catecholamine in the genetically obese (ob/ob) mice. METHODS: At 12-week of age, obese mice and their lean counterparts (+/?) were administered with caffeine (4 mg/d) in water for 4 weeks. The brain neurotransmitters levels and body fat content were measured. RESULTS: The obese mice without caffeine treatment had lower brain norepinephrine and epinephrine levels than the lean controls. And there had no difference between obese and lean mice in brain levels of serotonin, tryptophan, and 5-hydroxyindoleacetic acid. Caffeine treatment showed no effect on the food intake, but decreased the body fat content significantly in obese mice. Mice with caffeine treatment showed increase of the levels of brain neurotransmitters in both phenotypes; this effect was more predominant in obese mice. CONCLUSIONS: This study indicated that the effect of caffeine to decrease body fat deposition in the obese mice might be associated with the recovered increases of sympathetic activity.

Protective effects of ginsenoside on myocardiac ischemic and reperfusion injuries

Abstract: Thirty mitral valvular surgical patients were randomly divided into three groups for study of protective effects of Ginsenoside on myocardiac ischemic and reperfusion injuries. In GI, 11 patients (controls), no Ginsenoside was used, in GII, 11, Ginsenoside in total was added into the cardioplegic solusion made in our hospital, and in GIII, 8, instead of Ginsenoside in total Ginsenoside Rb was added. During operation comparative studies were made of pre- and postoperative cardiac functions with intraoperative transesophageal echocardiography and ultrastructures of myocardiac cells with electromicroscopy. We conclude that both Ginsenoside in total and Ginsenoside Rb have protective effects on myocardiac ischemic and reperfusion injuries in open heart surgery, and the effect of Ginsenoside in total is even better than that of Ginsenoside Rb.

Epidemiological characteristics of stroke in 16 provinces of China

Abstract: Epidemiological survey was conducted, according to diagnostic standard from WHO-MONICA project, on stroke events in 16 provinces of China. There were significant differences in geographical distribution of morbidity and mortality of stroke events. The morbidity and mortality were higher in northern China than in southern China (P < 0.001). The differences of morbidity varied from 11 to 14 times. The morbidity and mortality were higher in man than in woman (P < 0.01 or P < 0.05) and were higher in rural areas than in cities. The geographical differences in the morbidity and mortality for stroke may be related to many factors, and may be in parallel with the hypertension prevalence rate, which was higher in northern China than in Southern China. The age of patients with stroke was younger in northern China than in southern China (P < 0.01). The frequency of cerebral hemorrhage was higher in southern China than in northern China.

The infectivity of gametocytes of Plasmodium falciparum from patients treated with artemisinine

Abstract: 27 patients with gametocytes of P. falciparum were divided into groups A, B and C. 1,200 mg of artemisinine was given as a daily dose for 5 days to group A, 750 mg of mefloquine plus 45 mg of primaquine as a single dose to group C. After medication, gametocyte count was observed daily in addition to the infectivity of gametocytes of P. falciparum to Anopheles dirus. In group A, the density of gametocytes and the infectivity were significantly reduced on days 4, 7, 14 and 21 during the study. In group B, the density of gametocytes was significantly reduced on days 7, 14 and 21 and the infectivity was obviously lowered on days 14 and 21 after medication. In group C, gametocytes disappeared in 5 out of 9 patients with the failure of infection to mosquitoes on day 4 after treatment. This indicates that artemisinine can effectively influence the infectivity of gametocytes of P. falciparum. Artemisinine is superior to mefloquine in blocking the transmission of P. falciparum malaria.

[The effects of exercise on the arterial potassium and ventilatory response under hyperoxic, normoxic, and hypoxic conditions].

Abstract: BACKGROUND Exercise leads to an increase in plasma potassium, the animal experiments showed that potassium infusion stimulated ventilation and abolished by peripheral chemodenervation and also showed that combined effects of potassium and hypoxia were greater than the sum of the individual effects. This study proposed to investigate plasma potassium and its correlation with exercise, and to investigate the effects of hypoxia and hyperoxia on potassium and ventilation during steady state exercise. METHODS Ten male subjects exercised on a cycle ergometer. Each performed (1) incremental exercise test; (2) steady state exercise test with a work rate of about 75% of anaerobic threshold under hyperoxic (FiO2 100%), normoxic (FiO2 21%) and hypoxic (FiO2 12%) conditions, respectively. RESULTS Arterial plasma potassium concentration rose from a pre-exercise level of 3.97 +/- 0.40 mEq/L to the post-exercise level of 5.11 +/- 0.49 mEq/L. The increase in plasma potassium during exercise correlated well with the increase in lactate (r = 0.72, p 0.01). CONCLUSIONS It was concluded that (1) exercise can lead to an increase in arterial potassium, hydrogen ion, lactate in men; (2) hypoxia can stimulate the peripheral chemoreceptor and increase plasma potassium level. Potassium may, therefore, be an important factor by which the magnitude of the peripheral chemoreflex response is augmented during exercise.

