Efficient inhibition of in vivo human malignant glioma growth and angiogenesis by interferon-beta treatment at early stage of tumor development

Malignant gliomas are highly angiogenic and aggressive tumors. IFN-beta has been used for the treatment of patients with malignant glioma; however, its antitumor mechanism in vivo remains unclear. To understand the in vivo antitumor effect and mechanism of recombinant human IFN-beta (rhIFN-beta) depending on the stages of tumor development or progression, we used orthotopic xenograft brain tumors generated by stereotactic intracerebral implantation of U-87 human glioma cells in nude mice. Mice bearing tumors 7 days (group 1) and 21 days (group 2) postimplant were treated with 2 x 10(5) IU/day of rhIFN-beta or saline i.p. for 15 days, respectively. Tumor growth was suppressed by 69.6% in group 1 and 10.8% in group 2 compared with tumors of each control group treated with saline. rhIFN-beta-treated group 1 animals showed 38% reduction in vascularization along with a 2.5-fold increase of the apoptotic index and no change in the proliferative index as compared with untreated tumors. The expression level of vascular endothelial cell growth factor and basic fibroblast growth factor was not affected by rhIFN-beta treatment. rhIFN-beta showed inhibitory activity on proliferation of U-87 cells, human umbilical vein endothelial cells, and PAM 212 murine keratinocytes in vitro. Our results indicate that the in vivo antitumor effect of rhIFN-beta on malignant gliomas may be mediated, at least in part, via angiogenesis inhibition rather than antiproliferative activity and that rhIFN-beta may be more effective for the treatment of malignant glioma patients at an early stage with minimal or microscopic tumor burdens rather than at an advanced stage of tumor development.

Potentials and limitations of adenovirus-p53 gene therapy for brain tumors

We investigated the antineoplastic potentials of recombinant adenovirus containing wild-type p53 cDNA (Ad5CMV-p53) for malignant gliomas. In four human glioma cell lines (U-251 and LG expressing endogenous mutant p53, and U-87 and EFC-2 expressing wild-type p53) and two rat glioma cell lines (9L and C6, each expressing mutant and wild-type p53), gene transfer efficiency determined by X-gal staining and Western blotting was varied (10-99% at 10-500 multiplicity of infection, MOI). Growth inhibitory effect was drastic (>90% at 100 MOI) in U-251 cells and only moderate or minimal in other cell lines harboring wild-type p53 or low gene transfer efficiency. Ex vivo transduction of U-251 cells with Ad5CMV-p53 suppressed the in vivo tumorigenicity of the cells. Histopathologic examination for Ad5CMV-p53 toxicity to rat brains showed inflammatory reactions in half of the tested brains at 10(8) MOI. U-251 cells were inoculated intracerebrally in nude mice and injected Ad5CMV-p53 into the tumor, in which neither the tumor suppression nor the survival benefit was observed. In conclusion, heterogeneity of the cellular subpopulations of malignant glioma in p53 status, variable and insufficient gene delivery to tumor, and adenoviral toxicity to brain at higher doses may be limiting factors to be solved in developing adenovirus-p53 gene therapy for malignant gliomas.

Gas chromatographic-mass spectrometric determination of plasma saturated fatty acids using pentafluorophenyldimethylsilyl derivatization

An improved method for the detection of 11 saturated fatty acids (SFAs) including C12:0-C26:0 (even numbers only), C17:0, C19:0 and C23:0 in human plasma by gas chromatography-mass spectrometry (GC-MS) with a stable isotope internal standard as d3-stearic acid is described. This procedure was based on acidic treatment, liquid-liquid extraction, and chemical derivatization prior to instrumental analysis. Eleven pentafluorophenyldimethylsilyl-SFA derivatives were well separated without any interfering peaks in plasma samples. The characteristic ions at M-15, constituting the base peaks in the electron impact mass spectra for 11 SFAs, permitted their sensitive detection by GC-MS in the selected ion monitoring (SIM) mode. The SIM responses were linear with correlation coefficients varying from 0.993 to 0.999 in the concentration range of 0.05 to approximately 50 microg/ml for the 11 SFAs. The detection limits for SIM of the SFAs varied in the range of 0.05 to approximately 10.0 pg. When applied to the plasma samples of normal subjects and patients with X-linked adenoleukodystrophy, which is one of the hereditary peroxisomal disorders, the present method enabled us to determine the SFAs with good sensitivity and good overall precision and accuracy within the concentration ranges of 0.14 to approximately 82.35 micromol/l.

[Protective effects of baicalin, mannitol and dexamethasone on infective brain edema in rats]

OBJECTIVE

To compare the therapeutic effects of baicalin, mannitol and dexamethasone on infective brain edema(IBE) in rats.

METHODS

Forty normal Sprague-Dawley(SD) rats (200 +/- 30) g by weight were divided into 5 groups randomly: (1) normal saline control group(NS, n = 8); (2) infective brain edema group (BE, n = 8); (3) mannitol treatment group(MAN, n = 8); (4) dexamethasone treatment group(DXM, n = 8); and (5) baicalin treatment group(BC, n = 8). Pertussis bacilli(PB, contained bacilli in 10.8 x 10(9), 0.2 ml-1.kg-1) were injected into the left carotid arteries through the left common carotid arteries by puncture to obtain BE models. The contents of brain water, sodium ion, potassium ion and Evans blue in brain tissues were observed too.

RESULTS

The contents of brain water, sodium ion, and EB in BE group were higher than those in BE group(P < 0.01), they decreased in MAN, DXM, BC groups and were lower than those in BE group(P < 0.01). In MAN, DXM, BC groups, there were no significant difference in the contents of brain water and sodium ion(P > 0.05). The EB content in BC group was higher than that in MAN and DXM groups(P < 0.01). The content of potassium ion in BE group was higher than that in MAN and DXM groups, the content of potassium ion was similar to that in NS group, but lower than that in BC group. Light microscope inspection in MAN, DXM and BC groups showed lessened brain edema, slight increase of perivascular space, and occasional nerve cell pyknotic nucleus. We found on nerve cell vacuolar degeneration in DXM group.

CONCLUSION

Baicalin, mannitol and dexamethasone all have similar protective effects on infective brain edema in rats.

Fluid therapy of acute brain edema in children

The clinical experience with a new fluid therapy in children with acute brain edema complicated by infectious disease is reported. The clinical data of a retrospective group of 192 patients and a prospective study of 1,302 and 2,279 patients is summarized. One method of fluid therapy for children with acute brain edema is traditional; fluid intake is restricted to less than 1,200 mL/m(2) daily (60 mL/kg daily). Another method is the new fluid therapy regimen used in our prospective study, in which dehydration and fluid replenishment are individualized. On the first day the fluid intake of patients who survived varied from 40 to 208 mL/kg daily. The mortality rate in the two prospective groups was 19.66% in 1,302 patients and 17.2% in 2,279 patients, significantly lower than the 63.5% in the retrospective group (192 patients) (P <0.001). This result indicates that a wide range of fluid intake for children with acute brain edema is allowable during the first days of treatment. The appropriate dehydration and fluid replenishment should be individualized based on close observation of the patient's condition.

