Proposed New Electrolytic Conductivity Primary Standards for KCl Solutions

An absolute determination of aqueous electrolytic conductivity has been made for 0.01 molal (m) and 0.1 m potassium cliloride solutions, over the temperature range of 0 to 50 °C in 5 degree intervals. A cell with a removable center section of accurately known length and area was used for the measurements. Values were adjusted to be in conformity with the ITS-90 temperature scale. The overall uncertainty over the entire temperature range is estimated to be 0.03%. Values at 25 °C for 0.01 and 0.1 m are 0.00140823 and 0.0128246 S/cm, respectively. It is proposed that these values be adopted as primary standards for aqueous electrolytic conductivity, replacing the demal scale.

Familial patent ductus arteriosus. Report of a family

Three female patients of two generations in one family each had patent ductus arteriosus (PDA) that was proved by echocardiography and cardiac catheterization. Two of them received surgical ligation of the PDA because of large left to right shunt (Qp/Qs of 3.8 and 2.7, respectively), while the third patient with a Qp/Qs of 1.2 was not operated. Although the exact cause of PDA in this family is unclear, an autosomal recessive inheritance is highly possible.

Strong association of HLA-DRw9 in Chinese patients with recurrent oral ulcers

The frequency of HLA-DR and -DQ antigen occurrence was investigated in 80 Chinese patients with recurrent oral ulcers and 107 matched healthy control subjects of the same ethnic group. No significant differences in the presence of HLA-DQ antigens were found. However, the HLA-DRw9 antigen occurs more frequently in patients with recurrent oral ulcers (p less than 0.0001, corrected p less than 0.005) and may be considered as a genetic marker of the disease in the Chinese population.

Efficacy of ciclopiroxolamine 1% cream in onychomycosis and tinea pedis

Ciclopiroxolamine is now under use as an antifungal agent for about a decade. Its activity is well-known in moderate climates, but there is a lack of knowledge on the activity in tropical and subtropical areas. 49 patients suffering from onychomycosis (42) and/or tinea pedis (33) were enrolled in a clinical trial in Taiwan. The patients received ciclopiroxolamine 1% cream 2-3 times a day for 3 to 24 month. In addition, infected nails were filed to facilitate drug penetration. In onychomycosis, 14% of the patients were cured and another 36% improved. One patient relapsed after 10 months. Cure was achieved more easily, if there were only modest alterations of the nail plate. With respect to tinea pedis the results were more favourable, the cure rate was 42%, another 45% of the patients improved. Following this dosage regimen, side effects did not occur. The results show onychomycosis to be highly resistant to antifungal therapy, perhaps even more as compared to tinea pedis in temperate climates. The good tolerability favours topical ciclopiroxolamine for this recalcitrant disease.

Cryofibrinogenemia: report of a case

Cryofibrinogenemia, a rare disease, is diagnosed by the presence of reversible cryoprecipitate in plasma, which may cause various clinical manifestations of thromboembolic or hemorrhagic disorders. A 66-year-old female patient suffered from recurrent reticulate erythema, purpura and gangrene on the distal portion of the extremities and face during the winter for 5 years. Cryofibrinogenemia was proven with the following evidences: (1) Histopathologic findings revealed many eosinophilic cylinders, about 6-9 microns in diameter, deposited within the lumen of the blood vessels in the dermis and subcutaneous tissue. There was no evidence of vasculitis. These cylinders were fibrinogen in nature, as proven by direct immunofluorescence. (2) Cryofibrinogen was detected in the citrated plasma, which was confirmed by double immunodiffusion, the presence of an IgG-kappa M protein was also revealed by immunofixation. Debridement and skin grafts were performed, and prednisolone combined with cyclophosphamide were given. Skin lesions improved without recurrence, and the "cryocrit" decreased from 13.6% to less than 2% during the follow up. We conclude that if there is any case with the similar cutaneous manifestations, cryofibrinogenemia should be considered.

