Showing papers in "National Medical Journal of China in 1997"

The double-blind test of sodium hyaluronate (ARTZ) on osteoarthritis knee

Abstract: Background At this time, no definite treatment exists for osteoarthritis disease. Hyaluronate (ARTZ) is one of the most important components of synovial fluid. It is generally accepted that hyaluronic acid protects the articular cartilage and soft tissue surfaces from trauma during joint function. Methods Ninety patients with 116 knees diagnosed as early arthritis (mild to moderate) by four senior orthopaedic surgeons were selected to join this study. The trial design was applied with a double-blind model. The selected patients were randomly injected with 2.5 ml drugs (ARTZ or placebo) intra-articularly once a week for five consecutive weeks without the use of local anesthetic drugs. Evaluation results included grading of subjective and objective symptoms and daily activities. The follow-up period was up to six months after initial injection. Results According to the results of clinical evaluation and statistical analysis, SPH (ARTZ) is quite effective for osteoarthritis knees, and significantly better than the placebo. The effective peak was one week after five injections of ARTZ. The effective period could last up to three months without additional treatment. The efficacy of ARTZ on osteoarthritis knees was more prominent for relief of motion pain and improvement of knee movement. No side effects developed during a six month period. Conclusions Based on clinical results here, SPH is a safe drug for administration as an alternative approach to treat the osteoarthritis knee.

Surgical repair of Ebstein's anomaly.

Abstract: Background Ebstein's anomaly represents a congenital structural deformity of the tricuspid valve associated with a wide spectrum of morphologic and physiologic abnormalities. Valvuloplasty and tricuspid valve replacement are the main surgical treatments. Plication of the atrialized right ventricle and valvuloplasty of the tricuspid valve can achieve satisfactory clinical results. Two surgical techniques, known as Danielson's and Quaegebeur's methods, are often used clinically. This study was conducted to compare the postoperative results between both methods in treatment of Ebstein's anomaly. Methods Valvuloplasty of tricuspid valve and the plication of atrialized right ventricle were performed in 8 out of 17 patients with Ebstein's anomaly in our hospital from January 1986 to August 1996. Danielson's method was used in six of eight patients, and Quaegebeur's method was used in the remaining two patients. There were three males and five females, aged from 8 months to 61 years (mean: 14.1 years). Results All patients achieved clinical improvement in cardiothoracic ratio and heart functional class. Cardiac arrhythmia was the likely cause of death in two patients treated by Danielson's method, and one patient developed complete atrioventricular (A-V) block postoperatively. By Quaegebeur's method, all patients survived, but a permanent pacemaker was implanted for both patients due to their preoperative complete A-V block. Conclusions Both methods achieved satisfactory postoperative results. However, Quaegebeur's method seems to be more effective because it provided a simultaneous reconstruction of both tricuspid valve and right ventricle without the need for additional excision of the right atrium.

Enterovesical fistula: 10 years experience.

Abstract: Background Enterovesical fistula is a relatively uncommon complication of pelvic malignancies, diverticulitis of the colon, postoperative irradiation or trauma. Early diagnosis of enterovesical fistula is difficult and its management, complicated. The main purpose of this study is to investigate the most appropriate diagnostic method and to discuss the choice among different surgical managements. Methods From 1986 to 1995, 30 patients with enterovesical fistula were diagnosed and treated at Veterans General Hospital-Taipei. The records were reviewed retrospectively with regard to symptoms, primary disease process, diagnostic studies, management, complications, mortality and follow-up. Results Recurrent urinary tract infection (UTI) accounted for 73% and was the most common presenting symptom. Fecaluria (43%) and urine per rectum (40%) were another two common presenting symptoms. The major cause of these cases was malignancy (36%), followed by postoperative radiotherapy (17%) and iatrogenic injury (17%). Most of these cases were diagnosed by cystography (90%), barium enema (75%) or cystoscopy (69%). The rectum (52%) was the most common site involved, followed by the sigmoid colon (39%). The surgical management was individualized for each patient according to the general condition and the disease process. Conclusions By combining the results of cystography, barium enema and cystoscopy, diagnosis of enterovesical fistula can be established in almost all cases. Single-stage operation for enterovesical fistula should be limited to those patients in good nutritional state and without severe inflammation, radiation injury, intestinal obstruction, other major medical problem, advanced malignancy or old age.

The outcome of terminal liver cirrhosis patients requiring mechanical ventilation.

Abstract: BACKGROUND Liver cirrhosis is a common problem in Taiwan. Without liver transplantation, patients with end-stage liver cirrhosis frequently die of various complications and often require mechanical ventilatory support prior to their death. The purpose of this study was to investigate the in-hospital and short-term outcome of such patients. METHODS A retrospective review of 47 medical records of mechanically ventilated patients with primary diagnosis of liver cirrhosis, admitted from November 1990 to September 1993, allowed analysis of disease course and outcome for these patients. RESULTS Among the 47 patients, a Child-Pugh's class A patient receiving temporary mechanical ventilation (MV) after elective devascularization surgery was excluded from analysis. Among the remaining medically treated 46 patients, there were 33 Child-Pugh's class C patients, 9 class B patients and 4 unclassified patients. Primary reasons for endotracheal intubation and MV included airway protection, acute respiratory distress and shock. Of these patients, shock was present in 39 cases, upper gastrointestinal bleeding in 34, systemic inflammatory response syndrome in 32, renal insufficiency with creatinine greater than 1.3 mg/dl in 32, bacteremia in 14, parenchymal lung disease in 16, spontaneous bacterial peritonitis in 10, and intracerebral hemorrhage in 1 during their hospital courses. Thirty-eight patients (83%) died within 72 hours after being placed on mechanical ventilation. Patients requiring MV with complications of bacteremia, parenchymal lung disease or renal insufficiency during hospitalization were found to have a 100% mortality rate. Successful weaning occurred in only 3 of 46 patients (8.7%). Of these three, two (4.3%) went home alive and had survived over six months after discharge. CONCLUSIONS It was concluded that cirrhotic patients requiring MV have an extremely poor prognosis. Patients and their families should be fully informed of the prognosis, and routine use of MV should not be encouraged in patients with terminal stage liver disease.

