Conversion disorders in childhood and adolescence: a psychiatric consultation study in a general hospital

From March 1986 to April 1995, 418 consecutive psychiatric consultations for patients aged 18 or below were completed. Ten of these patients met the Diagnostic and Statistical Manual of Mental Disorders, 4th. edition (DSM-IV) diagnostic criteria for a conversion disorder. The medical and psychiatric consultation records of these patients were reviewed. Chief conversion symptoms included pseudoseizure (four cases), gait disturbance (two cases), abnormal movement (one case), four limbs weakness (one case), aphonia (one case) and tunnel vision (one case). The psychosocial problems of the patients included family problems (seven cases), interpersonal problems (two case) and concurrent physical illness (one case). Six patients (60%) manifested complete remission and others showed improvement of the symptoms.

Prenatal diagnosis in a Chinese family with type Ia glycogen storage disease by PCR-based genetic analysis

Type Ia glycogen storage disease (GSD), an autosomal recessive metabolic disorder, is caused by a deficiency in glucose-6-phosphatase (G6Pase). We had previously identified the nature of the causative mutations in a Chinese family whose first two children were affected with type Ia GSD. Two different point mutations in the G6Pase gene, a guanine to adenine substitution at base position 327 in exon 2 and a thymine to adenine substitution at base position 1101 in exon 5, change the restriction sites for the enzymes Fok I and Hinc II. Family study revealed that both parents were heterozygous carriers: the father with a mutant G6Pase allele at exon 2 and the mother with another mutant G6Pase allele at exon 5. This paper deals with a prenatal diagnosis on the fetus of this family who is at risk of type Ia GSD. Genomic DNA was extracted from a chorionic villus biopsy sampled at the tenth week of gestation. Exons 2 and 5 of the G6Pase gene were amplified by the polymerase chain reaction (PCR) followed by restriction enzyme digestion and direct sequence analysis. DNA analysis indicated that the fetus was a heterozygous carrier of type Ia GSD with a mutant G6Pase allele at exon 2 and a normal G6Pase allele at exon 5. The diagnosis was further confirmed by the same method with cultured amniocytes and with a blood sample after the baby was born. This is the first report of prenatal carrier detection of type Ia GSD at the gene level.

Participation of AT1 and AT2 receptors in the differential interaction between angiotensin II or III and alpha-2 adrenoceptors in the nucleus reticularis gigantocellularis in cardiovascular regulation and antinociception in rats

We evaluated possible interactions between angiotensin II (AII) or angiotensin III (AIII) and the alpha-2 adrenoceptors of the nucleus reticularis gigantocellularis (NRGC) in the medulla oblongata that are involved in cardiovascular regulation and antinociception, as well as the angiotensin receptor subtypes involved, using Sprague-Dawley rats that were anesthetized with pentobarbital sodium. The efficacy of guanabenz, which acts on the alpha-2 adrenoceptors in the NRGC to elicit hypotension, bradycardia and antinociception, based on tail-flick responses to noxious thermal stimuli (50 degrees C), was used as our experimental index. Bilateral microinjection of AII or AIII into the NRGC, at equimolar doses (40 pmol) that did not alter base-line systemic arterial pressure, heart rate or tail-flick latency, significantly and site-specifically attenuated the cardiovascular suppression elicited by guanabenz (100 micrograms/kg i.v.). This attenuation was appreciably antagonized by coadministration of the AT2 receptor antagonist PD-123319 (1.6 nmol). Concomitant examination of tail-flick responses revealed discernible inhibition by AII (40 pmol), but potentiation by AIII (40 pmol), of guanabenz-induced antinociception. These differential modulating effects of AII and AIII were, however, antagonized by comicroinjection of losartan (1.6 nmol) into the bilateral NRGC. Our results suggest that both AII and AIII produced a reduction, via AT2 receptors, of the activity of alpha-2 adrenoceptors in the NRGC that are involved in central cardiovascular regulation. On the other hand, antinociception induced by activation of alpha-2 adrenoceptors in the NRGC was suppressed by AII and potentiated by AIII, although AT1 receptors may play a major role in both interactions.

Clinical spectrum of Pseudomonas putida infection

The clinical and microbiologic characteristics of 55 cases of Pseudomonas putida infection in 53 patients in a medical center in Taiwan from April 1988 to March 1993 are reported. P. putida was cultured in the decreasing order of frequency from urine (24 isolates), sputum (12), blood (10), wound discharge (3), peritoneal fluid (3), cerebrospinal fluid (2) and umbilical swab (1). Of the adult patients, 23% (12/53) were considered to be contaminated or colonized with P. putida. Of the 41 patients with manifest disease. 17 (41%) had urinary tract infections, 10 (24%) had pneumonia, 8 (19%) had septicemia, 3 (7%) had wound infections, 2 (5%) had meningitis and 1 (2%) had peritonitis. Of these, 55% were nosocomial infections. The case fatality rate was 29% (12/41). There was no significant correlation between patient mortality and the type of disease caused by the bacterium. Results of in vitro susceptibility tests suggested that imipenem and ceftazidime were more effective than other antimicrobials. This study indicates that the clinical spectrum of diseases caused by P. putida is broader and the incidence of true infection is higher than previously expected, especially among hospitalized patients who undergo invasive procedures such as placement of intravascular devices, urinary catheterization and intubation.

Carbachol induces inward current in neostriatal neurons through M1-like muscarinic receptors

The effects of carbachol on rat neostriatal neurons were examined in the slice and the freshly dissociated neuron preparations using intracellular and whole-cell voltage-clamp recording methods. Superfusion of carbachol (30 microM) produced a depolarization concomitant with an increase in the rate of spontaneous action potentials. This depolarization was associated with an increase in the input resistance. The carbachol-induced membrane depolarization was blocked by pirenzepine (1 microM), a selective M1 muscarinic receptor antagonist. In other experiments, we observed that carbachol induced a transient inward current on the freshly dissociated neostriatal neuron at a holding potential of -60 mV in a concentration-dependent manner underlying the whole-cell voltage-clamp mode. The inward current caused by carbachol was not reduced by tetrodotoxin (1 microM), calcium-free recording solution or Cd2+ (100 microM). However, it was blocked by Ba2+ (100 microM). In addition, the carbachol-induced inward current reversed polarity at about the potassium equilibrium potential. The whole-cell membrane inward current in response to voltage-clamp step from -90 to -140 mV was reduced by 30 microM carbachol. With stronger hyperpolarization beyond the potassium equilibrium potential, carbachol produced a progressively greater reduction in membrane current. This inhibitory effect was also abolished by Ba2+ (100 microM). A concentration of 30 microM carbachol-induced inward current could be reversibly antagonized by the M1 muscarinic receptor antagonist pirenzepine (0.1-1 microM), with an estimated IC50 of 0.3 microM. However, other muscarinic receptor subtype (M2 or M3) antagonists could also block the carbachol-induced inward current. The rank order of antagonist potency was: pirenzepine (M1 antagonist) > 4-diphenylacetoxy-N,N-methyl-piperidine methiodide (M3/M1 antagonist) > gallamine (M2 antagonist). Based on these pharmacological data, we concluded that carbachol can act at M1-like muscarinic receptors to reduce the membrane K+ conductances and excite the neostriatal neurons.

