Showing papers in "National Medical Journal of China in 1998"

Minimally-invasive, direct coronary artery bypass grafting.

Abstract: BACKGROUND Minimally-invasive, direct vision coronary artery bypass grafting (MIDCAB) is a new surgical technique performed via limited thoracotomy in a beating heart without cardiopulmonary bypass. METHODS From June 1996 to December 1996, MIDCAB was performed in 12 patients (all male, average age, 65.9 years). In 11 patients with left anterior descending coronary artery lesions, thoracotomy was performed via the left, fourth intercostal space and the pericardium was incised to identify the target site. About 8 cm of the left internal mammary artery was harvested. Bilateral anterolateral thoractomy was performed in one patient with left anterior descending and right coronary artery lesions. Anastomosis was performed under direct vision in the beating heart without cardiopulmonary bypass. RESULTS MIDCAB was performed successfully without morbidity. The patients' average stay in the intensive care unit was 1.8 days. No patient had any early cardiac event requiring additional surgery or percutaneous transluminal coronary angioplasty. Postoperatively, all patients were asymptomatic and their recovery was uneventful. CONCLUSIONS Our initial experience indicates that MIDCAB offers good results and is a treatment option for selected patients with left anterior descending and/or right coronary artery lesions.

Acute pancreatitis in pregnancy.

Abstract: Background Acute pancreatitis in pregnancy is rare. Our purpose in this study was to discuss the etiology, incidence and course of pancreatitis in pregnancy and to evaluate the maternal and perinatal outcomes. Methods Pregnant women with pancreatitis admitted to China Medical College Hospital, Taiwan, from 1980 to 1995 were studied retrospectively. A total of 16 patients were enrolled in the study. Two patients had gallstones and hyperlipidemia; four had gallstones alone; seven had hyperlipidemia alone; one had gestational diabetes mellitus; one had hyperparathyroidism and pregnancy-induced hypertension alone; and one had Hashimoto's thyroiditis. Conservative treatment and low-fat diets were administered to the patients. Results The incidence of gestational pancreatitis in this series was one in 6,790 pregnancies. The fetal outcome included eight preterm deliveries and three fetal losses. There were no maternal mortalities. The etiologies of pancreatitis were primary hyperlipidemia (56.3%) and gallstones (37.5%). All patients responded favorably to supportive therapy, and most of the symptoms subsided after delivery. Conclusions Early diagnosis and treatment is of utmost importance in the management of acute pancreatitis in pregnancy. The results of this study showed good maternal outcome following appropriate treatment. Fetal prognosis was less favorable and was most often associated with hyperlipidemia. Fetal monitoring is essential during the management of pancreatitis in pregnancy.

Successful pregnancy after treatment of deep adenomyosis with cytoreductive surgery and subsequent gonadotropin-releasing hormone agonist: a case report.

Abstract: Adenomyosis is a common pathologic finding significantly related to the menstrual and reproductive characteristics of women. Although noted during younger reproductive years, it usually presents in women over 35 years of age. For those with a strong desire to preserve fertility, there is presently no uniform agreement on the most appropriate therapeutic methods to manage the condition. Herein, we present a case of long-term secondary infertility with successful pregnancy after treatment of deep adenomyosis with cytoreductive surgery and a subsequent six-month course of gonadotropin-releasing hormone agonist (GnRHa) therapy. For those who want to conceive, early combined GnRHa therapy immediately following cytoreductive surgery and a delay of four to six months before attempting to fall pregnant is advisable. This is because adenomyosis tends to recur rapidly and the myometrium can be significantly disrupted during surgery. The major obstetric complications, such as uterine atony, rupture or placenta accreta, do not increase with adenomyosis during pregnancy. Although two events of threatened abortion and one of preterm labor were encountered during the pregnancy course, a healthy 2,900-g female was delivered by low transverse cesarean section at term. A cesarean section was performed because of previous large cytoreductive surgery. In contrast to GnRHa therapy alone, we report an effective alternative to hysterectomy in order to maintain fertility and achieve successful pregnancy.

Value of gamma-glutamyl transpeptidase for early diagnosis of biliary atresia.

Abstract: BACKGROUND Early diagnosis of congenital biliary atresia (BA) is important because the prognosis is closely related to timing of a hepaticoportoenterostomy. In this study, we discuss whether the elevation of serum gamma-glutamyl transpeptidase (GGT) is accurate for the early differentiation of BA from neonatal hepatitis (NH). METHODS The effectiveness of using GGT before the age of 10 weeks and other tools in the differential diagnosis of BA and NH were analyzed retrospectively by reviewing the charts of 29 BA and 12 NH patients. The results of serial liver enzyme studies, abdominal sonography, hepatobiliary scintigraphy and transcutaneous liver biopsy were compared between both groups. RESULTS The peak GGT value in BA before 10 weeks of age was significantly higher than that in NH (622.5 +/- 211.9 U/l vs 168.8 +/- 100.3 U/l, respectively, p < 0.001). When a serum GGT concentration greater than 300 U/l was used as a diagnostic criterion for BA in patients younger than 10 weeks of age, the diagnostic accuracy was 85%. When an increase in GGT value (in serial measurements) of greater than 6 U/l/day was used as a criterion, the accuracy was 88%. The diagnostic accuracy of abdominal sonography, hepatobiliary scintigraphy and liver biopsy was 68%, 67% and 79%, respectively. CONCLUSIONS GGT concentration is diagnostically valuable when the results of other diagnostic methods are not available, or are controversial, in differentiating between BA and NH.