Clinical evaluation of erythrocytosis in patients with hepatocellular carcinoma.

Abstract: BACKGROUND Hepatocellular carcinoma (HCC) is a common malignancy in southeast Asia and sub-Saharan Africa. During its clinical course, patients may manifest a variety of paraneoplastic syndromes, including erythrocytosis. However, there are few reports on the clinical and biochemical characteristics of HCC patients who manifest erythrocytosis. The purpose of this study is to evaluate the incidence of erythrocytosis in a large series of the Chinese patients with HCC, and to investigate the association of erythrocytosis with tumor volume and with serum levels of alpha-fetoprotein (AFP) and erythropoietin. METHODS Among 792 Chinese HCC patients who were seen during a 3-year period, we identified HCC patients with erythrocytosis as those with hemoglobin levels greater than 16.7 gm/dL (two standard deviations above the mean hemoglobin level of matched normal controls). The tumor size and serum levels of AFP and erythropoietin were evaluated in HCC patients with erythrocytosis to compare with HCC patients without erythrocytosis. RESULTS 20 (2.5%) of 792 Chinese HCC patients presented with erythrocytosis. Nineteen of these 20 HCC patients were found to have either bi-lobar tumor involvement or a large tumor mass confined to one lobe of the liver. The estimated mean tumor volume of HCC patients with erythrocytosis was 50% of whole liver. When compared with HCC patients without erythrocytosis, the 20 HCC patients with high hemoglobin levels had significantly higher serum levels of AFP and erythropoietin (356,343 +/- 145,807 vs. 16,881 +/- 10,425 ng/mL, 135 +/- 45 vs. 25 +/- 4 mU/mL, respectively, p < 0.01). CONCLUSIONS Base on our findings, detection of erythrocytosis in a patient with HCC would indicate the presence of a large tumor burden, and high serum levels of both AFP and erythropoietin should be associated with this paraneoplastic syndrome.

Stress fractures of the ribs in amateur golf players.

Abstract: Background Stress fractures of the ribs are sometimes seen at the Outpatient Department in patients with a history of playing golf enthusiastically. Many are diagnosed as "muscle strain" or "myofascial pain" and patients are simply advised to take some rest or are treated with analgesics and local injection. This case study investigated 11 amateur golfers whose chief complaint was anterior, posterior or lateral chest pain. After X-ray and bone scan evaluation, "stress fracture of the ribs" was diagnosed. A questionnaire presented to them trying to find the possible mechanisms of these stress fractures. Biomechanical analysis showed that the bending force of the ribs was located at posterolateral segments where fractures tend to occur. Overuse, poor technique and inadequate stretch in beginners are postulated as causes for apparent increased susceptibility to these skeletal injuries. Methods Questionnaires inquired about (1) warm-up time, (2) number of strikes, (3) fracture sites, (4) pain patterns, (5) combined injuries. Results All 11 patients were beginners with right side hand dominance who had begun to play golf within the year. Right side ribs fracture occurred in six cases; left side ribs fracture occurred in eight cases including three patients with two fracture sites. Localized pain was reported in six cases and there were five cases with radiating pain along costal margins. All the golfers had spent no more than 10 minutes in warm up them. Seven patients suffered from multiple injuries after they had played. Five were diagnosed by X-ray and six showed positive finding after Tc-99m MDP bone scan. All lesions were located at the posterolateral segments of the ribs. Conclusions Stress fractures of the ribs in amateur golfers are certainly not uncommon. Predominant muscle forces are generated by forced coupling of scapular retraction and protraction, acting through the serratus anterior. With early diagnosis and relative rest for four to eight weeks, the pain will improve. Overuse, poor technique and inadequate stretch will probably lead to stress fracture of the rib.