The effect of systemic and local irradiation on wound macrophages and the repair promoting action of phenytoin sodium

Abstract: OBJECTIVE To study the effect of systemic and local irradiation on wound macrophages (M phi) and the pair promoting action of phenytoin sodium on irradiation-impaired wound healing. METHODS Wound M phi was collected by polyvinyl alcohol sponges which were implanted in a rat dorsum incision. The number of M phi, phagocytic function of wound M phi, and the release of tumor necrosis factor (TNT alpha) and interleukin-1 (IL-1) from wound M phi, and wound breaking strength (WBS) were respectively investigated. RESULTS WBS was deceased after 6Gy systemic irradiation and 20Gy local irradiation, and phenytoin sodium improved WBS in normal wound and radiation-impaired wound. After 6Gy systemic irradiation the phagocytic function of wound M phi, the release of TNF alpha and IL-1 from wound M phi, as well as the number of M phi in wound, were significantly decreased on days 3, 5, 8 after wounding. After 20Gy local irradiation, the ratio of M phi in wound cells was significantly decreased on days 3, 5, 8, 13 after wounding, but the function of macrophage was not significantly decreased. Phenytoin sodium significantly increased the number of wound M phi, improved the phagocytic function of M phi, and the release of TNF alpha and IL-I from wound M phi on days 3, 5, 8 days after wounding despite the rats were radiated or not. CONCLUSION The results indicated that the decrease of number and function of wound M phi play an important role in the impairment of early wound healing by systemic irradiation. Phenytoin sodium accelerated normal and irradiation-impaired wound healing by increasing the number of wound M phi and improving the M phi function.

Klebsiella pneumoniae meningitis: analysis on clinical features of thirty-two adult patients

Abstract: Background To assess the clinical features and therapeutic outcomes of adult Klebsiella pneumoniae (KP) meningitis. Methods Thirty-two adult patients with KP meningitis were included in this study. Their clinical features, the outcomes with the third generation cephalosporin (moxalactam, cefotaxime, ceftazidime) treatment and prognostic factors were analyzed. Results These patients' diseases were predominantly community-acquired. Males outnumbered females (3:1). Diabetes mellitus (DM) was the most common underlying disease, followed by other debilitating diseases such as liver cirrhosis, neoplasm and end-stage renal disease (ESRD). Patients with spontaneous meningitis had a more fulminant course with a higher prevalence of bacteremia, shock and death (66%). Metastatic septic abscess was frequent (19%). Among the 21 patients who received initial appropriate antimicrobial therapy (IAAT), 2 took cefotaxime and 1 died; 13 took moxalactam of whom 5 died; and 6 took ceftazidime of whom 3 died. All of the other 11 patients who did not receive IAAT died. Conclusions The clinical features of KP meningitis are various and indistinguishable from other form of bacteria meningitis. Most of the patients with KP meningitis are associated with underlying medical problems, such as diabetes mellitus and liver cirrhosis. Many factors, including septic shock, bacteremia, high cerebrospinal fluid lactate concentration, and IAAT, might influence the prognosis. In spite of a high mortality rate, however, IAAT is mandatory to improve the overall survival rate.

Primary intracranial germ-cell tumor in children.

Abstract: Background Primary intracranial germ-cell tumors (GCTs) account for about 11.1% of all primary brain tumors of children in Taiwan. Because these tumors commonly involve the hypothalamus-pituitary gland regions and their biochemical secreting character, patients frequently display neuroendocrinological symptoms and signs. Endocrinopathy, if present, often occurs prior to other neurological or radiological manifestations. This article reviews experience here, with present results comparing them with previous reports. Methods Twelve children who were diagnosed with primary intracranial germ-cell tumors between 1983 to 1995 were studied retrospectively. Their clinical presentations, laboratory results and treatment modalities as well as the current status were collected for presentation here. Results There were seven boys and five girls. The age distribution was from 5 to 15 years old. The most common symptom was increased intracranial pressure (9/12), followed by diabetes insipidus (8/12), vision deficit (8/12) and sexual precocity in 3 boys. In 11 patients the tumors arose from the suprasellar or pineal regions. In two patients the tumors arose synchronously in the suprasellar and pineal regions. Pure germinoma was found in six patients. Only one had an elevated tumor marker. These six patients all received radiation with or without operation therapy, and all are still alive. Six patients, each with a non-germinomatous malignant germ-cell tumor, had a poorer prognosis. Although they received aggressive treatment, including operation, radiation and chemotherapy, three patients died, with a mean survival period of 3.3 years. Conclusions In cases of diabetes insipidus in children or sexual precocity in boys, a thorough investigation for intracranial germ-cell tumors is recommended. The treatment and outcome are different for germinomas and non-germinomatous malignant germ-cell tumors. A thorough pathological diagnosis is recommended for planning of treatment protocol in order to improve prognosis.