Malignancy following renal transplantation.

Abstract: BACKGROUND A markedly increased incidence of malignancy in transplant recipients is well recognized. However, the incidence and pattern of post-transplantation malignancies shows some discrepancy among different reports. The renal transplant recipients monitored at Taichung Veterans' General Hospital comprise the largest group in Taiwan. An analysis of the characteristics of post-transplant malignancies emphasizes the differences from malignancies that occur in the Taiwanese general population and those reported in Western countries. METHODS The incidence and characteristics of de novo malignancy in 390 renal transplant recipients who underwent renal transplantation between May 1983 and June 1996 were analyzed. A total of 232 men and 158 women (mean age at transplantation: 38.5 +/- 10.7 years) were included. The relative risk for developing malignancies was calculated based on the sex- and age-matched cancer incidence of reference for the Taiwanese population; data from the Cancer Registry Annual Report in Taiwan (1989) was obtained for comparison. RESULTS A total of 25 cancers were diagnosed in 24 renal transplant recipients, for an incidence of 6.2%. The relative risk of renal malignancy was 13.8-fold higher among transplant recipients than in the general population. The impact of gender and age on the development of post-transplantation malignancy was not significant. The most common types of cancer were transitional cell carcinoma (TCC) of the urinary tract (8/25), and hepatoma (8/25), followed by two cases of Kaposi's sarcoma. Aside from immunosuppressive agents, the high incidence of hepatoma and TCC may be attributed to the high incidence of hepatitis infection and the possible carcinogenic effect of abnormal milieu induced by uremia per se. Survival was largely dependent on the extent of disease at presentation, and post-transplantation cancer did not show more aggressive behavior if detected early. CONCLUSIONS The high cumulative incidence of malignancies makes it imperative to define an effective safe immunosuppressive regimen to achieve a lower risk of malignancies. In the future, the prime approach to treatment of post-transplantation malignancies should begin with early detection and ensuing aggressive treatment to improve the outcome.

Impact of nutritional status on the survival of lung cancer patients.

Abstract: BACKGROUND Weight loss, disease extent, performance status and sex have emerged as prognostic factors for lung cancer. The assessment of performance status is rather subjective and crude. Parameters of nutritional status were used in this study to represent the performance status of patients. The prevalence of protein-calorie malnutrition in lung cancer patients and the impact of this on patient survival were also investigated. METHODS Nutritional status was assessed in 150 newly diagnosed lung cancer patients. Anthropometric and biochemical parameters measured were: weight/height ratio, percent of standard triceps skin-fold thickness, percent of standard arm muscle circumference, serum albumin, transferrin, creatinine height index and total lymphocyte count. Performance status and survival time were estimated for all patients. RESULTS The prevalence of abnormality in each nutritional parameter ranged from 15 to 31%. Most of the patients (59%) had at least one abnormal nutritional parameter. A low profile of performance status was associated with lower nutritional parameters such as triceps skin-fold thickness, percent of standard arm muscle circumference, serum albumin and creatinine height index. Patients who died within six months after diagnosis had significantly lower values of all nutritional parameters than those who survived more than six months. Patients with more abnormal parameters tended to have poorer survival rates. CONCLUSIONS Both anthropometric and biochemical nutritional parameters might be reliable indicators for the assessment of performance status and survival for patients with lung cancer.

Status of trace elements in patients with idiopathic dilated cardiomyopathy in central Taiwan.

Abstract: Background Sporadic cases of dilated cardiomyopathy (DCM) are often seen in central Taiwan. Though trace elements may play a role in the pathogenesis of idiopathic DCM, there are no reports concerning study of Taiwan's population in relation to trace elements in patients with DCM. Methods Serum selenium, zinc, copper and iron concentrations and blood glutathione peroxidase (GPX) activity were measured in 32 patients with DCM (24 males, 8 females; mean age, 44 +/- 14 years) and 31 age-matched normal volunteers (16 males, 15 females; mean age, 38 +/- 12 years). Results The average serum selenium concentration of 27.6 +/- 8.4 micrograms/l found in the DCM group was significantly lower than the average concentration of 47.2 +/- 14.7 micrograms/l in the normal group. Blood GPX activity was also significantly lower in the DCM group than in the normal group. Serum selenium concentration correlated well with blood GPX activity in the studied subjects. Serum copper and iron concentrations were significantly higher in the DCM group than in the normal group. There was no difference in serum zinc concentration between the two groups. Conclusions Deficiency of serum selenium in association with a low blood GPX activity, and high serum copper and iron concentrations, are found in patients with idiopathic DCM in central Taiwan.