Breast cancer and pregnancy.

Abstract: BACKGROUND: Breast cancer developing during pregnancy or lactation is such an infrequent problem that, when it occurs, physicians are confronted with ethical and therapeutic challenges. Moreover, there are very few references to compare or discuss breast cancer in pregnant women in Taiwan. We hope that data from this review will add to our understanding of such difficult problem as well as help improve the treatment of our patients. METHODS: Between 1979 and 1988 the charts of 21 women, who were pregnant or postpartum within one year of the breast cancer diagnosis, were analyzed retrospectively. All of the patients were followed until Dec. 1990. Patients with pregnancy-associated breast cancer were compared with nonpregnant women (199 cases) of similar age who were treated at the same hospital and during the same period. RESULTS: We found no statistical differences in the overall 5-year survival rate between pregnant (57.1%) and nonpregnant (69.6%) groups. It is noteworthy that the time lag was significantly longer in the pregnant group than in the nonpregnant group. A stage-by-stage comparison showed equivalent survival rates between pregnant and nonpregnant patients. The pregnant patients at stage II had a somewhat lower survival rate; however, there was no statistical significance. CONCLUSIONS: The rule of cancer treatment, "early diagnosis followed by aggressive management," is still a key principle to improve the treatment in pregnant women with breast cancer.

Intramedullary cryptococcal granuloma of spinal cord: a case report.

Abstract: The budding yeast, Cryptococcus neoformans, is widely distributed throughout the world and causes opportunistic and non-contagious infections in man. Involvement of the central nervous system has been found in 70% of patients at the time of diagnosis, and meningitis or meningoencephalitis are the most common manifestations. Space-occupying cryptococcal granuloma, on the other hand, is infrequently encountered in the brain and extremely rare in the spinal cord. Seven cases of spinal torulomas (cryptococcal granuloma) have been reported in the available literature. Only one was intramedullary. Here an isolated case of intramedullary cryptococcal granuloma in the spinal cord in an immunocompetent patient is reported; diagnosis was by intraoperative frozen section. After two months of post-operative antifungal treatment, the clinical condition has received markedly improvement.

Epilepsy with grand mal on awakening.

Abstract: BACKGROUND Epilepsy with grand mal (GMA) on awakening is a benign generalized idiopathic epilepsy, occurring around the time of puberty. There have been few reports regarding Chinese children with GMA, thus this analysis of fourteen Chinese children with GMA who have been encountered in the past 10 years. METHODS The medical and electroencephalographic (EEC) records of 14 Chinese children with GMA, 7 males and 7 females, were investigated retrospectively. RESULTS The age of onset ranged from 9 to 15 years with a mean of 12 +/- 1.6 years. Six patients had previous history of febrile convulsion; four and three patients had positive family history for epilepsy and febrile convulsion, respectively. All patients had generalized tonic-clonic seizures on awakening and three of them had concomitant myoclonic jerks. The precipitating factors were sleep withdrawal (9), photostimulation (4), hyperventilation (3), fevers (2), and menstruation (2). The first EEG findings included 3-4 Hz generalized spike-wave complex (8/14), photostimulation activated (4/14), and hyperventilation activated (3/14). Valproate had been regularly administered orally for a duration of 1 to 8 years with a mean of 3.8 +/- 2.0 years up to time of study. Six (75%) out of eight patients relapsed about 6 months to 1 years after discontinuation of anticonvulsant. CONCLUSION GMA may have some clinical relationship with other idiopathic generalized epilepsies, such as childhood absence epilepsy and juvenile myoclonic epilepsy. High-percentage relapse after drug discontinuation may be the rule for GMA patients, so long-term use of anticonvulsants may be needed.

The value of duplex and continuous wave Doppler sonography for evaluation of the extracranial vertebral arteries: a prospective comparison with angiography.