Modeling and direct sensitivity analysis of biogenic emissions impacts on regional ozone formation in the Mexico-U.S. border area

A spatially and temporally resolved biogenic hydrocarbon and nitrogen oxides (NOx) emissions inventory has been developed for a region along the Mexico-U.S. border area. Average daily biogenic non-methane organic gases (NMOG) emissions for the 1700 x 1000 km2 domain were estimated at 23,800 metric tons/day (62% from Mexico and 38% from the United States), and biogenic NOx was estimated at 1230 metric tons/day (54% from Mexico and 46% from the United States) for the July 18-20, 1993, ozone episode. The biogenic NMOG represented 74% of the total NMOG emissions, and biogenic NOx was 14% of the total NOx. The CIT photochemical airshed model was used to assess how biogenic emissions impact air quality. Predicted ground-level ozone increased by 5-10 ppb in most rural areas, 10-20 ppb near urban centers, and 20-30 ppb immediately downwind of the urban centers compared to simulations in which only anthropogenic emissions were used. A sensitivity analysis of predicted ozone concentration to emissions was performed using the decoupled direct method for three dimensional air quality models (DDM-3D). The highest positive sensitivity of ground-level ozone concentration to biogenic volatile organic compound (VOC) emissions (i.e., increasing biogenic VOC emissions results in increasing ozone concentrations) was predicted to be in locations with high NOx levels, (i.e., the urban areas). One urban center--Houston--was predicted to have a slight negative sensitivity to biogenic NO emissions (i.e., increasing biogenic NO emissions results in decreasing local ozone concentrations). The highest sensitivities of ozone concentrations to on-road mobile source VOC emissions, all positive, were mainly in the urban areas. The highest sensitivities of ozone concentrations to on-road mobile source NOx emissions were predicted in both urban (either positive or negative sensitivities) and rural (positive sensitivities) locations.

Diagnosis of papillary carcinoma in a thyroglossal duct cyst by fine-needle aspiration biopsy

The incidence of papillary thyroid carcinoma arising in a thyroglossal duct cyst is rare and occurs in about 1 % of thyroglossal duct cysts. Only 17 such cases diagnosed with fine-needle aspiration biopsy have been previously reported in the English-language literature, with a diagnostic rate of 53%. In this article, the cytologic features of the current case are emphasized and those of the previous reported cases are briefly reviewed. Diagnostic pitfalls of papillary carcinoma arising in thyroglossal duct cysts diagnosed by fine-needle aspiration biopsy are also discussed.

Epstein-Barr virus-containing T-cell lymphoma and atherosclerotic abdominal aortic aneurysm in a young adult

Malignant lymphoma infiltrating the abdominal aorta and resulting in an aortic aneurysm has never been documented. We report here a case of angiocentric T-cell lymphoma in a 33-year-old man who for months presented intermittent fever, splenomegaly, and an abdominal pulsatile mass. Angiography revealed extensive aneurysmal dilatation of the infrarenal abdominal aorta, bilateral iliac artery, and right common femoral artery. Splenic abscess and infected abdominal aortic aneurysm were initially suspected. An urgent splenectomy and aneurysmectomy with an aortic bifemoral bypass were performed. Pathological examination of the aortic aneurysm showed extensive necrosis, severe atherosclerosis, and lymphoma cell infiltration of the aortic wall. The lymphoid cells in the aorta and spleen were stained positive for CD45RO, CD56, and CD8, but negative for CD4 and CD19. Double-labeling immunohistochemistry and in situ hybridization using EBER1 for Epstein-Barr virus (EBV) revealed positive nuclear staining in the atypical T-lymphoid cells. This is the first definitive proof of peripheral T-cell lymphoma involving the abdominal aorta. Our evidence also supports that the EBV infection of T cells could be responsible for the atherosclerosis and hypertriglyceridemia, and the angiocentricity of the tumor cells apparently results in the presenting atherosclerotic aortic wall destruction, providing an additional causative concept for abdominal aortic aneurysm.

Papillary thyroid carcinoma with nodular fasciitis-like stroma. Pitfalls in fine-needle aspiration cytology

Papillary thyroid carcinoma with nodular fasciitis-like stroma is one of the rare variants of papillary thyroid carcinoma. The problems posed by the exuberant nodular fasciitis-like stroma, which obscures the neoplastic nature of the tumor, are recognized in surgical pathology but have received little attention in the cytopathology literature. We report a rare case of papillary thyroid carcinoma in which nodular fasciitis-like stroma posed difficulty on fine-needle aspiration cytology. The differential diagnosis of fibroproliferative processes in thyroid fine-needle aspirations is also discussed.

Inhibition of human malignant glioma growth in vivo by human recombinant plasminogen kringles 1-3

Human malignant gliomas are highly vascularized and aggressive tumors. Angiogenesis inhibitors have been shown to induce regression of a variety of primary and metastatic tumors in vivo. However, their usefulness in treating brain tumors is not well understood. Angiostatin, a multiple kringle (1-4 of 5)-containing fragment of plasminogen, is one of the highly effective natural cryptic angiogenesis inhibitors. In our study, the therapeutic efficacy of non-glycosylated and small molecular size recombinant kringles 1-3 (rPK1-3) was examined in the treatment of brain tumors generated by stereotactic intracerebral implantation of U-87 human glioma cells in nude mice. Mice bearing tumors 7 days post-implant were treated daily with rPK1-3 (100 mg/kg) s.c. for 21 days. Treated animals showed suppressed brain tumor growth by greater than 71.2% along with a 3-fold increase of apoptotic index and suppressed vascularization by 78.9%, without any observable signs of toxicity. Analysis of bFGF and VEGF expression in the tumors of treated animals using immuno-histochemical methods showed near complete absence of growth factors. Our results indicate that the non-glycosylated, small molecular size rPK1-3 is an efficient tumoristatic agent for the treatment of intracranial human glioma xenografts in mice and might provide new strategies for the treatment of brain tumors.

Comparison of fatty acid profiles in the serum of patients with prostate cancer and benign prostatic hyperplasia

OBJECTIVE

The role of dietary fatty acids (FAs) in benign and malignant prostatic diseases was investigated by comparing the composition value of serum fatty acids in the normal controls, and patients with prostate cancer (PC) and benign prostatic hyperplasia (BPH). Also, to estimate a possible association between PC risk and PUFAs, omega-3, omega-6 and omega-3/omega-6 FA composition ratios were compared among these groups.

METHODS

Serum samples were obtained from 24 BPH and 19 PC patients, and from 21 age-matched normal male subjects. The serum concentration of 21 fatty acids was determined using gas chromatography/mass spectrometry.