Aortic stenosis in children: 19-year experience.

Abstract: BACKGROUND: In the Taiwanese literature, few articles describe the pertinent features of aortic stenosis (AS). This study explores the features of AS in Chinese children. METHODS: 3808 children with congenital heart diseases have undergone cardiac catheterization at our institution over the past 19 years. Among them, 51 (1.3%) cases were AS. The clinical, electrocardiographic, echocardiographic and catheterization findings, the methods of treatment and outcomes were reviewed. RESULTS: Valvular AS occurred in 39 children (76.5%), subvalvular AS in 5 (9.8%), and supravalvular AS in 7(13.7%). Male was predominant (M/F ratio, 2.6) except in supravalvular type. Forty-three patients had associated cardiovascular defects. Aortic regurgitation (AR) was the most common one. Most patients (56.9%) were asymptomatic. Classic symptoms included exertional dyspnea (17.6%), syncope (9.8%), and chest pain (7.8%), etc. Left ventricular hypertrophy was noted in 31.2% of cases. The mean duration of follow-up was 3.9 +/- 3.4 years. Ten patients received open-heart surgery and 2 received balloon dilation. The pressure gradients across the stenotic area dropped from 95.3 +/- 29.3 to 51.4 +/- 35.8 and 53.1 +/- 12.3 mm Hg in early and late Doppler follow-up studies, respectively (p < 0.05). The average gradient increased from 36.9 +/- 25.3 to 40.8 +/- 32.6 mm Hg in nonsurgical patients. The result was insignificant. No mortality occurred following open-heart surgery. One child expired due to heart failure after the ligation of the patent ductus arteriosus and dilation of the stenotic aortic valve on the surgical table under general anesthesia. Autopsy revealed valvular rupture. In the nonsurgical group, no mortality occurred, but one patient was brought home by parents in critical condition and later died. CONCLUSIONS: We found that some clinical features of AS in Chinese children were different from those in occidental populations. (1) The incidence of AS was relatively low. (2) Subvalvular AS was the least common type in contrast to supravalvular AS in western studies. (3) Male predominance was not present in the supravalvular type, which lacked sexual proclivity. (4) Williams syndrome was a more frequently associated anomaly. Turner syndrome was not present in our study. (5) Isolated AS was less frequent. (6) The unusual finding such as right ventricular hypertrophy on EKG was present due to associated cardiac anomalies. Open-heart surgery is effective and safe, but the efficacy of balloon dilation requires further investigation.

Efficacy and safety of fenofibrate or gemfibrozil on serum lipid profiles in Chinese patients with type IIb hyperlipidemia: a single-blind, randomized, and cross-over study.

Abstract: BACKGROUND The purpose of the study was to evaluate the effects and safety of fenofibrate or gemfibrozil on plasma lipid profiles in Chinese patients with type IIb hyperlipidemia. METHODS Patients with previously diagnosed type IIb hyperlipidemia were initially evaluated in this single-blind, randomized, cross-over study. Only those who had persistent hyperlipidemia after a two-month diet control period were included. The patients were randomized to either fenofibrate 100 mg tid or gemfibrozil 600 mg bid for three months, then shifted to alternate drug for another three months after a two-month washout period. During the whole 10-month period, a prudent diet was maintained. Each patient was followed up at Out-patient Clinic regularly for diet interview, compliance and possible adverse events. RESULTS A total of 12 patients, 11 males and 1 female, completed the whole study. After a three-month treatment of fenofibrate, there was significant reduction in plasma total cholesterol (22.7%, p < 0.001), total triglycerides (43.2%, p < 0.001), and low-density lipoprotein (LDL)-cholesterol (25.7%, p = 0.001). Serum high density lipoprotein (HDL) cholesterol was also increased by 30.2% (p = 0.055). On the other hand, only total triglyceride was significantly reduced by 36.5% (p = 0.005) with gemfibrozil treatment. There was no significant change of serum total, HDL- and LDL-cholesterol after the three-month treatment of gemfibrozil. Besides, serum uric acid and alkaline phosphatase were significantly reduced with fenofibrate but not with gemfibrozil treatment. There was no obvious adverse event noted during each treatment period with either drug. CONCLUSIONS The findings suggest that in Chinese patients with type IIb hyperlipidemia, both fenofibrate and gemfibrozil can safely and significantly reduce serum triglyceride. Fenofibrate, but not gemfibrozil, could also reduce serum total cholesterol, LDL and uric acid. The results were compatible with the findings of previous studies in western patients with hyperlipidemia.

