Successful arterial switch operation in a low-birth-weight neonate who had transposition of the great arteries and advanced necrotizing enterocolitis

A low-birth-weight (LBW; 1,940 g) girl was born at the gestational age of 36 weeks without any perinatal insult. Transposition of the great arteries (TGA) with a large patent ductus arteriosus (PDA) and interatrial shunt was detected. Stage IIIB necrotizing enterocolitis (NEC) developed 46 hours after birth. She received ileostomy and drainage. Arterial switch operation was successfully performed at 23 days of age when her weight was 1,900 g. The enterostomy was successfully repaired at 104 days of age.

Treatment of unilateral crossbite using modified palatal arch: case report

Severe unilateral crossbite was diagnosed in a five-year and five-month Taiwanese girl. Clinical examination presented left posterior and anterior crossbites resulting in significant dental and facial midline deviations. Early intervention was recommended in this case for severe functional shift which might induce facial asymmetry. The unilateral crossbite was successfully treated using modified palatal arch with finger springs. The patient has shown stable occlusion and no midline deviation after six years of follow-up.

A follow-up study of annular pancreas in infants and children

Fifteen pediatric patients undergoing surgery for annular pancreas from 1984 to 1996 were analyzed. Vomiting was the most common presenting symptom. Twelve patients (80%) had associated anomalies including malrotation (40%), intrinsic duodenal obstruction (33%), Down syndrome (27%) and duodenal bands (27%). Their ages at operation were between 5 hours and 8.5 years, with a median of 4 days. Surgical treatment included duodenojejunostomy in nine, duodenoduodenostomy in five and duodenotomy with duodenoplasty in one. The mean duration for reestablishment of bowel transit was 17.9 days, with 22.8 days for duodenojejunostomy and 12.3 days for duodenoduodenostomy. All cases received postoperative follow-up, but only 11 of them were long-term followed until April 1997, with a duration ranging from 1 year and 2 months to 11 years, with a median of 7 years and 5 months. The survival was 100%, but 12 cases (80%) developed postoperative complications including cholestatic jaundice (53%), upper gastrointestinal motility disorder (47%), failure to thrive (40%) and chronic diarrhea (33%). Annular pancreas divisum was noted in one case with chronic relapsing pancreatitis. At the end of follow-up (April 1997), when final ages ranged from 1 year and 2 months to 18 years and 9 months with a median of 7 years and 5 months, there were still problems: steatorrhea in 1, diarrhea after fatty diet in 3, malnutrition in 4, failure to thrive in 3 and lower concentration of stool trypsin in 3 cases. In conclusion, close long-term follow-up is essential for infants treated for annular pancreas because many of them can be expected to develop complications, even if the initial postoperative period is uncomplicated and survival is excellent.

A survey on dental caries in schoolchildren on Lanyu Island

BACKGROUND

Lanyu Island has approximately 3000 inhabitants, mainly Yami aborigines. No survey of dental caries in schoolchildren has been done on this isolated island during the past decade. The purposes of this study were to investigate the prevalence of caries in schoolchildren on Lanyu and compare the results with the rest of Taiwan.

METHODS

A total of 289 schoolchildren (152 boys and 137 girls) aged 4 to 12 on Lanyu Island, were selected for this study. The dental examinations were done by 2 senior pediatric dentists using flashlight, dental mirrors and explorers during 4 days of examination. The survey included caries prevalence rate, restorative index, and mean scores for deft, DMFT, defs, and DMFS. Mean scores for carious teeth by type of surface and sex differences for deft and DMFT were also checked.

RESULTS

The results showed that Lanyu schoolchildren had a high caries prevalence rate (94.5%) and a low restorative index (5.75%). The mean scores of deft, DMFT, defs, and DMFS for all schoolchildren were 5.38 +/- 4.50, 1.67 +/- 2.22, 12.18 +/- 11.64, and 2.42 +/- 3.89, respectively. There were no significant sex differences in the overall mean scores of deft (p = 0.557) and DMFT (p = 0.151).

CONCLUSION

The data showed that the caries prevalence of Lanyu schoolchildren was as high as other Taiwanese schoolchildren. For the caries prevalence in deciduous teeth, the scores were even worse than the Taiwan average. This study will provide a baseline for future oral health policies on Lanyu Island.

The interactions of paeoniflorin and veratrine on isolated rat atria

In this study, we attempted to identify the interactions and mechanisms between veratrine and paeoniflorin on isolated rat atria. Paeoniflorin alone showed no effect on the rat atria. Veratrine increased the atrial contraction and induced arrhythmia at 1 x 10(-5) g/ml. Veratrine could directly induce contraction and elicit tetanic contraction at 1 x 10(-4) g/ml in the left atria with or without electric stimulation. Paeoniflorin (4.8 x 10(-6) to 4.8 x 10(-3) g/ml), verapamil (2.2 x 10(-6) g/ml), tetrodotoxin (TTX) (3.2 x 10(-8) g/ml) and quinidine (7.5 x 10(-6) g/ml) inhibited the increase of contraction and delayed the onset of contraction induced by veratrine (1 x 10(-5) g/ml). The inhibitory effect of paeoniflorin combined with verapamil on the contraction induced by veratrine was more potent than that of paeoniflorin or verapamil alone. However, the inhibitory effect of paeoniflorin was not potentiated by TTX or quinidine. From the above results, the contraction evoked by veratrine in the rat atria may be concluded to be caused by the stimulation of Na(+)- and Ca(2+)-ion channels. The inhibition of paeoniflorin on the contraction induced by veratrine may primarily be related to the blockade of Ca2+ channels.

Allogeneic bone marrow transplantation for Philadelphia chromosome-positive chronic myelogenous leukemia in childhood

Allogeneic bone marrow transplantation (BMT) offers the only potential for long-term control of chronic myelogenous leukemia. From November 1992 to August 1994, we prospectively studied five pediatric patients with Philadelphia chromosome-positive chronic myelogenous leukemia, a unique finding in Taiwan, who were treated with allogeneic BMT at different stages of the disease. Their ages at diagnosis ranged from 2 to 10 years. Four donors were HLA-matched siblings and the other was an HLA-matched unrelated donor. All patients received busulfan (4 mg/kg/day for 4 days) followed by cyclophosphamide (60 mg/kg/day for 2 successive days) as the conditioning regimen. Engraftment was documented within 22 days after transplantation in all five patients. Two out of the four patients in the sibling donor group, both of whom had BMT in the first chronic phase, achieved event-free survival after follow-up for 41 months and 17 months. The other two patients, who had BMT in the second lymphoblastic crisis and the second chronic phase, died within 6 months after transplantation due to lymphoid blastic crisis and complication of cytomegaloviral pneumonitis, respectively. The patient who received marrow from the unrelated donor underwent BMT in the accelerated phase and died within 6 months after transplantation due to myeloid blastic crisis. In conclusion, allogeneic BMT performed in the first chronic phase of childhood Philadelphia chromosome-positive chronic myelogenous leukemia seems to have better results than BMT after the first chronic phase.