A chromosomal locus required for copper resistance, competitive fitness, and cytochrome c biogenesis in Pseudomonas fluorescens

A chromosomal locus required for copper resistance and competitive fitness was cloned from a strain of Pseudomonas fluorescens isolated from copper-contaminated agricultural soil. Sequence analysis of this locus revealed six open reading frames with homology to genes involved in cytochrome c biogenesis in other bacteria, helC, cycJ, cycK, tipB, cycL, and cycH, with the closest similarity being to the aeg-46.5(yej) region of the Escherichia coli chromosome. The proposed functions of these genes in other bacteria include the binding, transport, and coupling of heme to apocytochrome c in the periplasm of these Gram-negative bacteria. Putative heme-binding motifs were present in the predicted products of cycK and cycL, and TipB contained a putative disulfide oxidoreductase active site proposed to maintain the heme-binding site of the apocytochrome in a reduced state for ligation of heme. Tn3-gus mutagenesis showed that expression of the genes was constitutive but enhanced by copper, and confirmed that the genes function both in copper resistance and production of active cytochrome c. However, two mutants in cycH were copper-sensitive and oxidase-positive, suggesting that the functions of these genes, rather than cytochrome c oxidase itself, were required for resistance to copper.

Identification of overlapping DNA-binding and centromere-targeting domains in the human kinetochore protein CENP-C

The kinetochore in eukaryotes serves as the chromosomal site of attachment for microtubules of the mitotic spindle and directs the movements necessary for proper chromosome segregation. In mammalian cells, the kinetochore is a highly differentiated trilaminar structure situated at the surface of the centromeric heterochromatin. CENP-C is a basic, DNA-binding protein that localizes to the inner kinetochore plate, the region that abuts the heterochromatin. Microinjection experiments using antibodies specific for CENP-C have demonstrated that this protein is required for the assembly and/or stability of the kinetochore as well as for a timely transition through mitosis. From these observations, it has been suggested that CENP-C is a structural protein that is involved in the organization or the kinetochore. In this report, we wished to identify and map the functional domains of CENP-C. Analysis of CENP-C truncation mutants expressed in vivo demonstrated that CENP-C possesses an autonomous centromere-targeting domain situated at the central region of the CENP-C polypeptide. Similarly, in vitro assays revealed that a region of CENP-C with the ability to bind DNA is also located at the center of the CENP-C molecule, where it overlaps the centromere-targeting domain.

Psychotic symptoms in psychiatric inpatients with dementia of the Alzheimer and vascular types

BACKGROUND

Demented patients often manifest psychotic symptoms including delusion, hallucination and misidentification. This report attempts to describe the frequencies and characteristics of such symptoms in psychiatric inpatients with dementia, and to identify the characteristics of dementia with and without psychotic symptoms.

METHODS

The study included 78 demented patients who were consecutively admitted to the psychiatric ward. Their psychotic symptoms were obtained from semistructured interview and the assessment using BEHAVE AD. Delusion and hallucination were rated as "present" if the descriptions were consistent with the definition of Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). Misidentification was defined individually.

RESULTS

There were 54 patients with DAT and 24 patients with VD. The frequency of psychotic symptoms in DAT and VD was 71.8%. The frequency of delusion in DAT and VD was 59.0%, misidentification, 33.3% and hallucination, 25.6%. Demented patients with psychotic symptoms were older (p = 0.037) than those without psychotic symptoms.

CONCLUSIONS

Psychotic symptoms are common in psychiatric inpatients with DAT and VD, the most common being delusional. Delusion of theft is the most common one. Demented patients with psychotic symptoms were older than those without.

Alagille syndrome with interstitial 20p deletion derived from maternal ins(7;20)

We present a 6-year-old Chinese boy with Alagille syndrome and an interstitial 20p deletion, with a karyotype of 46,XY,der(20)dir ins(7;20)(q11.23;p11.23p12.2 or p12.2p13)mat. He had a peculiar face and suffered from congenital heart disease, growth retardation, severe cholestasis, hepatosplenomegaly, and impaired renal function. The karyotype of his mother showed a balanced translocation, 46,XX,dir ins(7;20)(q11.23; p11.23p12.2 or p12.2p13), and her phenotype was normal. His dead elder brother was highly suspected as another victim of Alagille syndrome. The findings in the present family suggested that if Alagille syndrome is a single gene defect, the putative gene responsible for the syndrome would not be located at the insertion breakpoints but located within the deletion extent.

Increased intestinal contents viscosity reduces cholesterol absorption efficiency in hamsters fed hydroxypropyl methylcellulose

This study was conducted to test the hypothesis that increased intestinal contents viscosity lowers plasma cholesterol concentrations by decreasing cholesterol absorption. Male Golden Syrian hamsters were fed for 4 wk diets containing 0.12% cholesterol, and either 4% cellulose or four different viscosity grades of hydroxypropyl methylcellulose (HPMC). Dietary HPMC confers viscosity in the small intestine but is resistant to fermentation. Cholesterol absorption efficiency was measured using the dual isotope ratio method, and plasma and liver cholesterol concentrations were determined enzymatically. Ex vivo viscosity of intestinal contents supernatants was measured using a Wells-Brookfield cone/plate viscometer, and the means of treatment groups ranged from 6 to 6532 mPa.s. Relative to dietary cellulose, all viscosity grades of HPMC resulted in significantly lower cholesterol absorption efficiency, lower plasma cholesterol concentration, and lower liver cholesteryl ester content. The logarithm of intestinal contents ex vivo viscosity was inversely correlated with dietary cholesterol absorption (r2 = 0.84, P = 0.028). Furthermore, dietary cholesterol absorption was positively correlated with plasma cholesterol concentration (r2 = 0.89, P = 0.017) and liver cholesteryl ester content (r2 = 0.96, P = 0.0031). Thus, the data suggest an independent role of intestinal contents viscosity in lowering plasma cholesterol concentration and liver cholesteryl ester content by reducing cholesterol absorption efficiency.

Direct association of STAT3 with the IFNAR-1 chain of the human type I interferon receptor

Based on the reports of the activation of the transcription factor known as STAT3 (for signal transducers and activators of transcription) or APRF (for acute phase response factor) by various cytokines, we investigated the possible role of STAT3 in type I interferon (IFN) receptor signaling. We show that STAT3 undergoes IFNalpha-dependent tyrosine phosphorylation and IFNalpha treatment induces protein-DNA complexes that contain STAT3. In addition, STAT3 associates with the IFNAR-1 chain of the type I receptor in a tyrosine phosphorylation-dependent manner upon IFNalpha addition. The binding of STAT3 to the IFNAR-1 chain occurs through a direct interaction between the SH2 domain-containing portion of STAT3 and the tyrosine-phosphorylated IFNAR-1 chain. Furthermore, tyrosine-phosphorylated STAT3 bound to the IFNAR-1 chain also undergoes a secondary modification involving serine phosphorylation. This phosphorylation event is apparently mediated by protein kinase C, since it was blocked by low concentrations of the protein kinase inhibitor H-7. The biological relevance of IFN activation of STAT3 is further illustrated by the finding that STAT3 is not activated by IFN in a cell line resistant to the antiviral and antiproliferative actions of IFN alpha but in which other components of the JAK-STAT pathway are activated by IFNalpha.

