Showing papers in "National Medical Journal of China in 2001"

Thermal symmetry of skin temperature: normative data of normal subjects in Taiwan.

Abstract: BACKGROUND The aims of this study were (a) to establish normative data of thermal symmetry (left vs. right) in normal subjects; (b) to compare the skin temperature in various regions between young and old people in Taiwan and between male and female. METHODS The skin surface of 57 healthy volunteers (aged 24 to 80 yr) was divided into 25 areas and measured by an infrared thermography (Avionics TVS-2000, Japan). The average temperatures of these 25 regions were compared: (a) left vs. right side, (b) young ( 60 yr, n = 20), and (c) male vs. female. Student's t-test was used to assess means between both groups. RESULTS The neck carried the highest skin temperature (31.9 degrees C +/- 0.6; mean +/- SD) of the body in comparison with the toes that had the lowest one (27.5 degrees C +/- 2.0). The side-to-side temperature differences were subtle, which did not exceed 0.5 degrees C. The average skin temperature of elderly was slightly lower than that of young subjects in 11 out of 25 areas (p < 0.05), especially the distal parts of extremities. Elderly female had lower skin temperature in various truncal areas as compared with their counterpart. However, the skin temperature was higher in the distal extremity (p < 0.05). CONCLUSIONS The thermoregulatory system is substantially symmetrical. The result of this study offered valuable normative database on skin thermal symmetry in normal population of Taiwan, and may be useful as a diagnostic aid in patients with various states of disorders associated with autonomic dysfunctions.

Mitochondrial theory of aging matures--roles of mtDNA mutation and oxidative stress in human aging.

Abstract: Mitochondrial theory of aging, a variant of free radical theory of aging, proposes that accumulation of damage to mitochondria and mitochondrial DNA (mtDNA) leads to aging of humans and animals. It has been supported by the observation that mitochondrial function declines and mtDNA mutation increases in tissue cells in an age-dependent manner. Age-related impairment in the respiratory enzymes not only decreases ATP synthesis but also enhances production of reactive oxygen species (ROS) through increased electron leakage in the respiratory chain. Human mtDNA, which is not protected by histones and yet is exposed to high levels of ROS and free radicals in the matrix of mitochondria, is susceptible to oxidative damage and mutation in tissue cells. In the past decade, more than one hundred mtDNA mutations have been found in patients with mitochondrial disease, and some of them also occur in aging human tissues. The incidence and abundance of these mutant mtDNAs are increased with age, particularly in tissues with great demand for energy. On the other hand, recent studies have revealed that the ability of the human cell to cope with oxidative stress is compromised in aging. Comparative analysis of gene expression by microarray technology has shown that a number of genes related to oxidative stress response are altered in aging animals. We discovered that the transcripts of early growth response protein-1, growth arrest and DNA damage-inducible proteins and glutathione S-transferase genes are increased in response to oxidative stress in human skin fibroblasts. Moreover, the activities of Cu,Zn-SOD, catalase and glutathione peroxidase decrease with age, whereas Mn-SOD activity increases with age up to 65 years and slightly declines thereafter in skin fibroblasts. Such an imbalance in the function of antioxidant enzymes may result in excess production of damaging ROS in the cell. This notion is supported by the observation that intracellular levels of H2O2 and oxidative damage to DNA and lipids are significantly increased with age of the fibroblast donor. Furthermore, the mitochondrial pool of reduced glutathione declines and DNA damage is enhanced in aging tissues. Taken together, these observations and our previous findings that mtDNA mutations and oxidative damage are increased in aging human tissues suggest that mitochondrial theory of aging is mature.

Clinical spectrum of Kawasaki disease in infants.

Abstract: BACKGROUND: Kawasaki disease is a common acquired heart disease in children. Only a few reports have been published concerning Kawasaki disease in infants. This study was performed to assess the clinical spectrum of Kawasaki disease in infants. METHODS: Between January 1989 and December 1998, a total of 48 consecutive Kawasaki patients less than one year of age were enrolled and studied retrospectively. Coronary artery dilation was defined as the internal diameter of a coronary artery larger than 3 mm. All cases received 2 gm/Kg of intravenous immunoglobulin. We divided the patients into two groups; group I; coronary artery dilation (+) and group II; coronary artery dilation (-), and compared the clinical and laboratory data. RESULTS: Of 273 patients with Kawasaki disease, 48 (17.5%) were less than one year of age. Among these patients (< 1 year old), the median age was 7.8 +/- 2.8 months (range 2 months to 12 months), and the male to female ratio was 1.52:1. The incidence of atypical Kawasaki disease was 31.2% (compared with an incidence of atypical Kawasaki disease among patient more than one year of age of 7.5%; p < 0.001), and that of coronary artery dilation was 35.4%. Clinical manifestations included fever 100%, extremity change 91.6%, skin rash 89.6%, conjunctivitis 89.6%, oral mucosa change 89.6%, and cervical lymphadenopathy 0%. Laboratory data revealed white blood cell count: 15,403 +/- 6,282/mm3, hemoglobin: 10.1 +/- 1.0 gm/dl, neutrophil: 59.2 +/- 13.7%, lymphocytes: 30.6 +/- 13.1%, platelet count: 456,3000 +/- 216,4000/mm3, and C-reactive protein 8.2 +/- 5.6 mg/dl. Patients with coronary artery dilation had a longer duration of diagnosis, higher incidence of atypical presentation, lower incidence of conjunctivitis, lower incidence of skin rash, lower incidence of extremity change, and lower C-reactive protein. The predictive value of coronary artery dilation based on the combination of atypical presentation, duration of diagnosis, and C-reactive protein was 81.2%. CONCLUSIONS: Kawasaki disease in infants is associated with a high incidence of atypical presentation and increased risk of coronary artery dilation. We suggest that in an infant with insufficient diagnostic criteria for Kawasaki disease, care should be taken to avoid missing atypical Kawasaki disease. Echocardiography is an important tool for diagnosis of atypical Kawasaki disease.