Management of descending necrotizing mediastinitis.

Abstract: BACKGROUND Descending necrotizing mediastinitis (DNM) is uncommon, and may be lethal if not treated adequately and promptly. Delayed diagnosis of the disease is sometimes encountered in clinical practice. METHODS Eight consecutive patients with acute DNM were identified between 1991 and 1995, including five men and three women. The mean age was 45.8 years (range, 22-71 years). The infectious sources consisted of six esophageal perforations, one cervical cutting injury and one tonsillitis. The clinical presentations were evaluated. Diagnostic procedures including chest radiograph, sonogram and computerized tomography scans of the chest and neck were examined. Diagnosis and treatment, including culture results from drained fluids and debrided tissues, and antibiotic and supportive therapies were reviewed. RESULTS Six patients who underwent aggressive surgical treatment recovered well. Two patients who received supportive treatment died of sepsis alone. The cultured bacteria included: Klebsiella oxytoca, Staphylococcus aureus, Trichosporum and other mixed oral cavity flora. CONCLUSIONS Early diagnosis and adequate antibiotic and support therapies are essential to achieve good patient outcomes in acute descending mediastinitis. Adequate drainage and debridement, appropriate antibiotic therapy, and sufficient nutritional and respiratory support are the main treatment elements.

Incidence and clinical manifestations of Campylobacter enteritis in central Taiwan.

Abstract: Background Campylobacter species are recognized as a major cause of acute gastroenteritis in humans throughout the world and are increasingly associated with the development of Guillain-Barre syndrome. The age distribution of persons and the seasonal patterns of Campylobacter infection are different in many developed and developing countries. The present study reports the investigation of the clinical and epidemiologic features of Campylobacter infections in central Taiwan. Methods From January 1994 to December 1996, stool specimens from patients with diarrhea or gastroenteritis were cultured for the Campylobacter species at the China Medical College Hospital. Data collected and evaluated included the type of Campylobacter species isolated, date of report, age and sex of the person from whom the isolate came, and clinical symptoms. Results Of 6,540 patients with diarrhea or gastroenteritis, 162 Campylobacter isolates were identified, yielding an isolation rate of 2.5% from the population studied. One hundred and fifty-four patients (95%) with Campylobacter infection were younger than five years old, which was significantly different from the population studied (p 0.05). Watery diarrhea is the most characteristic manifestation of illness, and fever occurs in more than half of the patients. Conclusions In central Taiwan, the incidence of Campylobacter enteritis in patients with diarrhea or gastroenteritis is lower than those in China and Tanzania, but the highest prevalence occurs before five years of age in central Taiwan as well as these countries. The Campylobacter infection rate was significantly higher in males than females, and occurred primarily in winter. We conclude that Campylobacter cultures should be performed for fecal specimens of all diarrheal children aged up to five years.

Normal and variant anatomy of hepatic arteries: angiographic experience.

Abstract: BACKGROUND: Anatomic variation of hepatic arteries is reported to occur in 25-50% of the general population. Knowledge of the existing variations is important in planning and conducting surgical or radiologic procedures in the upper abdomen, such as liver transplantation and transarterial chemo-embolization (TACE). METHODS: Based on data from 321 patients undergoing upper abdominal arteriography, hepatic artery anatomy was analyzed and classified into three groups (single, double and multiple hepatic arteries at hepatic hilum) according to Suzuki's classification. Each group was subdivided into three types (celiac, mesenteric and mixed types) according to the origin of the hepatic arteries. The variations within each type were recorded. RESULTS: Two hundred and sixty one patients (68.%) had single hepatic arteries. One hundred and five patients (27.6%) had double hepatic arteries and only fifteen patients had multiple hepatic arteries. All of these variants, including twenty subtypes, were identified. CONCLUSIONS: This study, based on Suzuki's classification, provides basic data for the anatomic variations of hepatic arteries for the Chinese population in Taiwan.

Orbital invasion in nasopharyngeal carcinoma: evaluation with computed tomography and magnetic resonance imaging.

Abstract: BACKGROUND Ocular symptoms and tumor cranial nerve involvement are commonly observed in patients with nasopharyngeal carcinoma (NPC). These are primarily due to tumor invasion of the cavernous sinus and/or skull base, as direct tumor invasion of the orbit is very rare. This study was designed to assess computed tomography (CT) and magnetic resonance imaging (MRI) in documenting orbital invasion caused by NPC, with a special emphasis on the route of orbital extension. METHODS A total of 562 patients with histopathologically prove NPC were examined using CT and/or MRI for tumor staging or post-treatment follow-up. We retrospectively reviewed CT and MRI findings to identify tumor invasion to orbital cavities and to evaluate the pathway of tumor spread. RESULTS Eighteen patients had tumor extension into the orbital cavities. Seventeen patients had ocular complaints. Fourteen of 18 showed unilateral orbital involvement and four patients showed bilateral orbital involvement. The route from the pterygopalatine fossa and inferior orbital fissure into the orbital cavities was the most common pathway of NPC invasion (n = 13), followed by ethmoid sinus and/or sphenoid sinus into the orbits (n = 4). In one patient, the route of orbital invasion was difficult to determine due to massive tumor extension. CONCLUSION Direct orbital invasion is rare in NPC. The pterygopalatine fossa and inferior orbital fissure are the most common routes of invasion, followed by invasion via the ethmoid and/or sphenoid sinuses. Coronal sections best show these findings on CT or MRI. Our study also shows that either CT or MRI provide essential information in documenting orbital invasion and determining the pathway of tumor spread.