Vanidilol: a vanilloid-type vasorelaxant and ocular hypotensive beta-adrenoceptor blocker with partial beta-2-agonist activity

Vanidilol, [4'-(2-hydroxy-3-(tert-butylamino)propoxy)-3'-methoxyphenyl] -benzaldehyde, newly synthesized from vanillin, is a vanilloid-type beta-adrenoceptor blocker. The beta-adrenoceptor-blocking properties of vanidilol were studied both in vivo and in vitro. Intravenous injection of vanidilol (1.0, 3.0, 5.0 mg/kg) in anesthetized Wistar rats produced a decrease in blood pressure and a dose-dependent bradycardia response. Vanidilol inhibited the tachycardia effects induced by (-)isoproterenol, but had no blocking effect on the arterial pressor responses induced by phenylephrine. In isolated guinea-pig tissues, vanidilol attenuated the (-)isoproterenol-induced positive chronotropic and inotropic effects of the atria and trachea relaxation responses in a concentration-dependent manner. The parallel shift to the right of the concentration-response curve of (-)isoproterenol suggested that the agent was a beta-adrenoceptor competitive antagonist. The apparent pA2 values for vanidilol on the right atria, left atria and trachea were 7.67 +/- 0.03, 7.89 +/- 1.02 and 7.66 +/- 0.15, respectively, denoting that vanidilol was a nonselective beta-blocker. The intrinsic sympathomimetic activity of vanidilol and propranolol was determined on isolated atria and trachea from reserpinized guinea pigs. Propranolol caused significantly negative inotropic and chronotropic effects at 10(-6) mol/l or above, whereas vanidilol possessed less cardiodepressant activities than propranolol. In reserpinized tracheal strips, vanidilol produced dose-dependent relaxant responses, but propranolol was ineffective. Preincubating the preparations with ICI 118,551 (0.1-10 nmol/l), a beta 2-adrenoceptor antagonist, significantly shifted the concentration-relaxation curves of vanidilol to a region of higher concentrations. In isolated guinea-pig thoracic aorta, vanidilol (0.1-10 mumol/l) inhibited the phenylephrine (10(-5) mol/l)-induced tonic contraction in vascular smooth muscle which was related to the block of calcium influx. In 20% saline-perfused rabbits, vanidilol showed a marked delay in intraocular pressure recovery, demonstrating an ocular hypotensive action. Binding characteristics of vanidilol and propranolol were evaluated in [3H]dihydroalprenolol binding to porcine ventricular membranes. Vanidilol was less potent than propranolol in competing for the beta-adrenoceptor-binding sites. On the other hand, vanidilol had a high hydrophilicity in comparison with propranolol. In conclusion, vanidilol exhibited nonselective beta-adrenoceptor blocking, vasorelaxant and ocular hypotensive activities, but was devoid of alpha-adrenoceptor blocking and beta 1-agonist activity. Partial beta 2-adrenoceptor agonist activity and inhibitory activity on calcium influx may share in the vasorelaxant activity.

An unusual presentation of multiple congenital melanocytic nevi with a limb distribution

We report a newborn in whom multiple small congenital melanocytic nevi (MN) were noted on the right side involving the scapular area, shoulder, upper arm and forearm. Such a limb distribution of small congenital MN has never been reported in the literature.

[In vivo study of potassium oxalate gel in tooth hypersensitivity]

This study was aimed to test the effectiveness of a new desensitizing agent-30% potassium oxalate gel in tooth hypersensitivity. Thirty adult patients with 41 hypersensitive teeth were selected at Department of Dentistry, Chang Gung Memorial Hospital at Kaohsiung, from September 1992 to March 1993. Sensitivity scales were measured as follows: (1) 0-no pain; (2) 1-mild pain; (3) 2-moderate pain; (4) 3-severe pain; (5) 4-pain continued after removal of stimulus. Both air blast and cold water stimuli were tested before and after using the new desensitizing agent. The response of each tooth was also compared before and after treatment according to each scale. The results showed that 30% potassium oxalate gel had a significant reduction in the responses to air blast and cold water (p < 0.05), suggesting that 30% potassium oxalate gel may be another agent of choice for tooth desensitization.

Microbial corrosion of aluminum alloy

Several microbes were isolated from the contaminated fuel-oil in Taiwan and the microbial corrosion of aluminum alloy A356-T6 was tested by MIL-STD-810E test method. Penicillium sp. AM-F5 and Cladosporium resinac ATCC 22712 had significant adsorption and pitting on the surface of aluminum alloy, Pseudomonas acruginosa AM-B5 had weak adsorption and some precipitation in the bottom, and Candida sp. AM-Y1 had the less adsorption and few cavities formation on the surface. pH of the aqueous phase decreased 0.3 to 0.7 unit for 4 months of incubation. The corrosion of aluminum alloy was very significant in the cultures of Penicillium sp. AM-F2, Penicillium sp. AM-F5 and C. resinac ATCC 22712. The major metabolites in the aqueous phase with the inoculation of C. resinac were citric acid and oxalic acid, while succinic acid and fumaric acid were the minors.

Ectopically erupting mandibular first permanent molar: treatment of a case

This case report presented a rare case of irreversible ectopic eruption of right mandibular first permanent molar in a 6-year-old boy. Distal root resorption of primary second molar was found during routine radiographic examination. Early treatment of ectopically erupting permanent first molar was considered in favor of preventing space loss. Using a modified Humphrey appliance as the correcting appliance, the ectopic eruption of permanent first molar had been successfully uprighted and retained.