Inhibition of angiogenesis by antitumor antibiotic C1027 and its effect on tumor metastasis

Abstract: OBJECTIVE To investigate the effect of C1027, an enediyne antitumor antibiotic, on angiogenesis and its anti-metastatic activity. METHODS Chick embryo chorioallantoic membrane assay was used for anti-angiogenesis activity and bFGF receptor binding assay was used for the elucidation of the possible mechanism. Spontaneous pulmonary metastasis of Lewis carcinoma in mice was employed to evaluate the anti-metastatic effect. RESULTS C1027 was highly potent in suppressing angiogenesis with a minimum effective dose of 0.01 microgram/egg. Enediyne chromophore moiety of the C1027 molecule was essential to anti-angiogenesis activity. Receptor binding assay showed that C1027 blocked bFGF binding to its receptor with an IC50 value of 2.3 x 10(-6) micrograms/ml. C1027 markedly inhibited pulmonary metastasis of Lewis carcinoma in mice. Compared at equitoxic dosage level (1/4 LD50), C1027 (0.01 mg/kg, i.v., x 2) was more effective than mitomycin (1.25 mg/kg, i.v., x 2) and the percent inhibition of metastatic foci in the lung was 98% and 78%, respectively. CONCLUSIONS C1027 is a new potent anti-angiogenesis agent with markedly anti-metastatic activity. The mechanism of C1027 suppressing angiogenesis may be related to its blocking effect on bFGF binding to its receptor.

The relationship between TIL from human primary hepatic carcinoma and prognosis

Abstract: OBJECTIVE To determine whether tumor-infiltrating lymphocytes (TIL) could affect the prognosis for patients with primary hepatic carcinoma (PHC). METHODS Tissue distribution, proliferative property and cytotoxicity of TIL were measured in colour medical image analysis, immunohistochemical technique, 3H-thymidine proliferative response and LDH-release assay. RESULTS On the basis of infiltrating level of TIL, all patients with PHC were classified into three types in which there can be non-infiltrating, lower infiltrating and high infiltrating. The survival time of patients without TIL was shorter than that of patients with TIL. In addition, their postoperative intrahepatic recurrences were higher than those of the latter. Freshly isolated TIL showed more poor proliferation and cytotoxicity than autologous peripheral blood lymphocytes (PBL) in vitro. TIL activated with anti-CD3 McAb and rIL-2 displayed higher cytotoxicity against fresh autologous hepatic carcinoma cells than against K562 targets. CONCLUSION Clinically, TIL are associated with the prognosis for patients with PHC, however, it is in the tumor nest that the functions of TIL are impaired or suppressed by some factors locally produced by tumor cells in vivo.

Diagnostic laparoscopy: indication and benefit.

Abstract: Background Patients with an obscure and unrelievable abdominal condition may be forced to receive open laparotomy for diagnosis. Diagnostic laparoscopy has been suggested as an alternative to diagnostic laparotomy in selected cases. The aim of this article is to evaluate the circumstances suitable for laparoscopic diagnosis of certain abdominal conditions and the possible advantages of that approach. Methods Among 256 patients undergoing elective laparoscopic operations using conventionally pneumoperitoneal techniques from January 1994 to June 1995, twenty patients received diagnostic laparoscopy. The correlation between preoperative diagnosis, laparoscopic diagnosis and pathologic diagnosis as well as the outcome of laparoscopic diagnosis and treatment have been assessed. Results Major indications for diagnostic laparoscopy included acute abdominal pain (n = 4), chronic abdominal pain (n = 6), differentiating intraabdominal tumor (n = 4), staging known malignancy (n = 3) and evaluating intraperitoneal implantation (n = 3). Two of the four patients with acute abdominal conditions, one of the six patients with chronic abdominal pain. Four of the seven patients with undifferentiated/unstaged abdominal tumors and all of the three patients with intraperitoneal-implanted drainage tubes had no reasons for a further exploratory procedure, thus preventing the morbidity or mortality which might occur after unnecessary laparotomy. The duration of operation and hospitalization was shorter than the group without laparotomy. Conclusions Diagnostic laparoscopy benefits patients by avoiding unnecessary surgery, avoiding unnecessary delay in diagnosis and treatment and shortening the operative and hospitalized period. However, it provides only an alternative not a substitute for traditional diagnostic procedures and will never lessen the importance of conventional laparotomy.

Hyperprolactinemia in systemic lupus erythematosus.

Abstract: BACKGROUND Recent evidence demonstrates that hyperprolactinemia was found in active systemic lupus erythematosus (SLE). This indicates prolactin (PRL) is an important immunoregulator and may play a role in the pathogenesis of SLE. However, study of the prevalence and the clinical significance of hyperprolactinemia in SLE and other rheumatic disease has rarely been carried out. METHODS From January 1995 to January 1996, 79 individuals were enrolled in this study. PRL levels of 30 cases of SLE were compared with those in 29 rheumatoid arthritis (RA) and 20 normal healthy volunteers. Moreover, a correlation between levels of PRL and SLE disease activity index (SLEDAI) in SLE patients was studied. RESULTS The mean value of serum PRL level in SLE patients (19.35 +/- 11.33 ng/dl) was significantly higher than in RA patients (12.33 +/- 8.30 nd/dl, p < 0.05). The difference was more pronounced between SLE patients and healthy individuals (12.01 +/- 7.53 ng/dl, p < 0.01). However, patients with RA had no significant difference from the control group. Analysis made between SLEDAI and PRL levels in SLE patients revealed no significant correlation (r = 0.537, p = 0.07). Furthermore, no significant correlation was found between antinuclear antibody (ANA), C3, C4, anti-DNA and hyperprolactinemia. CONCLUSIONS This study has shown that hyperprolactinemia is prevalent in random SLE patients, but not in RA patients. The elevated PRL levels seem not to be associated with disease activity and ANA positivity.

Comparison of risk factors for lacunar infarcts and other stroke subtypes.