Diagnostic screening for mucopolysaccharidoses by the dimethylmethylene blue method and two dimensional electrophoresis.

Abstract: Back ground. The di ag no sis of a mucopolysaccharidosis (MPS) can be achieved by non-enzymatic screen ing meth ods, in clud ing twodimen sional elec tro pho re sis (2-D EP), and the dimethylmethylene blue (DMB) method. How ever, the con fir ma tion of MPS di ag no sis is dif fi cult to achieve in Tai wan due to the short age of a well-esta blished MPS di ag nos tic ser vice. In this ar ti cle, we in tro duce the MPS screen ing pro to cols we have al ready es tab lished, and also il lus trate the in ter pre ta tion of 2-D EP re sult for MPS typ ing de ter mi na tion. Methods. Thirty-seven pa tients with dif fer ent types of MPS were an a lyzed by 2-D EP and the DMB method. They were 4 with MPS I (Hurler), 15 with MPS II (Hunter), 10 with MPS III (Sanfilippo), 5 with MPS IV (Morquio), and 3 with MPS VI (Maroteaux-Lamy). Re sults. The elec tro pho retic pat terns of the af fected glycosamino glycans (GAGs) in dif fer ent MPS were il lus trated, which were the ba sis of MPS di ag no sis. The DMB re sults showed a sig nif i cant dif fer ence be tween these dis eases, and the dimethylmethylene blue/ crea tinine (DMB/CRE) ra tio of Hunter Syn drome was mark edly greater than those of the Sanfilippo, Hurler, and Maroteaux-Lamy Syn drome, suc ces sively. The 2-D EP is also ap pli ca ble for MPS pre na tal di ag no sis. One cell-free amniotic fluid with sus pected Hunter Syn drome was an a lyzed by 2-D EP, and the re sults ex cluded the pos si bil ity of MPS which was con firmed by en zy matic study. Con clu sions. The 2-D EP pro vides a good sep a ra tion of uri nary GAG, and the DMB method gives an es ti ma tion of the GAG con cen tra tion in the urine. Both of the meth ods are spe cific, sen si tive, and easy to per form for MPS screen ing and di ag no sis. [Chin Med J (Tai pei) 2001;64: 15-22]

Retinopathy of prematurity: screening, incidence and risk factors analysis.

Abstract: Background The sequela of retinopathy of prematurity (ROP) is an important cause of infant blindness. This study was designed to screen the high-risk premature infants and investigate the incidence and risk factors associated with the development of ROP. Methods From October 1997 to October 1998, all premature infants with birth body weight (BBW) less than 2000 gm or gestational age (GA) less than 36 weeks were enrolled and underwent ophthalmologic examination at 4 to 6 weeks of age at Taipei Veterans General Hospital. The perinatal variables were analyzed to evaluate their correlation with the development of ROP. Results In totally 108 premature infants, the incidence for development of ROP was 25% (27 in 108 patients). The threshold ROP occurred in 15 eyes (7%). The average BBW and GA (1267+/-341 gm and 29.7+/-2.7 weeks) were significantly lower in ROP group than in the non-ROP group (1703+/-368 gm and 32.3+/-2.2 weeks). The artificial ventilation for more than 5 days, chronic lung disease and periventricular leukomalacia were significant risk factors associated with highest rate of ROP. The respiratory distress syndrome, intraventricular hemorrhage, congenital heart disease and sepsis were significant risk factors accompanied by moderate rate of ROP. Conclusion Low birth body weight and young gestational age are the most important risk factors in the development of ROP. The analysis of risk factors will be helpful in understanding and prediction of ROP formation in high-risk neonates. The timely clinical screening retina examination of high-risk premature infants is important to prevent the development of advanced ROP.

Health literacy: an important issue for communicating health information to patients.

Abstract: "Health literacy" refers to an individual's ability to read, understand, and use the information necessary to obtain adequate health care. Because so much health-related information is provided to patients in written form, some degree of health literacy is essential. A review of the international medical and education literature was conducted to identify research on health literacy. Limited health literacy is a widespread problem in both non-industrialized and industrialized nations, and it is mostly related to deficient reading skills. Deficient reading skills are most prevalent among those with a limited educational background, but considerable research shows that limited reading skills exist even among those who have completed a formal education. Risk factors for limited literacy include poverty, membership in an ethnic minority group, advanced age, and other sociodemographic characteristics. Limited health literacy highly associated with poor health status, and literacy skills more accurately predict health status than education level, income, ethnic background, or any other sociodemographic variable. Individuals with limited literacy have higher rates of illness and more hospitalizations than individuals with more well-developed reading skills. Considerable effort has been directed at creating special health education materials for communicating with patients who have limited reading skills, but there is minimal evidence that these interventions have any effect on the health status of these individuals. In conclusion, poor health literacy is a common problem with important implications for health status. Limited data are available about how to best address the needs of patients with limited literacy skills.