Long-term hemodynamic results of percutaneous transvenous mitral commissurotomy in rheumatic mitral stenosis with pliable, non-calcified valves

Percutaneous transvenous mitral commissurotomy (PTMC) for severe, symptomatic mitral stenosis was successfully performed in 47 of 50 patients with pliable, non-calcified valves. The procedure resulted in immediate hemodynamic and sustained clinical improvements in all patients. Repeat cardiac catheterization was performed in 22 patients at a mean follow-up period of 15 months (range 12 to 29). The patients were similar to the other 25 patients in regard to gender, age, clinical and hemodynamic characteristics. There were 4 males and 18 females with a mean age of 37 years (range 20 to 61). Immediately after PTMC, there were significant increases in the mitral valve area (1.0 +/- 0.2 to 2.4 +/- .9cm2, p less than 0.001) and cardiac index (3.1 +/- 0.7 to 3.3 +/- 0.7 l/min/m2, p less than 0.05) and significant (p less than 0.001) decreases in the left atrial pressure (25.7 +/- 6.4 to 13.2 +/- 3.9 mmHg), the mitral valve gradient (15.7 +/- 5.7 to 3.9 +/- 1.4 mmHg), mean pulmonary arterial pressure (41.5 +/- 10.7 to 29.2 +/- 10.9 mmHg) and the pulmonary vascular resistance (4.2 +/ 3.4 to 3.5 +/- 2.9 Wood unit). At follow-up study, the mitral valve area (2.2 +/- 0.7 cm2) and the left atrial pressure (12.6 +/- 3.7 mmHg) remained unchanged. There were further decreases in the mean pulmonary arterial pressure (22.4 +/- 5.9 mmHg, p less than 0.05) and the pulmonary vascular resistance (2.0 +/- 1.5 Wood unit, p less than 0.05). There were significant (p less than 0.05) increases in the mitral valve gradient (6.6 +/- 2.5 mmHg) and the cardiac output (3.6 +/- 0.7 l/min/m2).(ABSTRACT TRUNCATED AT 250 WORDS)

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

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

Growth and characterization of normal human keratinocytes in F12 serum-free medium

In a F12 medium supplemented with epidermal growth factor (20 ng/ml), insulin (5 micrograms/ml), transferrin (5 micrograms/ml), hydrocortisone (1 microM), cholera toxin (40 ng/ml), endothelial cell growth supplement (15 ng/ml) and retinoic acid (1 x 10(-7) M) on Vitrogen coated culture dishes, normal adult and newborn human foreskin keratinocytes were cultured for 4- and 2-time with population doublings (PD) accumulated as 8 and 12, respectively. The cells grown in this medium possessed a basaloid, undifferentiated and hyperproliferating nature, with a population doubling time of about 24 hours at early passage. Between the 1st and 2nd subcultures, cell proliferation was the most active. Delaying the time of first subculture lowered the rate of cell proliferation. The keratin of the cultured cells was studied by immunoblotting and revealed the presence of permanent keratin markers of the human skin (AE1 50 kDa and AE3 58kDa) as well as a relatively high intensity of a proliferating marker (AE1 48 kDa) and a relatively low intensity of a differentiation marker (AE3 67 kDa).

Dermatological findings in children exposed transplacentally to heat-degraded polychlorinated biphenyls in Taiwan

We studied 128 children who were transplacentally exposed to polychlorinated biphenyls and dibenzofurans in Taiwan, their parents and siblings who were directly exposed, and 115 control children. Direct exposure of the mothers stopped in 1979 and the children were born as late as 1985. At birth, exposed children had increased rates of hyperpigmentation, eyelid swelling and discharge, deformed nails, acne, natal teeth and swollen gums compared to controls. On examination, they had a much higher rate of dystrophic finger-nails and pigmented or dystrophic toe-nails than controls. They also had an increased rate of hyperpigmentation and acne. In addition they had more generalized itching, localized skin infections and hair loss. The findings seen in transplacentally exposed children differ from those seen in people directly exposed, particularly in the latter group in higher prevalence of acne.

Hemodynamic and clinical efficacies of catheter balloon percutaneous transvenous mitral commissurotomy: experience of 100 patients with rheumatic mitral stenosis

