The simultaneous use of electrocochleogram, brainstem auditory evoked potential and facial muscle EMG in cerebellopontine angle tumor removal

In six cases of acoustic neurilemmoma, electrocochleogram (ECOchG), brainstem auditory evoked potentials (BAEP) and facial muscle electromyograms (EMG) were recorded to monitor facial nerve and brainstem function. Under isoflurane and nitrous oxide anesthesia, we recorded ECOchG from the tympanic membrane, BAEP from the scalp needle, and facial muscle EMG from the mentalis muscle. During surgery, the body temperature was kept above 36.5 degrees C, and PaCO2 above 30 mmHg. In all cases, the peak N1 of ECOchG and wave I of BAEP had identical latencies throughout the monitoring period. The response was faster and the amplitude was higher in the ECOchG recordings. For calculation of the I-III or I-V interpeak latency of BAEP, the wave I of BAEP could be confirmed more quickly and precisely by the peak N1 of ECOchG. During tumor removal, the embedded facial nerve pathway in the tumor was identified by electric stimulation of the intracranial facial nerve, followed by evoked facial muscle EMG. Facial nerve function was confirmed by nerve traction or direct electric stimulation after total removal of the tumor. No facial palsy or other neurologic sequelae was found after the operations.

Cytogenetic study of acute lymphoblastic leukemia and its correlation with immunophenotype and genotype

Among 72 Chinese patients with acute lymphoblastic leukemia (ALL), 50 had clonal chromosomal abnormalities. Structural abnormalities were detected in 42 patients: these included t(9;22) in 9, t(1;19) in 6, t(4;11) in 5, del(11)(q23) in 4, and del(6q) in 4. Adults had a higher incidence of t(9;22) and t(1;19) but a lower incidence of t(4;11) and hyperdiploid greater than 50 karyotype than children. A significant difference was also noted in white blood cell (WBC) count among various karyotypic groups. Patients with chromosomal abnormalities t(9;22), t(1;19), t(4;11) and del(11) (q23) had a shorter complete remission duration as compared with patients free of these abnormalities. Immunophenotyping was performed on 69 patients. All patients with t(9;22), t(1;19), and t(4;11) had B-lineage ALL restricted to certain stages of maturation: groups III and IV, groups IV and V, and group II, respectively (according to the classification of Foon and Tood). Among patients with t(9;22), t(4;11), and del(11)(q23), which have been considered to be associated with acute mixed-lineage leukemia, one each, respectively, showed myeloid antigen expression on the leukemic blasts (My+ ALL). No cross-lineage rearrangements of immunoglobulin (Ig) or T-cell receptor (TCR) genes were detected in these karyotypic subgroups of patients who underwent gene analysis.

Regulatory mutants and transcriptional control of the Serratia marcescens extracellular nuclease gene

The extracellular nuclease of Serratia marcescens is regulated in a complex fashion. Unlike most catabolic enzymes, it appears not to be substrate regulated. However we have shown it to be regulated by an SOS-like system in S. marcescens. Additionally nuclease expression is regulated in a growth-phase-dependent manner. In this work we demonstrate that growth-phase-dependent regulation is at the transcriptional level. The putative LexA-binding site which mediates SOS regulation is shown to act as an operator site in vivo. The boundaries of a minimal promoter, still regulated by growth phase and SOS regulation, are defined along with the transcriptional start site. However, a region upstream of the nuclease promoter is shown to enhance significantly the expression of nuclease.

Hodgkin's disease and non-Hodgkin's lymphoma containing Reed-Sternberg-like giant cells in Taiwan. A clinicopathologic analysis of 50 cases

Hodgkin's disease (HD) is uncommon in Taiwan. In reviewing the clinicopathologic features of 50 cases, the authors found that the diagnosis of HD was complicated with non-Hodgkin's lymphoma (NHL). Fourteen cases were reclassified as NHL containing Reed-Sternberg (RS) giant cells, mostly peripheral T-cell lymphoma (PTL), and 34 cases as classic HD, which included 8 cases of lymphocyte predominance, 10 of nodular sclerosis, 12 of mixed cellularity, and 4 of lymphocyte depletion. For cases of HD, there was a bimodal age-incidence distribution with peaks at the third and fifth decades; 61.8% manifested Stage B symptoms and 80.6% had Stage III/IV disease. The group of patients with NHL, compared with those with classic HD, was found to be older (mean age, 41.4 years versus 33.1 years; P less than 0.05), to have more extranodal disease (35.7% versus 8.8%, P less than 0.05), less complete remission rate (25% versus 67.9%, P less than 0.05), and shorter median survival (29 months versus 90 months). Most of the NHL patients originally were diagnosed as having atypical or unclassified HD. Thus, the authors conclude that the previous observation of a predominance of mixed cellularity HD in Asian regions may be attributable to the inclusion of PTL, which may mimic HD in histology. Because there is a marked difference in clinical behavior and prognosis, it is important to distinguish between HD and NHL containing RS giant cells in an area with a high incidence of PTL.

Chemotherapy-related side effects in children with acute lymphocytic leukemia in Taiwan: a nursing perspective

The purpose of this study was to understand the pattern of side effects experienced by children with acute lymphocytic leukemia (ALL) who were receiving the induction and consolidation phases of a specific chemotherapy regimen. One hundred and one children with ALL in treatment centers throughout Taiwan in June 1990 through June 1991 served as the sample for this study. Children had been divided into two groups, a standard risk group (SR) and a high risk group (HR), which received different therapeutic regimens. Of 101 children, 52 in SR and 27 in HR completed the induction and consolidation phases of treatment. Among sources of data for the study were nurses' prospective close observations in the natural care setting of each child. Chemotherapy-related side effects are multifaceted and intrusive, including changes in hematopoietic function, body function and body appearance. The most common side effects with regard to body function were elevation of body temperature, ulceration of oral mucous membrane, poor appetite, nausea and vomiting, ulceration of anus, diarrhea, impaired mobility. Side effects were greatest during the first through third weeks of the chemotherapy regimen. Twenty percent of the children developed infection. The findings stressed that nurses should be aware of such patterns of side effects so that they can provide optimal care to patients receiving chemotherapy.