Clinical and histopathological characteristics of primary cutaneous amyloidosis in 794 Chinese patients.

Abstract: Background Primary cutaneous amyloidosis (PCA) is not uncommon in Chinese patients. The disease is usually persistent and quite pruritic. Patients who suffer from this disease usually respond poorly to conventional treatment. We thus reviewed our cases of PCA to discuss the clinical and pathological characteristics. Methods Seven hundred and ninety-four Chinese patients with PCA who visited the Department of Dermatology, Taipei Veterans General Hospital during the last 26-year period were examined and retrospectively studied. The diagnosis in these patients was confirmed by histopathological studies. Results Among the many types of PCA, lichen amyloidosis was the most common clinical variant (67%). Pure cases of macular amyloidosis accounted only 8% and were often associated with lichenoid lesions to form biphasic amyloidosis, which was composed of 25% in our series. Other rare types of PCA, such as nodular, anosacral, and vitiliginous amyloidosis, always required a careful differential diagnosis clinically from other similar skin disorders. In addition, 56 familial cases were found. Histopathologically, the most common epidermal findings of PCA were hyperkeratosis, irregular acanthosis with thinning of rete ridges, and expansion of dermal papillae by amyloid deposition. Special histochemical stains were helpful for confirming the existence of amyloid. Conclusions Our study represents the largest number of cases of PCA collected to date. Based on the data, most cases are sporadic, except 56 familial cases which may suggest the possible genetic role. Rare types of PCA, such as anosacral and vitiliginous amyloidosis which need special attention, compose a diagnostic challenge to a dermatologist. Histochemically, H&E stain can give a primary clue for the diagnosis of amyloidosis and crystal violet stain is a very simple and sensitive method to detect the existence of amyloid.

[The clinical and pathological manifestations of aristolochic acid nephropathy--the report of 58 cases].

Abstract: Objective To realize and classify the aristolochic acid nephropathy (AAN) according to its clinical and pathological manifestations. Methods Fifty eight cases in our Division during October 1998 to August 2001 were reviewed, and their clinical, laboratory and pathological manifestations as well as the response of therapy were analyzed. The aristolochic acid (AA) component in some Chinese traditional drugs taken by our patients was detected with thin-layer chromatography (TLC) scan. Results AAN might be divided the following three types: (1) acute AAN (n = 4): acute tubular necrosis and acute renal failure were its pathological and clinical characters, respectively. (2) tubular dysfunctional AAN (n = 7): tubular degradation with atrophy, and renal tubular acidosis and/or Fanconi syndrome were its main pathological and clinical manifestations, respectively. (3) chronic AAN (n = 47): renal interstitial fibrosis with few infiltrated mononuclear cells, and chronically progressive renal failure were its dominant pathological and clinical findings, respectively. Steroid therapy was tried to treat some patients with AAN, and a few patients in the first two types obtained some good effects. AA component was demonstrated by the TLC scan in the drugs taken by our patients. Conclusion Chinese traditional drugs containing AA are able to cause a special tubulointerstitial nephropathy which may be classified three types with different outcome. To definite effects of steroid on AAN still need to be proved by further studies.

The outcome of shunted hydrocephalic children.

Abstract: BACKGROUND Neurological sequelae and mental retardation may result from different etiological types of hydrocephalus. The aim of our study is to determine the intellectual development and the "shunt history" of these children with regard to the complications and revision rates. METHODS We reviewed the medical history of non-tumoral pediatric hydrocephalic patients who had received first shunt insertions between 1983 and 1997 and had been regularly followed up at the out-patient clinics of Taipei Veterans General Hospital. These patients were categorized into five different etiological groups. Their intelligence test scores and the surgical morbidity encountered over this period were used as the main outcome measures. RESULTS Out of the seventy-three patients, post-meningitis hydrocephalus patients had the significantly highest shunt revision rate (2.50 +/- 0.82, p = 0.01). They also showed retardation in IQ scores, but the different was not significant when compared with other groups. The results of IQ tests were not related to either the age of initial shunt insertion (p = 0.461) or revision rates (p = 0.292). For physical disabilities, post-meningitis hydrocephalic patients showed-highest incidence of epilepsy (40%) while hydrocephalic patients associated with myelomeningocele had the highest incidence of motor deficits (56.25%). CONCLUSIONS Childhood hydrocephalic patients had different developmental neuroimpairments with respect to different etiologies. This study provides information about the physical and mental outcome of post-operative hydrocephalic patients which is valuable to assist in counsel of their families.

[Surveillance of bacterial resistance in China (1998-1999)].