From January 1987 to December 1988, 100 patients with symptomatic severe rheumatic mitral stenosis underwent percutaneous transvenous mitral commissurotomy (PTMC). The patients included 32 males and 68 females, aged 19-71 years (mean of 41). Mild mitral regurgitation (grade 1 or 2) was present in 23 patients and a history of thromboembolism in 12. One patient had had mitral restenosis after surgical open mitral commissurotomy 9 years earlier. The mitral valve was successfully dilated in 97 patients. PTMC resulted in immediate improvements in hemodynamic measurements. The left atrial pressure decreased from 24.5 +/- 5.3 to 14.8 +/- 5.2 mmHg (p less than 0.001), the mean mitral transvalvular gradient from 13.8 +/- 4.8 to 5.0 +/- 2.8 mmHg (p less than 0.001), and the mean pulmonary artery pressure from 38.8 +/- 12.0 to 30.6 +/- 10.3 mmHg (p less than 0.001). The mitral valve area increased from 1.1 +/- 0.3 to 2.2 +/- 0.8 cm2 (p less than 0.001). The cardiac output increased from 4.5 +/- 1.2 to 4.84 +/- 1.2 L/min (p less than 0.05). The right atrial pressure did not change significantly after PTMC (6.5 +/- 3.8 vs 6.4 +/- 4.0 mmHg). The mitral valve area measured by 2-D echocardiograms increased from 1.04 +/- 0.48 to 1.88 +/- 0.66 cm2 after PTMC (p less than 0.001). All 97 patients were followed for 6-24 months (median of 13) after the PTMC. After an initial recovery period of 1-2 weeks, all patients reported improvements in symptoms and in New York Heart Association (NYHA) functional class by at least one class. A comparison between treadmill exercise test durations before, and 3 months after PTMC, showed an increase from 9.1 +/- 4.3 to 15.4 +/- 3.8 minutes (n = 60; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Dysvascular amputee rehabilitation. The role of continuous noninvasive cardiovascular monitoring during physical therapy

Recognition of cardiac problems and their impact on the treatment of dysvascular amputees is important during rehabilitation because the energy demands and cardiac work loads of functional activities are substantially greater when performed by persons with amputation than when performed by control subjects. For this reason, monitoring the cardiovascular response to therapeutic exercise might be expected to enhance the medical and rehabilitative management of dysvascular amputees. In the present study, 31 amputees with peripheral vascular disease underwent continuous noninvasive dynamic cardiovascular monitoring during an initial physical therapy session. The sample had a mean age of 65 yr. There were 20 females. Twenty patients had unilateral below knee amputation. Fifty-two percent had a preamputation history of cardiac disease and six experienced major cardiovascular complications during rehabilitation. After a mean acute hospitalization of 20 days and a mean rehabilitation stay of 36 days, 11 patients were walking independently and 25 were discharged to home. During the monitored physical therapy session, patients achieved a mean maximum heart rate of 113 beats/min, mean maximum blood pressure of 159/81, mean maximum rate-pressure product of 14,546, and mean percent of age-predicted maximal heart rate of 73%. Seventeen (55%) patients demonstrated abnormalities during the monitored session, four of whom had no prior history of heart disease. These changes consisted predominantly of ST-T segment abnormalities, but also included exercise-induced arrhythmias and decreases in blood pressure. Patients with a history of heart disease demonstrated significantly more abnormalities during the monitored session than did those without a history of heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Inhibitory effects of isoquinoline-type alkaloids on leukemic cell growth and macromolecule biosynthesis

A number of benzylisoquinoline alkaloids of plants indigenous to Taiwan were isolated and purified and their chemical structures were determined. These compounds, namely benzyltetrahydroisoquinolines or their N-oxides, aporphines, oxoaporphines and 1-N, N-dimethylaminoethylphenanthrenes or their N-oxides, were studied for their potency in inhibiting precursor incorporation into DNA, RNA and protein. Inhibition of murine leukemic L1210 and human leukemic CCRF-CEM and HL-60 cell growth was also examined. Of the compounds evaluated for cell growth inhibition, (+-)-N-methylcoclaurine(3), (-)-norannuradhapurine HBr(19), oxoglaucine (23), dicentrine methine (27) and 1-(N-methyl-N-hydroxyaminoethyl)-3, 4-methylenedioxy-7-methoxyphenanthrene (28) showed an IC50 less than 10 microM.