High complete response rate of concomitant chemoradiotherapy for locally advanced squamous cell carcinoma of the uterine cervix

A prospective study with a newly designed schedule of concomitant chemoradiotherapy was initiated for 42 patients with previously untreated squamous cell carcinoma of the uterine cervix. Their ages ranged from 34 to 77 years, median 57 years. There were 13 FIGO stage IIB, 1 IIIA, 27 IIIB, and 1 IVA. Radiotherapy was administered using 1.8 Gy/day, 5 days a week, to the whole pelvis (50.4 Gy/28 fractions) with local boost if indicated. Intracavitary brachytherapy of 5 Gy for five times was delivered after 1-2 weeks of rest. The first 21 patients received concomitant chemotherapy of biweekly PEB regimen (100 mg/m2 etoposide + 50 mg/m2 cisplatin + 50 mg/m2 bleomycin) for two to three cycles during external irradiation. The chemotherapy for the latter 21 patients was modified to weekly PEBF (50 mg/m2 etoposide + 20 mg/m2 cisplatin + 10 mg/m2 bleomycin + 800 mg/m2 5-FU, mixed in normal saline, 24-hr continuous iv infusion) for five to six cycles. All except 1 patient achieved complete response (97.6%) and sustain so after a median follow-up time of 30 months. There were three relapses--one with persistent pelvic disease and two with distant metastasis. Two-year overall survival and disease-free survival rates were 97.6 and 92.9%, respectively. Myelosuppression was moderate but fully recovered. Other acute toxicities were tolerated except for 1 patient who encountered grade IV radiation colitis with cecum perforation and required surgery. As to late morbidity, the incidence of radiation proctitis was high (21.4%) but of a mild degree, with 1 patient needing repeated transfusion. One patient developed chronic cystitis with an acontractile bladder. Our preliminary results show that concomitant chemoradiotherapy for advanced cervical carcinoma is both feasible and effective with acceptable toxicities. Further follow-up is mandatory to ensure whether this high complete response protocol will translate into long-term local control and survival.

Overexpression of p53 is not a feature of ovarian granulosa cell tumors

The p53 tumor suppressor gene has been extensively studied in various human tumors including epithelial ovarian cancers. However, little is known about the expression of this gene in ovarian granulosa cell tumors, the most common histologic type of sex cord-stromal tumors. We investigated whether overexpression of the p53 gene product occurs in this specific ovarian tumor. Nineteen patients with ovarian granulosa cell tumors were recruited in this study. Immunohistochemical staining for the p53 protein with monoclonal antibody PAb 1801 was performed in the paraffin-embedded tissue of each case to screen for p53 overexpression. Among the 19 ovarian granulosa cell tumors, there was only one well-differentiated tumor found to have nuclear immunoreactivity in a small fraction of tumor cells. Polymerase chain reaction--single-stranded conformation polymorphism was used to study the tumor showing focal p53 positivity, but no mobility shift was noted from exon 4 through exon 9 of the p53 gene. On the basis of this observation, we propose that alteration of the p53 tumor suppressor gene is not a common finding in ovarian granulosa cell tumors.

Inhibition of retinal pigment epithelial cell-induced tractional retinal detachment by disintegrins, a group of Arg-Gly-Asp-containing peptides from viper venom

PURPOSE

Integrin-mediated extracellular matrix (ECM) attachment plays an important role in vitreous contraction of retinal pigment epithelial (RPE) cells. Disintegrins, a group of Arg-Gly-Asp (RGD)-containing peptides from viper venom, are potential anti-adhesion agents that interfere with integrin-ECM binding. This study was performed to determine whether disintegrins were effective in inhibiting RPE cell-induced matrix attachment in vitro and tractional retinal detachment in a rabbit model in vivo.

METHODS

Two disintegrins, echistatin from viper Echis carinatus and flavoridin from Trimeresurus flavoviridis, were used. The expression of integrins on the surface of bovine and rabbit RPE cells was examined by indirect immunofluorescent stain with specific anti-integrin monoclonal antibodies. The inhibitory effect of disintegrins on RPE cell-mediated ECM attachment and vitreous contraction was evaluated with cell adhesion and vitreous contraction assays. In the in vivo model, rabbit eyes were injected intravitreously with either homologous rabbit RPE cells alone or together with disintegrins to induce tractional retinal detachment. The cytotoxic effect of disintegrins was examined with a cell proliferation assay using the alamar blue method. Retinal toxicity of disintegrins was evaluated with electroretinograms and histologic examination of the rabbit eyes.

RESULTS

Bovine and rabbit RPE cells showed the positive staining for the integrins alpha 2 beta 1 and alpha 5 beta 1 on cell surface. Disintegrins, echistatin, and flavoridin inhibited RPE cell attachment to the ECM. The potency of disintegrins was 150 to 300 times higher than that of Gly-Arg-Gly-Asp-Ser (GRGDS) peptide. The disintegrins also inhibited RPE cell-induced vitreous contraction in a dose-dependent manner, whereas the GRGDS peptide had no effect. In the in vivo experiment, echistatin (50 microgram/ml) or flavoridin (80 microgram/ml) significantly inhibited RPE cell-induced tractional retinal detachment compared with the control group at week 2 (P< 0.05) and week 4 (P< 0.01) after surgery. Disintegrins were nontoxic to RPE cells and rabbit retina as evaluated by cytotoxicity tests, electroretinograms, and histologic examinations.

CONCLUSIONS

The disintegrins were effective in inhibiting RPE cell attachment to the ECM and vitreous contraction in vitro. They also were effective in suppressing RPE cell-induced tractional retinal detachment in the rabbit eyes. They were nontoxic. Disintegrins and their analogs might be potential anti-adhesion therapeutic agents in the treatment of proliferative vitreoretinopathy.

Oral tuberculosis

Tuberculous lesions of the oral cavity have become so infrequent that it is virtually a forgotten disease entity and may pose a diagnostic problem. Fifteen patients with conditions that were histologically diagnosed as oral tuberculosis were reviewed. All were men ranging in age from 29 to 78 years. The most common clinical presentation was odynophagia with a duration from less than 1 week to several years. The most frequently affected sites were the tongue base and gingiva. The oral lesions took the form of an irregular ulceration or a discrete granular mass. Mandibular bone destruction was evident in two patients. Two patients had a fever, and four had cervical lymphadenopathy. Eight cases were clinically suspicious for malignancy before biopsy. Only four patients had a history of tuberculosis, but 14 of the 15 patients were later found to have active pulmonary tuberculosis. Acid-fast bacilli were demonstrated in all patients. Tuberculosis should be considered in patients with an inflamed ulcer lesion. A biopsy specimen for histologic study, acid-fast stains, and cultures should be obtained for confirmation and differential diagnosis with other conditions. If a tuberculous lesion is suspected, a chest radiograph is indicated to investigate the possibility of pulmonary involvement.

p150TSP, a conserved nuclear phosphoprotein that contains multiple tetratricopeptide repeats and binds specifically to SH2 domains

Src homology 2 (SH2) domains are structural modules that function in the assembly of multicomponent signaling complexes by binding to specific phosphopeptides. The tetratricopeptide repeat (TPR) is a distinct structural motif that has been suggested to mediate protein-protein interactions. Among SH2-binding phosphoproteins purified from the mouse B cell lymphoma A20, a 150-kDa species was identified and the corresponding complementary DNA (cDNA) was molecularly cloned. This protein encoded by this cDNA, which we have termed p150TSP (for TPR-containing, SH2-binding phosphoprotein), is located predominantly in the nucleus and is highly conserved in evolution. The gene encoding p150TSP (Tsp) was mapped to chromosome 7 of the mouse with gene order: centromere-Tyr-Wnt11-Tsp-Zp2. The amino-terminal two-thirds of p150TSP consist almost entirely of tandemly arranged TPR units, which mediate specific, homotypic protein interactions in transfected cells. The carboxyl-terminal third of p150TSP, which is serine- and glutamic acid-rich, is essential for SH2 binding; this interaction is dependent on serine/threonine phosphorylation but independent of tyrosine phosphorylation. The sequence and binding properties of p150TSP suggest that it may mediate interactions between TPR-containing and SH2-containing proteins.