Texture features for classification of ultrasonic liver images

The classification of ultrasonic liver images is studied, making use of the spatial gray-level dependence matrices, the Fourier power spectrum, the gray-level difference statistics, and the Laws texture energy measures. Features of these types are used to classify three sets of ultrasonic liver images-normal liver, hepatoma, and cirrhosis (30 samples each). The Bayes classifier and the Hotelling trace criterion are employed to evaluate the performance of these features. From the viewpoint of speed and accuracy of classification, it is found that these features do not perform well enough. Hence, a new texture feature set (multiresolution fractal features) based on multiple resolution imagery and the fractional Brownian motion model is proposed to detect diffuse liver diseases quickly and accurately. Fractal dimensions estimated at various resolutions of the image are gathered to form the feature vector. Texture information contained in the proposed feature vector is discussed. A real-time implementation of the algorithm produces about 90% correct classification for the three sets of ultrasonic liver images.

Abnormal muscle response in microvascular decompression of hemifacial spasm

In 1976, Jannetta et al, suggested that microvascular compression caused by arteries and veins crossing the root entry zone of the facial nerve, was the major etiology of hemifacial spasm (HFS). Surgical treatment has become a major trend. Microvascular decompression (MVD) with teflon patches has a high cure rate. However, the possible occurrence of multiple vessel compression makes it difficult to decide which of these vessels are responsible for the symptom during operation. Recently, a method of abnormal EMG was elaborated upon by Møller and Jannetta in 1987, to ensure the quality of MVD intraoperatively. In this study, we report 6 cases who underwent the procedure successfully. After general anesthesia and muscle relaxation, the abnormal EMG was not suppressed. When the offending vessel was lifted up from the facial nerve, the abnormal EMG disappeared immediately. In each case, postoperative improvement of facial spasm correlated with intraoperative abnormal EMG changes. This method is not only able to guide the surgeon to the vessel that induces HFS but also guarantees the quality of MVD.

Acinetobacter calcoaceticus bacteremia: analysis of 48 cases

The medical records of 48 patients with Acinetobacter calcoaceticus bacteremia over a recent two-year period were reviewed retrospectively to determine the epidemiologic and clinical features. There were 34 males and 14 females with a median age of 51 years. Forty-six of the cases were hospital-acquired. The characteristics of these patients included residence in the intensive care unit, intubation and ventilatory support, preceding antibiotic therapy and intravascular catheterization. In vitro susceptibility testing for the isolated organisms revealed that 32% of these strains were resistant to gentamicin and 90% were aztreonam-resistant. Minocycline, amikacin, ceftazidime, ticarcillin, imipenem, and the new quinolones retained good activity. Although A. calcoaceticus causes septic pictures as do other aerobic Gram-negative bacilli and part of these isolates are multiple drug-resistant, the infection did not seem to be difficult to control. Twenty-six (54%) of these patients survived, including 9 patients without appropriate antimicrobial therapy initiated within 48 hours of blood sampling. The mortality was rarely due to bacteremia per se; most often, it resulted from the underlying diseases.

Actinobacillus actinomycetemcomitans endocarditis: a report of four cases and review of the literature

Four patients with infective endocarditis caused by Actinobacillus actinomycetemcomitans seen at the National Taiwan University Hospital between January 1985 and December 1990 are reported. There were two men and two women with a mean age of 40 years. Three had had a xenograft replacement, the other one had prolapse of mitral valve. Carious teeth were noted in two. The most common presenting symptoms were fever, cough, dyspnoea, and weight loss and the duration of symptoms before diagnosis varied from 2 weeks to 2 months. Peripheral stigmata of endocarditis were not present in any patient. Laboratory investigation revealed haematuria and anaemia in three patients, and elevated erythrocyte sedimentation rates in all four. None had leucocytosis. Echocardiography was performed more than once for each patient and vegetation was demonstrated in only one. Blood culture became positive after 7-10 days of incubation. One of the isolates was resistant to penicillin. The diagnosis was delayed due to the indolent clinical course, non-specific presentation, and the slow growth of the organism. However, all patients were cured clinically and bacteriologically after 6 weeks of intravenous antibiotic therapy which included penicillin, cefamandole, chloramphenicol, or aztreonam, with or without an aminoglycoside. All patients were free of evidence of recurrence after 6-25 months of follow-up.

[Lennox-Gastaut syndrome with band form heterotopia: a case report]

A 10-year-old girl with developmental delay, mental retardation and intractable seizures is reported. She manifested clinically as Lennox-Gastaut syndrome with unknown etiology before admission. Brain MRI revealed a band-like lesion over the bilateral subcortical region being later recognized as band-form heterotopia. This type of heterotopia may be overlooked easily due to its symmetrical distribution and mild degree of cortical convolutional anomaly. As it is often associated with intractable seizures and psychomotor retardation, the prognosis is poor. This patient responded poor to ketogenic diet and anticonvulsants. We present this case and review the related articles.

[Non-surgical treatment of spinal epidural abscesses: report of one case]

Spinal epidural abscesses (SEA) are uncommon in children. This paper reported a two-year-old boy who was noted to have neck stiffness, with local tenderness posteriorly. Bacterial meningitis was suspected initially in terms of the finding of the cerebral spinal fluid; antibiotics were prescribed. Three days later another spinal tap was performed because of persistent high fever and irritability. A pus-like material drained out as the needle punctured into the spinal region. A magnetic resonance image (MRI) scan of the spine revealed a SEA, with extensive involvement from the second cervical spine to the lumbosacral spine region. Culture of the pus, as well as the blood and CSF, were positive for Staphylococcus aureus. Because of extensive involvement of the spinal epidural space, the patient was again given antibiotics: Prostaphllin and Amikin intravenously for six weeks instead of laminectomy. Then the oral antibiotic (Keflex) was given to the patient for another three months after the boy was discharged from the hospital. A review of the literature shows the incidence of SEA to be increasing and the bacterial spectra to be broadening because of increasing use of immunosuppressing drugs or antibiotics, and the increase in numbers of immunecompromised patient. The clinical symptoms and signs of the SEA were non-specific, but SEA can be early diagnosed by computurized tomography (CT) scan or MRI scan with caution. The literature suggests that, if the patient's condition fits the criteria for non-surgical treatment, antibiotic therapy is the first choice for preventing the complication of spinal deformity, especially in children.