RESULT

The proportional values of saturated fatty acids (SFAs) groups demonstrated no specific difference between the control subjects and the patients. In the polyunsaturated fatty acids (PUFAs), we found that the omega-3 PUFAs level was significantly decreased in patient with BPH and PC and that the omega-6 PUFAs level was increased in PC only. The ratio of omega-3/omega-6 PUFAs decreased in the following order of normal, BPH, and PC.

CONCLUSION

It was proposed that the changed composition level of PUFAs including omega-3 and omega-6 PUFAs have certain relationship with both prostatic diseases. Therefore, the ratio of omega-3/omega-6 PUFAs also may have an important association with the benign and malignant status of prostatic disease.

Mitral valve replacement in the presence of massive posterior annular calcification

Replacement of the mitral valve in the presence of extensive calcification of the posterior annulus is a technical challenge. The heavily calcified annulus often results in difficulties of seating the prosthesis and later periprosthetic leakage. A radical calcium debridement may leave a friable and thin annulus that contributes to the risks of prosthesis dehiscence and ventricular perforation. To avoid technical difficulties and associated catastrophic complications, we devised a new technique of mitral valve replacement that allows a surgeon to implant a prosthesis securely. This technique involves inserting a larger single tilting disc mechanical valve (Medtronic Hall disc) with intra-atrial anchorage over the posterior sector of the calcified annulus, orienting the working (major) orifice of the mechanical valve anteriorly, and thereby tilting the lesser occluder segment of the disc upward into the atrium and away from the calcification in diastole. By utilizing this method, we have successfully performed mitral valve replacement in two patients who exhibited massive calcification of the posterior mitral annulus. Postoperative transeosophageal echocardiography showed excellent hemodynamic performance of the implanted valves. We therefore recommend this simple, safe, and time-saving procedure as a feasible method to deal with this surgical dilemma.

Prognostic determinants of infective endocarditis in the 1990s

The clinical profiles of infective endocarditis (IE) might have changed in recent years, owing to the advent of transesophageal echocardiography, the introduction of new diagnostic criteria, and the increased frequency of intravenous drug abuse. In this retrospective study, we sought to identify factors affecting the in-hospital outcome of IE patients in a single tertiary referral center in the 1990s (1990-1997). Eighty-eight episodes of IE in 80 consecutive patients admitted from January 1990 through June 1997 were evaluated. Clinical variables that were significantly associated with in-hospital mortality in univariate analyses were entered into a multiple logistic regression model. A total of 22 patients (25%) died. Fatal episodes were significantly more likely than non-fatal episodes to involve older patients (> or = 50 years), use of coumadin, short interval between symptom onset and hospitalization (< 15 days), noncardiac shock, and complications of the heart, central nervous system, and kidneys. White blood cell counts and C-reactive protein concentrations were also significantly higher in fatal than in non-fatal episodes of IE. Multivariate analysis showed that in-hospital mortality was associated with noncardiac shock, neurological complications, cardiac complications, and older age (> or = 50 years). Compared with previous reports, our findings suggest that the clinical profiles of IE have undergone some changes in the 1990s. The most important prognostic predictors of in-hospital mortality in patients with IE were noncardiac shock and neurologic complications.

Clinical spectrum of enterovirus 71 infection in children in southern Taiwan, with an emphasis on neurological complications

An outbreak of enterovirus 71 (EV71) infection occurred in Taiwan in 1998. The clinical spectrums and laboratory findings for 97 patients with virus culture-proven EV71 infections were analyzed. Eighty-seven percent of the patients were younger than age 5 years. Hand-foot-and-mouth syndrome occurred in 79% of the children and central nervous system (CNS) involvement in 35%, including nine fatal cases. The predominant neurological presentations were myoclonus (68%), vomiting (53%), and ataxia (35%). Brain stem encephalitis was the cardinal feature of EV71 CNS involvement during this outbreak. Magnetic resonance imaging and pathological findings illustrated that the midbrain, pons, and medulla were the target areas. EV71 brain stem encephalitis can present either with cerebellar signs and an initially mild, reversible course or with overwhelming neurogenic shock and neurogenic pulmonary edema (NPE) resulting in a fatal outcome. Brain stem encephalitis that progressed abruptly to neurogenic shock and NPE was indicative of poor prognosis in this epidemic. Early aggressive treatment and close monitoring of the neurological signs are mandatory to improve the chance of survival.

Cervical adenoid cystic carcinoma coexisting with multiple human papillomavirus-associated genital lesions. A common etiology?

Adenoid cystic carcinoma of the uterine cervix is a rare tumor with unknown etiology. We report a case of adenoid cystic carcinoma occurring in a young woman, associated with multiple human papillomavirus (HPV)-related lesions including condyloma acuminata, vulvar intraepithelial neoplasm, cervical intraepithelial neoplasm and invasive basaloid squamous cell carcinoma. While adenoid cystic carcinoma has previously been found to coexist with squamous cell carcinoma or cervical intraepithelial neoplasia, its association with such a variety of HPV-related lesions in our case has not been previously reported, and raises the speculation that HPV may also be the causative factor for adenoid cystic carcinoma. However, in situ DNA hybridization and polymerase chain reaction in our current study failed to demonstrate the existence of HPV DNA in adenoid cystic carcinoma.

Endoscopic saphenous vein harvest decreases leg wound complication in coronary artery bypass grafting patients

BACKGROUND

Coronary artery bypass grafting (CABG) is the most common procedure performed in adult cardiovascular surgery. The most frequently used conduit is the greater saphenous vein. Using traditional methods, the complication rate of the leg is relatively high (up to 24%). To decrease the complication rate, we used the Endo-Path to harvest the greater saphenous vein.

METHODS AND RESULTS

From May 1997 through March 1999, a total of 135 patients received the CABG operation. We excluded the patients who died immediately postoperatively or had concomitant surgical procedures. Sixty patients received the endoscopic saphenous vein harvest procedure (group A), while another 59 patients (group B) did not. No important differences were noted between the two groups in respect to the number of distal anastomoses, length of harvested vein, total surgical time, and length of ICU stay. However, the leg wound complication rate decreased from 20.3% to 5.0% (p < 0.001).

CONCLUSIONS

Although the long-term patency rate needs time to be proven, the endoscopic greater saphenous vein harvest method is an attractive and effective method.

Double-lumen aortic arch with anomalous left pulmonary artery origin from the main pulmonary artery--bilateral persistent fifth aortic arch--a case report

Both double-lumen aortic arch (i.e., persistent fifth arch) and anomalous origin of the left pulmonary artery from the ascending aorta (failure of the development of the sixth arch) are rare diseases. They are frequently associated with cardiovascular anomalies. However, the co-occurrence of these two diseases has not been previously reported. We report such a case in a female baby with facial anomalies similar to conotruncal anomaly face syndrome.