[Characteristics of dementia patients with hyperphagia]

Research into dementia has tended to concentrate on memory loss and other cognitive impairment, but attention has recently turned to the associated psychiatric symptoms and behavioral abnormalities. Among them, increases in the amount eaten or hyperphagia are not uncommon in dementia. This problem is of clinical importance since it not only jeopardizes patient's health, but also is a cause of caregiver burden. The aim of this study was to assess the prevalence of hyperphagia in dementia. Additionally, possible mechanisms underlying this problem were reviewed and related to the demographic data, cognitive function test, radiological findings and other psychiatric symptoms. Out of a sample of 91 demented inpatients, hyperphagia was present in 30.8%. Hyperphagia was significantly associated with delusion, misidentification, aggressive behavior, hoarding behavior and pica phenomena. But these patients did not show difference in cognitive function, radiological abnormalities, repetitive behavior and depressed mood when compared with other demented patients. The possible etiologies were discussed, including physiological and psychological factors. Hyperphagia is a complex phenomenon, better understanding of the underlying pathogenesis may highlight specific pharmacological or behavioral methods for the management this troublesome behavior.

Developmental synchrony of Ascogregarina taiwanensis (Apicomplexa: Lecudinidae) within Aedes albopictus (Diptera: Cuclicidae)

Development of Ascogregarina taiwanensis Lien & Levine was synchronized with its host, the Asian tiger mosquito, Aedes albopictus (Skuse). Trophozoites of the parasite migrate to the Malpighian tubules where the gamonts fuse to form gametocysts and later mature oocysts. In this study, we observed that water temperature, which alters the development time of mosquito larvae, also affected parasite development. A. taiwanensis developed in a shorter time at 29 degrees C, whereas at 14 degrees C, the development was extended to as long as 17 d. Few mature oocysts were produced at 29 degrees C, although gametocysts occasionally were found in the lumen of Malpighian tubules. In contrast, gametocysts did not develop at 14 degrees C unless pupation occurred. Stage transformation of the parasite was determined by the metamorphosis of the mosquito host. Gametocyst formation occurred earlier when infected larvae were injected with an appropriate concentration of 20-hydroxyecdysone, indicating this molting hormone was involved in regulating the synchronous development of A. taiwanensis in its mosquito host.

Physical aggression and associated factors in probable Alzheimer disease

Aggressive behavior is thought to be pervasive among and devastating to demented patients and their caregivers. This study investigated the prevalence of physical aggression in demented inpatients with Alzheimer disease (AD). Additionally, the characteristics and psychiatric symptoms that may be associated with aggression were tested. Forty-seven patients with probable AD were included in this study. Physical aggression was reported in 27 (57.4%) of the patients. These patients were older, had a later onset of dementia, and had a higher prevalence of misidentification, activity disturbances, and day/night disturbance. The relationship between these factors and physical aggression needs further clarification, which may help provide effective predictors and treatment of the aggressive behavior.

Salmonella infections: a retrospective 10-year analysis of 134 cases in a regional hospital in Taiwan

A total of 134 cases of salmonella infections have been noted during the past 10 years in our hospital. Cases of non-typhoidal salmonellosis increased gradually but infections due to Salmonella typhi did not show the same trend. Gastroenteritis was the most prevalent diagnosis in patients below 1 year of age and non-typhoidal bacteraemia and localized infections were the most prevalent in patients over 50 years. Diabetes mellitus was an important underlying disease especially in patients with localized infections (86%). Travelling history played an important role in cases of enteric fever. The susceptibility pattern in non-typhoidal salmonella changed markedly over the study period; multiple drug resistance was noted. The susceptibility pattern of S. typhi showed no significant change. Seven deaths due to salmonella infections were noted (5.2%); all due to non-typhoidal salmonellosis, especially serogroup B. Age above 50 years, localized infection, infection with serogroup B and diabetes were poor prognostic factors.

Inhibition of cell-induced vitreous contraction by synthetic peptide derived from the collagen receptor binding sequence

Cell-mediated tractional retinal detachment (TRD) is the end result of various intraocular proliferative disorders. Interactions between cells and extracellular matrix via cellular surface receptors, integrins, play an important role. Anti-adhesion therapy has been suggested as a promising way to treat the integrin-dependent pathological events. We tested three synthetic peptides, Gly-Arg-Gly-Asp-Ser (GRGDS), derived from the fibronectin receptor binding domain; Try-Ile-Gly-Ser-Arg (YIGSR), from the laminin receptor binding domain, and Ala-Asp-Gly-Glu-Ala (ADGEA), from the collagen receptor binding domain, to evaluate their inhibitory effect on cell-mediated matrix attachment and vitreous contraction in vitro, and on cell-induced TRD in rabbit eyes in vivo. Indirect immunofluorescent stain demonstrated both bovine retinal pigment epithelial (RPE) cells and rabbit dermal fibroblasts expressed the alpha 2 beta 1, alpha 5 beta 1 and alpha 6 beta 1 integrins, the collagen, fibronectin, and laminin receptors, respectively. GRGDS exhibited a broad spectrum of inhibitory activity on RPE cell attachment to extracellular matrices. YIGSR specifically inhibited RPE cell attachment to laminin, whereas ADGEA inhibited RPE cell attachment to collagen type I and IV. ADGEA inhibited RPE cell-induced vitreous contraction in a dose-dependent manner, whereas GRGDS and YIGSR had no effect. ADGEA (1250 micrograms/mL) delayed the development of TRD but did not prevent it. ADGEA was nontoxic to cells and retina, as demonstrated by cytotoxicity tests and histological examination. The synthetic peptide, ADGEA, and its analogs may be potential candidates for the treatment of cell-mediated collagenous contraction in the ocular tissues.

Prevention of false results from preferential PCR amplification or VNTR alleles

In forensic DNA typing, evidential samples generally involve limited amounts of DNA and so should be carefully utilized. Although polymerase chain reaction (PCR) of variable number of tandem repeats (VNTR) alleles is the prevailing method for forensic identification, the fidelity of amplification of heterozygous VNTR alleles with large disparities in length needs to be carefully examined. Reports in the literature and our own observations have demonstrated that PCR artifacts, bogus alleles and allelic drop-out of VNTRs, are related to the amount of genomic DNA, the number of amplification cycles and the length of alleles amplified. Two small (< 1 kb) hypervariable VNTRs (Apo B and HVR-Ig) markers used for forensic identification were chosen to study these relationships. The results revealed that PCR amplification for the heterozygous VNTR alleles with wide disparity in length (> 400 bp) easily produced the allelic drop-out problem and therefore, led to the false results; and the allelic fragment of PCR products was preferentially lost after only 2 cycles of overamplification. We also further established the relationship between the optimal number of amplification cycles and the amount of genomic DNA in the reaction mixture. In our routine forensic screening this relationship has been successfully applied to determine the optimal number of amplification cycles and to avoid the allelic drop-out problem and achieve fidelity of PCR-VNTR amplification. It has also been used to investigate forensic casework.