Astigmatic change following congenital ptosis surgery.

Abstract: BACKGROUND High astigmatism is frequently associated with congenital ptosis. Ptosis surgery itself may also induce astigmatic refractive change that will cause amblyopia in young children. The purpose of this study was to assess postoperative astigmatic change and the effect of different ptosis surgical procedures on astigmatism. METHODS An analysis of 63 consecutive surgical cases of congenital ptosis was conducted. The preoperative incidences of anisometropia, amblyopia, strabismus and high astigmatism were evaluated. All patients underwent levator resection or received frontalis sling. The postoperative astigmatic change after the follow-up period of 12 months was assessed in 28 patients. It included a total of 40 ptotic eyelids from 12 bilateral and 16 unilateral cases of ptosis. The eyes on the contralateral side in unilateral cases served as the control group. RESULTS In 63 cases of congenital ptosis, 30.2% (19/63) were associated with anisometropia and 39.7% (25/63) with amblyopia, and 11.1% (7/63) were combined with strabismus. Most cases of amblyopia were associated with high astigmatism (64%). The incidence of high astigmatism (> 2.5 diopters, D) in congenital ptosis was 25.3%. Of 40 ptotic eyelids included for the study of postoperative astigmatism change, 15% showed an increase of more than 0.5 D, whereas 27.5% showed a decrease of more than 0.5 D, and no significant change was observed in 57.5%. An average decrease of 0.18 D in astigmatism was observed, while no statistical difference was found between the study group and the control group for astigmatic change. Moreover, both the levator resection and frontalis sling groups showed a decrease in average cylinder, and again, demonstrated no statistically significant difference in astigmatic change. CONCLUSIONS A high incidence of amblyopia was associated with astigmatism in congenital ptosis. Postoperative astigmatic study also revealed some change in astigmatic power, but no new cases of amblyopia developed after ptosis surgery. Patients with congenital ptosis should have cycloplegic refraction as soon as possible, and long-term postoperative refraction check-up is also recommended.

[National epidemiological study on obesity of children aged 0-7 years in China 1996].

Abstract: Objective To study on obesity of children aged 0-7 years in 11 cities in 1996. Methods The sampling size was 208, 513. The children were divided into 9 groups: birth-, 1 mo-, 6 mo-, 1 yr, 2 yr-, 3 yr, 4 yr-, 5 yr-, 6-7 yr. Results The prevalence of overweight was 4.2% (M4.2%, F4.2%); and of obesity, 2.0%(M2.2% F1.9%). The obesity to overweight ratio (ORR) was 2.1%(M1.9%, F2.2%). The adiposity rebound age (ARA) was 5 years. The adiposity rebound ratio (ARR) was 3.2 for ARR1 (M2.9%, F.5%) and 2.0 for ARR2 (M1.7%, F2.4%) in obese children and 3.5 for ARR1 (M 3.5, F3.5) and 2.5 for ARR2 (M2.8, F2.8) in overweight children respectively. The secular trend of prevalence of childhood obesity during 1986-1996 showed that the prevalence of obesity increased annually at 9.1% (M10%, F8.7%). Conclusion The obesity has already been a severe health and social problem of preschool children in China. The increment of prevalence of obesity during 1986-1996 has been out of control. The earlier of ARA and the larger of OOR is an important risk factor of increasing of obesity. 1 year and 5 years after birth, predicted by ARR, are two critical periods of obesity control in preschool children in China.

Symptomatic patent ductus arteriosus in very low birth weight infants.

Abstract: BACKGROUND Premature neonatal survival rates have increased significantly The diagnosis of patent ductus arteriosus (PDA) has also increased In this paper, we present our experience of incidence, clinical features and outcome of the treatment of symptomatic PDA in very low birth weight infants METHODS From January 1990 to December 1995, 181 premature infants with birth weight less than 1,500 g were admitted to the Neonatal Intensive Care Unit (NICU) of Veterans General Hospital-Taipei Thirty-seven were diagnosed to have symptomatic PDA By reviewing hospital records, the clinical features and outcome of treatment of these infants were analyzed retrospectively RESULTS The incidence of symptomatic PDA was 209% and 214% in infants with birth weight less than or equal to 1,000 g, 1,001-1,500 g, respectively The mean age at diagnosis of infants with symptomatic PDA was significantly less than those without symptoms (36 +/- 29 days vs 96 +/- 172 days, p = 0044, 95% CI = 02-118) With fluid restriction and diuretic therapy, asymptomatic patients had a higher spontaneous ductal closure rate than symptomatic patients (583% vs 108%, p < 0001, 95% CI = 179-771%) Thirty-two (970%) infants with symptomatic PDA responded to indomethacin therapy However, four infants (121%) had recurrence These four infants and a nonresponder received surgical ligation of the PDA and survived There were four deaths The reasons for death were respiratory failure in two, sepsis in one and necrotizing enterocolitis with intestinal perforation in one CONCLUSIONS Conservative medical management such as fluid restriction and diuretics are often adequate for asymptomatic PDA However, since symptomatic PDA tends not to close spontaneously, patients should be treated with indomethacin if ductal shunting compromises cardiopulmonary function