Capsinolol: the first beta-adrenoceptor blocker with an associated calcitonin gene-related peptide releasing activity in the heart

1. The beta-adrenoceptor blocking and calcitonin gene-related peptide (CGRP)-releasing properties of capsinolol (N-[4-(2-hydroxy-3 (isopropylamino) propoxy)-3-methoxybenzyl]-nonanamide), derived from nonivamide, were investigated under in vivo and in vitro conditions. 2. Capsinolol (0.1, 0.5, 1.0 mg kg-1, i.v.), as well as (+/-)-propranolol, produced a dose-dependent bradycardia response and a temporary pressor action in urethane-anaesthetized normotensive Wistar rats. These cardiovascular effects were different from the vagus reflex and parasympathetic efferent effects shown by capsaicin (0.1 mg kg-1, i.v.) in the rat. 3. Capsinolol (1.0 mg kg-1) inhibited the tachycardia effects induced by (-)-isoprenaline, but had no blocking effect on the arterial pressor responses induced by (-)-phenylephrine. The findings suggest that capsinolol possesses beta-adrenoceptor blocking activity, but it has no alpha-adrenoceptor blocking activity. 4. In guinea-pig isolated tissues, capsinolol (10(-8) to 10(-6) M) antagonized (-)-isoprenaline-induced positive chronotropic and inotropic effects of the atria and tracheal relaxation responses in a concentration-dependent manner. The parallel shift to the right of the concentration-response curve of (-)-isoprenaline suggests capsinolol is a beta-adrenoceptor competitive antagonist. 5. Capsinolol (10(-5) to 10(-4) M) exhibited a positive cardiotonic effect that was not inhibited by (+/-)-propranolol and reserpine, but was inhibited by capsazepine (10(-6) M) and CGRP8-37 (10(-6) M). This effect was independent of intrinsic sympathomimetic effects. 6. An immunoassay of released CGRP from guinea-pig isolated perfused heart indicated that capsinolol increases the release of CGRP and thus produces positive cardiotonic effects. 7. In conclusion, capsinolol is a non-selective beta-adrenoceptor antagonist with capsaicin-like cardiotonic properties unrelated to traditional intrinsic sympathomimetic effects. It is suggested that capsinolol causes CGRP release from cardiac sensory neurones via a non-adrenergic mechanism and then activates CGRP receptors on cardiac muscle.

Vasomolol: an ultra short-acting and vasorelaxant vanilloid type beta 1-adrenoceptor antagonist

The ultra-short-acting and vasorelaxant beta 1-adrenoceptor blocking activities of vasomolol, a guaiacoxypropanolamine derivative of vanillic acid ethyl ester, were studied. Vasomolol (0.5, 1.0, 3.0 mg/kg intravenously, i.v.) produced a dose-dependent bradycardia response and demonstrated particularly a hypotensive action with an ultra-short-acting property in pentobarbital-anesthetized normotensive rats. Vasomolol's steady state of beta-blockade was attained < or = 10 min after initial infusion, and a rapid recovery from blockade occurred after discontinuation of the infusion, although intravenous infusion of vasomolol (300 micrograms/kg/min) could not inhibit pressor responses induced by (-)phenylephrine (10 micrograms/kg i.v.). In isolated rat thoracic aorta, vasomolol (1-10 microM) inhibited vascular smooth muscle contractions induced by both (-)phenylephrine (10(-5) M) and high K+ (75 mM) concentration dependently. This inhibitory effect of vasomolol was more sensitive on K(+)-induced than on (-)phenylephrine-induced contractions, suggesting that the block of Ca2+ influx may involve the major mechanism of vasorelaxation. In isolated guinea pig tissues, vasomolol (0.01-10 microM) antagonized the (-)isoproterenol (ISO)-induced positive inotropic and chronotropic effects of the atria and tracheal relaxation responses in a concentration-dependent manner. The parallel shift to the right of the concentration-response curve of (-)ISO suggested that vasomolol was a beta-adrenoceptor competitive antagonist. The effect of vasomolol was more potent on atria than on tracheal tissues, indicating that it possesses beta 1-adrenoceptor selectivity. In addition, vasomolol did not show intrinsic sympathomimetic activity (ISA). Moreover, the binding characteristics of vasomolol were evaluated in [3H]dihydroalprenolol ([3H]DHA) binding to porcine ventricular membranes. Vasomolol was an ultra-short-acting and highly selective beta 1-adrenoceptor antagonist with vasorelaxant activity and is devoid of ISA.

Paralytic shellfish poisoning in southern China

The rapidly expanding mariculture and commercial region along the southern coast of China has experienced sporadic outbreaks of paralytic shellfish poisoning for nearly 30 years, yet virtually nothing is known of the nature of that toxicity or of the causative organisms. This study presents the first direct comparisons of the high performance liquid chromatography toxin composition profiles of shellfish implicated in paralytic shellfish poisoning outbreaks in Daya Bay with Alexandrium tamarense cultures established from those waters. The three cultures that were analyzed produced an unusually high proportion of the low potency N-sulfocarbamoyl toxins C1 and C2 (nearly 90% of the total), and only trace quantities of the other saxitoxin derivatives. Total toxicity was thus very low with mild acid extraction, ranging between 7.2 and 12.7 fmole cell-1, or 0.7-0.9 pg saxitoxin equiv. cell-1. Following acid hydrolysis using the standard AOAC extraction method, the dominant toxins in the cultures were gonyautoxins 2 and 3 and decarbamoyl gonyautoxins 2 and 3. Total potency increased fourfold to 2.6-3.4 pg saxitoxin equiv. cell-1 following acid hydrolysis. These cultures are thus at the low end of the range of toxicities recorded for members of the A. tamarense species complex. Two scallop samples and one mussel sample collected from Daya Bay during paralytic shellfish poisoning episodes in 1990 and 1991 were also analyzed following the AOAC extraction procedure. The toxin profiles were similar for the three shellfish samples, in that the same suite of toxins were present in each, but the relative proportion of those toxins varied. The dominant toxins were gonyautoxins 2 and 3 and toxins C1-C4. Total toxicity was 336 and 654 micrograms saxitoxin per 100 g meat for the scallop samples, and 723 for the mussels. Toxins C3,4 were present in the shellfish at up to 22 mole%, but were not detected in cultures, even when mild acid was used for extraction. Despite the otherwise similar nature of the culture versus the shellfish toxin signatures, the presence of C3,4 indicates that another strain or species of Alexandrium, or possibly a paralytic shellfish poisoning-producing species of another genus was responsible for the 1990 and 1991 paralytic shellfish poisoning outbreaks in Daya Bay. Since the cultures analyzed were of low intrinsic toxicity, A. tamarense may be more widespread along the south coast of China than is suggested by the sporadic pattern of past paralytic shellfish poisoning outbreaks. Blooms with high cell density are required to generate sufficient toxin to be dangerous. The alarming increase in algal blooms in Chinese waters due to persistent and growing pollution may make these low toxicity populations more problematic in the future.