Staphylococcus capitis bacteremia of very low birth weight premature infants at neonatal intensive care units: clinical significance and antimicrobial susceptibility

Coagulase-negative staphylococci (CNS) are frequently isolated from blood cultures in critically ill neonates. However, Staphylococcus capitis is rarely reported as a pathogen in human beings. From January, 1995 to December, 1997 at a tertiary care neonatal intensive care unit (NICU), a total of 147 (62%) CNS isolates were detected from 236 positive blood cultures, including 27 isolates of S. capitis. Among the S. capitis bacteremia, 17 isolates were judged to be infections as opposed to 10 of the noninfection cultures. The occurrence of S. capitis infection was correlated with long hospital stay (52 +/- 17.6 days vs. 28 +/- 18.5 days, p=0.003) and total parenteral nutrition administration (46 +/- 17.4 days vs. 22 +/- 19.1 days, p=0.006). Apnea, bradycardia, temperature instability and poor activity were the predominant clinical features. Among the 17 episodes of bacteremia, one patient had complicated septic meningitis. There is no statistical significance between S. capitis infection and the duration of a central venous catheter placement (37 +/- 17.5 days vs. 26 +/- 19.5 days, p=0.165). No catheter related infection was proven. Removal of a percutaneous central venous catheter routinely in patients with S. capitis bacteremia is not recommended. All the patients survived after antibiotic treatment. The prevalence rate of multiple resistant S. capitis was 94%. All isolates were resistant to oxacillin, erythromycin and clindamycin but susceptible to ampicillin/sulbactam, vancomycin and teicoplanin. Empiric therapy for S. capitis infection in NICU with ampicillin/sulbactam is therefore recommended. It is important to detect S. capitis which has a high degree of antibiotic resistance in order to treat the patient correctly. S. capitis should be included as etiology and the possibility of nosocomial outbreak in very low birth weight (VLBW) premature infants at NICU.

High rates of antimicrobial resistance among clinical isolates of nontyphoidal Salmonella in Taiwan

To assess trends in antimicrobial-resistant Salmonella infections from 1989 to 1996 in southern Taiwan, the minimum inhibitory concentrations (MICs) of 14 antibiotics or antibiotic combinations were determined by the agar dilution method for 297 clinical isolates of nontyphoidal Salmonella. The rates of resistance to ampicillin, chloramphenicol, and tetracycline were 65, 67, and 78%, respectively. Resistance to trimethoprim-sulfamethoxazole (TMP-SMX) increased from 25% in 1989-1992 to 35% in 1993-1996 (P=0.057). For new quinolones and extended-spectrum cephalosporins, no resistant strains were encountered. Multiple resistance to more than five antimicrobial drugs doubled from 10.6% in 1989-1992 to 19.7% in 1993-1996. Multiply resistant salmonellae were isolated more commonly from blood samples than from feces (30% vs. 14%, P<0.05). In Taiwan, ampicillin, chloramphenicol, and even TMP-SMX are no longer the drugs of choice for treatment of serious nontyphoidal Salmonella infections. Extended-spectrum cephalosporins are now the preferred drugs in Taiwan for treatment of invasive Salmonella infections in children.

Fatal coxsackievirus B infection in early infancy characterized by fulminant hepatitis

OBJECTIVES

to clarify the major features of fatal coxsackievirus B infection characterized by fulminant hepatitis in early infancy.

METHODS

clinical manifestations and laboratory investigations concerning five consecutive young infants with overwhelming coxsackievirus B fulminant hepatitis between 1994 and 1997 were retrospectively reviewed. Aetiological diagnosis was made by viral cultures and confirmed by a neutralization test with a type-specific antiserum.

RESULTS

all five had a deteriorating clinical course of severe hepatitis complicated by disseminated intravascular coagulopathy (DIC). Coxsackievirus B1 infection was established in four patients and coxsackievirus B3 in one. The pathological findings of the two cases illustrated extensive hepatocellular necrosis. Fulminant hepatitis can occur as a leading presentation of disseminated coxsackievirus B infections and dominant the clinical features in neonates and young infants.

CONCLUSIONS

the liver was the target organ of fatal coxsackievirus B infection in our patients. Hepatic involvement progressed rapidly to jaundice and coagulopathy, and was considered to be indicative of poor prognosis. Coxsackievirus B hepatitis may be serious in early infancy.

Group B streptococcal infections in children: the changing spectrum of infections in infants

During a 9-year period from January 1988 to December 1996, 36 patients less than 18 years of age with Lancefield group B streptococcal infections were seen in the National Cheng Kung University Hospital. Among 33 infants with invasive group B streptococcal infections, 3 (9%) were early onset disease (EOD), 27 (82%) late onset disease (LOD) and 3 (9%) onset beyond the third month of life. All cases of EOD were detected during the first day of life and 2 of them were premature births. In the infants with LOD, a high incidence of meningitis occurred (78%). The most common clinical presentation in group B streptococcal infections was fever (81%), followed by irritable crying (42%) and poor feeding (39%). Seizure was noted in 57% of meningitis cases. Obstetric and neonatal risk factors were compared between EOD and LOD, with prematurity and low birth weight significantly (P=0.01) more common among infants with EOD compared with LOD. Of the strains tested, the sensitivity to penicillin, ampicillin and erythromycin were 83%, 74%, and 75%, respectively. All strains were resistant to tetracycline and gentamicin. There were 2 case fatalities (6%) and 6 (17%) had major neurologic sequelae. These data provide that the vast majority of EOD are recognized on the first day of life and prematurity is an important risk factor. In comparison to the previous report in Taiwan, a changing spectrum of GBS infections in infants occurs during the study period. The observed incidence of EOD is decreased and meningitis is still predominantly in LOD. It is suggested early recognition and aggressive therapy have resulted in a much lower mortality rate than previously reported.

Absence of an analgesic effect of qigong "external qi" in rats

The analgesic effect of "external Qi" emitted from the Qigong practitioner was investigated in rats. In behavioral experiments, the rat's tail-flick and head-movement threshold measurements were used to determine if the "external Qi" had analgesic effect. The results were negative. In electrophysiological study, the "external Qi" shows no significant changes in the pain-related evoked cortical potentials to tooth-pulp stimulation. Thus the results of this study are different from those reported by other investigators. It is proposed that this research be repeated and extended.

Effect of infection brain edema on NMDA receptor binding in rat brain in vivo

The purpose of this study was to determine the effect of infection brain edema (IBE) in the rat model induced by injecting pertussis bacilli (PB) into the left carotid artery. The specific binding of N-methyl-D-aspartate (NMDA) receptor with [3H] MK-801 was measured in the neuronal membrane of cerebral cortex. The Scatchard plots were performed. The Bmax values were 0.623 +/- 0.082 and 0.606 +/- 0.087 pmol/mg protein in the group that received normal saline (NS) and PB respectively (P < 0.05). The Kd values were 43.1 +/- 4.2 and 30.5 +/- 3.0 nM in the groups NS and PB respectively. The results indicated that the affinity of NMDA receptor was significantly higher in the group PB than group NS, whereas the total number of NMDA receptors had not changed in the IBE model. The increase of affinity of NMDA receptor can be blockaded by MK-801 pretreatment in vivo.

