HTLV-1-associated myelopathy: first case reported in Taiwan

Taiwan is geographically, culturally, and socially close to southern Japan, which is an endemic area of human T-lymphotropic virus type 1-associated myelopathy (HAM). Taiwan, however, is not an endemic area of HAM. We report the first case of HAM in a native Taiwanese, a 61-year-old woman, without known HTLV-1 risk factors.

Precise gene dosage determination by polymerase chain reaction: theory, methodology, and statistical approach

We developed a general method of quantifying relative copy numbers of specific DNA sequences based on the theoretical accumulation of polymerase chain reaction (PCR) products when two DNA sequences are amplified together (co-amplified). Our experiments illustrate the development and theory of the technique. The precision of our estimates is demonstrated by statistical confidence intervals. Tests for effects introduced by experimental factors were performed. The precision of the technique was established by examining the relative gene dosage of the X-linked dystrophin gene in human genomic DNAs from a male, a normal female, a 47,XXX female, and a 48,XXXX cell line. The sensitivity was sufficient to distinguish three copies of the gene from four copies; equivalent to detecting loss of heterozygosity in half the cells of a tumour. Confidence intervals allowed us to reject the hypothesis that there was no difference between DNA samples. Four sample pairs would be required to demonstrate relative gene dosage ratios of 2.0 to 1.0; eight sample pairs would be required to demonstrate a relative gene dosage ratio of 1.3 to 1.0. This method should be useful in detecting gene amplification and deletion in a variety of situations.

DNA sequence of a Salmonella-specific DNA fragment and the use of oligonucleotide probes for Salmonella detection

Hybridization specificity of a 1.8-kb HindIII DNA fragment isolated from Salmonella typhimurium by a molecular cloning technique was confirmed by colony hybridization with 327 Salmonella isolates of various serotypes and 56 non-Salmonella isolates including Enterobacteriaceae closely related to Salmonella, such as Escherichia coli, Klebsiella, Citrobacter and Shigella. It was found that this 1.8-kb DNA fragment was highly specific for all the Salmonella isolates tested. The DNA sequence of this 1.8-kb fragment was then determined by the dideoxynucleotide chain termination method. According to this DNA sequence, six oligonucleotide fragments ranging from 17- to 26-mer were then chemically synthesized and tested for their hybridization specificities. Results show that three of the six oligonucleotide fragments are highly specific for all 327 Salmonella strains tested and can be used as probes for the specific detection of Salmonella in foods or other samples.

[Comparison of nasal mucociliary clearance before and after operation in chronic sinusitis]

Nasal mucociliary clearance is a first line of defence mechanism of the respiratory system against inhaled particles. It transports particles depositing into the nasal passages to the pharynx to be swallowed or expectorated, thus protecting the respiratory system from injury. Clearance function is affected by many factors such as the chronic inflammation of the paranasal sinuses. A group of 13 healthy volunteers (controls) and a group of 17 patients suffering from chronic sinusitis was investigated in the Department of Otolaryngology of Taichung Veterans General Hospital between June and October of 1990. A radioisotope method was used to measure the velocity of nasal mucociliary transport in the participants. This involved the use of radioisotope Tc99m combined with albumin particles and measurements were made in one nasal chamber at a time. The sinusitis patients were then surgically treated and they all improved. In all 25 tests were made in the control group and the mean velocity of their mucociliary transport was found to be 4.56mm/min. In the patients 28 measurements were made and their mean velocity was found to be 2. 67mm/min before the operation and 4.03mm/min after the operation. The difference between pre- and post-operative velocities was statistically significant as was the difference between the pre-operative velocities of the patients and those of the controls. The difference between controls and patients after the operation was not significant.

Quantitative 99Tcm-HMPAO white blood cells and 67Ga scanning in rheumatoid arthritis

This investigation assessed 99Tcm-HMPAO white blood cell (Tc-WBC) and 67Ga knee uptake indices before and after 90Y treatment in patients with intractable rheumatoid arthritis (RA) and correlated the uptake indices with the clinical score. Sixteen knee joints with RA were treated with intra-articular injection of 185 MBq of 90Y-silicate colloid (Amersham) flushed with 50 mg of hydrocortisone. Clinical score, quantitative 67Ga and Tc-WBC knee uptake indices were obtained before and three weeks after treatment. Our results showed that 9/16 (56%) had a good response and 7/16 (44%) had a poor response to 90Y injection. There was poor correlation between clinical improvement and changes in 67Ga and Tc-WBC knee uptake indices (r = 0.46 and 0.14, respectively). The correlation coefficient between changes in 67Ga and Tc-WBC knee uptake indices was 0.29.