Effect of vapor phase corrosion inhibitor on microbial corrosion of aluminum alloys

Vapor phase corrosion inhibitors were used to investigate the antimicrobial activities and anticorrosion of aluminum alloy. Aspergillus flavus, A. niger, A. versicolor, Chaetomium globosum and Penicillium funiculosum had moderate to abundant growth on the aluminum alloy AA 1100 at Aw 0.901, while there was less growth at Aw 0.842. High humidity stimulated microbial growth and induced microbial corrosion. Dicyclohexylammonium carbonate had a high inhibitory effect on the growth of test fungi and the microbial corrosion of aluminum alloy, dicyclohexylammonium caprate and dicyclohexylammonium stearate were the next. Aluminum alloy coating with vapor phase corrosion inhibitor could prevent microbial growth and retard microbial corrosion.

Postoperative diaphragmatic dysfunction in patients undergoing open-heart surgery

Diaphragmatic elevation after cardiac surgery may result in compromized post operative respiratory function, prolonged ventilator use, longer intensive care unit (ICU) stays, poor quality of life and even mortality. 200 patients receiving open-heart surgery during the two years from October 1990 to October 1992 were studied retrospectively. 26 patients developed postoperative diaphragmatic elevation (Group 2). On the other hand, 174 patients did not (Group 1). The mean age of Group 1 (37.3 +/- 20.0 years) was younger than that of Group 2 (57.4 +/- 9.1 years), P < 0.0001. The mean aortic cross-clamp time was 70.1 +/- 38.1 minutes in Group 1. On the other hand, Group 2 had a longer crossclamp time (84.5 +/- 31.3 Minutes), p < 0.03. Our study revealed that the patients who suffered post operative diaphragmatic dysfunction were older and had a longer aortic crossclamp time than the patients who did not.

Isolated persistent fifth aortic arch with right-sided aortic arch

A persistent fifth aortic arch was recognized in a 4-year-old boy by echocardiography, magnetic resonance imaging and angiocardiography. The case was unique in at least two respects: right-sided aortic arch, and systemic-to-pulmonary connection without intracardiac lesion. This rare type of anomaly was correctly diagnosed and successfully repaired by patch closure of the arch. This is the first report of this combination of lesions in the Orient.

Performance of older adults with and without cerebrovascular accident on the test of visual-perceptual skills

OBJECTIVES

The purposes of this study were to (a) investigate whether older subjects with brain damage score lower on the Test of Visual-Perceptual Skills (TVPS) than control subjects without brain damage matched for age and education, (b) determine the demographic effects on test performance in both groups, and (c) determine the capacity of TVPS in identifying visual-perceptual deficits in adults with brain damage.

METHOD

The study sample consisted of 22 subjects with cerebrovascular accident (CVA) and 155 subjects who were neurologically intact (control group). The TVPS was administered individually to each subject. Raw scores (total response time and accuracy) were analyzed to generate descriptive statistics. Other statistical analysis included analysis of variance, analysis of covariance, discriminant analysis, and Pearson product-moment correlations.

RESULTS

There were significant between-group differences on all TVPS measures, with control subjects performing better than subjects with CVA. Age was shown to affect performance on most subtests of the TVPS in the control group. Education had significant influence over each measure, whereas gender differences were significant only in two subtests. No demographic effects were found in the group with CVA. The total TVPS accuracy score was the most powerful discriminator between the two groups, correctly classifying 74.4% of the subjects. Finally, the total accuracy score inversely correlated with total time score.

CONCLUSION

The TVPS may be useful in screening for visual-perceptual impairments in adults with CVA. Age, gender, and educational level have no significant impact on the magnitude of visual-perceptual dysfunctions.

Surgical treatment of pericardial effusion in cancer patients

31 cancer patients with symptomatic pericardial effusion were treated by subxiphoid pericardiotomy with simultaneous pleuropericardial window creation. There were no patients who died during surgery. In all patients, relief of cardiac compression by the effusion was immediate and complete. 10 patients died of advanced malignancy within 30 days after operation without evidence of recurrent pericardial effusion. During the period of follow-up, another seventeen patients died, and no death was related to pericardial effusion. It is concluded that pleuropericardial window through the subxiphoid approach is the treatment of choice for pericardial effusion in cancer patients. The procedure provides immediate and long-lasting relief of cardiac compression with acceptable mortality and morbidity.

Predictors of shoulder subluxation in stroke patients

Shoulder subluxation has been recognized as a major and frequent complication in patients with hemiplegia. It may worsen and may be associated with shoulder and extremity pain, nerve damage, and interfere with functional activities. The overall goal of this study was to examine the significant predictors of shoulder subluxation in stroke patients and to suggest a way of early prevention and management of hemiplegic shoulder subluxation. A retrospective study was performed and backward stepwise logistic regression analysis was used to analyze the available collected data. The result showed that significant predictors of hemiplegic shoulder subluxation were Brunnstrom's arm motor stage (beta = -2.480, the Wald statistic = 10.03, p = 0.0015) and arm sensory (tactile) status (beta = 1.0283, the Wald statistic = 3.93, p = 0.0474). This study supports that sensory (tactile) impairment may be a precipitating factor for hemiplegic shoulder subluxation and it may highlight the importance of both motor and sensory preventive strategies in early prevention and management of shoulder subluxation. The preventive strategies for shoulder subluxation during the acute/flaccid phase of neural recovery are also discussed in this study.

[Application and evaluation of multiple exposure photography and motion analysis system in gait measurement]

Accurate techniques to evaluate and quantitate gait patterns have been available in clinical applications for the last 20 years. In this study, by employing multiple exposure photography, the walking velocity, stride length, step cadence and joint angle of the lower limbs were recorded for normal young men during the gait cycle. Data were compared with results from the motion analysis system and related researches. The results showed that multiple exposure photography can also provide quantitative analysis of several important time-distance parameters in the gait cycle.