The role of microvascular permeability in the mechanism for stunned myocardium in rats

The microvascular permeability of stunned myocardium in rats in vivo was studied with FITC-labeled albumin (FITC-BSA). It was found that 15 and 20 min of myocardial ischemia followed by 1 hr of reperfusion resulted in myocardial stunning. The concentrations of FITC-BSA in myocardial tissue were 240.6 +/- 7.8 (IS15) and 267.4 +/- 7.9 (IS20) micrograms/g myocardium in ischemic groups, respectively, which were significantly higher than those in the control group (166.0 +/- 7.9 micrograms/g myocardium; P < 0.01). In stunned groups, the concentrations were 224.8 +/- 11.8 (MS15) and 241.7 +/- 6.0 (MS20) micrograms/g myocardium, decreased from those in ischemic groups but still higher than those in control group by 35.4 and 45.6%, respectively. The more significant the concentration of FITC-BSA, the more serious the myocardial stunning. Electron microscopy revealed no significant vascular injury. The results suggest that the increase in microvascular permeability resulting from transient ischemia is functional and is involved in the pathogenesis of stunned myocardium.

Aluminum utensils contribute to aluminum accumulation in patients with renal disease

Presently, aluminum utensils are widely used in the world, especially in the developing countries. However, whether aluminum leaching from such utensils contributes to aluminum accumulation or causes any damage in patients with renal disease remains unknown. We designed a prospective study to evaluate this problem. After excluding patients who were not examined at follow-up or who poorly complied during the study period, the opened randomized study consisted of 42 patients with chronic renal insufficiency (creatinine clearance <60 mL/min and >10 mL/min). All patients had not taken any aluminum-containing agents for 3 months, but used aluminum kitchen utensils for more than 1 year. Twelve patients comprised the control group; the other 30 patients comprised the study group. The aluminum kitchen utensils used by the study group patients were replaced with stainless steel utensils for 3 months, but those used by the control group were not. After 3 months, the decrements of serum aluminum (5.5 +/- 4.6 microg/L v 2.1 +/- 3.5 microg/L; P = 0.012) and daily urine aluminum excretion (14.3 +/- 15.2 microg/d v 2.1 +/- 5.6 microg/d; P = 0.005) in the study group patients were greater than those in the control group patients. The increments of transferrin saturation of the study group patients (1.8% +/- 9.5% v -3.7% +/- 9.5%; P = 0.052) were greater than those of the control group patients. In addition, the increments of iron (r = 0.368, P = 0.035) and transferrin saturation (r = 0.345, P = 0.049) positively correlated with the decrements of daily aluminum excretion in all patients. The study group patients with greater decrements of serum aluminum (>5.5 microg/L) had greater serum iron levels (90.2 +/- 27.7 microg/dL v 71.9 +/- 27.8 microg/dL; P = 0.047) and transferrin saturation (30.5% +/- 11.0% v 23.0% +/- 9.5%; P = 0.046) than those with less decrements of serum aluminum (<5.5 microg/L) after the study. Our study demonstrates that aluminum kitchen utensils may be the important aluminum exposure source for patients with chronic renal insufficiency who are not taking aluminum-containing agents, and hints that the long-term exposure of aluminum leaching from aluminum utensils probably affects iron levels in patients with chronic renal insufficiency. Further studies are clearly needed to confirm this observation.

Myocarditis with complete atrioventricular block associated with herpes simplex virus infection: report of one case

Myocarditis with complete atrioventricular block is a very unusual complication of the herpex simplex infection. We report a 10-year-old boy infected very likely by the herpes simplex virus and who presented with high fever, erythema multiforme, complete atrioventricular block, and Adams-Stokes seizures. Emergent temporary pacemaker was performed for bradycardia. A sixteen-fold rise in herpes simplex antibody titer by a complement fixation method occurred within two weeks. Normal cardiac rhythm recovered 11 days later with a sequela of complete right bundle branch block after 2 years follow-up.

Streptococcal toxic shock syndrome complicating varicella in children

The most common complication in children with varicella is cutaneous superimposed infection with pyogenic bacteria. Group A beta-hemolytic streptococci, which are known to cause life-threatening infections in both previously healthy children and those with underlying diseases, are the most frequently associated pathogens. A newly recognized disease, called streptococcal toxic shock syndrome, is associated with severe morbidity and mortality. We report a 3-year-old boy with a diagnosis of this syndrome who presented with increasing fever, vomiting, and lethargy 7 days after the development of a classic varicella skin lesion. In spite of aggressive fluid supply, administration of inotropic agents, and cardiopulmonary resuscitation, a rapidly deteriorating clinical course led to death 4 hours after hospitalization. This is the first report of this association in Taiwan. Pediatricians evaluating children with varicella must be mindful of the potential for Group A beta-hemolytic streptococcal infection.

Bezoar manifested with digestive and biliary obstruction

BACKGROUND/AIMS

Gastrointestinal obstructions caused by bezoars are uncommon but are encountered with increasing frequency in general surgery.

METHODOLOGY

We made a retrospective review of 30 cases treated in the National Cheng Kung University hospital between July 1988 and December 1994.

RESULTS

Fourteen patients had either prior gastric surgery (9) or peptic ulcer disease (5) and were categorized as group I. The remaining 16 patients without above conditions were categorized as group II; and seven of them had history of ingestion of Pho Pu Zi (Cordia dichotoma Frost. f.), three had food bolus ingestion, two had diverticulum, two had adhesion and the remaining two had no significant features. Two patients, who received endoscopic removal of gastric bezoar and subsequently developed bowel obstruction, needed operation. Sixteen of 30 who underwent operation within 24 hours after arrival, recuperated uneventfully and most were discharged within a week. Eleven patients who received operation after 24 hours resulted in prolonged hospitalization in 9 and death in two. Re-operation was performed in one case for the recurrence of obstruction by the residual bezoar.

CONCLUSION

Dietary factors (Pho Pu Zi or bolus ingestion), and gastrointestinal (GI) anatomical lesion (diverticulum or adhesion) are the profound etiologies for formation of bezoars in cases without previous gastric surgery. On the other hand, gastric factors (previous ulcer surgery or peptic ulcer) play a major role even after ingestion of nonspecific high fiber diet. Early diagnosis, surgical intervention without delay and thorough exploration of the entire GI tract are essential for good postoperative results.

Effect of sodium glycyrrhetinate on chemical peritonitis in rats

AIM

To study the anti-inflammatory mechanisms of sodium glycyrrhetinate (SG).

METHODS

Rat chemical peritonitis was used. The protein content and prostaglandin E2 (PGE2) content in exudate were measured by Folin-phenol assay and RIA, respectively. SOD activity in neutrophils (Neu) was determined by pyrogallol-NBT colorimetry. cAMP content in Neu was detected by competitive protein binding assay.