Effect of erythropoietin on neutrophil chemiluminescence in hemodialyzed patients

Erythropoietin (EPO) has been used widely for correcting anemia in hemodialyzed (HD) patients. Enhancement of phagocytic function during EPO treatment of HD patients has been studied, but no data have been available on the effect of EPO on neutrophil chemiluminescence (CL) after challenge with phorbol myristate acetate (PMA). CL was measured in prehemodialysis whole blood samples from 15 stabilized patients and 15 normal healthy control subjects (C) after challenge with PMA. Before EPO treatment, CL was noted to be significantly higher in HD patients than in C, which changed significantly after 5 weeks of treatment (Rx) and continued for 13 weeks of Rx. There was a significant increase in hematocrit in these HD patients after 5 weeks that persisted until the 13th week. It was concluded that there is a significant decrease in whole blood CL in response to challenge with PMA during correction of anemia in HD patients treated with EPO. This study demonstrated that EPO could decrease enhanced PMA-activated reactive oxygen metabolite production and suggested that this decrease may protect against tissue damage, including red blood cell hemolysis in the uremic milieu.

[The pattern electroretinogram in diabetic retinopathy]

The pattern electroretinogram (PERG) was examined in 79 eyes (47 patients) of diabetic retinopathy (DR), with the results that the amplitude of b-wave was significantly reduced early in the subclinical phase of DR, and the latency was lengthened from stage I on. The value of PERG in the early functional diagnosis of DR was discussed.

A subset of acute lymphoblastic leukemia with co-expression of myeloid antigens: prevalence and clinical significance

In order to evaluate the biological features and clinical significance of myeloid antigen expression in acute lymphoblastic leukemia (ALL), immunophenotype analysis was performed on leukemic cells from 160 patients diagnosed as ALL by the French, American and British (FAB) criteria using a comprehensive panel of monoclonal antibodies to lymphoid and myeloid associated antigens. Expression of myeloid antigens was found in 32 cases (20%), including 11 out of 49 adults (22.4%) and 21 out of 111 children (18.9%). CD33 was positive in 18 patients (11.3% of the total cases), CD13 in 15 patients (9.4%), CD 11b in 12 patients (7.5%) and CD14 in 1 patient (0.6%). Nine patients expressed two or more myeloid antigens. There were no significant differences in clinical manifestations and hematological pictures between the ALL patients with myeloid antigen expression (My+ ALL) and those without (My- ALL). No consistent chromosomal abnormality was found in My+ ALL. Eighty percent of the childhood and 44.4% of the adult My+ ALL patients achieved complete remission, compared with 87% and 80%, respectively, for childhood and adult My- ALL, but the differences were not statistically significant. After a median follow-up of 2.1 years, there were also no statistically significant associations between myeloid antigen expression and shorter duration of remission or poorer survival rate for patients with both adult and childhood ALL.

Vernal keratoconjunctivitis with shield ulcer--a case report

This 9-year-old boy had a three-year history of vernal keratoconjunctivitis. A shield ulcer developed in the superior part of the cornea. The shield ulcer is a rare manifestation of the disease. Although the cause of shield ulcer is unknown, the association of shield ulcer with large papillae suggests a mechanical cause. The symptoms of itching and mucous discharge were relieved after medications with topical steroid and cromolyn sodium, but the large shield ulcer was persistent. The vernal ulcer was treated with a 72 hours collagen shield. The ulcer healed rapidly within 5 days, leaving a corneal opacity about the level of Bowman's layer.

Promoting health care for children with cancer in Taiwan

In Taiwan cancer has become the second leading cause of death of children, subjecting healthcare professionals to new challenges in carrying out their duties. Not only is the treatment long, but relapses often occur, requiring expensive, repeated hospitalization and appropriate care. To help families cope with the financial burden of long treatments, nurse researchers involved in a study of the cost pressures of such treatment literally went to the streets--including a TV programme on the plight of these children and their families--and collected financial contributions from both the public and medical professions. Thanks to their efforts a Childhood Cancer Foundation is now aiding these children and their families both financially and morally. Below, a report on how the nursing profession took action to involve the community and government in a collective effort.

Immunoglobulin and T-cell receptor gene rearrangements in acute lymphoblastic leukemia--a higher incidence of double rearrangements in patients with myeloid antigen expression

Among 160 patients who were diagnosed as having acute lymphoblastic leukemia (ALL) by French American British (FAB) criteria, 32 patients (20%) expressed myeloid-associated antigens on leukemic blasts (My+ALL). Correlation of immunophenotype with rearrangement of immunoglobulin (Ig) heavy chain and T-cell receptor (TCR) beta chain genes was performed on 73 of these patients (21 were My+ALL). Rearrangements of both Ig and TCR genes (double rearrangements) were detected in 24 patients, including three (19%) of 16 T-lineage ALL. 17 (33%) of 52 B-lineage ALL, and four of five ALL expressing both B and T-cell surface markers. Also a higher incidence of double rearrangements in My+ALL was found as compared with My-ALL (43% vs 29%). This difference was more evident when only B-lineage ALL was considered (50% in My+ patients vs 24% in My- patients). However the difference is not statistically significant yet possibly due to the small number of patients in the study. Further studies on more patients are needed to confirm this. In My-B-lineage ALL, rearrangements of TCR beta chain gene were restricted to certain subgroups (Groups III & IV) of patients who expressed CD10 surface antigens but lacked cytoplasmic Ig. In My+ B-lineage ALL, rearrangements of TCR beta chain gene could be found in various subgroups studied (Groups II through V). Cross-lineage gene rearrangement in My+ALL may involve mechanisms different from those in My-ALL.