Abstract: OBJECTIVE To determine the rates of bacterial resistance of clinical isolates obtained from patients with hospital infections (HI) or community acquired infections (CAI) in the study wards of 13 hospitals located at different areas in China. METHODS Susceptibility test was performed on 2 081 strains isolated from 13 hospitals, using standard plate dilution method according to the guidelines of NCCLS (1998). MIC(50) and MIC(90) were used to show the antibacterial activity of antimicrobial agents, and data of R%, I% and S% represent resistant, intermediate and susceptible rates of bacteria to antimicrobial agents tested. RESULTS Among total 98 strains of S. aureus, 87 were isolated from patients with CAI and 11 were from HI patients. The incidence of methicillin resistant S.aureus (MRSA) from total infections caused by S. aureus was 27.55%, while the incidence of MRSA from HI patients was 81.82%, which was significantly higher than that (21.84%) from CAI patients. The rate of penicillin resistant S. pneumoniae (PRSP) (R% + I%) was 22.50%; the rate of R (MIC >/= 2 mg/L) was 2.5%, and most of PRSP strains was intermediate, with I% of 20%. No strains of S. aureus, neither strains of E. faecalis, nor of E. faecium were found resistant to vancomycin. The intermediate rate (I%) of E. faecalis and E. faecium to vancomycin was 3.23% and 3.77%, respectively. Cross resistance of E. coli to quinolones was present obviously, and more than 60% of E. coli strains were resistant to fluoroquinolones tested. CONCLUSION Multi-drug resistance (MDR) of bacteria is a serious problem in China, including MDR of MRSA, PRSP, and enterobacteriaceae; and the resistant rate of enterobacterinceae is the highest up-to-date.

Factors related to utilization of traditional Chinese medicine in Taiwan.

Abstract: Complementary and alternative medicine use is increasing worldwide. Expenses for complementary and alternative medicines are high, while the effectiveness of such medicines is still in debate. This paper reviewed the utilization of complementary and alternative medicines. Complementary and alternative therapies are used frequently and increasingly. Alternative therapies were used often for chronic conditions, including back problems, anxiety, depression and headaches in the United States. Musculoskeletal and respiratory complaints were the most frequent causes for complementary and alternative medicine consultation in Israel. In Taiwan, a systematic series of studies on factors related to utilization of traditional Chinese medicine (TCM) were conducted, including: (1) factors related to the choice of medical service (single or dual approach); (2) factors related to the choice of clinic type between TCM and western medicine among patients with single approach and among patients with dual approach; (3) factors related to patient choice of institute providing TCM (between TCM department in teaching hospital and regular TCM clinic) among patients using TCM only; and (4) knowledge, attitude and behavioral intention regarding TCM among patients using TCM only and among community residents over 30 years old. The findings of the above studies are summarized and presented accordingly.

Rehabilitation therapy for short bowel syndrome

Abstract: Objective To investigate the effect of rehabilitation therapy for short bowel syndrome on patient nutritional status and intestinal adaptation Methods The rehabilitation therapy included enteral or parenteral nutrition, glutamine, recombinant human growth hormone and rehabilitative diet From January 1997 to July 2000, twenty seven patients with short bowel syndrome received the treatment The average age of the patients was 38 5±19 3 years, and the length of residual small intestine ranged from 15 to 80 cm, with an average of 46 8±23 4 cm The ileocecal valve was preserved in 14 cases, and the average time between the onset of short bowel syndrome and the rehabilitation therapy was 86±105 days Results After the treatment, nutritional status of the patients improved markedly, and intestinal absorptive capacity improved Eight patients were followed up for more than 2 years, among whom 4 (50%) were weaned from total parenteral nutrition Thirteen patients were followed up for more than 1 year, and 10 patients (76 9%) were weaned from total parenteral nutrition Conclusions Rehabilitation therapy for short bowel syndrome can improve patient nutritional status effectively and promote intestinal adaptation, providing a new hope for these patients The therapeutic effects are related to the length of the residual small intestine, patient's age and duration between massive intestinal resection and start of the treatment Early initiation of rehabilitation therapy promotes intestinal adaptation and increases patient's ability to wean from total parenteral nutrition

[Protective effect of bicyclol on concanavalin A-induced liver nuclear DNA injury in mice].

Abstract: Objective To study the protective effect of bicyclol on concanavalin A (Con A) induced liver nuclear DNA injury in mice. Methods Bicyclol was fed into the stomachs of 32 mice. Then Con A was injected into their caudal veins. Six, twelve, twenty four, and forty eight hours after the injection, 8 mice were killed at each time point and their blood and livers were taken to be tested. Serum alanine aminotransferase (ALT), and nuclear DNA fragmentation, DNA ladder, H 2O 2 level, and sensitivity of nuclear DNA to oxidative damage by CuSO 4 ortho phenanthrolin vitamin C H 2O 2 system in hepatocytes of mice were determined. The protective effect on damage of pure DNA by CuSO 4 ortho phenanthrolin vitamin C H 2O 2 system was determined in vitro too. Eight mice were injected with Con A only as normal controls. Nine mice were injected with Con A only as Con A controls. Results In the experimental groups, six hours after the injection of Con A, the serum ALT level increased significantly ( P 0.05), reached the peak after 12 hours ( P 0.01), and then decreased. The liver nuclear DNA fragmentation increased 12 hours after injection of Con A in the Con A control group. However, the liver nuclear DNA fragmentation was significantly less in bicyclol groups ( P 0.05 and P 0.01). The percentage of DNA ladder in the 150 mg/kg bicyclol group was 25%, significantly lower than that in Con A control group (100%). The H 2O 2 level in liver was significantly increased 12 hours after injection of Con A in the Con A control group, and remained normal in the 150 mg/kg bicyclol group. The Con A induced decrease of sensitivity of liver nuclear DNA to damage by CuSO 4 ortho phenanthrolin vitamin C H 2O 2 system was counteracted by bicyclol injection. Conclusion Bicyclol is significantly effective in protecting liver from nuclear DNA injury of hepatocytes induced by Con A in mice.

The in vitro inhibitory effect of flavonoid astilbin on 3-hydroxy-3-methylglutaryl coenzyme A reductase on Vero cells.