RESULTS

In peritonitis caused by histamine, SG 10-20 mg.kg-1 i.m. reduced exudate volume and Neu counts, and 5-20 mg.kg-1 i.m. lowered the protein content in exudate. In peritonitis induced by carrageenan, SG 20 mg.kg-1 i.m. reduced exudate volume, Neu counts, protein content and PGE2 content in exudate, increased SOD activity in Neu, but did not affect beta-glucuronidase release from Neu. In peritonitis induced by arachidonic acid, SG 20 mg.kg-1 i.m. reduced Neu counts, protein content, and PGE2 content in exudate, and attenuated the reduction of cAMP level in Neu.

CONCLUSION

SG exerts its anti-inflammatory action by lowering permeability of capillaries in inflammatory site, inhibiting Neu emigration and PGE2 biosynthesis, and scavenging oxygen free radicals.

Thrombolytic therapy for mitral valve thrombosis

A 44-year-old man with a St. Jude mitral valve was admitted because of progressive pulmonary edema. He was diagnosed with prosthetic heart valve thrombosis (PHVT) based on the findings of "muffled" prosthetic valve clicks. Doppler echocardiographic evidence of severe mitral stenosis and transesophageal echocardiographic evidence of limited mitral valve motility. Because the patient hesitated to undergo our recommended surgical treatment, he was immediately treated with intravenous recombinant tissue plasminogen activator (100 mg over 3 h) followed by heparinization. Two hours after the thrombolytic therapy, the prosthetic valve clicks became clearly audible and his congestive symptoms were dramatically improved. Follow-up echocardiography no longer-showed significant mitral valve obstruction. A transient cerebral ischemic attack occurred at the end of thrombolytic therapy but there were no neurologic sequalae. The patient, on warfarin therapy, was well at follow-up 8 months after discharge. Surgical intervention has long been the standard therapy for patients with PHVT. Our case experience suggests that thrombolytic therapy may be considered as an effective alternative to surgical intervention for selected patients with PHVT. In this report, we also review the current literature regarding the indications, effectiveness and safety of thrombolytic therapy in PHVT.

Surgical experience with Salmonella-infected aneurysms of the abdominal aorta

Five patients, aged between 64 and 75 years with Salmonella-infected abdominal aortic aneurysms were surgically treated between 1993 and 1995 at the National Cheng Kung University Hospital. Cultures of aneurysmal wall tissue and blood yielded Salmonella enteritidis Group B in three patients and Salmonella choleraesuis in the remaining two. All patients presented with fever and abdominal or back pain. Pulsatile masses were noted in only two patients. Infrarenal abdominal infected aneurysms were demonstrated by computed tomography and aortography in each patient. The five patients underwent aneurysmal resection with in situ graft reconstruction from 1 to 20 days after the diagnosis was made. The graft was wrapped with an omental pedicle. Duodenal repair was performed in one patient due to an aortoduodenal fistula found during surgery. He died 19 days after surgery because of duodenal leakage and uncontrolled sepsis. Four patients survived and remained well 11 to 34 months (mean, 25 mo) after surgery. Postoperatively, only one patient developed adhesion ileus and required enterolysis. Parenteral antimicrobial therapy was continued in all patients after surgery for 2 to 4 weeks; only one patient had an additional 4 months of oral antibiotics. Although the number of patients was small, the survival rate was high, at 80%. Our experience suggests that Salmonella-infected aneurysms of the abdominal aorta can be successfully treated by resection of the aneurysm with extensive debridement followed by in situ graft interposition with omentum wrapping. Once diagnosed, the patients should be scheduled for surgery as soon as possible. Antibiotics should be continued parenterally for at least 2 to 4 weeks postoperatively. While long-term suppressive antibiotic therapy is usually recommended, it might not be essential with our surgical approach.

Cantrell's syndrome in an infant

Cantrell's syndrome is a rare combination of congenital midline thoracoabdominal defects and congenital heart disease. surgical repair can correct many of the anomalies. We report a neonate who presented with a short sternum, defective upper abdominal muscle, ectopic umbilicus, anterior diaphragmatic defect, ventricular septal defect and an intra-abdominal left ventricular diverticulum. Initially, the infant was treated with digoxin and diuretics for 5 months. Due to poor control of heart failure, one-stage surgical correction was performed with patch repair of the ventricular septal defect, ligation of left ventricular diverticulum and closure of the defects of the diaphragm and upper abdominal wall.

Papillary cystic tumor of the pancreas in children

Papillary cystic tumor of the pancreas, so-called Frantz tumor, is a very rare tumor in children. Only 157 cases had been reported since 1959. The clinical manifestations of this disease are usually a slowly growing abdominal mass with or without abdominal pain. It occurs predominantly in young females, and its pathogenesis is still unknown. Surgical resection is usually curative, and its prognosis is excellent. Four adolescent girls with acute or chronic abdominal pain were found to have papillary cystic tumor of the pancreas at our hospital in the past 4 years. They all have a variable clinical presentation. Papillary cystic tumor of the pancreas should therefore be considered one of the differential diagnoses of abdominal pain or abdominal mass in adolescent girls.

Role of endothelial cell mitosis in transendothelial transport of low density lipoprotein in hypercholesterolemic and normal rabbits

BACKGROUND

Atherosclerosis is characterized by focal areas of lipid accumulation and intimal smooth muscle cell proliferation in large arteries. It has been suggested that the permeability of arterial endothelium to lipid is an important factor in the initiation and progression of atherosclerosis. The mechanism by which macromolecules such as low density lipoprotein (LDL) enter the arterial wall, however, is still not completely understood. Our previous studies have demonstrated that there is close association of endothelial cell turnover with transendothelial macromolecular transport in normal rat aorta. Because hypercholesterolemia has been well documented as one of the major risk factors for atherosclerosis, we explore the relationship between endothelial cell mitosis and transendothelial transport of LDL in hypercholesterolemic rabbits.

METHODS

The present study is designed to perform on thoracic aortae from 30 male New Zealand white rabbits fed with either 1% cholesterol-enriched diet (HC group; n = 15) or normal diet (NC group; n = 15). The concentrations of serum cholesterol and triglycerides from two groups were measured by enzymatic procedures using commercial kits. The aortae of hypercholesterolemic and normocholesterolemic rabbits underwent perfusion-fixation 10 min following the intravenous injection of low density lipoprotein conjugated with Lucifer yellow (LY-LDL) for fluorescence microscopy. En face preparations of the thoracic aortae stained with hematoxylin allowed the identification of ECs in mitosis. The relationship between LY-LDL leakage and endothelial cell mitosis was determined.

RESULTS

Although endothelial cell mitosis is infrequent (NC: 0.0022 +/- 0.0007%; HC: 0.0004 +/- 0.0001%) in the thoracic aorta of New Zealand white rabbits, 68.2 +/- 8.4% (NC) or 74.3 +/- 9.0% (HC) of dividing cells in the M phase were associated with LYLDL leakage. These dividing cells accounted for 65.0 +/- 9.2% (NC) or 64.4 +/- 11.3% (HC) of all LY-LDL leaky spots.