Abstract: BACKGROUND The role of duplex sonography in the detection of the extracranial vertebral arteries is not well established The purpose of this study was to determine the practical possibilities of vascular sonography for non-invasive investigation of the vertebral arteries METHODS The extracranial vertebral artery was divided into the pretransverse segment, the intertransverse segment C6-C2, and the atlas loop The first two segments were examined by duplex probe and the third segment, by continuous-wave probe Sixty vertebral arteries were studied for detecting vessel diameter, peak systolic as well as diastolic frequency shifts, flow direction and Doppler flow characteristics A blind angiographic comparison was also performed for the sake of confirming morphological findings and flow direction RESULTS Duplex imaging could detect more than 90% of the vertebral arteries The mean value of vessel diameter was 33 +/- 06 mm for the right vertebral artery and 35 +/- 05 mm for the left Peak systolic as well as diastolic frequency shifts expressed in KHz was 14 +/- 04 versus 16 +/- 05 and 05 +/- 02 versus 05 +/- 02 in the right and the left vertebral arteries respectively A 74% agreement in vessel size was obtained by both duplex scanning and angiography A 100% accuracy was obtained for blood flow direction through means of a Doppler signal Abnormal findings included stenosis or occlusion (four arteries), hypoplasia or aplasia (two arteries), and subclavian steal phenomenon (two arteries); Six of these eight were correctly predicted by confirmation of the angiographic findings CONCLUSIONS A combination of duplex and continuous wave Doppler sonography was affirmed in this study as a relatively accurate screening technique for detection of vertebral artery abnormalities

Diffuse pigmented villonodular synovitis of the shoulder: a case report.

Abstract: Pigmented villonodular synovitis (PVNS) of the shoulder is an uncommon disorder with unknown etiology. It is characterized by synovial proliferation and hemosiderin deposition into the synovial tissues of the affected joints. PVNS affects mainly the knee joint and shoulder involvement is rare. There are only 12 cases of shoulder involvement reported in the English-language literature. A case of PVNS of the shoulder with simultaneous rotator cuff tear is presented and the literature is reviewed.

Intravenous infusion or nebulization of salbutamol for treatment of hyperkalemia in patients with chronic renal failure

Abstract: BACKGROUND Hyperkalemia is one of the frequent medical emergencies in patients with chronic renal failure (CRF). We studied and compared the efficacy and safety of salbutamol either by intravenous infusion (i.v.) or nebulization (NB) in treating CRF patients with hyperkalemia. METHODS Thirty-four patients (BUN > 80 mg/dl, serum creatinine > 8.0 mg/dl, and plasma potassium > 5.0 mEq/L) were randomly assigned to receive either i.v. (0.5 mg) or NB (10 mg) treatment of salbutamol. Plasma potassium, sodium, osmolarity, glucose, insulin, PCO2, blood pH, blood pressure and heart rate were monitored. RESULTS One third of i.v. group and one fourth of NB group of patients were resistant to salbutamol treatment and were excluded from the study. All the baseline data were similar between 2 groups. After treatment, significant decrease in plasma potassium was found in both groups. The maximal reduction of plasma potassium was 0.95 +/- 0.14 mEq/L and occurred 30 minutes after i.v. treatment (n = 12) while it was 0.88 +/- 0.13 mEq/L and occurred 90 minutes after NB treatment (n = 12). During the first ninety minutes after treatments, the decrease of plasma potassium in IV group was faster and greater than in NB group. After that, the hypokalemic effect was more profound in NB group till the end of the study. The hypokalemic effects of both treatments sustained for at least 3 hours. Plasma insulin and glucose increased (p < 0.05) in both groups, whereas blood pH, PCO2, sodium, osmolarity and blood pressure did not change significantly. The reduction of potassium was significantly correlated with the elevation of insulin (i.v.: r = -0.56, p < 0.05; NB: r = -0.54, p < 0.05). Heart rate elevated significantly in both groups; nevertheless, this elevation was less marked in NB group. CONCLUSIONS Both routes of administration of salbutamol resulted in a prompt and significant decrease of plasma potassium concentrations and both are considered as simple, effective and safe alternatives in treating hyperkalemia in patients with CRF. However, i.v. therapy might be preferred in CRF patients requiring a rapid lowering in plasma potassium; nebulization, on the other hand, should be preferred in CRF patients with coronary artery diseases.

Comparison between skin testing and in vitro testing for diagnosis of allergen in asthmatic children.