Deletion of the human retinoblastoma gene in primary leukemias

As an initial step in evaluating the role of tumor suppressor genes in leukemogenesis, we surveyed primary leukemia cells from 130 patients for possible deletion of the retinoblastoma susceptibility (Rb) gene by Southern blot analysis. Two of them clearly showed homozygous deletion of Rb alleles. The first patient was a pre-B acute lymphoid leukemia (ALL) associated with a cytogenetic translocation: t(14;16)(q24;q22). The deletion was located at the 3' portion of the Rb gene, very close to the site of Rb gene deletion recently identified in an ALL cell line. The absence of Rb110 protein was further confirmed by Western blot analysis. The second patient was a chronic myelomonocytic leukemia (CMMoL), terminated in acute blastic transformation. Deletion of the 5' portion of Rb gene was found in leukemic cells in the chronic stage. The results indicated that inactivation of the Rb gene occurred in certain cases of leukemia. Its significance warrants further study.

[Epidemiologic study of pathogens causing nosocomial infections]

Nosocomial infection is a global problem. It significantly adds to the expected duration of hospitalization resulting with an increased economic burden and represents a leading cause of death. The characteristics of nosocomial infection vary from country to country and also changes with time. In order to understand the pathogens causing nosocomial infection in the large teaching hospital in Taiwan, we collected and analysed the surveillence data of nosocomial infection at the National Taiwan University Hospital from 1981 to 1989. We found that the nosocomial infection rate had been around 4-5% annually since 1981 till 1989. As ranked according to the site of infection, surgical wound infections were the most common, followed by the urinary tract, respiratory tract, and blood stream infections. However, the incidence of surgical wound infections had decreased gradually. About one third of nosocomial infections were caused by multiple microorganisms. The most frequently isolated pathogen has changed from Escherichia coli in early years to Pseudomonas aeruginosa in the most recent years. Gram-negative aerobic bacteria has been the major pathogens resulting in nosocomial infections for the past 9 years, accounting for 55-66%. In contrast, fungi have increased rapidly from 1.8% of total isolates in 1981 to 7.7% in 1989. Gram-positive cocci have also increased in recent years. The leading pathogen by infection site was P. aeruginosa in surgical wound infections, E. coli in urinary tract infections, and P. aeruginosa in respiratory tract infections. In earlier years E. coli was the major isolate in bacteremic cases, but glucose non-fermenters, including P. aeruginosa, Acinetobacter calcoaceticus and others, plus Enterobacter species-emerged as the major pathogens of recent years.(ABSTRACT TRUNCATED AT 250 WORDS)

Cutaneous manifestations of postthymic T cell malignancies: description of five clinicopathologic subtypes

This study was undertaken to identify the cutaneous manifestations among different prognostic subgroups of postthymic T cell malignancies. Cutaneous involvement was demonstrated in 43 of 88 cases. We recognized five clinicopathologic subtypes: type I, classical cutaneous T cell lymphoma (CTCL) or mycosis fungoides, six cases; type II, primary large cell type CTCL, Ki-1 antigen (Ki-1+ or Ki-1-), seven cases; type III, primary angioinvasive T cell lymphoma, three cases; type IV, human T-lymphotropic virus type I (HTLV-I+) adult T cell leukemia/lymphoma (ATL), eight cases; type V, secondary cutaneous involvement by peripheral T cell lymphoma (PTL), 19 cases. Primary CTCL and ATL tend to involve papillary dermis with or without epidermotropism, whereas PTL and angioinvasive T cell lymphoma predominantly affect skin adnexae, vessels, and subcutis. Cutaneous lesions in type V PTL are heterogeneous and may be confused with panniculitis, vasculitis, or an eczematous eruption. Classic CTCL, Ki-1+ lymphoma, and angioinvasive T cell lymphoma have a chronic course, whereas ATL, Ki-1- large cell lymphoma, and PTL are clinically aggressive.

Delayed erythropoiesis after major ABO-incompatible bone marrow transplantation: report of a case

Major ABO-incompatible bone marrow transplantation (BMT) may be associated with delayed erythropoiesis. A 38-year-old man (blood group O) with chronic myelogenous leukemia received a BMT from his histocompatibility antigen (HLA) identical brother (blood group A). The pre-BMT anti-A titer of the patient was 1:4. The harvested marrow was depleted of RBC by 6% hydroxyethyl starch sedimentation and Ficoll-Hypaque gradient centrifugation. No acute hemolysis occurred after marrow infusion. Myeloid and megakaryocytic series engrafted promptly. However, delayed erythropoiesis up to day 266 was found. Prolonged presence of anti-A antibody was noted for more than 250 days after BMT, although the peak titer was only 1:8. After the reconstitution of bone marrow, the erythroid series was confirmed as donor origin (RBC cell typing A). It is proposed that the prolonged presence of anti-A antibody probably produced from the residual host B lymphocytes, would destroy the regenerating erythroid precursors. Also, use of cyclosporin A may be associated with higher rates of prolonged production of anti-A/B antibodies and the subsequent delayed erythropoiesis.

Energy storage in quantum-well lasers

A new scheme of energy storage in single-quantum-well semiconductor lasers is analyzed. This scheme involves the storage of the majority of injected carriers in the continuum states of the surrounding bulk material, in which the carrier density is diluted and the higher-order carrier-density-dependent recombination processes are much smaller. This allows the inversion level to build up to a much higher level during the pumping stage of Q switching. The possibility of using indirect-band-gap semiconductors for carrier storage is also proposed.