Abstract: Background Epidemiological studies have shown that hypercholesterolemia is a major risk factor for coronary heart disease. In clinical trials of lipid lowering therapy, 3-hydroxy-3-methylglutaryl Coenzyme A (HMG-CoA) reductase inhibitor has been shown to decrease cardiac events and mortality. Flavonoids are polyphenolic natural antioxidants existing in vegetables, fruits and beverages such as tea and wine. Previous studies have shown that some antioxidants had hypocholesterolemic effect, and flavonoid intake was associated with the decrease of mortality from coronary artery disease. The aim of this study was to evaluate the inhibitory effect of flavonoids on HMG-CoA reductase. Methods The methods for analysis of specific inhibitors of mevalonate biosynthesis have been well-established, using Vero cells, a cell line obtained from kidneys of African green monkeys. Flavonoids isolated from different traditional Chinese herbs were dissolved in DMSO and incubated with Vero cells with or without the addition of 1 mM mevalonate or 5 mM sodium acetate in order to observe cell growth for 24 h. Results Concentrations of 1 mM mevalonate or 5 mM sodium acetate were added into culture medium in order to observe the effect on cell growth. Different concentrations of pravastatin to inhibit cell growth were used as a positive control. About 40 flavonoid compounds were used for study, only one compound, astilbin (belonging to the flavonol group), showed significant inhibition of Vero cell growth. Conclusions This study shows that one flavonoid compound, isolated from traditional medicinal herbs, may be an effective HMG-CoA reductase inhibitor which might be developed into a new hypocholesterolemic agent.

Surveillance of bacterial resistance in Shanghai

Abstract: OBJECTIVE To analyze the surveillance data on bacterial resistance in Shanghai hospitals reported from January 1 to December 31, 1999. METHODS Data on bacterial susceptibility testings of 14 855 clinical isolates collected from eleven Shanghai hospitals were performed using Kirby-Bauer method and the results were analyzed according to NCCLS (1999). RESULTS Methicillin resistant strains accounted for 64% and 77% of S. aureus and CNS respectively; and no vancomycin resistant strains were found. In Enterococcus spp, vancomycin resistant strains accounted for 3.5% and 1.7% of E.fecalis and E.fecium, respectively. Resistant rates of E.coli against piperacillin, gentamicin and fluoroquinolones were about 50% or higher. Resistant rates of Klebsiella spp, Enterobacter spp, Citrobacter spp and Acinetobacter spp against the third generation cephalosporins have increased markedly. Besides, the resistant rates of P.aeruginosa against ceftazidime and imipenem have increased to 27% and 20% respectively. CONCLUSION A national strategy on the restrictive and prudent use of antibiotics is urgently needed.

[Clinical characteristics and treatment of midline nasal and nasal type NK/T cell lymphoma].

Abstract: Objective To study the clinical characteristics and treatment of midline nasal and nasal type T/Nk cell non Hodgkin lymphoma. Methods A retrospective study was made on the clinical characteristics, treatment, short term effect, and two year survival rate of 37 patients with midline nasal and nasal type T/NK non Hodgkin lymphoma. Results All of the patients were primarily treated with 2 cycles of CHOP chemotherapy. Ten of them were with good effect (common group). Then they were given 6 cycles of chemotherapy followed by focal radiotherapy and reached complete remission (CM). The other 27 patients failed to reach partial remission (PM) or even with their condition worsened after 2 cycles of CHOP regimen and were included into the refractory group. Fourteen of them received L asparaginase based salvage chemotherapy followed by focal radiotherapy (L ASP group), and salvage therapy without L ASP and followed by focal radiotherapy was given to the other 13 patients (non L ASP group). Continuous fever, angioinvasive growth and necrotic lesion could not be found among the patients in the common group. Their international prognostic indexes (IPI) were 0～1. Seventy percent of them were at the stages I or II. Continuous fever, angioinvasive growth and necrotic lesion could be found in the patients in refractory group. The IPIs among 85% of them were 2, and 82% of them were at the stages III and IV. The CR rate was 46% for all patients as a whole, 100% for the common group, 26% for the refractory group ( P 0 005); and was 50% for the L ASP group and 0% for the non L ASP group ( P 0 005). The 2 year survival rate was 43% for all patients as a whole, 100% for the common group, 20% for the refractory group ( P 0 005); and was 50.8% for the L ASP group and 0% for the non L ASP group ( P 0 005). Conclusion Patients with midline nasal and nasal type T/NK non Hodgkin lymphoma can be treated primarily by CHOP regimen and local radiotherapy. Refractory patients can be treated by salvage therapy based on L ASP chemotherapy with a rather good effect. The clinical characteristics of most of the refractory patients include continuous fever, angioinvasive growth, necrotic lesion, being at stage III and IV, and with an IPI 2.

Six months follow-up of patients with methamphetamine psychosis

Abstract: Background It has been nearly 50 years since the psychotic state caused by amphetamine was first reported. However, the prognosis of methamphetamine (MAP) psychosis and its relationship with chronic schizophrenia are still vague. Some authors preferred MAP psychosis model of schizophrenia, while other studies found difference between the two groups of patients in the aspects of negative symptoms. Methods In this study we followed 21 psychiatric inpatients with diagnosis of MAP psychosis. Schedule for affective disorders and schizophrenia (SADS), scale for assessment of negative symptoms (SANS) and global assessment scale (GAS) were used for evaluation of these patients during admission and six months after discharge. Results Seventeen patients were interviewed and eight of them confessed reuse of MAP. The follow-up examinations found decreased total scores of delusion and hallucination in SADS and increased GAS scores. The SANS scores of the MAP psychotic patients in this study were lower than moderate level. No significant change could be found for most SANS subcategory scores except some items. Conclusions Most MAP psychotic patients followed in this study improved much in six months. The results of the SANS evaluation and the clinical course for six months indicated that the MAP psychosis is a psychotic disorder different from chronic schizophrenia.