Brain natriuretic peptide is synthesized in the human adrenal medulla and its messenger ribonucleic acid expression along with that of atrial natriuretic peptide are enhanced in patients with primary aldosteronism

The present study was designed to determine whether brain natriuretic peptide (BNP) is synthesized in the human adrenal gland and, if so, to investigate the BNP content of adrenal tissue and the changes in BNP messenger ribonucleic acid (mRNA) in patients with primary aldosteronism. A considerable amount of BNP-like immunoreactive substances was extracted from the adrenal glands of kidney donors for transplantation (0.21 +/- 0.02 pmol/g wet tissue; n = 3) and the remnant nontumorous adrenal glands of patients with primary aldosteronism (0.20 +/- 0.05 pmol/g wet tissue; n = 3; mean +/- SEM). Immunohistochemical study with a specific antihuman BNP antibody revealed that BNP-like immunoreactivity was localized in the adrenal medullary area, and an in situ hybridization study indicated that the BNP mRNA was mainly expressed in the cells of adrenal medulla. Using a reverse transcription and polymerase chain reaction technique, BNP complementary DNA was cloned from the human adrenal gland, and the sequence was identical to that of BNP identified in the atria. The level of BNP mRNA in the adrenal glands of patients with primary aldosteronism (n = 4) was obviously elevated compared to that in the kidney donors (n = 4), as determined by Northern blot analysis. Quantitative polymerase chain reaction measurements of BNP and atrial natriuretic peptide (ANP) mRNAs showed that both of the adrenomedullary natriuretic peptide gene transcriptions were enhanced in patients with primary aldosteronism, but the amount of ANP mRNA was far higher than that of BNP mRNA in the human adrenal gland. Our results are the first to indicate that BNP is synthesized in the human adrenal medulla, and that such medullary BNP synthesis increases in patients with primary aldosteronism. These facts support the proposal that adrenomedullary BNP along with ANP may play some role in water and electrolyte homeostasis or act in a paracrine manner to regulate adrenocortical functions.

Surgical correction of sinus venosus atrial septal defect associated with partial anomalous pulmonary venous connection to high superior vena cava--case report

A 63-year-old woman complained of general malaise and insomnia initially. Atrial septal defect was diagnosed by transthoracic echocardiography thereafter. She had not received complete cardiac studies until progressive dyspnea was noted half a year later. After a series of examinations, sinus venosus type atrial septal defect (ASD) associated with partial anomalous pulmonary venous connection to high superior vena cava (SVC) and persistent left SVC was documented. Surgical correction was performed later. The postoperative course was smooth and her condition improved gradually at 10-month follow-up.

Use of glutaraldehyde solution in the treatment of acute aortic dissections

We report on a promising method for toughening and strengthening the fragile aortic wall that involves the direct application of a 25% glutaraldehyde solution and that has proved to be both technically simple and safe. The operation was successfully employed in 5 patients with acute aortic dissections, 3 with a Stanford type A and 2 with a type B dissection. Histologic examination of the glutaraldehyde-treated portions of the aortic wall showed no detectable difference between them and the sections of untreated aortic wall. All patients survived the operation. The duration of follow-up ranged from 9 to 31 months (mean, 14.0 months). All 5 patients were in good condition at the time of the last follow-up. The preliminary results indicate that the use of a 25% glutaraldehyde solution to strengthen the aortic wall during operations for the repair of acute aortic dissections, regardless of whether they are type A or type B, may reduce the incidence of catastrophic perioperative bleeding and promote favorable results.

[A clinical study of endodontic flare-ups]

The purpose of this study was to investigate the clinical variables influencing endodontic flare-ups. Three hundred and thirteen teeth receiving endodontic treatment at the Endodontic Department, Chang Gung Memorial Hospital were studied from December 1992 to February 1993. Among them, 21 teeth with significant pain and 9 with apical swelling were noted after the first appointment of treatment. Three teeth with persistent pain and one with apical swelling were also found one week after completion of endodontic therapy. The results showed significant improvement of clinical symptoms and signs one week after completion of endodontic treatment in comparison with pretreatment and after the first appointment (p < 0.025). The factors such as presence of pretreatment complaints, periapical lesions and vital pulp had significant effects on the incidence of endodontic flare-ups after the first appointment of treatment (P < 0.025). In contrast, patients' sex, the number of visits, and whether this was a retreatment case or not had no significant effect on the frequency of these endodontic flare-ups.

Performance of normal Chinese adults on grip strength test: a preliminary study

This study investigated grip strength performance in normal Chinese adults. Grip strength of 160 Chinese subjects (80 males and 80 females) from a major metropolitan city in southern Taiwan was measured with a newly calibrated Jamar dynamometer. The subject was tested in a standing position, with shoulder adducted and neutrally rotated, elbow flexed at 90 degrees and forearm and wrist in neutral position. Subjects exerted one maximal effort with both right and left hands. Results indicate that the grip strength of Chinese males peaked within the 20 to 39 year-old group. For Chinese females, the highest grip strength score occurred in the 40 to 49 year-old age group and declined as a function of age. Males consistently had higher grip strength than females across age ranges. Finally, there was no 10% variance in grip strength from the dominant to nondominant hand for each age group of both sexes. Instead, there were 49 (31%) of all subjects who had nondominant hand strength scores that were equal to or greater than their dominant hand strength scores. Clinical implications and recommendations for future research are suggested.

Effectiveness of coenzyme Q10 on myocardial preservation during hypothermic cardioplegic arrest

A prospective, randomized, double-blind trial assigned 11 patients to receive coenzyme Q10 and 11 to receive none. Patients pretreated with coenzyme Q10 had a lower left atrial pressure and a lesser incidence of low cardiac output. They also had a wider pulse pressure. The right and left ventricular myocardial ultrastructure was better preserved in patients receiving preoperative treatment with coenzyme Q10. There was no demonstrable benefit to the atrial myocardium.