Abstract: BACKGROUND Lacunar infarction (LI) is an ischemic stroke subtype with unique clinical, radiological and pathological features. Its relation to other stroke subtypes is unclear. To better understand the underlying pathological process of LI, we compared the risk factors of LI with those of other stroke subtypes. METHODS During the study period (from January 1, 1990 to December 31, 1991), 240 consecutive patients with first-ever strokes admitted to the stroke unit of our hospital were enrolled to the study and were classified into one of the four stroke subtypes (52 with LI, 80 atherothrombotic infarcts, 38 cardiogenic embolism and 70 brain hemorrhage) based on their computed tomography (CT) and clinical features using the guideline developed by the National Institute of Neurological Disorders. Eighty outpatients of similar age who had either low back pain or cervical spondylosis were recruited from the clinics of Neurology to serve as non-stroke controls. Data collected included demographics, lifestyle, and other vascular risk factors. Detailed physical and neurological examination, blood biochemistry and Doppler ultrasound on cervical vessels were performed. RESULTS Our investigations revealed that LI is a common stroke subtype accounting for 21% of all first-ever strokes in our hospital. Like ischemic stroke patients, those with LI were much more likely to have hypertension, diabetes, heart disease and carotid disease when compared with non-stroke controls. Patients with brain hemorrhage had less history of diabetes and lower levels of cholesterol than LI patients. CONCLUSIONS LI patients seemed to share more risk factors with ischemic stroke patients than with brain hemorrhage patients. These shared risk factors suggest a possibly similar underlying pathological process between ischemic strokes and LI patients. Careful screening for those risk factors should be part of the mandatory clinical management for the prevention of LI.

Clinicopathological comparison of resectable hepatocellular carcinoma between the young and the elderly patients.

Abstract: Background Hepatocellular carcinoma (HCC) is one of the most common cancers in many parts of the world. In Taiwan it is the leading cause of death in male cancer patients. The peak age of onset of HCC varies according to geographic barriers, which indicates different hepatocarcinogenesis among different age groups. This study aims to evaluate whether there exists significantly different clinicopathological features between young and elderly HCC patients. Methods During a six-year period, a total of 248 patients with HCC underwent liver curative resection at Veterans General Hospital-Taipei, Taiwan. Among them, 22 patients were younger than 40 years of age, and 43 patients were older than 70 years of age. Important clinicopathological characteristics of the patients (including sex, family history of HCC, smoking habits and alcohol consumption patterns, hepatitis B or C infection, indocyanine-green retention rate at 15 minutes (ICGR-15), serum alpha-fetoprotein value, tumor size, tumor number, tumor venous invasion, capsular formation, tumor staging, cirrhosis, and tumor DNA ploidy) and postresectional prognosis were compared between young and elderly HCC patients. Results The frequency of presence of family history (22.7% versus 4.7%), hepatitis B surface antigen carrier rate (81.8% versus 48.8%), and patients with large-sized tumors (31.8% versus 7.0%) were significantly higher in young patients than in elderly patients. The male:female ratio (4.5:1 versus 42:1), degree of liver damage (reflected by the ICGR-15 value, 5.6 +/- 5.0% versus 13.1 +/- 8.8%) and the incidences of liver cirrhosis (18.2% versus 48.8%) were significantly lower in young patients than in elderly patients. However, there were no significant differences in postresectional survival rates between these two groups. Conclusions There are age-related differences in clinicopathological characteristics of HCC patients. Accordingly, different mechanisms of hepatocarcinogenesis may exist between young and elderly HCC patients.

[The role of MMP-2 in the invasion and metastasis of hepatocellular carcinoma (HCC)].

Abstract: OBJECTIVES To get insights into the role of MMP-2 in the invasion and metastasis of hepatocellular carcinoma (HCC), and to find a method to judge the invasion and metastasis of HCC through MMP-2. METHODS Zymograph and immunohistochemistry were used to study the content and types of positive cells of MMP-2 in the HCC, and statistical methods were used to analyse the association between the content of MMP-2 and the pathological indexes of HCC. RESULTS MMP-2 was expressed by all the normal liver, HCC and surrounding liver parenchyma. The increase of MMP-2 and the presence of the active type of MMP-2 were related to the invasion and metastasis of HCC. The content of MMP-2 in HCC being higher than that in surrounding liver parenchyma was an important index to judge the invasion and metastasis of the HCC. The positive cells of MMP-2 found in immunohistochemistry were normal hepatocytes, cholangioepithelial cells, Ito cells, regenerated hepatocytes, new generated cholangioepithelial cells, and HCC cells. CONCLUSION MMP-2 was related to the invasion and me astasis of HCC. The content of MMP-2 in HCC being higher than that in surrounding liver parenchyma could be bused as an important index to judge the invasion and metastasis of HCC.

Clinical treatment in colonoscopic perforation: a comparison of surgical and conservative management.

Abstract: BACKGROUND Successful management of colonoscopic perforation by conservative treatment has been reported, but management remains controversial. Delayed surgery in some situations may lead to an irretrievable result. How to make the best decision? A retrospective study was designed to address this challenge. METHODS From the period October 1982 and December 1995, 9214 consecutive colonoscopic examinations at Taichung Veterans General Hospital were reviewed. RESULTS Twenty perforations (0.22%) related to the procedure were found. Of those 16 occurred during diagnostic colonoscopies, and four, during therapeutic colonoscopies. Fifteen perforations caused by diagnostic colonoscopies were treated by surgery, one perforation caused by diagnostic colonoscopy and the four by therapeutic colonoscopies were treated by non-surgical methods. CONCLUSIONS A standard text on large bowel surgery recommends laparotomy for most cases of colonoscopic perforations. In experience here, however, non-operative management was indicated if the perforation was small with no signs of general peritonitis, and the patient's condition was good. However, if the patients deteriorated with non-operative treatment, immediate laparotomy is indicated.