The subtypes, distribution and location of human papillomavirus DNA in genital warts and genital Bowen's disease--a study using in situ DNA.DNA hybridization

The aim of this study is to investigate the difference in subtypes and distribution of human papillomavirus (HPV) between the benign pathological condition- Genital wart (condyloma acuminatum, verruca- like lesion and papular lesion) and genital Bowen's disease (Bowenoid papulosis, Mollucum contagiosum with Bowenoid papulosis and Condyloma acuminatum with verruca- like lesion and pathological bowenoid change) of genitalia by in situ DNA.DNA hybridization. In situ DNA.DNA hybridization was performed by hybridizing the RNAse treated and denatured frozen skin section with 3H-labeled HPV 6, 11, 16 and 18-DNAs probes and then developed autoradiogram on a glass slide. The results reveal that: (1) The benign cases are strongly associated with HPV 6/11, while the bowenoid cases are associated with HPV 16/18, indicating 16 positive in 24 cases and 3 positive in 5 cases respectively; (2) Four of sixteen benign cases were doubly infected with HPV 6/11 and 16/18; and 2 of 2 bowenoid cases were infected with HPV 16/18 only (3) In benign cases, HPV distributes through the upper third of epidermis and in bowenoid cases, HPV scatters throughout the whole epidermis including parabasal layers. These findings may indicate that the subtypes of HPV, the interaction of weak oncogenic virus (HPV 6/11) and strong oncogenic virus (HPV 16/18) and the presence of HPV on proliferating cells (parabasal layers) all play a part in oncogenicity. The detectability of HPV 6/11 DNA in both the nucleus and cytoplasm indicate that: 1). In situ DNA.DNA hybridization is a more sensitive method than the immunological detection of capsid antigen. 2). In addition to the nucleus, the cytoplasm is a site through which HPV 6/11 virus should pass during their life cycle. Using PEG hybridization mixture, it was revealed that 6 of the 6 HPV 6/11 positive condyloma acuminata harbored HPV 6. This result indicates that the subtype of HPV determine the gross morphology of skin lesion.

Antiplatelet effects of protopine isolated from Corydalis tubers

Protopine inhibited the aggregation and ATP release of rabbit platelets induced by ADP, arachidonic acid, PAF, collagen and ionophore A23187. Although the platelet aggregation caused by thrombin was not inhibited by protopine (100 micrograms/ml), the release reaction was partially suppressed. In rabbit platelet-rich plasma, protopine also inhibited the platelet aggregation caused by ADP, arachidonic acid, PAF and collagen. The thromboxane B2 formation of washed platelets caused by arachidonic acid, collagen, ionophore A23187 and thrombin was suppressed by protopine. Protopine inhibited the intracellular calcium increase caused by arachidonic acid in quin-2/AM loaded rabbit platelets. In the presence of indomethacin, the intracellular calcium increase caused by collagen and PAF was completely suppressed by protopine, and the intracellular calcium increase caused by thrombin was partially inhibited. The phosphoinositides breakdown caused by collagen and PAF was inhibited by protopine, but that by thrombin was not affected significantly. Protopine did not cause the elevation of cyclic AMP level of platelets. It is concluded that the antiplatelet effects of protopine is due to inhibition on thromboxane formation and phosphoinositides breakdown and then lead to the decrease of intracellular calcium concentration.

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

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

Cytotoxic isoquinoline alkaloids from Xanthorhiza simplicissima

Two cytotoxic isoquinoline alkaloids, liriodenine and palmatine, were isolated from the Xanthorhiza simplicissima Marsh. Liriodenine, isolated for the second time from the family of Ranunculaceae, demonstrated potent cytotoxicity against KB, A-549, HCT-8, P-388, and L-1210 tumor cells, while palmatine showed marginal cytotoxicity against KB cells.

Anti-mucosal antibodies in recurrent aphthous ulcers

Using indirect immunofluorescent antibody technique, anti-mucosal antibodies were evaluated in single or sequentially multiple sera from 21 patients with recurrent aphthous ulcers (RAU), 41 age/sex-matched healthy subjects, and 40 patients with miscellaneous oral mucosal diseases. Although anti-mucosal antibodies were found widely distributed in patients having oral mucosal diseases, there were significantly higher rates of positive anti-mucosal antibodies (15/21, 71%) and circulating intercellular substance (ICS) antibodies (14/21, 67%) in RAU patients as compared with either the healthy subjects or patients with miscellaneous oral mucosal diseases. Circulating ICS antibodies of IgG class were found to be significantly predominant in the active phase of 67% (14/21) RAU patients. The percentage decreased in the order of 25% (4/16) in the remission phase of one week, and to 10% (1/10) in the remission phase of two weeks. The presence of pemphigus-like antibodies might be elicited by the epidermal occult antigens released from damaged tissue and/or due to the transient immunoregulatory dysfunction caused by certain infectious agents.