Thymectomy in the treatment of myasthenia gravis

Abstract: Objectives To review the clinical course of patients with myasthenia gravis following thymectomy and to identify prognostic factors that may influence outcome. Methods We follow-up 91 patients with myasthenia gravis surgically treated with thymectomy through a median stereotomy from May, 1983 to October, 1993. The overall 5-year remission and improvement probabilities were obtained by Kaplan-Meier Method. Results 36 (39.6%) patients showed remission, 27 (29.7%) improvement, 14 (15.4%) no change and 14 (15.4%) worsening. The overall 5-year remission and improvement probabilities of patients were 64% and 88% respectively. Conclusions Most patient's symptoms after thymectomy were progressively improved with time, which is probably attributable to thymectomy, and the natural history of myasthenia gravis. Age at surgery, sex, duration of clinical course and pathological findings may be important prognostic factors for patients with myasthenia gravis after thymectomy.

Tuberculum sellae meningiomas: clinical manifestation, radiologic diagnosis, surgery and visual outcome.

Abstract: BACKGROUND: Most patients with tuberculum sellae meningioma (TSM) present with visual symptoms mimicking a pituitary macroadenoma. Accurate preoperative differentiation is important because TSM requires a craniotomy, whereas the transsphenoidal route is preferred for removal of most pituitary macroadenomas. METHODS: From 1989 to 1994, five patients with TSM were treated at Taichung Veterans General Hospital. All were female, ranging in age from 20 to 60 years. This paper is a retrospective review of clinical features, diagnostic methods, treatment and postoperative visual recovery. RESULTS: The most common symptom, with a duration of one month to two years, was asymmetrical visual loss. Abnormal endocrine levels were found in one patient (prolactin: 47.91 ng/ml). Another patient was misdiagnosed as having a pituitary adenoma by coronal view computed tomography (CT) and underwent a transsphenoidal operation. Later, an accurate diagnosis was made using magnetic resonance imaging (MRI). She then underwent another operation--unilateral subfrontal craniotomy with total removal of the tumor. The other patients were preoperatively diagnosed as having meningioma by MRI. They also underwent unilateral subfrontal craniotomy with total removal of tumor. All patients showed good visual improvement after their operation. The extent of visual improvement was closely related to the duration of preoperative visual loss. There was no tumor recurrence after a follow-up period of six months to five years (mean, two years and six months). CONCLUSIONS: It should be emphasized that the diagnosis of TSM must first be based on clinical symptoms and signs, or "chiasma-syndrome". It can be accurately diagnosed preoperatively by sagittal view MRI. Early diagnosis will increase the chances of a good postoperative visual outcome.

Computerized tomography in the diagnosis of subluxation of the distal radioulnar joint.

Abstract: Background The diagnosis of distal radioulnar joint (DRUJ) subluxation is difficult. Routine radiographs are imprecise in clinical analysis. However, the anatomy and dynamic configuration of this articulation have been clearly defined utilizing computerized tomography (CT). Three CT criteria for the evaluation of DRUJ subluxation have been reported: Mino's criteria, the epicenter method and the congruity method. Previous reports discussed these criteria in the analysis of symptomatic DRUJ, but no clear conclusion has been reached. The purpose of this study is to investigate accurate criteria of CT in defining subluxation of the DRUJ. Methods Eighty distal radioulnar joints in 40 patients with suspected DRUJ subluxation underwent CT scans of both symptomatic and asymptomatic wrists. The CT scan was obtained through the DRUJ with the forearm in neutral rotation, active full supination and active full pronation. Three CT criteria were used to assess the DRUJ in all positions of unstable and normal wrists. Results Overall, 54 wrists were included in the final analysis. Seventeen symptomatic wrists had frank DRUJ instability diagnosed from true lateral radiographs, and 11 were reconfirmed from intraoperative pathology. The other 37 wrists had normal DRUJ. Among the three methods, the epicenter method had similar sensitivity to Mino's criteria and the congruity method. However, the epicenter method had much better specificity than Mino's criteria and the congruity method. Conclusions For accurate diagnosis of subluxation of the DRUJ, CT scan through the symptomatic DRUJ in neutral rotation, active full supination, active full pronation and analysis with the epicenter method are recommended.