Ligand-directed immunoaffinity purification and properties of the one-carbon, reduced folate transporter. Interspecies immuno-cross-reactivity and expression of the native transporter in murine and human tumor cells and their transport-altered variants

Almost complete purification (> 95%) of the 46-kDa murine, one-carbon, reduced folate transporter (RFT) at a recovery of 20% was obtained by ligand-directed immunoaffinity fractionation from transporter overproducing L1210/R83 cells. These cells were labeled with the N-hydroxysuccinimide ester of [3H]aminopterin (AMT), the isolated plasma membrane alkaline washed to remove nonintegral membrane proteins, detergent-solubilized, and RFT-separated on an anti-AMT antibody-protein G-Sepharose column followed by preparative SDS-polyacrylamide gel electrophoresis. Anti-RFT antibody, subsequently derived, differentially blotted (L1210/R83 >> L1210/0) a 46-kDa protein during SDS-polyacrylamide gel electrophoresis of plasma membrane from L1210/R83 and L1210 cells and in L1210/R83 cells after trichloroacetic acid precipitation. In contrast to that reported for human tumor cells, glycosidase treatment of RFT revealed no common N- or O-linked core oligosaccharides associated with this protein. The same 46-kDa protein at different relative levels was revealed in a Western blot of plasma membrane from other murine tumors. Blotting of plasma membrane from methotrexate resistant, transport defective L1210 cell variants exhibited wild-type levels of a less electrophoretically mobile RFT or greater levels of the same 46-kDa RFT which could not be affinity labeled with N-hydroxysuccinimide-[3H]AMT. The same antibody differentially blotted a 83-kDa plasma membrane protein from human HL-60 and CCRF-CEM cells with different levels of reduced folate transport and affinity labeling of RFT, verifying the conserved nature of this protein consistent with earlier functional studies.

Effects of propofol on nociceptive response and power spectra of electroencephalographic and systemic arterial pressure signals in the rat: correlation with plasma concentration

We applied simultaneous spectral analysis of electroencephalographic (EEG) and systemic arterial pressure signals in Sprague-Dawley rats to monitor the status of consciousness and cardiovascular functions during intravenous anesthesia with propofol and to assess their correlations with plasma propofol concentration. Our results support the hypothesis that a 'threshold' plasma concentration (1.7-1.8 micrograms/ml) exists for propofol anesthesia. This threshold level, we further showed, may be attained by both i.v. bolus injection and continuous infusion, although the pharmacokinetic profiles, as well as EEG and hemodynamic correlates, may be different. Continuous, on-line power spectral analysis of EEG signals revealed that the degree of reduction in the power density of the theta and delta bands and root mean square value paralleled the level of anesthesia. Significant suppression of both alpha and beta components occurred only concomitant with EEG burst suppression. At the subanesthetic dose, i.v. infusion of propofol increased preferentially the power density of the theta and delta bands, suggesting the validity of including sedation as a nonhypnotic therapeutic application of propofol. We also found that appreciable cardiovascular suppression took place only upon anesthetic doses of propofol. Power spectral analysis of systemic arterial pressure signals indicated that this was accompanied by a progressive depression of spectral parameters that signify peripheral vascular resistance and baroreceptor reflex response.

[Characteristics of dementia patients with aggressive behaviors]

Aggressive behaviors are found in dementia patients and pose major problems for their caregivers and may be amenable to treatment. The present study aims to determine the frequency of aggressive behaviors in dementia patients and to test whether there is a relationship with the psychiatric symptoms. Ninety-one dementia patients from a geriatric psychiatry unit were surveyed for the aggressive behaviors and psychiatric symptoms by semi-structured interview with the patients and their caregivers. Major findings included that 53.8% of these patients had aggressive behaviors; these patients were older and had later onset of dementia; the presence of hallucination, misidentification and wandering were significant predictors of physical aggression; the association of aggressive behaviors with the cognitive test and delusion was not significant. These observations suggest that dementia patients have a high prevalence rate of aggressive behaviors that warrants the prevention and intervention. Hallucination, misidentification and wandering are risk factors for physical aggression and potentially trestable. Further research is needed to identify the cause and the management of aggressive behaviors in dementia patients.

Cytology of metastatic leiomyosarcoma. A case report

BACKGROUND

Metastasis of leiomyosarcoma is not uncommon. Determination of the primary site may be confused with the presenting symptoms and even the known pathology.

CASE

A 62-year-old man presented with chest pain, a productive cough and a lung mass on radiography. Fine needle aspiration of the tumor showed pleomorphic tumor cells. The patient began to have abdominal symptoms one year after presentation. Jejunal leiomyosarcoma was proven after an emergency exploratory laparotomy for mechanical ileus. Sputum cytology disclosed tumor cells one month before death. Necropsy of the lung mass demonstrated findings similar to those of the intestinal tumor microscopically.

CONCLUSION

Without laparotomy, our patient would have been diagnosed as having a primary pulmonary leiomyosarcoma by the presenting symptoms and known pathology.

Effect of orchiectomy on the alpha adrenergic contractile response of dog prostate

PURPOSE

To investigate the effect of androgen deprivation on the alpha-adrenergic contractile response of the dog prostate using both in vitro and in vivo methods.

MATERIALS AND METHODS

In vitro muscle bath study: One month after surgery, responses to KCl (120 mM.) and norepinephrine (10(-8) to 10(-3)M.) of prostatic tissue strips (of the same size) from castrated (n = 6) and sham-operated (n = 6) adult mongrel dogs were determined. In vivo study: Before and 1 month after surgery, the intraprostatic urethral pressure response to intravenous norepinephrine administration of 6 castrated and 5 sham-operated adult dogs was examined.

RESULTS

(1) Before castration the serum level of testosterone was 1.24 +/- 0.2 ng./ml.; 1 month after castration, it had dropped to an undetectable level. (2) Histological examination of the prostates from castrated animals revealed profound atrophy of glandular tissue with a relatively increased stromal tissue component in each section. (3) In vitro study: The contractile responses to KCl and norepinephrine of individual prostate strips (same size) from castrated animals were significantly higher than control. However, if the response to norepinephrine was normalized to the response to KCl, there was no significant difference in response to norepinephrine between the 2 groups. In addition, the ED50 of the norepinephrine-stimulated contractile response was not changed by castration. (4) In vivo study: There was no significant change in intraprostatic urethral pressure response to intravenous norepinephrine administration after orchiectomy.

CONCLUSIONS

The results of this study show that the sensitivity of the alpha-adrenergic contractile response of the dog prostate is not affected by androgen deprivation, nor is alpha-adrenergic contractile activity of the dog prostate regulated by androgen.

Presynaptic D2 dopaminergic receptors mediate inhibition of excitatory synaptic transmission in rat neostriatum

The effect of dopamine (DA) on excitatory synaptic transmission was studied in rat neostriatal neurons using intracellular- and whole-cell voltage clamp-recording methods. Depolarizing excitatory postsynaptic potentials (EPSPs) were evoked by cortical stimulation. Superfusion of DA (0.01-10 microM) reversibly decreases EPSP in a concentration-dependent manner and with a estimated IC50 of 0.3 microM. In addition, the inhibitory effect induced by DA at a low concentration (0.1 microM) was antagonized by sulpiride (1-10 nM), a selective D2 dopaminergic receptor antagonist. However, D1 dopaminergic receptor antagonist SKF-83566 (1-5 microM) did not affect the blocking effect by DA 0.1 microM. Based on these findings, we conclude that DA at a low concentration (< or = 0.1 microM) reduced the excitatory response of neostriatal neurons following cortical stimulation via the activation of D2, but not D1 dopaminergic receptors, located on the terminals of corticostriatal neurons.