Staphylococcus aureus endocarditis in drug addicts: report of 2 cases

Two young men presented with prolonged hectic fever and chills followed by chest pain, dyspnea and hemoptysis. The chest films revealed multiple lung infiltrates, and blood cultures yielded Staphylococcus aureus. Echocardiographic examination confirmed the diagnosis of tricuspid valve endocarditis. Multiple punctate lesions in the bilateral inguinal areas and dragon tattoos over the forechest gave rise to the suspicion of drug abuse. After prolonged antimicrobial therapy, bacteremia was eliminated, and elective vegetectomy and valvuloplasty were performed on one of the patients. The other one suffered recurrent episodes of pulmonary embolism. Disappearance of the large vegetation was disclosed by echocardiography. Both of them eventually regained their health with the abstinence of drugs. This report illustrates two typical cases of infective endocarditis in drug addicts.

Chromosome and bcr rearrangement in chronic myelogenous leukaemia and their correlation with clinical states and prognosis of the disease

Among 77 unselected patients with chronic myelogenous leukaemia (CML), 70 had Philadelphia chromosome (Ph1) in blood cells. Extra chromosomal abnormalities were noted in 4%, 55% and 78% of Ph1-positive patients in chronic phase, accelerated phase and acute blast crisis, respectively. Rearrangement of the bcr was detected in 46 of 47 Ph1-positive patients studied and also in three of five Ph1-negative ones. The locations of the breakpoints were mapped to one of four zones of the bcr in 45 patients. The median duration from diagnosis of CML to onset of acute blast crisis was not significantly different between the two groups of patients with breakpoints in the 5' portion (34 months), and in the 3' portion (39 months) of the bcr. In addition, the locations of the breakpoints within the bcr did not change as the disease progressed in the six patients who had DNA analysed both in the chronic phase and subsequently in transformation. In one of them, an additional aberrant band which was not present in the beginning of the acute phase was detected in blood cells taken 2 months later. It is suggested from the studies that transformation of CML may not be related to alterations within the bcr.

Secondary prevention of ischemic stroke with low dose acetylsalicylic acid

In order to evaluate the efficacy of low dose acetylsalicylic acid (ASA) for the secondary prevention of ischemic stroke, this cooperative multicenter clinical trial was conducted on a non-blind basis. Patients having a first transient ischemic attack (TIA), reversible ischemic neurological deficit (RIND) or completed ischemic stroke were eligible for this trial. A total of 590 patients including 47 cases of TIA, 23 cases of RIND and 520 cases of completed stroke entered this study. These patients were allocated by the time of admission to one of the following 5 trial regimens: (1) vasodilators having no known inhibitory effect on platelet function (control group), (2) dipyridamole (DP) 50 mg 3 times a day (DP group), (3) ASA 300 mg once a day (ASA 300 mg group), (4) ASA 300 mg once in combination with DP 50 mg 3 times a day (ASADP group), and (5) ASA 100 mg once a day (ASA1 group). No difference in effect between the control and DP groups was observed, nor between the ASA 300 mg and ASADP groups. Therefore, we combined the control and DP groups to make a non-ASA group, and joined the ASA 300 mg and ASADP groups to make an ASA3 group. The differences in the cumulative event-free rate appeared to be significant between the non-ASA group and the ASA3 group and also between the non-ASA group and the ASA1 group. But the frequency distribution of age, territory of stroke, diabetes mellitus, cardiac disease, hematological disease and hyperuricemia were significantly different among these 3 study groups. We thus included these covariates in the Cox's proportional hazard model to control their possible confounding effects.(ABSTRACT TRUNCATED AT 250 WORDS)

bcr rearrangements in Philadelphia chromosome-positive acute lymphoblastic leukemia. A study of five Chinese patients in Taiwan

Cytogenetic studies were successfully conducted on 73 Chinese patients with acute lymphoblastic leukemia (ALL). A Philadelphia chromosome (Ph) was identified in four (9%) of the 46 children and in four (15%) of the 27 adults. None of these patients had any clinical features suggestive of chronic myelogenous leukemia (CML). Leukemic cells from five of the eight Ph-positive (Ph+) ALL patients were analyzed for bcr rearrangement by Southern blot analysis with three restriction enzymes and two bcr probes. One of the three children and both adult patients studied showed bcr rearrangement. Based on the data from the literature and the present study, 58% of adult and 14% of childhood Ph+ ALL patients demonstrated bcr rearrangement. There were no significant differences in clinical or laboratory findings between the two groups of patients with or without bcr rearrangement. Patients who had Ph+ ALL but no bcr rearrangement appear to have been victims of de novo acute leukemia, but it was still difficult to determine whether patients with bcr rearrangement had acute lymphoid transformation of subclinical CML. More studies and longer follow-ups are needed for clarification.

The significance of detecting serum fluorine level in the diagnosis of drowning

In view of the high content of fluorine in the water of a vast area of Guangdong Province, we detected the serum fluorine level in rabbits that died of drowning and compared them with those obtained from rabbits immersed in water after death from hanging. The fluorine content in water is about 15-fold higher than in the normal serum content. In drowned rabbits, the serum fluorine values are significantly higher than normal while in control cases the serum fluorine values are slightly lower than normal. The fluorine content in human serum is similar with that of rabbits. It suggests that detection of serum fluorine content might be a valuable method for the diagnosis of drowning in those areas where there are high water fluorine content.

Psychological and social support systems in intensive and critical care

Advanced medical technology makes intensive care available to save a persons life. A person is a bio-psycho-social being. Meaning of having a critical health problem is conceived objectively. Psychological and social support or expressive provision, which is a complementary component together with the instrumental component comprising caring, is a bridge between advanced medical technology and the quality of life of a person.