A cross-sectional study on HGV infection in a rural population *

Abstract: AIM To determine the epidemiological characteristics and clinical significance of HGV infection, and to compare with HBV and HCV infections. METHODS Anti-HGV, HBsAg, anti-HBs, antiHBc and anti-HCV were detected by enzymelinked immunoassys (EIA). Anti-HGV positive sera were further tested for HGV RNA by a nested reverse transcription polymerase chain reaction (RT-nPCR). RESULTS The anti-HGV prevalence rate was 12.9% in the rural population. It was relatively low in children under 10 years of age, and then increased with age and peaked in the group of 5059 years (29.2%). The Carrier rate of HBsAg was 12.6% in the population and quickly reached the highest (16.2%) in the 5-year age group. The prevalence rate of HBV infection was 64.9%, and rose to a high level in the group of 10 years, and maintained high till up to the top of 79.2% in the 50-59 age group. The HCV infection rate was 15.3%. No Anti-HCV positive cases were found in the group under 10 years of age. It was particularly high in the 20-40 age group, and reached the peak in the group of 30 years old. No significant differences were found in the infection rates of HBV, HCV and HGV between male and female. HGV infection was associated with the history of blood donation and the sexual transmission. The anti-HGV positive rate in wives of husbands with HGV infection was 53.3%, significantly higher than that in those with anti-HGV negative husbands (7.8%). HGV coinfection with HBV or HCV had no influence on serum alanine aminotransferase (ALT). No ALT elevation was found in the group with HGV infection alone. CONCLUSION The epidemiological characteristics of HGV infection are different from that of HBV and HCV. HGV is transmitted by blood and sex, and does not seem to cause liver damage.

Testicular volume in Taiwanese boys.

Abstract: Background Testicular volume is used to evaluate male growth and development. Since the volume of the testes varies in different races, data for Taiwanese boys are essential to assess normal testicular growth. Methods Testicular volume was measured using Prader's orchidometer in 430 boys aged 0-14 years. Results Testicular growth was minimal before nine to 10 years of age. The mean testicular volume (mean of left and right testes) was 1.3 +/- 0.3 ml in newborns, 1.8 +/- 0.5 ml at six years of age and 9.1 +/- 3.5 ml at 12 years of age. Conclusions Data on the normal values of testicular volume in Taiwanese boys will be helpful in assessing the growth of normal individuals as well as in patients with testicular or hormonal disorders.

Uterine myoma after cessation of gonadotropin-releasing hormone agonist: ultrasound and histopathologic findings.

Abstract: Background This study attempted to search for the possible mechanism of regrowth of uterine myoma after cessation of gonadotropin-releasing hormone agonist (GnRHa) therapy Methods Five premenopausal women presenting with symptomatic uterine myoma were prospectively studied in this trial All patients were treated with a subcutaneous injection of goserelin depot 36 mg every four weeks for 16 weeks Clinical examinations as well as hormonal and ultrasound determinations were performed before, during and after treatment to monitor the efficacy of therapy At the end of the treatment period, all patients underwent myomectomy The ultrastructural change of the myoma was evaluated postoperatively Results The volume of the uterus decreased 21-57% and the volume of the uterine myoma decreased 21-65% after therapy There was no significant change in resistance index of the uterine vessels or major vessels supplying the uterine myoma between pretreatment and post-treatment values The morphologic features of the treated myoma showed marked cellular shrinkage and loss of myofibrillar structure Conclusions There is no significant cellular damage to the cellular structure that contributes to regrowth of treated intramural uterine myoma following cessation of treatment

The association of sasceptibility of SLE and the gene polymorphism of TNF

Abstract: OBJECTIVE To evaluate the association between the susceptibility of SLE and the gene polymorphism of TNF in Chinese Han population. METHODS The single base change polymorphism in both TNF alpha gene and TNF beta gene were analyzed among SLE patients and normal controls by using PCR-SSCP and PCR-RFLP. RESULTS No difference of gene or genotype frequencies of TNF alpha was noted in SLE patients and normal controls (P > 0.5), whereas TNF beta * 2 gene frequency increased significantly in SLE patients (SLE patients 65.7%, normal people 54.5%, P < 0.05). CONCLUSION TNF alpha gene polymorphism has no effect on SLE, but TNF beta * 2 allelic type may be related to the susceptibility of SLE in Chinese Han population to some extent.

Community investigation of the activities of daily living (ADL) and medical conditions of the elderly in Shanghai

Abstract: Objective To study the ADL status and prevalence of medical conditions in aged population in Shanghai, and to analyze the impact of dementia syndrome and other illnesses to ADL performance. Methods Both the Chinese version of ADL scale (five items) and the list of self-reported illnesses questionnaire (32 conditions) were used in the survey. After screening and case-identification, 3745 noninstitutionalized aged residents, who were 65 years and older, were included in the analysis sample. A separate multiple logistic regression model was used in both groups (65-74 years and over-75), observing the effect of age, gender, education and medical conditions (as control variables) on ADL dependence. Results The prevalence rate of functional dependence in ADL was 8.28%, and the prevalence curve was doubled steeply along with each ten years. The most prevalent medical conditions (> 20%) were hypertention, heart disease, cataract/glaucoma and artheritis/rheumatism, whereas, dementing disorder was 4.61%. Of all illnesses, stroke, Parkinson's disease, dementia, diabetes and emphysema were the most important predictors of ADL dependence in both aged groups. In the group more than 75 years old, cancer, arteriosclerosis and hypertension seemed to be strongly related to ADL dependence, dementia syndrome was one of the remarkable risk factors. Conclusion Dementing disorders such as Alzheimer's disease may lead to severe disturbance of ADL performance in the aged, therefore, the community rehabilitative measures and health care services should be stressed by the society to improve the quality of life of the elderly.