In situ remineralization of root surface lesions using a fluoride chewing gum or fluoride-releasing device

The in situ remineralization of early root surface lesions was studied using a fluoride-releasing device (FRD) or a fluoride chewing gum. Root specimens with subsurface lesions were mounted in removable lower appliances in 6 adult subjects. Test groups chewed five sticks/day (0.1 mg F/stick) or one FRD (0.5 mg F/day release rate) was mounted in the midline of the appliance. A fluoride-free dentifrice was used three times/day for each 21-day control and the two test regimens. Separate root lesions were used to measure fluoride uptake or changes in mineral content by quantitative microradiography. Comparable values for percent remineralization for both FRDs and F gum were higher than controls, and the F uptake for FRDs exceeded both the F gum and controls (p = 0.05).

Cardiac amyloidosis--a case report

A 52-year-old male patient presented with resistant congestive heart failure. Echocardiographic findings revealed increased right ventricular (RV) wall thickness in conjunction with concentric left ventricular (LV) hypertrophy, LV systolic dysfunction and a granular sparking myocardial appearance. Doppler assessment showed a restrictive LV and RV diastolic filling pattern. These echocardiographic features combined with low voltage of the electrocardiogram is highly suggestive of cardiac amyloidosis. The diagnosis was confirmed by cardiac catheterization and endomyocardial biopsy.

[A comparison of ankle fixation between two kinds of low-temperature plastic anterior ankle foot orthoses]

The low-temperature ankle foot orthosis (AFO) was designed in the anterior leaf type, called anterior AFO, to meet the need of indoor barefoot walking. It could be easily molded and remolded to fit the foot, as well as to adjust the position of the foot and ankle. Two kinds of low-temperature plastic anterior ankle foot orthoses, anterior encased and anterior direct molding ankle foot orthoses, were compared to analyze the effectiveness of ankle fixation in plantar flexion and inversion. Force was applied to each of the anterior AFOs at the anterior-middle and anterior-lateral sides to simulate the movement of ankle plantar flexion and inversion. At the same time, the deformation in plantar flexion and inversion of both anterior AFOs were recorded to analyze the relationship between force and the deformed angle. The results showed that plantar flexion deformed angles of the anterior direct molding AFO were 2.6 times more flexible than anterior encased AFO. The ankle inversion deformed angles of the anterior direct molding AFO were 3 times more flexible than the anterior encased AFO in inversion. These results support our belief that anterior encased AFO is more effective in controlling ankle plantar flexion and inversion than anterior direct molding AFO, especially for severe spastic hemiplegia in gait correction.

[Comparison of various patterns of chopstick use and functional performance]

Three hundred and ninety-seven normal adult subjects were tested in order to investigate the prevalences of various patterns of chopstick-use. Manipulation speed was also compared. According to the movement of the fingers, finger positions and contact areas, we can divide the various chopstick-use patterns into 3 basic patterns with 13 variations. Prevalences of the 3 basic patterns were palmar prehension (68.5%), lateral prehension (14.2%), and dynamic palmar prehension (17.3%). There was a statistically significant difference in manipulation speed among the 3 basic patterns. The influence of sex and age on manipulation speed was also analyzed for each of the 3 basic chopstick-use patterns. The results of this study will serve as a reference for occupational therapists in the evaluation and training for eating activities.

[Investigation of activity of daily living performance in patients with Duchenne muscular dystrophy]

The purpose of this study was to reach a better understanding the deficits of activity of daily living (ADL) skills in patients with Duchenne muscular dystrophy (DMD), and their influencing factors. Our samples consisted of 35 male DMD patients, aged 3-24 years. The Barthel index was used to assess daily living abilities. Besides ten different motor abilities, muscle strengths of both upper and lower extremities and joint contractures were also included in each patient's evaluation. The results of degree of severity in ADL performance showed that 21.1% of patients were classified as totally dependent, 48.5% were severely dependent, 12.1% moderately dependent, 9.1% mildly dependent and 9.1% totally independent. Among the ADL skills, the bathing needed most assistance whereas feeding required the least. Two of the sixteen factors influencing ADL performance was calculated to be significant after stepwise multiple regression analysis. They were hip contracture and static sitting balance. In conclusion, we find that DMD patients are highly dependent in carrying out ADL tasks. Therefore, it is very important to avoid contracture, to increase static sitting balance and to use appropriate devices to improve their daily living abilities. Finally, the Barthel index proved acceptable in evaluating Taiwanese children over six years of age.

Synthesis and cytotoxicity of 1,6,7,8-substituted 2-(4'-substituted phenyl)-4-quinolones and related compounds: identification as antimitotic agents interacting with tubulin

A series of 1,6,7,8-substituted 2-(4'-substituted phenyl)-4-quinolones and related compounds have been synthesized and evaluated as cytotoxic compounds and as antimitotic agents interacting with tubulin. The 2-phenyl-4-quinolones (22-30) with substituents (e.g. F, Cl, and OCH3) at C-6, C-7, and C-8 show, in general, potent cytotoxicity against human lung carcinoma (A-549), ileocecal carcinoma (HCT-8), melanoma (RPMI-7951), and epidermoid carcinoma of the nasopharynx (KB) and two murine leukemia lines (P-388 and L1210). Introduction of alkyl groups at N-1 or C-4 oxygen led to inactive compounds (35-43 and 50). In addition, compounds 24, 26, and 27 were evaluated in the National Cancer Institute's 60 human tumor cell line in vitro screen. These compounds demonstrated the most marked effects in the screen on two colon carcinoma cell lines (COLO-205 and KM-20L2) and on a central nervous system tumor cell line (SF-539) with compound 26 the most potent of the three agents. Compounds 24, 26, and 27 were potent inhibitors of tubulin polymerization, with activity nearly comparable to that of the potent antimitotic natural products colchicine, podophyllotoxin, and combretastatin A-4. The three agents also inhibited the binding of radiolabeled colchicine to tubulin, but this inhibition was less potent than that obtained with the natural products.

Open heart surgery in a patient with an implanted pacemaker: case report

When a patient has a pacemaker and requires operation, surgeons have to consider some possible intraoperative pacemaker complications induced by electrocautery. Electrocautery is commonly used during surgery to achieve hemostasis. However, this very effective tool may introduce innumerable problems in the paced patient, including irreversible damage to the pulse generator, pacemaker reprogramming, induction of a rise in the capture threshold, and ventricular fibrillation. Although electrocautery may be avoided in some surgical procedures, open heart surgery cannot be performed without it. One case is presented to illustrate how to achieve hemostasis while decreasing electric interference and how to protect the permanent pacemaker while avoiding those possible complications during the defibrillation. The purpose of this article is to call attention to potential problems induced by electrocautery and in an effect to facilitate the perioperative management of the paced patient undergoing open heart surgery.