Abstract: BACKGROUND This study was designed to compare the skin testing and in vitro testing for the diagnosis of most common inhalant allergens in asthmatic children. METHODS Sixty-two asthmatic children positive to most common allergens in the area of skin tests and multiple allergosorbent chemiluminescent assay (MAST-CLA) were subjected to another Pharmacia CAP test (CAP). RESULTS The agreement between the results of MAST-CLA and CAP was variable. The correlation coefficient for CAP with MAST-CLA was significant for five allergens except candida, dog dander and Willow pollen when the diagnostic levels of MAST-CLA and CAP were compared with skin test reactions. For all the allergens tested, MAST-CLA showed a sensitivity of 51%, a specificity of 84% and an efficiency of 73%, compared with 57%, 80% and 74%, respectively, in the CAP analysis. CONCLUSIONS MAST-CLA and CAP can be used as a screening test to measure allergen IgE level. Both MAST-CLA and CAP were comparable in their ability to diagnose of allergy to tested allergens.

Stress shielding and fracture healing

Abstract: The influence of stress shielding after fracture fixation with plate on fracture healing was studied. The results of animal and biomechanical experiments as well as the clinical observations demonstrated that rigidity of the plate was not the only factor causing stress redistribution and stress shielding effects of bone. Either the internal fixation with different implants or external fixation with fixators all might lead to physical and chemical characteristic changes of bone tissue. In the early stage, the disturbance of blood supply and the bone structure remodeling may be the main reasons. Reaction to the implant was another cause in the middle stage. If the affected limb can take weight-bearing normally at late stage, the influences of plate on fracture healing mechanical properties of bone and the osteoporosis cause by stress shielding effects will become much less. The tissue of the affected limb was the most important factor which may cause osteoporosis and refracture. Osteoporosis, bone atrophy and immobilization syndrome of bone and joint can be prevented and treated by taking normal weight-bearing and overcoming infection and implant reaction.

Ginseng saponin treatment for intrauterine growth retardation

Abstract: Twenty eight patients with intrauterine growth retardation (IUGR) in 31-34 gestational weeks were clinically treated with Chang Bai Shan ginseng saponin tablets, while 26 pregnant women with IUGR were nutritionally treated as controls. The results indicated that in the experiment and control groups, the height of fundus and fetal diparietal diameter (BPD) gradually approached to those of the normal pregnancy group. The urinary estrogens/creatinine (E/C) ratio and serum human placental lactogen (hPL) were close to those of the normal pregnancy group (P > 0.05) after 35 gestational weeks. The weight of neonates treated nutritionally and with ginseng saponin approached to that of the normal pregnancy group. There was no significant difference as compared with the normal pregnancy group (P > 0.05). Glucose and albumen levels in blood of neonates were not significantly different between experiment and control groups, but they were higher than those in IUGR group (P < 0.05). The present results suggest that in treating IUGR, ginseng saponin may show the same effect as in the nutritional treatment.

Management for acute corrosive injury of upper gastrointestinal tract.

Abstract: BACKGROUND It is imperative that the surgeon promptly determine the severity of any acute injury of the upper gastrointestinal (UGI) tract by caustic material ingested and the definite therapy be instituted. Prognostic factors of such injuries have not been clearly demonstrated in previous reports. Here, some prognostic factors and recommended emergency surgical indications in clinical assessment are discussed. METHODS Forty-six patients (22 men and 24 women; age range 19 to 77 years), sustaining acute corrosive injuries to the UGI tract, were retrospectively assessed from November 1990 to May 1993. Immediate management was given to prevent shock, to identify any associated injury and to observe patency of the airway. Emergency operation was performed if any signs of peritonitis, mediastinitis or sepsis were present. Age, sex, time interval between ingestion and initial resuscitation, consciousness, peritoneal sign, shock index, pH value and [HCO3-] in arterial blood gas were evaluated as prognostic factors with respect to mortality. Chi-square test with Yates' correction was used. A p value less than 0.05 was regarded as statistically significant. RESULTS Suicide attempt by caustic ingestion was in 40 patients (87%) and ingestion was accidental in 6 (13%). Acidic injury was specified in 36 patients (78.3%). In 14 severely injured patients, emergency exploratory laparotomy with or without esophagogastrectomy was performed in 9 (19.6%), of whom 2 survived. The other five patients were treated conservatively, and all died. Overall mortality rate was 26.1% (12/46). A significantly higher mortality rate was observed in patients with age > or = 50 years, positive peritoneal sign, shock index > 1, pH below 7.2 and bicarbonate concentration below 16 mEq/L as revealed by arterial blood gas (p < 0.05). CONCLUSIONS The prognostic factors related to a higher mortality rate included age 50 years old or more, positive peritoneal sign, shock index above 1, pH below 7.2 and [HCO3-] below 16 mEq/L in arterial blood gas. Recognition of these factors indicates further detailed study will be required to propose a caustic injury score for predicting severity. Nevertheless, emergency operation is recommended if there are positive signs of peritonitis or mediastinitis, shock index above 1, pH below 7.0 and [HCO3-] below 10 mEq/L in arterial blood gas.