Coronary angiography using fast selective inversion recovery

Using a fast version of selective inversion recovery, we have obtained coronary angiograms of normal volunteers showing the proximal portions of the left coronary artery. Blood is tagged in the aortic root at end systole using a 2D inversion pulse. After a wash-in time of 300-600 ms, the coronary vessels are imaged with a 2- to 3-cm-thick slab in either axial or oblique projection. The scan is completed within a breathhold in 24 heartbeats.

Infantile spasm induced by hemispheric pachygyria ultrasound, MRIand Tc-99m HMPAO SPECT

We report a case of infantile spasm induced by hemisphere pachygria in which ultrasound and MRI provided precise anatomic information of hemisphere pachygria and Tc-99m HMPAO SPECT scintigraphy supplied an accurate assessment regional cerebral blood flow of infantile spasm during a seizure.

Multiple-readout selective inversion recovery angiography

We have developed a variation of selective inversion recovery (SIR) angiography that allows us to obtain a collection of several angiograms within the same acquisition time previously required to obtain a single image. In basic SIR, a single readout is performed after the tagging inversion pulse. In multiple-readout SIR, a succession of readout pulses is applied following the inversion pulse. By varying the gradients appropriately during the successive readouts, we can obtain a set of multiple projection-angle angiograms, or, by appropriately spacing the readouts throughout the cardiac cycle, we can obtain a set of time-resolved angiograms. This technique allows us to obtain additional spatial or temporal information without increasing total scan time. A sequence of increasing flip-angle read pulses is used to maintain a constant signal level across the images. A trade-off exists between SNR and the number of images acquired.

Impact of demented patients on their family members and care-givers in Taiwan

A standardized questionnaire was sent to family members or care-givers of 105 patients with dementia; 68 were returned. Eighty-eight percent of the patients were cared for at home by their spouses or adult children. The adverse impacts of dementia on patient family's economy, relations among family members, and social life are recognized. The majority of the subjects had only limited understanding of dementia. Having medical insurance helps the family in caring for the demented patients, emotionally and socially, but not financially. A better social welfare system, as well as health insurance, is recommended.

Familial Mediterranean fever--linkage studies with genetic markers on chromosome 6

Familial Mediterranean Fever (FMF) is an autosomal recessive disease manifested by recurrent short episodes of fever associated with polyserositis. Although the biochemical defect is unknown, there are several immunologic abnormalities which have been described in this disease. To examine critically whether there is linkage between FMF and the immunogenetic region (major histocompatibility complex-MHC) on chromosome 6, including the HLA, BF, and GLO1 loci, blood samples from members of 13 nuclear Armenian families were tested for these genetic markers. These 13 families included 28 affected and 42 unaffected family members. Linkage could be excluded at 7.5% recombination with the HLA ABC and D loci. Linkage could be excluded at 2.5% recombination for GLO1. Linkage could not be excluded with BF individually, but can be rejected based on the haplotype data. No association was found with either BF, GLO1, and HLA DQ alleles. HLA DR4 was found more often in affected cases than in controls; however, after adjusting for the number of antigens tested this was not significant. Our results would appear to exclude the immunogenetic region on chromosome 6 from linkage with FMF in the Armenian population.

Transfer function analysis of the ventricular function: a new method for calculating right ventricular ejection fraction

The relationship between the ventricular transfer function and ejection fraction has been investigated by the routine procedure of first-pass radionuclide angiocardiography. Ejection fraction has been shown to equal 1-e(-b), where b is the ratio of the R-R interval over the mean transit time difference between ventricular and atrial time-activity curves. To evaluate the effect of region of interest (ROI) on the right ventricular ejection fraction (RVEF), the results of the transfer function analysis (TFA) technique using precise ROI, TFA using rectangular ROI, and the routine method were compared. Regression analyses among RVEFs obtained from the above ROI methods yielded good correlations. Reliable RVEFs have been obtained even in the case of an improper bolus injection. Thus, the TFA technique is a new, simple, and reliable method for calculating RVEF without needing to outline the right ventricle precisely.

[The coagulogram in patients with nephrotic syndrome]

The coagulogram done in half of the 100 cases of nephrotic patients admitted into our hospital from 1986 to 1988 was studied. It is shown that the patients of either the renal vein thrombosis (RVT) positive or negative group were in hypercoagulability state. 46 patients in this series had RVT proved by renography. The mechanism of RVT and the clinical significance of the changes of these hemostatic data are discussed.