Benign cystic mesothelioma of the peritoneum: report of a case

A 36-year-old multiparous woman presented with the chief complaint of mass and fullness over the lower abdomen for the previous 3 months. Abdominal ultrasound revealed a uniloculated, thin-walled cyst attached to the peritoneal surface of the right lower abdomen. The cyst was surgically excised and confirmed to be cystic mesothelioma of the peritoneum by histopathologic and immunohistochemical studies. Benign cystic mesothelioma is an extremely rare intraperitoneal tumor. Although its etiology remains unclear, one distinctive clinicopathologic feature is a symptomatic abdominal mass in young females. The presence of a thin-walled cyst attached to the peritoneum on ultrasound should alert physicians to the possibility of this disease. The treatment of choice is complete resection and reexcision may be required due to a preponderance for local recurrence. Regular postoperative ultrasound follow-up is recommended to check for possible recurrence.

The effects of 3-deazaguanine on Rous sarcoma virus transformation

An expression of cellular transformation in chicken embryo fibroblast infected with Rous sarcoma virus (RSV) was inhibited by 3-deazaguanine (3-DG). Re-transformation of normal rat kidney cells infected with a temperature-sensitive mutant of RSV was suppressed by 3-DG when the cells were shifted from the non-permissive temperature (38 degrees C) to the permissive temperature (33 degrees C). Removal of the inhibitor enabled the cells to revert to the transformed state. Finally, 3-DG had little or no effect on replication of RSV in the chicken embryo fibroblast cells.

Secondary polycythemia associated with membranous nephropathy

A 61-year-old male patient had secondary polycythemia associated with idiopathic nephrotic syndrome. Renal biopsy revealed membranous nephropathy. Polycythemia did not change in spite of partial remission of proteinuria. Serum erythropoietin determined by an enzyme-linked immunosorbent assay was 7.2 mU/ml. His serum erythropoietin maintained at a constant level during polycythemia was higher than it was before the appearance of renal ischemia, so he was kept in a polycythemic state. Whether decreasing proteinuria can improve renal ischemia requires future study. We must observe the patient for the occurrence of thromboembolism. Renal ischemia possibly induced by nephrotic syndrome is likely to cause secondary polycythemia.

[Comparison between responses of monkey prefrontal neurons to signal and to indifferent stimuli]

Unit activities of the principal sulcus area were recorded in three monkeys (Macaca mullata). Two of them were trained to perform visual discrimination task, and the other had not received any training. The sequence of the task is as follows: (1) a cue of presentation of red (in R Model) or blue (in B Model) light (1.3s); (2) a delay period (2.1s); (3) a reaction period of presentation of white light (4.88s). The monkey should draw a bar after the onset of the white light of R Model to avoid a electric shock, and should not draw the bar after the onset of the white light of B Model in which the monkeys would not receive the electric shock. Of 127 prefrontal units recorded from the two trained monkeys when they were performing the task, 80 units (63%) were related to the events of the task. Ninety six units were recorded for the test of responses to click and flash in the intertrial interval, and 23 units (24%) responded to click and/or flash. Fifteen out of 23 units were event-related. Twelve out of 103 units responded to the red, blue and white flash in the intertrial interval. A hundred units were recorded from the untrained monkey a only 4 units showed nonspecific responses to the indifferent stimuli. The results showed that after training much more prefrontal neurons involved in processing of the information of signal stimuli than those in response to the indifferent stimuli. In other words, the prefrontal neurons possess plasticity and change their activities during the training of visual discrimination task.

Morphological aspects of inhibition of transformation of rat kidney cells infected with a temperature-sensitive mutant of the Rous sarcoma virus by rat fibroblast interferon

Normal rat kidney cells (NRK) infected with a temperature-sensitive (ts) mutant of Rous Sarcoma virus (RSV) at the permissive temperature (33 degrees C) exhibit the morphological and growth characteristics of the transformed state. By the use of this system, it has been shown that the addition of rat fibroblast interferon to infected cells grown at a nonpermissive temperature (38 degrees C) prevents re-transformation when they are introduced to the permissive temperature. Merely treating cells at the permissive temperature with rat fibroblast interferon causes them to change from the transformed phenotype to a normal phenotype. These effects require the continuous presence of interferon and are quite species specific as observed with the ineffectiveness of mouse fibroblast interferon. Therefore, the results suggest that interferon might restore the growth control of transformed cells which could in part accounts for its anti-tumor effect.

A subset of acute nonlymphocytic leukemia with expression of surface antigen CD7--morphologic, cytochemical, immunocytochemical and T cell receptor gene analysis on 13 patients

An increasing number of acute leukemias coexpressed markers normally believed to be restricted to a single lineage have been found recently. This special subgroup of leukemias have drawn a lot of attention because of their biologic and clinical significance. In a study of 100 consecutive de novo ANLL patients diagnosed by FAB criteria, T-cell antigen CD7 was identified on the leukemic blasts of 13 patients, ten of whom had M1 subtype of leukemia, myeloblastic leukemia without maturation. All the patients showed positive staining with myeloperoxidase and expressed myeloid markers CD13 and/or CD33, but lacked CD11b, a marker of more mature myeloid cells. Combined staining with myeloperoxidase and CD7 of the cells from four patients revealed coexpression of both markers on the same cells. None of the patients expressed the two other T-cell antigens CD2 or CD5. All ten patients who had DNA analysis showed germline configuration of TCR beta and gamma chain genes. One patient had chromosomal translocation involving 11q23, t(11; 19) (q23; p13), which is the site frequently associated with both myeloid and lymphoid malignancies. The clinical implications of this subgroup of patients need further study on more patients, and need longer follow-up.