Morphologic and molecular evidence of apoptosis during reperfusion phase after brief period of renal ischemia

Abstract: A multiparametric analysis was made to demonstrate that brief period of ischemia can initiate extensive loss in a rat kidney through the process of apoptosis during early reperfusion. Microscopic examination of mouse renal tissues subject to a 5, 30, or 45 minute period of complete ischemia showed the presence of apoptotic bodies both within and occasionally between renal tubular, appearing as early 6 hours after reperfusion and increasing in numbers at 12 hours. Furthermore, DNA extracted from such reperfusion renal tissue demonstrated the appearance of a distinct "ladder pattern" of DNA fragments after electrophoresis in agarose gels. It was suggested that renal reperfusion injury after ischemia can initiate a form of cell death-apoptosis that is drastically different from cellular necrosis induced by prolonged severe ischemia.

Salmonella infections in infants and children.

Abstract: Background Salmonella is an important pathogen for infants and children of which multiply resistant strains were recently reported. Our interest was the annual variation of clinical manifestations, serotype and the sensitivity rate for antibiotics during the past decade. Increased incidence of bacteremia in infants is reported. In order to find the predisposing factors of patients with acute gastroenteritis complicated with bacteremia, we conducted a retrospective analysis. Methods We reviewed the records of documented patients who had positive culture for Salmonella in our Pediatric Department from September 1982 to September 1992. Those patients with acute gastroenteritis were divided into two groups: I, those complicated with bacteremia and II, non-bacteremic cases. Then we compared the age, body temperature, severity of clinical symptoms, white blood cell count and Salmonella serotype of these two groups. Results There were 180 cases of Salmonella infection in our Pediatric Department during the past decade. The mean age was 14.80 months. Most (88.9%) patients were under two years old and 146 subjects were victims of acute gastroenteritis. Six cases had infection of the central nervous system (CNS). Five cases presented typhoid fever. Of three mortal cases, two died from meningitis with sepsis and one was a victim of malignant lymphoma and septic arthritis complicated with sepsis. Salmonella group B was the most common pathogen. There were no cases of typhoid fever after 1989. The sensitivity to ampicillin, chloramphenicol, and ceftriaxone for group B were 25.7%, 26.1% and 100% respectively. Multiply resistant Salmonella species were not present in our cases. The severity of clinical symptoms varied in significantly between those who had acute gastroenteritis with bacteremia (Group I) and those who had acute gastroenteritis without bacteremia (Group II). However, there was a significant distinction in the average age of the two groups (P = 0.005). Conclusions Although the annual number of cases did not decrease in recent years, the number of cases of typhoid fever did decrease. Most patients were infants and acute gastroenteritis was most common. In our series, the relative sensitivity for ampicillin, chloramphenicol was small over the past decade. Multiply resistant Salmonella species were not found, which may be due to the small sample size.

Infective endocarditis in infants and children during the past ten years.

Abstract: BACKGROUND Infective endocarditis occurs infrequently in the general pediatric population, but is often associated in patients with underlying heart disease. Even today it remains a serious threat leading to relevant mortality in all pediatric groups, in spite of better antibiotic treatment and prophylactic measures for endangered persons. This retrospective analysis reports experience here with infective endocarditis in children. METHODS The clinical and laboratory findings in 28 children with 30 episodes of infective endocarditis, from July 1984 to June 1993, were reviewed retrospectively. RESULTS Twenty-one children (75 percent) had congenital heart disease, three (11 percent) had rheumatic heart disease and four (14 percent) had no underlying cardiac abnormality prior to presentation. Twenty-six (87 percent) of the 30 episodes had positive blood cultures. The most common organism isolated was streptococcus viridans (14 percent), followed by staphylococcus aureus (7 percent). Echocardiography identified vegetation in 21 of 28 (75 percent) patients. Twenty children were successfully treated medically. Four developed complications requiring surgery, of whom two died. A total of six children (21 percent) died of the disease or its complications. There were a high case fatality rate for children below the age of two years (75 percent), and children without an underlying cardiac abnormality (50 percent). CONCLUSIONS It was concluded that patient survival is dependent on several factors which include early diagnosis, appropriate antimicrobial therapy and aggressive surgical intervention.