[An epidemiologic study of bowel habit in adult non-patient population in Beijing area].

Abstract: Objective To determine the bowel habit and its influencing factors in the adult non patient population in Beijing area. Methods A questionnaire survey was conducted among 2 486 adult permanent residents in Beijing area by randomized stratified sampling. The bowel habit (defecation frequency, characters of feces, time of defecation, and abnormal defecation) of the 1 952 non patients among them were further investigated. The non patient subject should fulfil the following criteria: (1) without gastrointestinal and hepatic organic diseases; (2) without metabolic disease affecting the motility of the gastrointestinal tract, such as diabetes mellitus and thyroid hyperfunction; (3) without irritable bowel syndrome which fits in the Manning criteria; and (4) considering oneself as having normal bowel habits. Results 84.17% of the non patient interviewees defecated once per day with the mean defecation frequency of 7.09 times per week. 89.86% of the interviewees had formed or soft stool. 93.08% of the non patients defecated formed or soft stool 3 to 21 times per week. No evidence showed that the frequency of defecation and character of feces were related to age and sex. 77% of them defecated in the morning. The prevalence rates of constipation, diarrhea, and abdominal pain associated with defecation were 3.74%, 1.08%, and 7.38% respectively. Conclusion The defecation frequency of adult non patient population in Beijing area is almost identical to that reported in the west. 93.08% of the non patient subjects have normal defecation patterns. It is necessary to define the judgement criteria for constipation and diarrhea for Chinese based on their defecation patterns.

Valproate-induced encephalopathy.

Abstract: A 50-year-old woman taking carbamazepine (CBZ) 1200 mg daily for her partial epilepsy developed acute confusion after valproate (VPA) add-on treatment for 10 days. The administration of VPA started from 1000 mg daily and, 3 days later, increased to 1500 mg daily. Beside a mildly elevated serum ammonia level (81 microg/dL), her electroencephalogram showed diffuse background slowing intermixed with 2-2.5 Hz of high-amplitude slow waves, which indicated a diffuse encephalopathy. The serum levels of VPA and CBZ were 49.1 mg/L and 8.6 mg/L, both being non-toxic. The liver functions appeared normal. She recovered rapidly after discontinuation of VPA. In this patient, a safe previous administration of VPA did not preclude the occurrence of encephalopathy. A relatively large initial VPA dosage could possibly be the culprit.

Pregnancy and its outcome in women with malformed uterus

Abstract: OBJECTIVE To analyze the clinical characteristics of fertility and pregnancy in women with congenital uterine malformations and explore optimal treatments to improve the prognosis. METHODS A retrospective study was conducted on the fertility and obstetric outcome in 153 in patients with uterine malformations treated in our hospital from January 1984 to December 1998. Twenty-seven cases with other kinds of genital and/or urinary anomalies but with normal uterus was used as the control group. RESULTS The infertility rate was 22.2% (34/153). The miscarriage rate was 44.3% (86/194), preterm labor rate was 9.3% (18/194). Abnormal fetal presentation rate was as high as 28.4% (29/102), the cesarean section rate was 61.8% (63/102), perinatal mortality rate was 11.8% (12/102). CONCLUSION Women with congenital uterine malformation usually have higher incidence of infertility and complications during pregnancy and delivery. Bicornuate and septate uterus could be associated with poorer obstetric outcome.

Cathepsin E and subtypes of intestinal metaplasia in carcinogenesis of the human stomach.

Abstract: BACKGROUND: Cathepsin E is found mainly over the gastric surface and foveolar epithelial cells, and it also is found in the metaplastic pyloric glands and cancer cells. The exact function of cathepsin E in gastric mucosa remains unclear. The colonic type (type III) of intestinal metaplasia (IM) is strongly associated with intestinal-type gastric carcinoma. IM is considered to be a precancerous lesion. The aim of this study was to find out the role of cathepsin E in IM, dysplasia and cancer of stomach. METHODS: Sixty nine biopsy specimens with IM and dysplasia and 33 gastrectomy specimens with gastric carcinoma were fixed, sectioned and stained with PAS-alcian blue stain, high iron-diamine alcian blue stain to classify IM and immunohistochemical stain to localize cathepsin E. Those patients with dysplastic gastric lesions received regular endoscopic follow-up. RESULTS: Fifteen of 69 patients with gastric dysplasia developed cancer in a median 10.5 months follow-up. Severe dysplasia developed carcinoma significantly higher than mild dysplasia (12/20 vs. 1/25, p < 0.001), and type III intestinal metaplasia seemed to have significantly predilection for severe dysplasia and gastric cancer. Cathepsin E was stained in intestinal metaplasia with dysplastic change in 44/69 specimens (63.8%), and carcinoma in 28/48 (58.3%) specimens, there was no significant difference between intestinal type and diffuse type carcinoma in cathepsin E staining. The positive staining for cathepsin E decreased significantly in severe dysplastic gastric mucosa. CONCLUSIONS: Type III IM is commonly associated with severe dysplasia and cancer; it may be a precancerous lesion. The positive staining of cathepsin E decreased with the severity of gastric dysplasia, representing dedifferentiation of the cells.