CONCLUSIONS

Thus, this study not only confirmed the close association of EC mitosis with macromolecular permeability in normal group, but also demonstrated that the same relationship existed in hypercholesterolemic rabbits. These observations lend support to the theory that transiently open junctions surrounding the endothelial cells undergoing cell turnover provide pathways through which LDL enters the subendothelial space, resulting in lipid accumulation and atherosclerosis.

Incidence of post-transfusion hepatitis in Taiwan before and after introduction of anti-HCV testing

The effectiveness of second-generation anti-hepatitis C virus antibody (anti-HCV) screening of blood donations for the prevention of non-A, non-B post-transfusion hepatitis (NANB PTH) was assessed. A prospective study of 192 transfusion recipients was performed to compare the incidence of NANB PTH after the introduction of the second-generation anti-HCV test with the incidence before its introduction. We used a polymerase chain reaction to detect HCV-RNA and HBV-DNA in the sera of patients with NANB PTH. The incidence of acute post-transfusion hepatitis C was 11% (8 of 71) before the screening for anti-HCV as compared with 2.5% (3 of 121) after the screening (p < 0.05). Viremia was detected within the first five weeks of infection in 10 patients with acute post-transfusion hepatitis C. However, there was no significant difference in the incidence of non-A, non-B, non-C (NANBNC) PTH before screening (3 of 71, 4.2%) compared with after screening (3 of 121, 2.5%). Usually, NANBNC PTH was not clinically important. Anti-HCV screening of blood donors significantly reduces the incidence of post-transfusion hepatitis C, but not the incidence of NANBNC PTH.

Chronic elemental mercury intoxication: neuropsychological follow-up case study

In initial and follow-up investigations of neuropsychological function in a patient with elemental mercury intoxication, his scores were compared with those of a group of normal control subjects matched for sex, age and education. Each subject received a comprehensive neuropsychological examination including a personality inventory. On the initial examination the results indicated that the patient had a significant depression of performance intellectual functioning, impairments of attention, non-verbal short-term memory and visual judgement of angles and directions, psychomotor retardation and personality changes including depression, anxiety, desire to be alone, lack of interest and sensitivity to physical problems. Such an impairment picture is compatible with the previous observations of individuals with chronic exposure to elemental, organic or inorganic mercury. The follow-up study was undertaken about 1.5 years later. The results show that the patient's cognitive and personality functions were fully recovered. Our findings thus suggest a reversibility of impaired neuropsychological function in persons with elemental mercury poisoning if a prompt removal from the toxic environment is accomplished, together with proper medical treatment.

Hepatitis C virus RNA in peripheral blood mononuclear cells: comparing acute and chronic hepatitis C virus infection

Hepatitis C virus (HCV) can infect peripheral blood mononuclear cells (PBMC) of patients with chronic HCV infection. No data are available on PBMC testing for HCV RNA in acute hepatitis C. This study investigated the presence of HCV RNA in PBMC of patients with acute posttransfusion hepatitis C, compared with those with chronic HCV infection. Nested polymerase chain reaction (PCR) was applied to detect HCV RNA in 111 and 48 paired samples of serum and PBMC of 11 patients with acute posttransfusion hepatitis C and 48 patients with chronic HCV infection, respectively. In patients with acute posttransfusion hepatitis C, HCV RNA was detected in 17 of 29 (59%) and 67 of 82 (82%) serum samples collected during the incubation period and acute phase, respectively. Meanwhile, of the 48 patients with chronic HCV infection, 41 had serum HCV RNA (85%). HCV RNA was not detected in PBMC samples from incubation period or from acute-phase hepatitis, although it was detected in 12 of the 48 PBMC samples of chronically infected patients (25%) P < .005). Of the 12 PBMC specimens positive for positive-stranded HCV RNA, 6 were also positive for negative-stranded HCV RNA. Among patients with chronic HCV infection, HCV infection of PBMC was not related to age, sex, blood transfusion, serum alanine transaminase (ALT) levels, or serum virus titers. In conclusion, HCV infection of PBMC rarely exists in patients with acute hepatitis C. As HCV infection persists, the incidence of HCV infection of PBMC becomes higher.

Upper airway obstruction caused by vascular anomalies in children

Vascular ring or sling is one of the important etiologies for congenital upper airway obstruction in children. Between July 1988 and July 1995, a total of 92 children with stridor were initially evaluated by an esophagogram and two-dimensional echocardiogram. Seven children (7.7%) with variable types of vascular anomalies were diagnosed including pulmonary artery sling (2 cases), double aortic arch (1 case), right arch with left aberrant subclavian artery and ligamentum ductus (1 case), double aortic arch with one atretic arch (2 cases), and innominate artery compression of the trachea (1 case). The age at diagnosis ranged from 18 days to 3 years old. Only one patient was associated with an intracardiac anomaly. Five of the 7 patients were diagnosed as having laryngomalacia previously. Six patients had esophageal indentation on their esophagograms. Besides external airway compression, three patients also had intrinsic tracheal stenosis. Six patients received surgery because of severe respiratory distress. The patients' symptoms improved after surgery, but a premature baby died after a second operation for intrinsic tracheal stenosis at the age of 8 months.

One-stage repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries by a handmade trifurcated valved conduit

An 18-year-old girl with pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (MAPCAs) was reported. Her left-side pulmonary artery was absent, and the blood flow to the left lung was derived from two MAPCAs. One-stage correction, including the left-side thoracotomy and followed by the median sternotomy, was performed. A handmade trifurcated valved conduit was used to connect the right ventricle and the distal pulmonary arteries. The patient was doing well 3 years after the operation.

In vitro enhancement of antibody responses by T delta cells expressing IgD receptors

Previous in vivo studies have shown that murine T cells induced to express receptors specific for IgD (IgD-R) have humoral immunoaugmenting properties with respect to both primary and secondary antibody responses to various antigens. Such murine IgD-R+ T cells (T delta cells) belong to the CD4+ T cell population in contrast with human T delta cells which also include CD8+ cells. The purpose of these studies was to develop an in vitro assay system to examine the mechanism by which T delta cells facilitate enhanced antibody responses. Our studies demonstrate that B cell responses to both soluble and particulate antigens can, indeed, be enhanced in vitro by coculture with T cells previously induced to express IgD-R. This in vitro effect requires cognate interaction between T and B cells and is dependent on the presence of adherent cells or IL-1. T cell priming with antigen, while not a prerequisite, was found to result in more effective T delta-B cell interactions compared with naive T delta cells. Finally, evidence was obtained in support of an adhesion-mediated T delta-B cell interaction since the immunoaugmenting properties of T cells expressing IgD-R are completely blocked by the addition of very low doses of monomeric IgD to the cultures.