Cutaneous Rosai-Dorfman disease manifestating as recurrent breast tumor: a case report.

Abstract: A case of cutaneous Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) manifestating as a recurrent breast tumor is reported. The tumor occurred on the left breast of a 35-year-old woman. Before arriving at the correct diagnosis, four biopsies had been performed with various diagnoses of chronic inflammation, plasma cell mastitis and inflammatory pseudotumor. Numerous typical histiocytes with lymphophagocytosis appeared in the final excised specimen, and a correct diagnosis was made. Ultrastructural examination revealed no evidence of Birbeck granule. The literature concerning Rosai-Dorfman disease manifestating as breast tumor is reviewed. Since the diagnosis is often overlooked in the absence of lymphadenopathy, a high index of suspicion is required to recognize this rare cutaneous Rosai-Dorfman disease.

Epidemiological study of external genital diseases in 5172 adolescents

Abstract: OBJECTIVE To study the incidence of external genital diseases and the health status of external genitalia in male adolescents in china. METHODS 5172 male adolescents aged 7-22 were sampled randomly to examine the diseases and health status of external genitalia. According to the diagnostic criteria in textbook Surgery (3rd edition), all examinations were carried out by urologists. RESULTS The total incidence of redundant prepuce was 67.79%, phimosis 10.09%, varicocele 19.82%, hydrocele 0.87%, concealed penis 0.68%, cryptorchidism 0.39%. CONCLUSION The health status of external genitalia in male adolescents is bad. Redundant prepuce and phimosis are common diseases. The examination of external genitalia should be carried out in the physical examination of admission. This study may provide the theoretical evidence for prevention and treatment of male external genital disease as well as the important data for study on andrology.

The painful experience of inappropriate therapy of snake bites: a report of two cases.

Abstract: Recognizing the exact species of snake and specific antivenin administration are the most important modality of treatment for poisonous snake bites. In Taiwan, there are six kinds of medically important snakes--two species of Elapidae and four species of Viperidae. Two kinds of polyvalent antivenins and one monovalent antivenin are available. But for snake bites, questions about the prescription of antivenins are still the major problems addressed to the Poison Control Center. Improper use of antivenin may delay a patient's recovery from snake poisoning and even lead to mortality. Here, two cases of snake bites are presented. Each had severe complications and mortality as a result of inappropriate therapy, and the most rational management of snake bite in Taiwan is discussed, too.

Hyperbaric oxygen as an adjunctive treatment for descending necrotizing mediastinitis: A case report

Abstract: Descending necrotizing mediastinitis is a rare but serious complication of oropharyngeal and deep neck infection which spreads down to the mediastinum via the cervical-facial planes. Its mortality rate remains high even with aggressive surgical drainage and appropriate antibiotics. Here, a case of descending necrotizing mediastinitis secondary to peritonsillar abscess is reported. It was successfully treated with hyperbaric oxygen and antibiotics followed by surgical drainage. Based on this report, hyperbaric oxygen therapy might be of great value as an adjunctive management to control this fatal infection.

Double effects of arsenic trioxide (As2O3) on acute promyelocytic leukemic cell line

Abstract: OBJECTIVE To investigate the effects of a wide range of concentrations of As2O3 on NB4 cells. METHODS Cell morphology, cell-DNA content distribution, CD11b and CD33 antigens and nitroblue tetrazolium (NBT) reductions were evaluated in an APL cell line NB4 cells with or without As2O3 treatment. In addition, immunofluorescent analysis for APL marker molecule PML-RAR alpha was also performed. RESULTS 1-2 mumol/L of As2O3 treated NB4 cells presented morphologically some features of apoptotic cells such as intact cell membrane, chromatin condensation and nuclear fragmentation. Sub-G1 cells, whose percentage presents concentration and time-dependency, were observed by flow cytometer. Otherwise, NB4 cells with the treatment of As2O3 at 0.1-0.25 mumol/L for a long time (10 days) have differentiation-related morphology, and their differentiation antigens CD11b and CD33 were also modulated to some extent. In addition, 0.1-2 mumol/L of As2O3 could rapidly and effectively modulate and degradate PML/PML-RAR alpha proteins. CONCLUSION As2O3 had double effects (induction of apoptosis and imcomplete differentiation) on NB4 cells, which could associate with rapid modulation and degradation of PML/PML-RAR alpha proteins.

Application of subtractive hybridization in screening for colorectal cancer negatively related genes

Abstract: OBJECTIVE To search previously uncertained factors that corelated with the occurence and development of human colorectal cancer. METHOD Subtractive hybridization technique was employed to screen down-regulated genes of colorectal cancer. RESULTS We obtained 46 clones which highly were expressed in normal intestinal mucosa but much lower or none in colorectal cancer. Two of the 46 clones, SCN6 and SCN19, were accepted by the Genbank Database as novel genes with the accession numbers U17714 and U20248. Full length cDNA (2932bp) of SNC6 was sequenced, and supposed to encode a protein comprised 271 amino acids, MW30kd, which shared less than 30% homology with the protein database. The gene was localized to human chromosome 22q13. RNA dot blot analysis showed that the expression level of SNC6 was lower in colorectal cancer than in normal intestinal mucosa, and similar results were found in breast cancer. Northern blot showed higher expression levels of SNC6 in liver, lung, prostate, testis, ovary and K562 cell line than in other tissues. CONCLUSION SNC6 can be further investigated as a novel colorectal cancer negatively related gene.