Effect of moisture content on the microbial activity in JP-5 fuel oil

The water solubility of JP-5 fuel oil was found to be proportional to the reciprocal of absolute temperature from 0 degree C to 60 degrees C. Water in the fuel oil would become condensed once the temperature was shifted from a high temperature to low temperature. During the storage, condensed water was precipitated in the bottom of the tank. Both the static and the dynamic dehumidification processes with molecular sieve could reduce the moisture content of fuel oil to less than 5 ppm. However, pre-dried fuel oil had a mildly hydroscopic phenomenon at relatively high humidity condition. The spores of contaminated microbes could survive in the fuel oil with 5 to 80 ppm of moisture content. High moisture content of fuel oil was not favorable to the spore survival. Penicillium sp. could survive in the fuel oil longer than Cladosporium resinae.

Successful surgical correction of acute ascending aortic dissection: a case report

The prognosis of patients with acute aortic dissection is extremely poor, especially when involving the ascending aorta. It has long been recognized as a catastrophic cardiovascular event. Acute dissections involving an ascending aorta have approximately a 90 percent acute mortality rate if left untreated or treated medically. Therefore, nearly all patients with acute ascending aortic dissection should be surgically treated immediately after a diagnosis has been established. A 60-year-old man having an acute ascending aortic dissection was successfully operated on with a resection of the dissecting aorta which was replaced with a Dacron graft. The postoperative course was complicated with a respiratory insufficiency and a disruption of the sternal wound. A 4 years follow-up confirmed the patient was in good condition. This is the first successfully operated case of acute ascending aortic dissection at our hospital.

Evidence of direct activation of adenosine A1 receptor by 5'-adenosine monophosphate in isolated guinea pig atrial myocytes

The electrophysiological effect of 5'-adenosine monophosphate (AMP) was examined in isolated atrial myocytes of guinea pig. Membrane potential and ionic currents were measured by the tight-seal, whole-cell patch-clamp technique. AMP caused the shortening of atrial action potential in a dose-dependent manner. In voltage-clamp experiments, AMP (3-10 microM) caused the activation of IKACh as well as the decrease in basal ICa. Prolongation of action potential duration caused by isoproterenol (20 nM) was antagonized by AMP (10 microM). Isoproterenol (20 nM) occasionally caused the sustained rhythmic activity and the subsequent application of AMP (10 microM) terminated it. AOPCP (10 microM), which inhibits 5'-nucleotidase and hence prevents breakdown of AMP, did not significantly attenuate the effect of AMP on shortening action potential. However, the application of adenosine deaminase (1 U/ml), which deaminates adenosine to inosine, partially reversed the shortening of action potential caused by AMP (10 microM). These results indicate that (1) AMP could activate IKACh and decrease basal ICa simultaneously, and antagonize the isoproterenol-stimulated action potential prolongation; and (2) the observed electrophysiological effect of AMP in whole-cell preparation is attributed to AMP per se as well as its degradative product, adenosine.

Inconsistent effectiveness of myocardial preservation among cardiac chambers during hypothermic cardioplegia

The purpose of this study was to examine the selective and differential natures of ischemic injuries among three cardiac chambers (right atrium, right ventricle, and left ventricle) from the viewpoint of ultrastructural morphometric study. Twenty consecutive adult patients undergoing cardiac operations were studied. The duration of aortic crossclamp time varied from 36 to 142 minutes (mean 83.4 +/- 36.4 minutes). Two serial specimens (preischemic and ischemic) were obtained from the right atrium, the right ventricle, and the left ventricle, respectively. A total of 120 biopsy specimens was obtained from these 20 patients. The average mitochondrial surface area of the left ventricle was 0.308 +/- 0.062 micron 2 in the preischemic stage and 0.352 +/- 0.083 microns 2 in the ischemic stage. This represented a 14.3% increase in mitochondrial surface area after ischemic injury (p less than 0.01). The mitochondrial surface area of the right ventricle showed an average increase of 43.7%, from 0.252 +/- 0.036 micron 2 in the preischemic stage to 0.362 +/- 0.087 micron 2 in the ischemic stage (p less than 0.0005). With respect to the mitochondrial surface area of the right atrium, there was an increase of 88.0%, from 0.217 +/- 0.044 micron 2 in the preischemic stage to 0.408 +/- 0.084 micron 2 (p less than 0.0005). The difference of mitochondrial swelling among three chambers was statistically significant (right atrium versus right ventricle versus left ventricle, p less than 0.0005). Moreover, the differences of mitochondrial swelling between any two chambers were also highly significant (right atrium versus right ventricle, p less than 0.0005; right ventricle versus left ventricle, p less than 0.01; right atrium versus left ventricle, p less than 0.0005). In conclusion, our findings suggest that from the viewpoint of ultrastructural morphometric study myocardial injury after an average of 83 minutes of ischemic arrest is poorer in the right chambers of the heart than in the left ventricle, with the right atrium having the poorest preservation.

In vivo study of fluoride chewing gum for the remineralization of human root lesions

The purpose of this study was to study the efficacy of a fluoride-containing chewing gum (0.1 mg F/stick chewed 5 x/day) in the remineralization of artificial caries lesions in abraded root surfaces compared to sorbitol-containing chewing gum and a no gum control group in vivo. Root specimens were cut from human root surfaces and polished. The specimens were demineralized in a buffered lactate solution with low concentration of fluoride in order to preserve an intact surface layer. Six healthy subjects wore mandibular Hawley-type appliances containing up to fourteen slabs for each of one control and two experimental periods. The experimental protocol included chewing five pieces of gums per day and brushing with fluoride-free dentifrice for each 21 days period. All three regimens were analyzed for fluoride uptake and microradiography. The results indicate that fluoride-containing chewing gum has a highly significant fluoride uptake and remineralization compared to sorbitol gum and control regimens, suggesting that fluoride chewing gum may provide another vehicle for fluoride delivery.