Effect of peritoneal fluid and serum from patients with endometriosis on mouse embryo in vitro development.

Abstract: Background The adverse effects on early embryo development as caused by peritoneal fluid exudate and serum from endometriosis patients have been shown, but the underlying mechanism and clinical significance remain unknown. Methods Peritoneal fluid (PF) and serum (S) from patients with minimal to mild endometriosis (Group A, n = 12), moderate to severe endometriosis (Group B, n = 6), and others including tubal ligation and uterine myoma (Group C, controls n = 6) were obtained during laparoscopy. Two-cell mouse embryos were cultured at 37 degrees C in 5% CO2, 95% air with supplementation of 10%PF + 1%BSA, 10%S and 10%S + 10%PF in HTF medium. The percentage of progression to the blastocyst stage at 72 and 96 hours was observed and compared among the three groups. Results Serum and peritoneal fluid from infertile patients with moderate to severe endometriosis appeared to be embryotoxic to the in vitro development of two-cell mouse embryos, but no significant differences were found between minimal to mild endometriosis and group C patients. Conclusions These data suggest that the production of embryotoxic factor(s) is related to the clinical stage, and may be derived from endometriotic implants. The correlation of the embryotoxic effect of the peritoneal fluid with that of the serum indicates that embryotoxic factor(s) may enter the systemic circulation and impede early embryogenesis in the reproductive tract. The nature and mechanism of this result demand further study.

Renal angiomyolipoma with a prominent angiomatous component and extramedullary hematopoiesis: a case report.

Abstract: Renal angiomyolipoma is a benign tumor of hamartomatous nature. A case of asymptomatic renal angiomyolipoma in a 57-year-old female is reported. Her right renal mass was incidentally discovered during the evaluation of acute hepatitis by abdominal sonography. She received right simple nephrectomy. The renal pelvic tumor was found to be an angiomyolipoma with a prominent angiomatous component containing hematopoietic elements. Unfortunately, the patient died of peritoneal carcinomatosis because of adenocarcinoma of the transverse colon five years later.

An epidemiological study on etiology of mental retardation

Abstract: A cross-sectional epidemiological study was conducted to assess the prevalence and etiology of mental retardation (MR) among children under 14 years of age. The definition of MR and the criteria for diagnosis were adopted from WHO (1985). The IQ/DQ was evaluated with standardized psychological tests. The etiology of MR was specified by medical, genetic and psychosocial studies. A total of 862 retarded children were found among 85,170 surveyed. The overall adjusted prevalence rate was 1.20%. The percentage of mild, moderate, severe and profound MR was 60.6%, 22.7%, 9.6%, and 7.1%, respectively. Specific causes were found in 673 cases (79.1%). The etiology was unknown in 21.9% children. Timing of the causes showed prenatal in 34% perinatal 11.9%, postnatal 33%. Biomedical causes consisted of 89.6% and sociocultural factors, 10.4%. Among the prenatal factors, genetic diseases ranked first and manifested as chromosomal abnormalities and inborn errors of metabolism. Among the postnatal causes, sequelae of CNS infections and other forms of acquired brain insult were most important. Most children of socio-cultural MR were at school age and of the mild category. Our results show that most MR cases are preventable.

Q fever in Taiwan.

Abstract: Background Although Q fever, a rickettsial disease caused by Coxiella burnetii, is supposed to occur sporadically worldwide, there is only one case report of this disease in Taiwan. We examined the antibody of Q fever to evaluate the status of Q fever in Taiwan. Methods In total, 579 paired serum specimens of suspected febrile patients sent by several hospitals and sanitary stations to this Institute in 1991 and 1992 were tested according to the technique of indirect fluorescent antibody (IFA). Results In total 48 serologically acute Q fever cases were found, mostly from Tainan, Pingtung and Kaohsiung. There was only one female, and the age of most patients was 40-50 years. The high season is in June and July. Conclusions The antibody titer of all 48 positive cases reached 1:320 or higher on the 13th day after onset of the disease. IFA as a diagnostic tool to detect acute and convalescent serum antibody titer is discussed.