Hearing-damage risk and communication interference in dental practice

The use of high-speed air-turbine handpieces, operated at 300,000 to 400,000 revolutions per minute, has led to concern over the possibility of noise-induced hearing loss. Sound levels were measured in clinical settings and in a pre-clinical laboratory for estimation of hearing-damage risk among dentists, and the extent of communication interference. Octave-band sound pressure levels were obtained with use of a Fast-Fourier-Transform analyzer and associated instrumentation. The results of this study indicate that the sound energy contribution of a typical dental practice is about 8% to 12% of the dentist's average 24-hour noise exposure. However, noise levels during dental procedures result in an articulation index of 0.21 to 0.37, corresponding to understanding of about 18% to 48% of nonsense syllables and 52% to 90% of sentences. It appears that hearing-damage risk is slight among dentists using modern equipment. However, further noise control in handpieces is necessary so that error-free communication during dental procedures can be ensured.

I-131-orthoiodohippurate renal function test in detection of renal artery occlusion in aortic dissection

By use of I-131-orthoiodohippurate (I-131-OIH) comprehensive renal function test (CRFT), we studied 4 patients with aortic dissection and various degrees of renal artery obstruction and 39 patients without aortic dissection. Of the 39 patients, 3 had significant renal artery stenosis (RAS group) and 36 had normal renal arteriogram and renal function test (control group). Three of the 4 patients with aortic dissection had complicated renal artery occlusion (RAO group), one had independent RAS. The results indicate that: (1) In the RAO group, the difference in peak time (DPT) between the affected and contralateral kidneys was above 4 minutes: whereas that of the control group was 0-2 minutes (0.5 +/- 0.6 min). (2) In the RAO group, the percent difference of split effective renal plasma flow (%DSERPF) between the 2 kidneys were 29.6% and above or near 80% in patients with incomplete and complete RAO respectively; whereas that of the control group was below 22% (mean = 7.7 +/- 5.7%). In the RAS group, moreover, DPT was 0-2 minutes; and %DSERPF were above and below 22% in 1 case with marked (75% stenosis) and 2 with mild RAS (50-60% stenosis) respectively. The renogram curves were also evaluated. It was found that (1) In the RAO group, 2 cases with complete RAO showed flat shape in the affected kidney (similar to the background surve). The case with incomplete RAO showed markedly delayed rounding peak in phase 2 and slow descent in phase 3. The case with independent RAS showed only impaired phase 3 with saw-tooth waves and less steep slope. (2) In the RAS group, the 2 cases with mild RAS showed normal in one and slightly delayed peak with less steep descent in phase 3 in the other. The case with marked RAS showed reduced and delayed peak in phase 2, and less steep descent in phase 3 with saw-tooth waves and "cross-over" of the two kidney curves. It is concluded that use of I-131-OIH CRFT to evaluate DPT, %DSERPF and the renogram curve may help distinguish amongst RAO (with aortic dissection), RAS and the normal individual in most cases.

Xenon-133 hepatic retention ratio: a useful index for fatty liver quantification

Xenon-133 hepatic retention ratio was developed for quantifying fatty liver. Data were acquired in frame mode in the hepatic region and both lung bases for 5 min after rebreathing 20 mCi of gaseous 133Xe and for another 5 min during washout. Static [99mTc]sulfur colloid liver imaging was performed with the patient in the identical position immediately after the ventilation study and data were stored for liver localization. A hepatic time-activity curve corrected for background activity was generated. The 133Xe retention ratio was derived by dividing the activity at 3.5 min after washout by the peak activity. The data of 16 controls and 20 patients with fatty liver were analyzed. The retention ratio (mean +/- s.d.) was greatly increased in patients with fatty infiltration (0.43 +/- 0.20 vs. 0.04 +/- 0.08 in controls, p less than 0.001). There was a strong positive correlation between the 133Xe retention ratios and percentage of fat on biopsy as assessed by the amount of the liver tissue occupied by fat globules on H & E stained sections. The 133Xe hepatic retention ratio is a simple, accurate and clinically useful index of detecting, quantifying and managing fatty infiltration of the liver.