Solitary fibrous tumor of the liver.

Abstract: Solitary fibrous tumor of the liver is a rare neoplasm. So far, 21 cases have been described in the English literature. We reported an additional case. Our patient, a 75-year-old man, suffered from abdominal fullness and body weight loss of 6 kg over 6 months, and chills and fever for 2 months. Hypoglycemia was noted at admission. Both abdominal sonography and CT showed a huge mass occupying the right lobe of liver. Liver biopsy showed fibrous tumor. Right lobectomy was performed and the tumor was resected. Pathological examination showed spindle-shaped and fibroblast-like cells within the collagenous stroma. On immunohistochemical stains, these spindle tumor cells showed CD34 positive reactivity. The post-operative course was uneventful and there was no more hypoglycemia. The patient recovered smoothly, regained his body weight, and was alive without evidence of disease recurrence at the last follow-up visit in November, 2000.

Hepatic encephalopathy in rats with thioacetamide-induced fulminant hepatic failure: role of endotoxin and tumor necrosis factor-alpha.

Abstract: Background Hepatic encephalopathy, a complex neuropsychiatric syndrome secondary to acute liver failure, chronic parenchymal liver disease or portal-systemic shunting, may possibly develop through mediators of endotoxin and tumor necrosis factor-alpha (TNF-alpha). However, there are no published data concerning the relationships between the severity of encephalopathy and the plasma levels of endotoxin and TNF-alpha. Methods Male Sprague-Dawley rats weighing about 300-350 g were used. Fulminant hepatic failure was induced by intraperitoneal injection ofthioacetamide (350 mg/kg/day) for 3 consecutive days. Severity of encephalopathy was assessed by measuring motor counts using an Opto-Varimex animal activity meter. Plasma levels of endotoxin and TNF-alpha were determined by chromogenic Limulus assay and ELISA method, respectively. Results Our study revealed that higher plasma levels of endotoxin (> 5.9 pg/ml) and TNF-alpha (> 18.8 pg/ml) were significantly associated with more blunted motor activities in rats with fulminant hepatic failure (p 0.05). Conclusions In addition to endotoxin and TNF-alpha, other factors may participate in the pathogenesis of hepatic encephalopathy in rats with thioacetamide-induced fulminant hepatic failure.

Correlation between anti-Ro/La titers and clinical findings of patients with systemic lupus erythematosus.

Abstract: BACKGROUND Systemic lupus erythematosus (SLE) is a complex autoimmune disease with various clinical and serological manifestations. Previous studies have shown the association of SLE and anti-Ro, anti-La and anti-dsDNA autoantibodies with various clinical manifestations. We investigated the relationship between these autoantibodies and clinical findings of our patients with SLE. METHODS Eighty patients with SLE at Department of Pediatrics, Taipei Veterans General Hospital, Taiwan from October 1999 to March 2000 were enrolled in the study. Frequencies of various clinical manifestations were calculated. Autoantibodies to Ro, La and dsDNA were measured using ELISA method. RESULTS The most frequent clinical findings were arthritis (92.3%), photosensitivity (90.9%) and malar rash (86.1%). The most frequent laboratory findings were positive anti-nuclear antibody (ANA) (94.9%), low serum CH50 hemolytic titer (88.6%) and positive anti-dsDNA level (72.5%). Patients with anemia or photosensitivity had higher titers of anti-Ro antibody (Ab) than those without the respective clinical findings (p = 0.001 and 0.002, respectively). However, patients with proteinuria had lower anti-Ro Ab titers (p < 0.05). There was no correlation between clinical findings and anti-La Ab titers. Patients have higher titers of anti-dsDNA Ab if they had clinical findings of Raynauld's phenomenon, photosensitivity, arthritis, hypocomplementemia (p < 0.001), thrombocytopenia, proteinuria, or serositis (p < 0.05). No correlation was found between renal involvement and titers of various autoantibodies. CONCLUSIONS Neither anti-Ro, anti-La nor anti-dsDNA antibodies was correlated with renal involvement in patients with SLE. However, patients with proteinuria had significantly lower titers of anti-Ro Ab than those without proteinuria.

Prevalence of childhood cerebral palsy in six provinces in China

Abstract: Objective To investigate the prevalence of childhood cerebral palsy (CP) in China Methods A cross sectional survey was carried out among 1047327 children aged 1 approximately 6 years old in six provinces of China during May 1997 approximately December 1998 Results The crude prevalence of CP for children aged 1 approximately 6 years old was 192 per thousand; in addition, prevalences of CP were also reported for factors such as sex, age, ethic group, birth weight, gestational age, and area Conclusion Prevalence of CP in China is at the low range among the world, which may be due to low prevalence and low survival rate of premature newborn in China The prevalence of cp is associated with areas, sex, age, ethnic group, birth weight, and gestational age

A metastatic pituitary carcinoid tumor successfully treated with gamma knife radiosurgery.