Salmonella pericarditis and empyema: a case report

A 54-year-old female diabetic patient who had been under regular oral hypoglycemic agent control for 2 years was admitted because of having dyspnea and orthopnea for several days. Massive pericardial effusion and a moderate amount of bilateral pleural effusion were noted at the time of admission. Pericardiocentesis and thoracocentesis were performed; both cultures grew Salmonella typhimurium. Antibiotic therapy was started immediately, but pleural effusion persisted. After repeated thoracocentesis and pleural effusion drainage, the patient was discharged 51 days later with complete recovery. Pericarditis and empyema are rare complications of Salmonella infections. Coexistence is even more rare, and only three cases have been reported in the English literature. Therefore, this case is presented with a review of the previous literature followed by discussion.

Overexpression or mutation of the p53 tumor suppressor gene does not occur in malignant ovarian germ cell tumors

BACKGROUND

The p53 tumor suppressor gene has been well studied in epithelial ovarian cancers. However, little is known of the expression of this gene in ovarian germ cell tumors. The authors attempted to investigate whether p53 alterations occurred in this group of tumors.

METHODS

Twenty-two patients with malignant ovarian germ cell tumors were included in this study. Immunohistochemical staining for p53 was performed on paraffin embedded tissue of each case. Single-strand conformation polymorphism analysis of exons 4-9 of the p53 gene was performed on 9 of the 22 tumors where genomic DNAs were obtained from the frozen tissue samples. Three tumors that revealed focal p53 positivity by immunostaining were studied further with direct DNA sequencing.

RESULTS

Overexpression of p53 was not observed in all of the 22 ovarian germ cell tumors; only 3 were found to have nuclear staining in a small fraction of the malignant cells (< 5% in 1 immature teratoma, 5-10% in 2 yolk-sac tumors). Among the nine frozen tumors subjected to single-strand conformation polymorphism analysis, none revealed p53 mutation in exons 4-9. There was no p53 mutation detected by DNA sequencing of the three tumors with focal immunoreactivity.

CONCLUSIONS

Alterations of the p53 tumor suppressor gene may not be associated with the pathogenesis of ovarian germ cell tumors. Instead, genetic changes such as inactivation of other tumor suppressor genes and/or activation of some protooncogenes need to be studied to determine the genetic mechanisms of the tumor development.

Genetic regulation of shoot development in Arabidopsis: role of the EMF genes

To investigate the genetic mechanism regulating Arabidopsis shoot maturation and development, we characterized eight emf mutants that bypassed the vegetative phase of the life cycle. Genetic complementation studies identified two EMF loci; both mapped to chromosome five. Double mutant analysis showed that the early- and late-flowering mutants, co, fb, elf1, elf2, and elf3, could not rescue vegetative development in the emf mutants, confirming the need for both EMF gene activities for rosette development. A series of phenotypes involving successive loss of reproductive organs was also observed in emf single mutants, in emf1-1/emf1-2 transheterozygotes, and in emf1 emf2 double mutants, suggesting that the EMF genes not only specify the rosette (vegetative) but also are involved in inflorescence and flower (reproductive) development. Phenotypic analysis of double mutants between emf and tfl1, lfy, and ag indicated interactions between EMF and genes regulating inflorescence meristem development and floral organ identity. A model depicting the role of the EMF genes in regulating shoot maturation and their interaction with genes that affect phase transitions is presented.

Cutaneous manifestation of Kikuchi's disease: a case report

A 22-year-old male was admitted with a 1-month history of chills, fever, multiple skin eruption and painless lymphadenopathy. He has later been confirmed by typical histopathological findings to be a case of Kikuchi's histiocytic necrotizing lymphadenitis. Extranodal involvement with skin manifestation in Kikuchi's disease has rarely been reported; herein this unusual case is described.

Functional modulation of multidrug resistance-related P-glycoprotein by Ca(2+)-calmodulin

Studies with inside-out plasma membrane vesicles from multidrug-resistant (MDR 3) murine erythroleukemia (MEL/VCR-6) cells have provided evidence for down-modulation of P-glycoprotein (P-gp) function by Ca(2+)-calmodulin (CLM). These studies showed that CLM in the presence or absence of Ca2+ had no effect on binding of [3H]vinblastine (VBL) by P-gp in inside-out plasma membrane vesicles. However, profound inhibition of ATP-dependent [3H]VBL efflux by these vesicles was demonstrated by the addition of subnanomolar concentrations of CLM (IC50 = 0.15 +/- 0.02 nM). The addition of 1 microM Ca2+ reduced the inhibition of [3H]VBL efflux by CLM, shifting the concentration required for inhibition to the nM range (IC50 = 2.55 +/- 0.35 nM). The inhibition of as 0.01 mM Ca2+, and no inhibition occurred with concentrations greater than 0.2 mM Ca2+. Binding of CLM, itself, to P-gp was demonstrated in two ways. The P-gp content of detergent-solubilized plasma membrane from MEL/VCR-6 cells could be appreciably depleted by treating this material with CLM-Sepharose beads as shown by SDS-polyacrylamide gel electrophoresis (PAGE) and Western blotting with anti-P-gp antibody (C219) before and after CLM-Sepharose treatment. Also, depletion of P-gp from solution by CLM was less in the presence of 1 mM Ca2+. Blotting of P-gp after SDS-PAGE of plasma membrane from MEL/VCR-6 cells was also obtained using 125I-CLM as a probe. These results strongly suggest that the MDR 3 homolog of P-gp is a CLM-binding protein and that direct interaction of Ca(2+)-CLM with P-gp, while not affecting its binding of [3H]VBL, down-modulates the translocation of this agent in the presence of ATP.

Unusual presentation of acute abdomen in scrub typhus: a report of two cases

Two young soldiers presented with acute abdomens, then received surgical procedures under initial impression of acute cholecystitis and acute appendicitis respectively. Operative findings did not confirm the initial diagnosis, and the clinical condition did not improve after operation. Scrub typhus was suggested later by clinical manifestations of fever, chills, headache, lymphadenopathy, skin rash and presence of eschar formation; this diagnosis was finally confirmed by positive serologic results of high Weil-Felix OXK agglutination and/or Rickettsia tsutsugammushi immunoflorescence titers in paired sera. Both patients rapidly became afebrile after administration of tetracycline. This unusual presentation with acute abdomen in scrub typhus is emphasized, with caution that the possibility of scrub typhus should be taken considered, especially in patients coming from hyperendemic areas.

Long-term disease-free survival after autologous bone marrow transplantation in a primary plasma cell leukaemia: detection of minimal residual disease in the transplant marrow by third-complementarity-determining region-specific probes

Primary plasma cell leukaemia (PPCL) is a rare form of plasma cell neoplasm. Treatments of PPCL have been most disappointing. A patient with PPCL received high-dose melphalan plus total body irradiation and autologous bone marrow transplantation (ABMT). By using third-complementarity-determining region (CDRIII)-specific probes, minimal residual disease (MRD) was detected in remission marrow, collected 1 month before ABMT. MRD was no longer detected by CDRIII-specific probes 6, 19 and 26 months after transplantation. The patient remained in complete remission up to 59 months after ABMT.