Experimental study of selective muscarinic receptor antagonists on attenuation of morphine tolerance and dependence in rats

Abstract: Objective To characterize the role of muscarinic receptor subtype in the process of the morphine tolerance and dependence. Methods The morphine (Antinociception) tolerance was assessed by using hot-plate latency, and morphine dependence was characterized by naloxone-precipitated withdrawal. Intraperitoneal (i.p.) or intrathecal (i.t.) injection of muscarinic M1 selective antagonist pirenzepine or M2 selective antagonist methoctramine was carried out. Results Methoctramine (i.p.) for 6 days restored the sensitivity to morphine in male Sprague Dawley rats that are tolerant as a result of 6 days of b.i.d. morphine injection, in contrast, saline and pirenzepine (i.p.) did not increase the mean HP latency of morphine tolerant rats. Both methoctramine and pirenzepine in doses did not alter the baseline HP latency. Concurrent treatment with pirenzepine (i.t.) significantly attenuated the development of morphine tolerance produced by twice daily injection of morphine in a dose-dependent manner, however, methoctramine (i.t.) also decreased without dose-relation. In addition, the withdrawal symptoms precipitated by naloxone in morphine dependent rats were blocked by methoctramine (i.p.) or pirenzepine (i.t.) at single dose injection in a dose-dependent manner. Methoctramine (i.t.) at 200 micrograms/kg could partially inhibit the withdrawal symptoms. Conclusions The data suggested that the muscarinic receptor subtype predominating M2 receptor at the peripheral and M11 in the spinal cord mediate the process of morphine tolerance and dependence in rat.

The clinical experience of gaseous retroperitoneoscopic and gasless retroperitoneoscopy-assisted unroofing of renal cyst.

Abstract: BACKGROUND: The aim of this study is to compare the application of gaseous retroperitoneoscopic (GR) and gasless retroperitoneoscopy-assisted (GLRA) unroofing of renal cysts. METHODS: Fourteen patients with symptomatic simple renal cysts had undergone unroofing of the cyst with GR in seven cases and GLRA in seven others. Three trocars (10 mm, 10 mm and 5 mm) were inserted in the GR procedure. A 3 cm flank muscle-split incision was made and retroperitoneoscopy was performed through the same incision in the GLRA procedure. Then, the cyst was unroofed. RESULTS: The mean operative time was 104.3 minutes in the GR group and 52.1 minutes in the GLRA group, respectively (p = 0.001). The mean requirement of postoperative meperidine hydrochloride injection was 21.4 mg in the GR group and 71.4 mg in the GLRA group, respectively (p = 0.017). In the GR group, the mean postoperative stay was 3.7 days, and the time needed for return to normal activity was 7 days. In the GLRA group, the mean postoperative stay was 4.6 days, and the time needed for return to normal activity was 8 days. CONCLUSIONS: GR and GLRA techniques for unroofing of renal cysts are safe, effective and minimally invasive. GLRA is easy to perform and a more time-saving procedure when compared to GR, however, the patients of GLRA suffered more postoperative pain than after GR. GLRA is recommended in patients who had received retroperitoneal surgery or who have multiple renal cysts.

Clinical and experiment study of cooling therapy on burned wound

Abstract: OBJECTIVE: To observe the subjective benefit of pain relief by cooling therapy when wound temperature drops to below 28 degrees C (threshold for pain). METHOD: 22 patients with partial-thickness burns who received cooling therapy showed 2 days early healing as compared with untreated burn wounds. As a first aid measure, prolonged cooling therapy (up to 30') was recommended. In experimental study, the protective effects with cooling therapy were observed in wistar rats with deep second degree burns. RESULTS: Lower epithelial cell activity and higher schiff alkaline values were seen in the wound skin tissue in the non cooling therapy than in early cooling therapy groups and healthy controls. The groups with early cooling therapy (at once, 10', 20' after scalded injuries) the epithelial cell activity maintained at 83%, 80%, 65%. CONCLUSION: The results suggest that cooling therapy can protect the epithelial cell activity to some extent after scalded injuries which may be associated with inhibition of lipid peroxide.

Suprasellar meningiomas: analysis of 32 cases.

Abstract: BACKGROUND Suprasellar meningiomas originating from the tuberculum sellae, diaphragma sellae and planum sphenoidale are uncommon. Tumors of these regions can cause insidious visual loss and often remain undiagnosed until they have enlarged substantially or the symptoms have become aggravated. Previous reports have identified tumor size and duration of symptoms as the major factors determining the patient outcome. METHODS Between 1984 and 1995, at the Department of Neurosurgery, Neurological Institute of Veterans General Hospital-Taipei, 32 patients with histopathologically identified meningiomas originating from the suprasellar region received surgical tumor removal. In this study, the records and clinical data of these patients are retrospectively analyzed. RESULTS Tumor sizes ranged from 1.4 to 6.4 cm (average 3.4 cm) in diameter. The age of the patients ranged from 15 to 70 years (average 49 years), with the highest number of patients in their 50s. The male to female ratio was 7:25, with female predominance in all age groups. The presenting symptoms were mostly visual loss (87.5%) and the duration of symptoms ranged from 2 months to 35 years (average 4.25 years). Prognosis was evaluated according to the tumor size and duration of symptoms. Results showed that prognosis was favorably affected by a tumor size of 3.0 cm or less, and symptom duration of one year or less. CONCLUSIONS In this series, patients with a tumor size of 3 cm or less and patients with a duration of symptoms for one year or less had a better visual outcome, higher total removal rates, lower mortality rates and lower recurrence rates.