Recovery from axial apraxia in the lateral hypothalamic labyrinthectomized rat reveals three elements of contact-righting: cephalocaudal dominance, axial rotation, and distal limb action

In earlier work, we showed that in rats, proprioceptive-tactile information is sufficient for contact-righting on the ground (from lying on one side to prone). Thus, axial rotation, starting with the shoulders and followed by the pelvis, occurs normally in labyrinthectomized animals with eyes occluded. After damage to the lateral hypothalamus, even with labyrinths intact, contact-righting is at first abolished (1-2 days postoperatively), and when it reappears, involves pushing by the hindlegs. Rostrocaudal contact-righting, involving axial rotation, takes 3-4 days to recover. If labyrinthectomy is combined with lateral hypothalamic damage, the deficit is exaggerated and recovery is greatly slowed down, now requiring 2-3 weeks. The present paper shows that during this prolonged period of recovery several transitional forms of righting are present, each produced by a different combination of limb and body axis movements. At first, axial rotation is absent, and righting is achieved only by pushing with the limbs. This is followed by a transitional form in which, even though axial rotation cannot be triggered directly by contact with the ground, it can be triggered indirectly as an allied reflex when the paw places on the ground. Eventually the body axis actively initiates the rotation to proneness (at first, in the pelvis, later in recovery, in the shoulders), with the limbs being carried. Recovery of axial rotation overlaps with the recovery of cephalic dominance, yielding complex intermediate forms of righting.

Treatment of refractory or relapsed adult acute leukemia by using mitoxantrone-containing regimens

Twenty-eight adult patients with primary refractory or relapsed acute leukemia were treated. The regimens consisted of mitoxantrone plus cytosine arabinoside for 17 patients with acute non-lymphocytic leukemia (ANLL) and mitoxantrone accompanied with vincristine and prednisolone for 11 patients with acute lymphoblastic leukemia (ALL). In primary refractory patients, 1 of the 4 (25%) ANLL and 1 of the 3 (33%) ALL attained complete remission (CR). Excluding 2 patients who underwent bone marrow transplantation, 8 of the 13 (62%) relapsed ANLL and 4 of the 8 (50%) relapsed ALL achieved CR with a median duration of remission of 6.2 months and 3.8 months, respectively. Myelosuppression occurred in all treatment courses and was associated with pyrexia due to infections in 84% of the cases. Nausea, vomiting and stomatitis were mild. Abnormal liver function tests were observed in 8 (28%) patients. One patient, pretreated with 550 mg/m2 of doxorubicin, developed congestive heart failure. The results suggest that mitoxantrone is of value in the treatment of Chinese patients with refractory or relapsed acute leukemia.

Cytomegalovirus retinitis treated with ganciclovir in a renal transplant recipient

Cytomegalovirus retinitis is an opportunistic and vision-threatening disease in immunosuppressed patients. Currently available antiviral agents have been unsuccessful in halting its progression. We report a case of cytomegalovirus retinitis which occurred 6 months after renal transplantation and was successfully treated with an investigational drug, ganciclovir (DHPG [Dihydroxy propoxymethyl guanine], Cytovene, BW-B759U), via intravenous administration, with resolution of active retinal lesions and the cessation of cytomegalovirus shedding in the urine. There was neither a recurrence of cytomegalovirus retinitis nor an occurrence of retinal detachment during the 9-month follow-up after intravenous ganciclovir therapy.

Spatial and temporal expression of the two sucrose synthase genes in maize: immunohistological evidence

We describe the spatial and temporal immunohistological distributions of the two sucrose synthases, SS1 and SS2, encoded by the Sh and Sus genes, respectively, in different parts of the maize plant. The two similar isozymes were differentially localized in developing endosperm cells through the combined uses of a shrunken (sh) mutant lacking the SS1 protein and the SS1 and SS2 antisera. The accumulation of SS1 protein always coincided with starch deposition in the Sh endosperm cells, whereas in the sh endosperm, the centrally located cells were lost at or during the most critical phase of starch biosynthesis. The SS2 specific cells, including aleurone layer and the basal endosperm transfer cells in both genotypes, were not associated with detectable starch deposition. Such heterogeneity was indicative of two cell types separable by gene expression, and of differential in vivo roles of the two isozymes in the endosperm. In young roots, the expression of both SS encoding genes was predominantly in the vascular cylinder region. These data fulfill a previous prediction, based on the genetic analyses, that the expression of the SS genes is spatially and/or temporally separated in endosperm cells but not in root cells.

[Psoas abscess: report of a case]

The retrofascial space is a concealed one located behind the transversalis fascia in the posterior peritoneal cavity. It contains mainly muscles and fasiae and extends from the mediastinum to the pelvis. Clinical manifestations of an abscess are usually obscure except for hip joint problems when the abscess developed. Computed tomography is done immediately if an abscess is suspected, and there have been good results under incision with drainage and antibiotics. It is different from retroperitoneal abscess anatomically, pathologically, bacteriologically and clinically, so we report a case for reference. The patient, a 43-year-old female worker, had suffered from disability of her left lower limb for more than 5 months before admission. She even visited her local medical doctor, but in vain. In the week prior to admission, left hip swelling with awkwardness in walking was felt, and she called on an orthopedist. After brief examination, impaired hepatic and renal function was noted, so she was referred to our hospital. The chief complaint on admission was left hip swelling and pain with radiation to the inguinal and knee area for one week. The past history was insignificant except for a cesarean section and an appendectomy done more than 10 years before. Upon physical examination, the patient was found to be pale, emaciated, mildly icteric and had a flexion contracture of the left thigh. Laboratory data revealed anemia, leukocytosis, impaired hepatic and renal function. The chest X-ray was normal, and KUB demonstrated left hip joint flexion and external rotation. A sonogram showed a localized hypoechoic lesion in the left posterior peritoneal cavity 2 days later.(ABSTRACT TRUNCATED AT 250 WORDS)

Infection of human T-cell leukemia virus type I and development of human T-cell leukemia lymphoma in patients with hematologic neoplasms: a possible linkage to blood transfusion

Among 354 adult patients with either hematological malignancy or aplastic anemia, eight were positive for anti-HTLV-I antibodies; six of eight had received multiple transfusions. There was an approximately 3.5-fold increase (P less than .001) of HTLV-I seropositivity in the patients with hematologic disease (8 of 354, 2.23%) compared to the healthy adults older than 20 years (34 of 5252, .65%). Two hematological patients, one with Hodgkin's disease and one with acute promyelocytic leukemia, were found to be positive for HTLV-I, and developed and died of adult T-cell leukemia/lymphoma (ATL) subsequently. Both were long-term survivors of the primary disease and had received multiple transfusions. The latent period from blood transfusion to onset of ATL was 6 months and 11 years, respectively. Immunocompromised patients, who were seropositive for HTLV-I, may be at increased risk for ATL compared to healthy carriers of HTLV-I, and the latent period may be shorter.