Frequency distribution of hypervariable VNTRs in Apo B, HVR-Ig and COL2A1 loci in Taiwan: forensic application

By use of a simple, rapid and reliable polymerase chain reaction (PCR)-based method, we analyzed three hypervariable tandem repeats in the 3'-Apo B, 5'-HVR-Ig and 3'-COL2A1 loci. As accurate data of allele frequency of genetic markers is a prerequisite for forensic application, the allele frequency distribution of the three variable number of tandem repeats (VNTR) among the Chinese population in Taiwan were studied. In a total of 123 unrelated Chinese subjects, the Apo B VNTR demonstrated a heterozygosity of 68.2% with 9 alleles, 0.85 of the power of discrimination (PD) value and 0.74 of the allelic diversity (h) value. In a sample of 103 unrelated Chinese subjects, the COL2A1 VNTR showed 49.0% heterozygosity with six alleles, 0.79 of the PD value and 0.74 of the h value. In 106 unrelated subjects, the HVR-Ig VNTR showed 47.4% heterozygosity with seven alleles, 0.79 of the PD value and 0.59 of the h value. The data obtained in this study are not only useful for forensic identification, but will also be helpful for paternity testing, genetic linkage studies and the identification of the three VNTR loci associated with human genetic diseases. Some verifying examinations for the validity and reliability of the three VNTR were performed. The high sensitivity and inexpensive nature of this approach make it superior to the traditional method of DNA fingerprinting for forensic typing. With the use of this PCR-VNTR system, many forensic cases have been successfully identified. The value of this system is illustrated in the investigation of a rape and murder case.

Flow chart HLA-DQA1 genotyping and its application to a forensic case

The detection of genetic polymorphism has become increasingly important in forensic science as well as in medical genetics. In this report, we describe a systematic flow chart system for HLA-DQA1 genotyping by an improved PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) method coupled with the PRSM (PCR-mediated restriction site modification) method. This flow chart typing system can easily discriminate between a total of eight reported DQA1 alleles commonly found in Chinese. We have applied this flow chart typing system in a forensic case as well as in the determination of the frequencies of the eight DQA1 alleles in 121 unrelated Taiwan Chinese subjects. Our results show that the flow chart DQA1 genotyping is a simple, fast, and accurate system which, in the future, may be considered as an alternative method for routine individual identification in forensic casework, and for paternity testing and tissue typing in medical genetics.

Hepatic dysfunction in scrub typhus

Scrub typhus is an acute febrile illness that generally causes non-specific symptoms and signs of which fever is the most common. It is one of the causes of "fevers of unknown origin" in the Asia-Pacific region. The relationship between hepatic dysfunction and scrub typhus has been given little attention in the literature. From 1982 to 1993, 47 patients diagnosed with scrub typhus at Tri-Service General Hospital, Taipei, were studied, with attention being given to hepatic dysfunction. The medical records of these patients were reviewed thoroughly. Hepatic dysfunction occurred in 77% (36/47) of patients. Among the liver function parameters, the percentage of abnormality was 74.5% for aspartate aminotransferase, 74.5% for alanine aminotransferase, 57.4% for alkaline phosphatase, 44.7% for lactate dehydrogenase and 44.7% for serum bilirubin. Six patients presented with a picture of true hepatitis similar to acute viral hepatitis. The results indicate that hepatocellular damage does occur in scrub typhus, and is perhaps, more common than previously realized. We recommend that the differential diagnosis of patients from high-risk groups and endemic areas who present with hepatitis-like symptoms should include examination for scrub typhus.

[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.

Effect of pilocarpine on anterior chamber angles

Pilocarpine is widely used in the treatment of glaucoma, especially for the acute form of angle-closure glaucoma. Previous studies have shown that pilocarpine decreases central anterior chamber depth. In the present study, a quantitative measurement method, applying Scheimpflug photography, was used to report whether pilocarpine also affected the anterior chamber angles. Twenty-nine normal Chinese subjects, 17 female and 12 male with an age range from 11 to 63 years old, were enrolled. One eye of each subject was treated with one drop of 2% pilocarpine. Photographs of each of four quadrants were taken prior to, and after, pilocarpine treatment in both eyes, using a rotating slit-lamp video camera based on the Scheimpflug principle. The slit beams were set at 0 degrees and 90 degrees. The eyes which did not receive pilocarpine treatment served as control. The angles of the four quadrants were calculated for both eyes both prior to, and after, pilocarpine treatment, and results were compared by Student's paired t-test. The comparison of angles between the eyes prior to, and after, pilocarpine treatment indicated that there is a significant narrowing of angles in all quadrants. The complex factors involved in the change of anterior chamber angle are reviewed in the light of muscarinic action of pilocarpine.

Blood flow of the urinary bladder: effects of outlet obstruction and correlation with bioenergetic metabolism

This study investigated the effects of outlet obstruction on blood flow and high energy phosphates content in the rabbit urinary bladder. Mild bladder outlet obstruction was induced by placing a silicon ring (diameter 7 mm) around the bladder neck of each male New Zealand White rabbit (n = 7). Before and immediately after inducing obstruction, and 2 weeks later, the bladders were emptied and regional blood flow measured using laser Doppler flowmetry (LASERFLO BPM2, Vasamedics Inc., St. Paul, Minnesota). Six different areas of each bladder were measured, and the average blood flow calculated for each rabbit. Then, the animals were sacrificed, the bladder excised, and the tissue content of high energy phosphates determined by high performance liquid chromatography (HPLC). Six normal male New Zealand White rabbits served as controls. The results can be summarized as follows: (1) Before surgery, bladder blood flow was similar in all animals (16.3 ml/min/100 g); positioning the silicon ring around the bladder neck did not affect blood perfusion, two weeks after the induction of outlet obstruction, bladder blood flow was significantly decreased (4.9 ml/min/100 g). (2) There was no significant difference between control and obstructed bladders in NAD, AMP, or ADP content. However, the obstructed bladders contained significantly less phosphocreatine (12.0 vs 21.9 nmol/mg protein) and ATP (4.0 vs. 6.1 nmol/mg protein) than control bladders. In summary, this study showed that urinary bladder blood flow was reduced by outlet obstruction, and the reduction in blood flow was associated with decreased tissue high energy phosphates content.(ABSTRACT TRUNCATED AT 250 WORDS)

Enterococcal bacteremia in a medical center

BACKGROUND

The enterococci have become important nosocomial pathogens. They can cause multiple site infections and enterococcal bacteremia becomes more frequently associated with a high mortality rate. Previous studies of enterococcal bacteremia showed a variety of results. To establish the significance and importance of enterococci as nosocomial pathogens in this hospital, to characterize their clinical pictures and to search for the risk factors for mortality, this retrospective study was performed.

METHODS

There were 208 cases of enterococcal bacteremia which occurred from 1988 to 1992. Twenty-seven cases had no medical charts, dismissing possibility of evaluation. Finally, 181 cases of enterococcal bacteremia were analysed.

RESULTS

One hundred and eighteen episodes were nosocomial infections. Polymicrobial bacteremia occurred in 68.5% of the patients and the most common co-isolate was Pseudomonas aeruginosa. Those patients (78.5%) with underlying diseases and malignancies were the most common underlying problems. The portal of entry could be found in 69.6 percent of patients, with the gastrointestinal tract the most common sources. Antimicrobial susceptibility testing showed high gentamicin resistance rate (89.5%), and ampicillin still had about 80 percent sensitivity rate. The group who received specific antibiotic therapy for enterococcus showed lower mortality (36.4% versus 47.6%). Only one case had infective endocarditis. Forty-nine patients suffered from septic shock, the cause of 30 deaths. Totally 75 patients died during hospitalization. Besides sepsis, another major cause of death was their underlying diseases itself.