The value of Tc-99m MIBI SPECT during isosorbide dinitrate infusion in assessment of viable myocardium in patients with myocardial infarction

Tc-99m MIBI myocardial SPECT has shown promise for evaluation of coronary artery disease. But its role in predicting myocardial viability is still under investigation. The purpose of this study was to evaluate the value of Tc-99m MIBI myocardial SPECT during isosorbide dinitrate (ISDN) infusion in the assessment of myocardial viability. Thirty-seven patients with previous myocardial infarction (the infarct age ranged from < or = 30 days to 900 days) were studied, of them 13 patients had Tc-99m MIBI studies before and after coronary artery bypass grafting (CABG). The results showed that out of 134 segments with hypoperfusion at resting SPECT, 56 segments (41.8%) had an increase in Tc-99m MIBI uptake during ISDN infusion. Among them, 17 segments (30.4%) were normalized, 6 segments (10.7%) were significantly improved and 33 segments (58.9%) were improved. The degree of improvement in perfusion was related to the age of the myocardial infarction. In 13 patients with CABG, of 31 segments with improvement in perfusion post CABG, 25 segments (80.6%) showed perfusion improvement during ISDN infusion, and of 28 segments with improved wall motion post CABG, 23 segments (82.1%) showed improvement in perfusion during ISDN infusion. Tc-99m MIBI SPECT during ISDN infusion may therefore be a useful approach for assessing myocardial viability.

Modified Senning procedures for simple transposition of the great arteries

From December 1990 to July 1994, 10 infants with simple transposition of the great arteries (TGA) underwent the Senning procedure at National Cheng Kung University Medical College. Their ages ranged from 1 to 8 months (mean, 4.8 +/- 2 months), and their body weight ranged from 3.5 to 7.5 kg (mean, 5.7 +/- 1.2 kg). Four infants were treated with the conventional method by covering the sinoatrial (SA) node with the anterior right atrial flap (group 1). The other six patients had modified procedures, having the suture line across the caval vein, caudal to the SA node (group 2). Three of the group 1 patients experienced junctional rhythm temporarily, another had SA node dysfunction for 1 week postoperatively. In group 2, all patients were in sinus rhythm except one, who returned to sinus rhythm on the second postoperative day. There was one (10%) surgical mortality, a patient in group 1, and one (10%) late mortality, in group 2. The clinical follow-up interval was 6 to 46 months (mean, 28.8 mo). All survivors were in sinus rhythm, and echocardiographic studies demonstrated no difference between the two groups as to conduit obstruction or degree of tricuspid valve regurgitation. In conclusion, in situations that require atrial switch for the correction of TGA, a suture line across the caval vein, caudal to the SA node, may be a useful modification to prevent arrhythmias.

Tetralogy of Fallot with an additional muscular inlet type ventricular septal defect--repair with split patch technique

An 8-year-old girl with tetralogy of Fallot (TF) and double ventricular septal defects (VSDs) was reported. The additional VSD was a muscular inlet type. A split patch technique was used to cover both VSDs during the total correction. Follow-up echocardiogram demonstrated no residual shunt nor significant tricuspid valve regurgitation. The patient is doing well 2 years after operation.

Schwann cell properties: 3. C-fos expression, bFGF production, phagocytosis and proliferation during Wallerian degeneration

The role of Schwann cells (SC) during Wallerian degeneration has been controversial. The consensus opinion is that monocytes/macrophages are mainly responsible for myelin removal although SC were shown to phagocytose myelin in vitro and in vivo. In the present study, we correlate proto-oncogene expression with phenotypic changes in SC during Wallerian degeneration using immunohistochemistry and electron microscopy. The proliferative cells are labeled with proliferative cell nuclear antigen (PCNA), and macrophages are labeled with ED1 macrophage marker. We demonstrate c-fos expression in SC at the onset of axon disintegration 12 hours post-axotomy followed by expression of ED1, basic fibroblast growth factor (bFGF) and PCNA after 1 day. The myelin sheath fragments at the nodal region and forms ellipsoids. Schwann cells move to internodes and undergo nuclear and cytoplasmic hypertrophy; they phagocytose myelin ellipsoids with thick vimentin-rich processes and undergo mitosis. Resident macrophages express c-fos and phagocytose myelin debris sequestered into endoneurium by SC after 3 days, but they do not enter the tube until the fifth day. We believe that SC are induced by signals from injured axons to express c-fos which activates downstream genes that lead to the acquisition of phagocytic and proliferative activities. Myelin debris processed by SC may act as an inducer and a chemoattractant for resident macrophages. Cytokines produced by macrophages may stimulate SC proliferation and production of neurotrophic factors.

Effect of injury on the bi-affinity alpha 1-adrenoreceptor binding in rat brain in vivo

Focal freezing lesions in rats cause a widespread decrease of cortical glucose utilization in the lesioned hemisphere, probably as a reflection of depressed cortical activity. The noradrenergic neurotransmitter system was implicated in these alterations when it was demonstrated that prazosin, a specific norepinephrine (NE) antagonist at alpha 1-adrenergic receptors, prevented their development. In normal rat brain, specific binding of [125I]HEAT [(+/-)2-(3-[125I]iodo-4-hydroxyphenyl)-ethyl-aminomethyl-tetralone], another selective alpha 1-adrenoreceptor ligand, was demonstrated in vivo at sites consistent with the alpha 1A- and alpha 1B-adrenoreceptor subtypes. In the present study, the effect of a freezing lesion on specific binding of [125I]HEAT in rat brain in vivo was determined three days after traumatization when cortical glucose use suggested the greatest degree of functional depression. The steady-state volumes of distribution of [125I]HEAT three days after injury were significantly increased in all the cortical areas of the lesioned hemisphere, but not in the subcortical structures. Injury did not modify the binding affinities for HEAT. However, a statistically significant increase in the number of low-affinity binding sites for this ligand was demonstrated in all cortical areas of the lesioned hemisphere, but not in subcortical structures. The traumatization did not modify Bmax estimates for the high-affinity binding of HEAT. The results support the hypothesis that changes in the noradrenergic system are of functional importance in brain injury and that at least some effects of injury are mediated by alpha 1B-adrenergic receptors.

Cardiac responses activated by nicotine in canine ganglial plexus between aorta and pulmonary artery

In order to study the location and function of nicotine-sensitive neurons of cardiac ganglial plexuses, microdissections of collections of fat pads were carried out, and nicotine (100 micrograms) was injected into the ganglial plexus between aorta and pulmonary artery (A-PGP) in 30 anesthetized open-chest dogs. There were numerous ganglia or neurons in A-PGP. Either positive or negative inotropic and chronotropic responses were elicited following injections of nicotine into A-PGP. Control injections of 0.1 ml saline into A-PGP and injections of nicotine (100 or 200 micrograms) into right marginal ganglial plexus did not elicit any cardiac responses. After acute decentralization, nicotine (100 micrograms) was again injected into the same locus of A-PGP. Some positive and negative responses could still be induced, but their frequencies were reduced. These suggest that nicotine can directly activate the efferent parasympathetic and sympathetic neurons and indirectly activate them by stimulating the afferent neurons existing on the surface of dog heart.