The skin manifestation of acute graft-versus-host disease: clinical and pathological analysis

We report 11 cases of acute graft-versus-host disease (GVHD); 10 occurred after bone marrow transplantation (BMT) and one following transfusion of nonirradiated whole blood in a patient with severe combined immunodeficiency (SCID). According to the Seattle Classification, 5 cases were of Grade III, 2 Grade II, and 4 Grade I. The skin rash developed between the 6th to 47th day (22 +/- 12 day) after transplantation or transfusion, and was usually manifested initially as erythematous macules or papules in the neck or upper chest. The rash resolved in scaling or became purpuric, pigmented or erythrodermic in severe cases. The grading of skin pathology correlated well with clinical severity of GVHD. Four of the five who had advanced GVHD (Grade III) died. In all 4 cases but one (the SCID case), the skin pathology showed extensive basal vacuolization and multiple dyskeratotic cells. None of the others with mild or focal basal vacuolization and few dyskeratotic cells progressed into advanced GVHD. Three of the 5 cases with advanced GVHD received an underdose of cyclosporin A. These results suggest that severe GVHD carries a poor prognosis and an adequate dose of cyclosporin A is important in alleviating the severity of GVHD and reducing the mortality. The sero-virologic study performed during the skin rash period was negative, suggesting that the skin rash following BMT is mainly caused by GVHD and always precedes intestinal or hepatic manifestations.

Acute graft-versus-host disease: a clinical report and analysis of risk factors

Of the 31 cases of allogeneic bone marrow transplantation performed in the past 4 years at the National Taiwan University Hospital, 25 evaluable cases were retrospectively studied for incidence, severity, and risk factors of acute graft-versus-host disease (GVHD). The incidence was 60% (15/25) with the proportion of severe form (greater than or equal to grade II) being 53% (8/15). Skin involvement was the most common (13/15), gut the second (5/15), and liver the third (4/15). Most of the diagnosis of skin disease were confirmed by biopsy. Acute GVHD accounted for 3 deaths directly and was the next most common cause of death in post-transplant patients. The long-term survival rate for cases with grade 0-I disease was 65%, and that for those with grade II-III disease was 38%. Multivariate linear regression analysis of risk factors associated with severe form GVHD showed that the diagnosis of aplastic anemia was the most significant factor. Total lymphoid irradiation with or without plasmapheresis in aplastic anemia might contribute to the occurrence of severe acute GVHD.

Direct comparisons of peripheral T-cell lymphoma with diffuse B-cell lymphoma of comparable histological grades--should peripheral T-cell lymphoma be considered separately?

Peripheral T-cell lymphoma (PTCL) forms a morphologically heterogeneous group of non-Hodgkin's lymphomas (NHL) with distinct immunophenotypes of mature T cells. Progress has been slow in defining specific clinicopathological entities to this particular group of NHL. In order to elucidate the specific characteristics of PTCL, a direct comparison of PTCL with a group of diffuse B-cell lymphomas (DBCL) was performed. Between June 1983 and December 1987, we studied 114 adults with NHL, using a battery of immunophenotyping markers. Adult T-cell leukemia/lymphoma, lymphoblastic lymphoma, mycosis fungoides/Sézary syndrome, follicular lymphoma, well-differentiated lymphocytic lymphoma, and true histiocytic lymphoma were excluded from this study since these are distinct clinicopathologic entities with well-recognized immunophenotypes. Of the remaining 75 patients, 70 who had adequate clinical information were analyzed, and of these, 34 were PTCL and 36 were DBCL. Classified according to the National Cancer Institute (NCI) Working Formulation (WF), 68% of PTCL and 31% of DBCL were high-grade lymphomas. Clinical and laboratory features were similar, except PTCL had a characteristic skin involvement and tended to present in more advanced stages with more constitutional symptoms. Induction chemotherapy was homogeneous in both groups, and complete remission rates were 62% for PTCL and 67% for DBCL. Patients with DBCL had a better overall survival than patients with PTCL, but the survival benefit disappeared after patients were stratified according to intermediate- or high-grade lymphoma. A subgroup of PTCL patients who had received less intensive induction chemotherapy was found to have a very unfavorable outcome. We conclude that (1) PTCL follows the general grading concept proposed in WF classification; (2) within a given intermediate or high grade, PTCL and DBCL respond comparably to treatment; (3) the intensity of induction chemotherapy has a crucial impact on the outcome of PTCL patients; and (4) with a few exceptions, the clinical and laboratory features of PTCL and DBCL are comparable.

Chromosomal characteristics of Ph-positive chronic myelogenous leukemia in transformation. A study of 23 Chinese patients in Taiwan

Cytogenetic study was performed in the past 3 years on 23 Chinese patients with Philadelphia chromosome (Ph) positive chronic myelogenous leukemia (CML) in transformation; seven were in accelerated phase and 16 in acute blast crisis. Chromosomal abnormalities in addition to Ph were found in three (43%) of the patients at accelerated phase and 14 (88%) of the patients at blast crisis. The common nonrandom chromosomal aberrations were double Ph, trisomy 8, trisomy 19, and trisomy 21, which occurred in 47%, 41%, 35%, and 29%, respectively, of the total patients with extra chromosomal abnormalities. Isochromosome for the long arm of chromosome 17 was found in only one patient. In patients with blast crisis, the type of blast cell was characterized through morphologic, cytochemical, and immunocytochemical studies. Eleven cases were classified as myeloid and five as lymphoid transformation. Trisomy 8, 19, and 21 were detected only in patients with myeloid blast crisis. This study also revealed a high incidence of trisomy 21 and a low incidence of i(17q) in Chinese patients with transformation of CML.