[A clinical and pathologic analysis of 13 cases of adult respiratory distress syndrome]

The autopsy findings and clinical features of 13 cases of adult respiratory distress syndrome (ARDS) were analysed. The underlying causes consisted of malignant tumor of the hematopoietic tissue, severe infections, surgical wounds and water drowning. Although tachypnoea and dyspnoea are the chief symptoms of ARDS., we noticed, however, that at the beginning of the episode or when complicated by other factors (such as fracture of cervical vertebra with transverse paralysis), the pulmonary symptoms may be not very obvious. Histological examination showed hyperplasia and fibrosis of the alveolar epithelium in those cases with a course of more than 5 days. Such findings rendered classification of ARDS into acute and chronic types reasonable.

The effect of intravenous captopril on the left ventricular function-an acute study by hemodynamics and radionuclide angiography

Acute hemodynamic effects of intravenous captopril were measured, and left ventricular function was analyzed by radionuclide angiography in 11 patients with moderate to severe hypertension. All subjects received 1 mg captopril bolus injection initially, and followed in 10 minutes intervals by 2 mg or 5 mg injections according to their blood pressure response. Eight patients experienced an acute reduction of blood pressure; three patients remained unresponsive. The onset of action occurred within 5 minutes with peak effect at 5 to 10 minutes and a duration of action of 20 to 30 minutes. The hemodynamic effects were characterized by arteriolar dilation (reduced systemic vascular resistance P less than 0.01), and apparent venous dilatation (reduced right atrial, pulmonary wedge pressure P less than 0.05 & 0.01 respectively). Pulmonary vascular resistance was not altered. Ejection fraction remained unchanged. Isovolumic relaxation period lengthened (109 +/- 20.1 vs 137.39 +/- 21.15 msec, P less than 0.05) and coronary perfusion pressure gradients dropped (113.8 +/- 5.6 vs 101.1 +/- 11.3 mmHg P less than 0.001) following intravenously administered captopril. Intravenous captopril may reduce arterial pressure by inducing arterial dilatation with minimal adverse effect. The prolongation of isovolumic relaxation period should mainly attribute to the decrease of coronary filling load.

Impotence evaluated by the use of prostaglandin E1

We screened 80 patients at our hospital for the differential diagnosis of impotence using intracavernous injection of prostaglandin E1 (20 micrograms). The rate of positive response was 78.8 per cent (63 patients). Neither systemic reactions nor priapism occurred. However, a considerable incidence (23.8 per cent, 19 of 80 patients) of tolerable injection pain was encountered. The 133xenon penile washout study was conducted routinely in impotent men for hemodynamic evaluation of penile vascularity. In 80 patients a positive correlation between the response of intracavernous prostaglandin E1 injection and the result of the washout study was found (r equals 0.381, p less than 0.0002). We selected 14 subjects randomly to receive additional intravenous infusions of prostaglandin E1 (6 ampules, 120 micrograms total) for 3 days, after which another 133xenon washout study was done. The washout studies before and after intravenous prostaglandin E1 infusion were compared, and 10 patients (71.4 per cent) appeared to obtain improvement in half-time clearance and penile blood flow. However, only 3 patients noticed improvement subjectively. We suggest that prostaglandin E1 could be a desirable alternative for the diagnosis and treatment of impotence.

Induction of differentiation in HL-60 cells by retinoic acid and lymphocyte-derived differentiation-inducing factor but not by recombinant G-CSF and GM-CSF

Various concentrations of retinoic acid (RA, 10(-9) to 10(-7) M), lymphocyte-derived differentiation-inducing factor (DIF, 10-30%), and recombinant human G-CSF (100-4000 U/ml) and GM-CSF (100-4000 U/ml) were used to induce the differentiation of the HL-60 promyelocytic leukemia cells. Retinoic acid at a concentration of 10(-7) M could significantly inhibit the growth of HL-60 cells both in suspension and in soft agar cultures, and induced these cells to differentiate into mature granulocytes capable of reducing nitro-blue tetrazolium and ingesting latex beads. Thirty per cent (v/v) DIF was also an effective inducer of HL-60 cell differentiation, but it triggered the cells to mature into monocytes rather than granulocytes. In contrast, rG-CSF and rGM-CSF had no growth inhibitory effect on HL-60 cells either in suspension or in agar cultures at all concentrations tested, nor could these factors induce HL-60 cells to acquire the more mature granulocytic or monocytic phenotypes. Furthermore, rG-CSF/rGM-CSF had no differentiation-enhancing effect when added to RA-containing HL-60 cultures. These results argue against the efficacy of using CSFs for the treatment of myelocytic leukemia based on the principle of differentiation induction.