Free fatty acids promoting PTP1B expression in rat skeletal muscle and hepatic cells

Abstract: Objective To determine whether that free fatty acids (FFAs) impair glucose metabolism is associated with altered insulin signaling system. Methods After skeletal muscle and hepatic cells were incubated with palmitate (0.25 mmol/L) or oleate (0.125 mmol/L) for 6, 12 or 24 hours, the protein abundance of SH-PTP2 and PTP1B was assessed by western blot. Results SH-PTP2 protein levels showed no significant change in both fatty acids treated muscle and hepatic cells at all time points. The PTP1B was significantly elevated in both liver and muscle cells incubated with FFAs at 6, 12 and 24 hours. Conclusions FFAs promote the expression of PTP1B in rat skeletal muscle and liver cells, and the elevated PTP1B may mediate the insulin resistance induced by FFAs.

A review of ocular emergencies in a Taiwanese medical center

Abstract: BACKGROUND Ocular injury is one of the most common problems in the Emergency Department (ED), but a general survey of ocular injuries has rarely been reported in the literature. This article reviews cases of ocular injury collected in the ED of a medical center over a 12-month period. METHODS A retrospective analysis was done on 1,314 consecutive patients who presented with eye complaints to the ED of the Veterans General Hospital-Taipei between November 1993 and October 1994. Common ocular diagnoses and their associated variables were assessed separately. RESULTS Ocular injuries occurred in a male to female ratio of about 1.9:1 with a peak age in the third decade. Diagnoses were grouped as trauma (43.8%) and non-trauma (56.2%). Corneal abrasion was the most common trauma reported. The main circumstances of eye trauma were play (50.0%) in children (< 15 years), work (37.1%) in the age group of 16 to 59 years and domestic activity (45.8%) in patients over 60 years of age. Blunt objects and contusions (hits or falls) caused nearly 50% of all ocular injury cases. Most of the non-traumatic cases were due to acute conjunctivitis (19.1%), followed by contact lens (CL)-related disorders (11.4%). Three cases of CL-induced corneal ulcer resulted in permanent visual morbidity. There was a trend toward an increase in acute conjunctivitis in the summer, corneal ulcer in the spring and acute glaucoma in the winter. CONCLUSIONS Young males were found to run a higher risk of ocular accidents, especially at work. Penetrating injuries with or without a retained intraocular foreign body were the leading cause of poor visual outcomes and often occurred in patients without protective eyeglasses. With the widespread use of CLs, many potentially serious complications were noted in the ED, which deserve attention.

Preoperative diagnosis of primary fallopian tube carcinoma by magnetic resonance imaging: a case report.

Abstract: Because of the rarity and insidious onset of primary adenocarcinoma of the fallopian tube, early diagnosis is very difficult Primary fallopian tube carcinoma is also rarely diagnosed preoperatively This report reviews the value of magnetic resonance imaging (MRI) in aiding the detection of early-stage primary fallopian tube carcinoma in a 48-year-old female The diagnosis was based on clinical suspicion, elevated CA-125 and MRI MRI demonstrated the tumor as an area of solid masses with marked enhancement after gadolinium-diethylenetetraaminepentaacetic acid (Gd-DTPA) administration Primary fallopian tube carcinoma was confirmed by pathologic examination We hope that, with improvements in imaging, early diagnosis of such a malignant disease could become routinely possible in the future

Biological diagnostic and therapeutic study on the infection of Helicobacter heilmannii

Abstract: OBJECTIVE: To study the epidemiology, microbiology, pathogenicity, diagnosis and therapy of Helicobacter heilmannii (Hh) infection. METHODS: Morphological methods, such as Gram staining of gastroscopic biopsy smears, Giemsa staining of histological slides and scanning electromicroscopy(SEM), and biochemistry techniques such as urease test(CLO), 14C urea breath test(UBT) were used to identify Hh infection in natural populations. The 16S rRNA gene of 4 strains of Hh were amplified, sequenced and analysed, using bacterial universal and Helicobacter genus-specific primers. RESULTS: Twenty cases of Hh infection were found in 992 peoples with the positive rate of 2.0%. There existed the phenomena of intrafamily cluster of Hh infection. 14 case of the gastic tissues were CLO positive and 3 cases of these patients were UBT positive, the bacterium cannot be isolated in vitro. Sporadic invasion of lymphocyte/plasmic cell were found in gastric mucosa with Hh infection. Formation of lymph follicles and invasion of neutrophlic cell could be found too. The "old triple therapy" regimen could eradicate Hh easily. The homology of 16S rRNA gene among 4 strains was between 98.7%-99.7%, and can not be devided into two subtypes. The homology between Hh and H. felis or Hp were 95.6%-96.5% and 96.4%-97.1%, respectively. CONCLUSION: The prevalence of Hh in southern China is higher than that reported abroad. There may exist animal to person and person to person transmission mechanisms. Hh should be a new Helicobacter with lower activity of urease and weaker pathogenicity when compared with H. pylori. The infection of Hh is easy to eradicate through drug therapy.