Abstract: Intracranial metastasis occurs in a certain number of patients with carcinoid tumor. However, carcinoid tumor with metastasis to the pituitary gland is extremely rare. Up to the present, no effective treatment for either a metastatic intracranial carcinoid tumor or a metastatic pituitary lesion of any origin has been documented. We have treated a case of metastatic carcinoid tumor of the pituitary gland with transsphenoidal tumor resection followed by gamma knife radiosurgery. A 59-year-old man presented with headache and left oculomotor palsy. He was treated at the same hospital for bronchial atypical carcinoid tumor one and a half years ago. Magnetic resonance image of the brain showed a pituitary tumor. There were no signs of recurrent or metastatic lesion elsewhere despite thorough investigation. Transsphenoidal approach for removal of tumor was done and the pathology turned out to be a metastatic carcinoid tumor. Subsequent gamma knife radiosurgery was given for residual tumor. The oculomotor palsy improved after radiosurgery. No neurological deficit occurred. Follow-up CT scan of the brain showed complete resolution of the tumor. We concluded that gamma knife radiosurgery could be used to treat a metastatic intracranial carcinoid tumor. It can also be used to treat a metastatic lesion of the pituitary gland without causing neurological deficit.

Resection of triple synchronous tumors--gastric adenocarcinoma, gallbladder adenocarcinoma and stromal tumor of the stomach.

Abstract: We herein report a rare case of triple synchronous tumors: gastric adenocarcinoma, gallbladder adenocarcinoma and stromal cell tumor of stomach, which were resected in the same operation. A 72-year-old male patient suffered from poor appetite and epigastric pain that radiated to his back for one month. Upper gastrointestinal endoscopy showed a gastric ulcer measuring 1.5 cm at the prepyloric area, which was proven to be adenocarcinoma by biopsy. A second tumor was found in the gallbladder, measuring 3 cm, by ultrasonography. On computed tomography, a third tumor about 2.5 cm in size was recognized posterior to the gastric high body and anterior to the pancreas. Given the presence of three tumors, he underwent a radical subtotal gastrectomy with Billroth-II gastrojejunostomy and simultaneous cholecystectomy. Pathological findings revealed gastric adenocarcinoma, gallbladder adenocarcinoma and stromal cell tumor of the stomach. The postoperative course was smooth.

Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome with acute cortical blindness.

Abstract: The coincidence of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and cortical blindness is an uncommon but very dramatic event. We describe a case of HELLP syndrome complicating with acute cortical blindness before delivery. A 27 year-old woman, gravida 1, para 0, with normal medical history, was referred to our emergency department at the 33th week of gestation due to headache, vomiting, and blurred vision. The ophthalmologic examination showed intact pupillary light reflexes and normal ophthalmoscopic findings, but no light perception in either eye. Brain computed tomography showed normal findings. HELLP syndrome and preeclampsia was diagnosed based on the findings of hypertension and proteinuria as well as laboratory data. Prompt delivery was performed in order to achieve good maternal and neonatal outcomes.

[Association of 16189 variant (T-->C transition) of mitochondrial DNA with genetic predisposition to type 2 diabetes in Chinese populations].

Abstract: Objective To assess the prevalence of 16189 variant (T-->C transition) of mitochondrial DNA in Chinese populations and to study the relation between mtDNA 16189 variant and insulin resistance and the role it plays in genetic predisposition to diabetes. Methods PCR and RELP techniques were used to examine 383 unrelated type 2 diabetics and 151 non-diabetic controls selected by random sampling. Results (1) The prevalence of 16189 variant among type 2 diabetics was significantly higher than that among the controls. (2) The prevalence of 16189 variant was significantly higher among type 2 diabetics with maternal family history than among those without maternal family history. (3) In comparison with the type 2 diabetics without 16189 variant, those with 16189 variant showed higher fasting serum insulin level, decreased insulin sensitivity index, and higher Homa insulin resistance index. (4) In the control group, no significant difference in age, gender, body mass index, waist to hip ratio, serum lipid level, fasting plasma glucose level, fasting serum insulin level, insulin sensitivity index, and Homa insulin resistance index was found between those with 16189 variant and those without 16189 variant. Conclusion 16189 variant of mitochondrial DNA is one of the genetic predisposing factors for type 2 diabetes mellitus in Chinese populations. It might interfere with the energy metabolism and the production of ATP, thus causing insulin resistance in peripheral tissues.

Risk factors of catheter-related infections in total parenteral nutrition catheterization.

Abstract: Background The use of central venous catheter for administration of total parenteral nutrition (TPN) is a risk factor of catheter-related infections (CRIs) that are associated with increased morbidity and mortality, prolonged hospitalization, and increased medical costs. The purpose of this study is to evaluate the risk factors of CRIs in patients with administration of TPN. Methods A total of 1134 patients receiving TPN between January, 1996 and December, 1998 were studied. The category of infection included definite catheter-related bloodstream infection (CR-BSI), probable CR-BSI, and insertion site infection. Statistical analysis of risk factors was performed. Results A total of 131 episodes of CRI occurred, representing an infection rate of 11.46%. Ninety-three episodes (8.1%) had probable CR-BSI, 13 episodes (1.1%) had definite CR-BSI, and 25 episodes (2.2%) had insertion site infection. Duration of TPN infusion and frequency of catheter insertion showed statistically significant difference by logistic regression multivariate analysis. The isolated organisms were in sequence of coagulase-negative Staphylococci (19.4%), Staphylococcus aureus (17.2%) and Candida albicans (14.4%). Conclusions Risk factors influencing the occurrence of CRI in TPN administration were multifactorial; however, duration of TPN infusion and frequency of catheter insertion were the main factors in our study.