Chronic diabetic complications and treatments in Chinese diabetic patients

Abstract: Objective To investigate the prevalence of diabetes complications and the control of blood glucose, lipids and treatments in Chinese diabetic patients. Methods In 1994-1996, 626 Chinese diabetics were investigated for their diabetic complications, the control of blood glucose, lipids and their treatments by a multi-disciplinary team which included diabetic specialists, ophthalmologists, neurologists, nephrologists, dieticians, cardiologists, and others. Results Of these patients, 49.6% had hypertension, 46.5% neuropathy, 37.0% retinopathy, 25.4% ischemic heart disease (including 2.3% with myocardial infarction), 22.8% proteinuria (including microalbuminuria), 12.3% cerebral infarction and 1.0% amputation. 16% had preproliferative and proliferative retinopathy, and 10.5% maculopathy. 28 patients (44 eyes) were blind, but only 29% of them were checked by ophthalmologists before this screening. 36% of these patients with antihypertensive agents had their blood pressure controlled. 60% patients with hypertension were not taking any antihypertensive agent, one-third hypertensive patients had their blood pressure uncontrolled even if they had been treated with antihypertensive agents. Hyperglycemia was controlled unsatisfactorily in half of the patients. Over one-fourth of the patients had severe hyperglycemia. 24%, 48% and 59% of the patients had hypercholesterolemia, hypertriglyceridemia and low HDL level respectively. 21.9% kept on diabetic diet and about one-fourth had their diet uncontrolled, including 14% who had never controlled their diet even if their hyperglycemia was severe and 20% newly diagnosed diabetic patients untreated. One hundred twenty-seven newly diagnosed patients with duration less than 1 month were investigated for their diabetic complications. 19.6%, 17.8% and 42.5% of them had retinopathy, proteinuria and neuropathy. Eight patients had preproliferative and 1 had proliferative retinopathy. Three patients (5 eyes) had maculopathy. 33% of these newly diagnosed patients had hypertension, 7 severe hypertension, including 3 patients with antihypertensive therapy. Conclusions Diabetes was found late in the Chinese patients and diabetic complications had occurred in some patients by the time the disease was diagnosed. Hypertension was common in the Chinese diabetics. Over half of the diabetics had their blood glucose and blood pressure uncontrolled. Most of the diabetic patients had not controlled their diet. Macrovascular diseases and abnormal lipids metabolism were common. The risks of diabetic complications such as smoking, obesity and hypertension were not controlled and the awareness of these risks was low in the Chinese diabetics.

Cytomegalovirus appendicitis in a patient with acquired immunodeficiency syndrome: a case report.

Abstract: Cytomegalovirus (CMV) infection occurs predominantly in immunocompromised hosts. Involvement of the gastrointestinal tract in acquired immunodeficiency syndrome (AIDS) patients is frequent. Nevertheless, CMV appendicitis is exceeding rare. This report describes a patient with AIDS who presented with right lower quadrant abdominal pain, high fever, nausea and vomiting, but without leukocytosis. Diagnosis of CMV appendicitis was confirmed by appendectomy and histopathological examination. Problems related to the diagnosis and therapeutic management of CMV appendicitis in AIDS patients are discussed. The importance of early surgical intervention is emphasized, as is postoperative ganciclovir therapy for treatment of such patients.

Genetic polymorphism of monoamine oxidase B and susceptibility of Parkinson's disease.

Abstract: BACKGROUND Monoamine oxidase B (MAO-B) may play a role in the progression and cause of Parkinson's disease (PD), given consideration of the biochemistry and pathophysiology of the disease, and experiments on primates and humans. Assuming that the structural gene determines enzyme activity, an association study was undertaken to examine MAO-B genetic polymorphisms and look for the unique MAO-B gene alleles which occurred at a higher frequency in PD patients. METHODS Sixty-five PD patients, diagnosed according to the criteria set by a Core Assessment Program for Intracerebral Transplantations Committee, and 108 healthy controls were enrolled in this study. Genomic DNA was extracted from peripheral leukocytes by using a puregene kit. Polymerase chain reaction (PCR) was used to amplify the MAO-B genome. The PCR products were screened by restriction enzyme Hae III digestion and analyzed by single-stranded conformational polymorphism (SSCP). RESULTS Two bands with different mobility shifts, defined as MAO-B allele 1 and allele 2, were observed in SSCP analysis. Neither genotypes nor allelic frequencies of MAO-B showed a significant difference between PD patients and controls in our study. CONCLUSIONS Polymorphism of MAO-B genome was demonstrated in this study. It failed to show an association of a genetic marker with PD. However, this did not necessarily exclude the MAO-B locus from playing a role in causing PD because a polymorphism different from the one evaluated here may show some disease association.