Delayed postpartum hemorrhage in adenomyosis: a case report.

Abstract: Adenomyosis of the uterus is a serious problem for women of reproductive age because of its possible consequence of infertility. We present the case of a woman who had adenomyosis of the uterus, a successful spontaneous pregnancy, and delayed and tenacious postpartum hemorrhage that did not respond to conservative treatment. The 26-year-old woman, gravida 1, para 1, suffered from fulminating vaginal bleeding and associated shock 20 days after the delivery of a 3,450-g female by Cesarean section. Conservative treatment included uterine compression and massage, blood transfusion, intravenous administration of high-dosage estrogen, oxytocin and sulprostone (prostaglandin E analogue), and gauze packing from the vagina into the uterine cavity. Despite treatment, the patient went into shock due to persistent vaginal bleeding. Emergency exploratoric assessment laparotomy was performed, followed by a stotal hysterectomy. Pathology revealed extensive adenomyosis of the uterus without other significant abnormality. The potential dangers of adenomyosis in pregnancy should not be overlooked when patients seek treatment for infertility.

[Cardiovascular protective effects and NO-mediated cerebrovasorelaxant effects of extract of ginkgo biloba leaves].

Abstract: OBJECTIVE To examine the anti-free radical related cardiovascular protective effects and NO-mediated cerebrovasorelaxant effects of extract of the leaves of Ginkgo biloba(EGb) in isolated preparations. METHODS Experiments on the anti-free radical related cardiovascular protective effects were performed in rabbit Langendorff heart and isolated aortic rings damaged by diphenyl-picryl hydyazyl(DPPH). Protective effects of EGb were determined by comparing the results of EGb pretreated group with the DPPH-injured controls. Cerebrovasorelaxant effects of EGb were examined in ring preparations of isolated porcine basilar artery in vitro using tissue bath techniques. RESULTS EGb protected the isolated rabbit heart from the DPPH-injury to the cardiac contractility and the aortic endothelium from DPPH-attenuated ACh-induced relaxation. EGb concentrationde dependently relaxed the basilar artery and this effect was more significant in endothelium intact rings than those endothelium denuded rings. EGb enhanced the TNS-induced relaxation in basilar artery and this effect was abolished by pretreatment of N-nitro-L-arginine or tetrodotoxin. CONCLUSIONS EGb exerts cardiovascular protection against DPPH-impaired cardiac contraction in rabbit isolated heart and endothelium-dependent relaxation in the aortic ring of rabbit in vitro. EGb relaxes porcine basilar artery and enhances the TNS-induced relaxation via a NO pathway.

Benign cystic teratoma of unilateral fallopian tube associated with intrauterine pregnancy: a case report.

Abstract: Primary teratomas of the fallopian tube are extremely uncommon. To date, only about 50 cases have been reported in the literature. Six of them are reported to have been in conjunction with tubal ectopic pregnancies. Herein we present the first case of benign cystic teratoma of the unilateral fallopian tube associated with an intrauterine term pregnancy, reported in Taiwan.

The management of patients with advanced motor neuron disease.

Abstract: BACKGROUND There is no specific treatment for motor neuron disease (MND) except hospice or palliative care to improve patients' quality of life and decrease complications. This topic is seldom discussed in Taiwan. METHODS A retrospective study was conducted of patients with terminal MND who were treated and died at the Veterans General Hospital-Taipei from March 1986 through April 1996. Patients' characteristics, management, length of survival and cause of death were analyzed. RESULTS Twenty-three patients (M/F, 17/6) were included. The median age of onset was 59 years (range, 24-69). The median interval from onset of symptoms to diagnosis was nine months (range, 2-36). Seventeen patients received mechanical ventilation for an average median of six months. Nineteen patients had dysphagia, 17 received long-term nasogastric tube feeding, one had gastrostomy and one was treated with cricopharyngeal myotomy. Pain over the neck, trunk or limbs was reported by 18 patients; none received narcotics. Only two patients received respiratory exercise training and two had a cervical collar for stabilization. Electronic communication aids were not available. The median survival from onset of symptoms was 36 months (range, 7-99). The causes of death included sepsis (n = 13), respiratory failure (n = 7), heart disease (n = 2) and MND-related cachexia (n = 1). Cardiopulmonary resuscitation was performed for 12 patients. CONCLUSIONS In Taiwan, management of patients with advanced MND is mainly hospital-based and most of the effort is focused on life-sustaining. More attention needs to be paid to improvement of the quality of life and dignity of the patient.