CONCLUSIONS

Enterococci have no doubt become important nosocomial pathogens and enterococcal bacteremia were associated with high mortality, especially in elderly patients with underlying diseases such as malignancy or diabetes. When clinically dealing with sepsis from the gastrointestinal or biliary tract, especially when previous cephalosporins therapy showed no response, the possibility of enterococcal bacteremia should always be considered.

Mixed cellular population in primary and metastatic periampullary adenocarcinoma of the duodenum: report of a case

There are numerous reports on the mixed cellular population of primary tumors, especially in the gastrointestinal tract. However, reports of mixed cellular population in metastatic foci are rare. This is a report of a case of periampullary papillary adenocarcinoma of the duodenum with 4 types of cellular population. Metastases to the regional lymph nodes also contained 4 different cell types. The histogenesis of the mixed cellular population in the primary tumor and theories proposed to explain the pathophysiologic mechanisms of mixed cellular population in the metastatic foci are discussed.

Mutational effects of space flight on Zea mays seeds

The growth and development of more than 500 Zea mays seeds flown on LDEF were studied. Somatic mutations, including white-yellow stripes on leaves, dwarfing, change of leaf sheath color or seedling color were observed in plants developed from these seeds. When the frequency of white-yellow formation was used as the endpoint and compared with data from ground based studies, the dose to which maize seeds might be exposed during the flight was estimated to be equivalent to 635 cGy of gamma rays. Seeds from one particular holder gave a high mutation frequency and a wide mutation spectrum. White-yellow stripes on leaves were also found in some of the inbred progenies from plants displayed somatic mutation. Electron microscopy studies showed that the damage of chloroplast development in the white-yellow stripe on leaves was similar between seeds flown on LDEF and that irradiated by accelerated heavy ions on ground.

Purification and characterization of beta-glucuronidase from bull seminal plasma and its role in fertilization

Bull seminal plasma contains high levels of beta-glucuronidase. The present study describes the isolation and characterization of beta-glucuronidase, and its role in fertilization. beta-glucuronidase was purified by ion exchange chromatography, saccharolactone-agarose affinity chromatography, and gel filtration. The specific activity of the purified enzyme was 4,414 mumoles/mg protein/min. The purified enzyme showed a single band on 7.5% PAGE. On SDS-PAGE, the enzyme appeared to consist of four identical subunits of M(r) 75,000 each. The apparent Km and Vmax for beta-glucuronidase were 0.4 mM and 5.7 mumol/min using phenolpthalein mono-beta-glucuronic acid as the substrate. beta-glucuronidase appeared to accelerate the cumulus dispersion in vitro.

Severe isolated acute hepatic graft-versus-host disease with vanishing bile duct syndrome

A 28-year-old man with chronic myelogenous leukaemia in blastic transformation underwent allogeneic bone marrow transplantation from his HLA-identical brother. Severe, progressive cholestatic jaundice developed from day 25 and did not respond to repeated therapy with high-dose methylprednisolone. In addition to marked cholestasis, both liver biopsy (day 69) and autopsy (day 134) findings revealed total disappearance of interlobular bile ducts in all of the portal areas, although extrahepatic manifestations of GVHD were minimal. Isolated acute vanishing bile duct syndrome can occur as the most severe form of acute hepatic GVHD.

Ethnic variation in the CYP2E1 gene: polymorphism analysis of 695 African-Americans, European-Americans and Taiwanese

Human cytochrome P4502E1 (CYP2E1) is inducible by ethanol and is involved in metabolism of many known carcinogens including N-nitrosodimethylamine, butadiene, benzene, and carbon tetrachloride. A 50-fold variability in CYP2E1 enzyme activity in humans has been observed but it is unknown whether the basis for this variation is genetic or environmental. Recently, two restriction fragment length polymorphisms (RFLPs) within the CYP2E1 gene have been suggested as genetic markers of risk for cancer. The first was a Rsa I polymorphism in the 5' regulatory region that appeared to alter transcriptional activation of the gene and the second was a Dra I polymorphism located approximately 7000 bp downstream in an intron. Rare alleles at each of these loci have been associated with a reduced risk for lung cancer in Japanese and Swedish populations. We have used a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method to determine the genotype frequency for each of these CYP2E1 RFLPs in 695 individuals of Taiwanese, African-American or European-American background. Genotype and allele frequencies for Taiwanese were significantly different from those of African-Americans and European-Americans at either Rsa I or Dra I sites (p < 0.0001). Allele frequencies for African-Americans and European-Americans were significantly different at the Rsa I site (p = 0.03). The rare alleles (c2 and C) occurred at frequencies of 0.28 and 0.24 in Taiwanese, 0.01 and 0.08 in African-Americans, and 0.04 and 0.11 in European-Americans. In addition, we describe three haplotypes common to all three population samples and a fourth haplotype that was only detected in the Taiwanese population sample. This fourth haplotype may have been caused by a recombination event between these markers.(ABSTRACT TRUNCATED AT 250 WORDS)

Concomitant chemoradiotherapy for advanced epidermoid carcinoma of the uterine cervix: a preliminary report

BACKGROUND

Because the prognosis of advanced carcinoma of the uterine cervix is poor, and has improved very little in the last 20 years, a prospective study was initiated to evaluate the feasibility, response and toxicities of concomitant chemoradiotherapy for such cervical cancer.

METHODS

From May 1992 to December 1992, 22 patients entered the study, 21 of them completed the entire treatment. Their ages ranged from 47 to 72 years, median 57. There were 16 FIGO stage IIIB, and 5 stage IIB. Radiotherapy was administered using 1.8 Gy/day, five days a week, to the whole pelvis (50.4 Gy/28 fractions) with or without parametrial boost according to the tumor response. Intracavitary brachytherapy 5 Gy x five to six times was given after one or two weeks of rest. Chemotherapy consisted of etoposide 100 mg/m2 day 1 + cisplatin 50 mg/m2 day 1 + bleomycin 25 mg/m2/day day 2-3, repeated every two weeks during external irradiation.

RESULTS

All 21 eligible patients achieved complete response, sustaining during a median follow-up time of 12 months. All the initially elevated tumor markers (SCC, CEA, CA-125) returned to normal range after treatment. The toxicity was well tolerated.

CONCLUSIONS

Concomitant chemoradiotherapy for advanced cervical carcinoma is both feasible and effective, with acceptable toxicities. Long-term follow-up is mandatory, and a randomized trial to confirm the superiority of this protocol will be started soon.

Neurological complications of varicella: a report of two cases

Varicella (chickenpox) is the primary infection of Varicella-Zoster virus, characterized by generalized vesicular eruption, fever and mild constitutional symptoms. Chiefly infecting children of 1 to 14 years of age, the disease has been almost neglected because of its inevitable and benign outcome. Adults are rarely infected with an incidence of less than 20%. These two cases are presented of normal adults with marked neurological complications 10 and 14 days, respectively, following typical skin eruption of varicella. The first case developed transverse myelitis and the second, an encephalomyelitis. Neurological complications are very rare post-varicella infection. Although prognosis is good and complete recovery is the rule, still some morbidity with neurological sequelae and mortality have been reported. The present cases had extensive neurological deficit, despite aggressive treatment, making a high index of suspicion for differential diagnosis in patients who present with encephalitis. Especially following the typical exanthema of varicella, this possibility is emphasized and the literature is reviewed.