Buffer and pH effects on propranolol binding by human albumin and alpha 1-acid glycoprotein

Propranolol binding to isolated human alpha-1-acid glycoprotein (AGP) and human albumin (HSA) was studied by equilibrium dialysis at 37 degrees C. With AGP (0.067%) and HSA (4%), total propranolol concentration was varied from 0.7 to 93,000 ng mL-1. Over this concentration range the percentage drug bound to HSA declined from 49 to 39% while that to AGP declined from 68 to 4%. Two classes of sites were identified on AGP with n1k1 = 8.50 X 10(4) M-1 and n2k2 = 3.12 X 10(4) M-1. With a pH 7.4 phosphate buffer, propranolol binding to AGP was greatest when the protein was initially dissolved in pH 7.4 water compared with pH 7.2 water or the phosphate buffer. Thus, the method of AGP solution preparation affected propranolol binding by this protein. For both AGP and HSA, greater drug binding was noted with phosphate buffers in comparison with a physiological buffer. With phosphate buffers, decreasing pH from 7.4 to 7.0 decreased propranolol binding by AGP, while decreasing pH from 7.7 to 7.4 had little effect. With HSA, the percent propranolol bound consistently decreased on lowering pH from 7.7 to 7.0.

Left ventricular diastolic function in hypertrophic cardiomyopathy: assessment by radionuclide angiography

Diastolic left ventricular function was studied in 20 patients with obstructive hypertrophic cardiomyopathy, 10 with apical hypertrophic cardiomyopathy, and 20 control subjects. The left ventricular time-activity curve was filtered using Fourier expansion with 4 harmonics. The first and second derivatives of the filtered curve were used to define various parameters of the left ventricle. Isovolumic relaxation period and time to peak filling rate were prolonged in obstructive hypertrophic cardiomyopathy and apical hypertrophic cardiomyopathy (101.56 +/- 44.81 msec, 105.19 +/- 45.27 versus 72.19 +/- 29.36 (CS) P less than 0.05; 169.70 +/- 50.73 msec, 173.83 +/- 50.53 versus 138.02 +/- 29.54 (CS) P less than 0.05, respectively). Rapid filling period, diastasis, atrial contraction period, time to peak filling rate-isovolumic relaxation period, and filling fraction of diastasis were not significantly different in these groups. Fasting filling fraction was 11% lower in hypertrophic groups than in control subjects. The filling fraction of atrial contribution was 12% higher in hypertrophic groups. We conclude: Isovolumic relaxation period, rapid filling phase, and diastasis atrial contraction period can be clearly defined by this technique. Impaired relaxation is an important determinant of decreased left ventricular filling in patients with obstructive hypertrophic cardiomyopathy and apical hypertrophic cardiomyopathy. Prolonged time to peak filling rate is mainly due to increased isovolumic relaxation period in hypertrophic patients. Atrial contraction contributes to more stroke volume in patients with hypertrophic cardiomyopathy.

Brain SPECT imaging with 99Tcm-hexamethylpropyleneamine oxime in the early detection of cerebral infarction: comparison with transmission computed tomography

A new cerebral blood flow agent, 99Tcm-hexamethylpropyleneamine oxime (HM-PAO), was evaluated for early detection of acute cerebral infarction in conjunction with the transmission computed tomographic (CT) studies. The data from 22 cases were analysed. Results reveal that 99Tcm-HM-PAO enables the early detection of acute cerebral infarction prior to CT with rather proper depiction of the extent of physiological abnormality in the majority of patients. This promising result together with the lack of logistical problems will make 99Tcm-HM-PAO a useful and practical agent worldwide for diagnosing and managing acute cerebral infarction.

Proboscis lateralis, microphthalmos, and cystic degeneration of the optic nerve

An unusual case is described of multiple congenital facial anomalies, including proboscis lateralis, microphthalmos, and cystic degeneration of the optic nerve. This child's condition did not seem to fall into a previously described classification.

Visual field topography in the frog's nucleus isthmi

Responses to visual stimulation were extracellularly recorded with micropipettes from 125 neurons of the left nucleus isthmi in frogs, Rana nigromaculata, and 101 electrode tip positions were marked with cobalt staining. The present study indicates that: (1) the entire contralateral hemifield and the nasal 40 degree of the ipsilateral hemifield project on the nucleus isthmi topographically, and (2) there exist binocular units in this nucleus.

Atmospheric transmittance: improvement of LOWTRAN prediction by incorporating turbulence effects

Using the mutual intensity function, we calculate the turbulence loss-effect and add such effects into LOWTRAN predictions and the experimental data. The turbulence corrections bring the Lowtran-calculated transmittance and the experimentally obtained transmittance into closer agreement with each other.