The results of transplant livers from selected non-heart-beating cadaver donors

The clinical experience following transplantation of livers obtained from non-heart-beating cadaver donors (NHBD) with the use of core cooling method is presented here. Six livers procured from such cadavers were transplanted into 6 recipients with hepatoma involving right and left lobes but without distant metastases. The first liver subjected to 75 minutes of warm ischemia had insufficient function after transplantation. The recipient died of graft failure 54 days later. The other 5 livers with 32 to 45 minutes of warm ischemia had a good or excellent immediate function. These 5 recipients died of tumor recurrence, acute rejection or septicemia 131 to 261 days after transplantation. The utilization of selected NHBD is suggested by our practice as a possible approach to help alleviate the acute organ shortage in the areas where heart-beating cadaver donors of brain death are not available.

Alcohol and aldehyde dehydrogenase genotypes and alcoholism in Chinese men

The liver enzymes alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), which are responsible for the oxidative metabolism of ethanol, are polymorphic in humans. An allele encoding an inactive form of the mitochondrial ALDH2 is known to reduce the likelihood of alcoholism in Japanese. We hypothesized that the polymorphisms of both ALDH and ADH modify the predisposition to development of alcoholism. Therefore, we determined the genotypes of the ADH2, ADH3, and ALDH2 loci of alcoholic and nonalcoholic Chinese men living in Taiwan, using leukocyte DNA amplified by the PCR and allele-specific oligonucleotides. The alcoholics had significantly lower frequencies of the ADH2*2, ADH3*1, and ALDH2*2 alleles than did the nonalcoholics, suggesting that genetic variation in both ADH and ALDH, by modulating the rate of metabolism of ethanol and acetaldehyde, influences drinking behavior and the risk of developing alcoholism.

[Permanent pacemaker with implantation in a young child with congenital complete atrioventricular block: a case report]

Congenital atrioventricular block is a congenital disorder of the cardiac conducting system. Pacemaker implantation is the treatment of choice for patients with congenital A-V block if prior medical treatment fails. The criteria for pacemaker implantation in infants and children are (1) frequent syncope (2) heart failure (3) ventricular rate below 55 beats/min (4) ventricular arrhythmia (5) QRS widening in the ECG (6) moderate to severe exercise intolerance. Our experience with a 15-month-old male child is herein presented. The patient suffered from frequent attacks of upper respiratory tract infection, bradycardia and complete A-V block as found on electrocardiograms. At 15 months old, he was admitted again due to respiratory tract infection and several attacks of syncope. Stokes-Adams syndrome was noted several times despite medical treatment. Following implantation of a VVI mode epicardiac pacemaker, the patient's condition, including resistance to heart failure and respiration, were improved dramatically. He was followed up regularly for 4 years, his heart beat remaining stable.

Meniscectomy operation as a surgical treatment for internal derangement of the temporomandibular joint in our department

This paper describes the surgical treatment of six patients with internal derangement of the temporomandibular joint (nine joints). Meniscectomy was performed on all the patients, because severely advanced cases in which the articular disk could not be preserved or replaced were chosen. Our surgical technique and the results of short-term follow up are presented. Indications of meniscectomy and the criteria for postoperative evaluation are also described. The postoperative outcomes were assessed as "good" for seven joints in five patients and as "acceptable" for two joints in one patient.

[The relationship between early motor stage and hand function recovery six months after stroke]

The prognosis of hemiplegic hand function may reflect intrinsic recovery. Applying the variables of initial neurological loss in the hemiplegic upper extremity to predict the prognosis of hand function will enable therapists to establish the ultimate goals of rehabilitation and to select the appropriate treatment programs. Pinch and grip strength tests, Frenchay arm function test and the nine-hole peg test were used to determine the relationship between the initial Brunnstrom motor stage of the hemiplegic upper extremity and the prognosis of hand function after six months. Forty stroke patients were divided into three groups. Group I was subjects with a motor stage below the Brunnstrom motor stage III in both proximal and distal parts of the hemiplegic upper extremity. Group II was subjects with motor stage below Brunnstrom motor stage III in the proximal part and above stage III in the distal part or vice versa. Group III was subjects with a motor stage above Brunnstrom motor stage III both in the proximal and the distal parts. The results of this study indicated that the prognosis of the Brunnstrom motor stage of the hemiplegic upper extremity generally improved about one or two stages. According to the results of the grip and pinch strength tests, the Frenchay arm function test or the nine-hole peg test, group I patients could hardly use their affected hand functionally. The grip strength and the pinch strength deficits of group I were 93.8% and 91.4% respectively. The grip strength and the pinch strength deficits of group II were 72.1% and 68.5% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Uneven myocardial hypothermia among cardiac chambers during hypothermic myocardial preservation

During the development of methods to protect the heart from ischaemic injury, attention has been focused on protection of the left ventricle. In an attempt to assess right heart preservation. 55 consecutive patients undergoing open heart surgery were studied. Mean aortic cross-clamp time was 59.3 +/- 29.4 min. Temperature probes were inserted into the right atrium (RA), right ventricle (RV), and left ventricle (LV). During cardioplegia, the mean myocardial temperatures of RA, RV and LV were 19.1 degrees +/- 4.1 degrees C, 12.7 degrees +/- 4.8 degrees C and 7.3 degrees +/- 3.4 degrees C, respectively. Of the LV temperature measurements, 67.2% were 10 degrees C or lower. By contrast, 94.1% of RA measurements and 58.5% of RV measurements were above 10 degrees C. The inhomogeneity of chamber temperatures was observed irrespective of the patient's disease or age and whether the atrium or right ventricle were open or not. Hearts with mitral regurgitation (MR), in contrast to mitral stenosis and stenoinsufficiency, had higher LV temperatures, similar to those in the RV. We conclude that there is uneven hypothermia among the three cardiac chambers during hypothermic cardioplegic arrest, regardless of disease states except MR and regardless of age and procedure performed.

[Lymphoepithelial cyst of the upper neck: report of a case]

A case of lymphoepithelial cyst of the upper neck is presented. The patient was a 77-year-old woman. After her lesion was extirpated under clinical diagnosis of salivary gland tumor, identified as lymphoepithelial cyst (so-called branchial cyst). Histopathologically salivary gland was observed in the cyst wall composed of lymphoid tissue and was demonstrated highly active amylase-enzyme (S type) in the cyst fluid. These findings are convicted that our case originates ductal epithelium entrapped in cervical lymph node (inclusion theory of Bhaskar).