Congenital poisoning by polychlorinated biphenyls and their contaminants in Taiwan

In 1979, a mass poisoning occurred in Taiwan from cooking oil contaminated by thermally degraded polychlorinated biphenyls. Because these chemicals persist in human tissue, children born to female patients after the outbreak were exposed in utero. In 1985, 117 children born to affected women and 108 unexposed controls were examined and evaluated. The exposed children were shorter and lighter than controls; they had abnormalities of gingiva, skin, nails, teeth, and lungs more frequently than did controls. The exposed children showed delay of developmental milestones, deficits on formal developmental testing, and abnormalities on behavioral assessment. These findings are most consistent with a generalized disorder of ectodermal tissue. This syndrome is one of very few documented to result from transplacental exposure to pollutant chemicals.

Treatment of leachate from a solid waste landfill site using a two-stage anaerobic filter

Raw leachate was treated using a two-stage upflow anaerobic filter process. Leachate from a solid waste landfill site, which received both municipal and industrial wastes, contained high organic matter (17-21 g/L COD, 13-14 g/L BOD, and 3.5-4.6 g/L volatile acids), and low metal (Zn and Fe) concentrations. Depending on sampling time, leachate composition and characteristics varied considerably. At an organic loading up to 4 g COD/day(2) media area, the BOD and COD removal percentages were 98 and 91%, respectively. The biofilters were also effective for metal removal. However, the filter effluent contained a high concentration of ammonia. System overloading was characterized by the accumulation of large quantities of volatile acids and by a now ratio of alkalinity/volatile acids, resulting in low COD removal and reduced gas production. Once the first filter was upset, the second stage could only partially respond to the volatile acids accumulated in the effluent of first filter.

Functional skills after spinal cord injury rehabilitation: three-year longitudinal follow-up

Reports that spinal cord injury (SCI) patients maintain or improve functional abilities after initial rehabilitation have been limited by small sample size, inadequate functional measures, cross-sectional assessment at only one point in time, and lack of detailed statistical analysis. This study evaluated the follow-up functional status levels of 236 patients with traumatic SCI who completed comprehensive inpatient rehabilitation and were also followed for three years. The sample population was 83% men, with a mean age of 27.0 years. The 100-point Modified Barthel Index (MBI) was used to assess functional abilities. The 75 patients with complete quadriplegia had mean MBI scores of 30.3 at rehabilitation discharge and 37.8 at three-year follow-up. The 53 patients with incomplete quadriplegia were discharged with a mean MBI score of 53.8, and scored 68.3 at three-year follow up. The mean MBI scores for the 66 patients with complete paraplegia were 72.0 at discharge and 75.6 at three-year follow-up. The 42 patients with incomplete paraplegia had mean MBI scores of 77.0 at discharge and 86.1 at three-year follow-up. Each of the four groups demonstrated stability or increases in the proportions of patients who were independent in performance of each of the 14 MBI component tasks from discharge to follow-up. The finding that SCI patients, in this large series, maintained or improved functional levels for three years after discharge is consistent with previous studies and is reassuring to rehabilitation providers.

Waldenstróm's macroglobulinemia with peripheral neuropathy--the role of IgM M-protein in autoimmune mechanism

A total of 11 cases of Waldenstróm's Macroglobulinemia (WM) have been investigated to study the association of the disease with neuropathy. A 53-year-old female patient (Wu) had a pronounced peripheral neuropathy, in which the role of IgM M-protein could be observed. Sections of Wu's biopsied sural nerve were subjected to light and electron microscopy and direct immunofluorescence (IF). Myelin degeneration with axonal change was found, while fluorescence reaction occurred in epineurium only. Sections of a healthy dog's sciatic nerve were submitted to purified IgM M-proteins from Wu and another WM patient (Kon) without neuropathy, respectively. Indirect IF showed a deposit of fluorescence on the myelin sheath by Wu's, but not by Kon's, M-proteins. It is proposed that an autoimmune mechanism underlies the peripheral neuropathy in the WM patient.

Lymphocyte function in patients with recurrent aphthous ulcers

Lymphocyte proliferation (LP) responses to mitogens: phytohemagglutinin (PHA), concanavalin A (ConA) and pokeweed mitogens (PWM) were studied in 17 patients with recurrent aphthous ulcers (RAU) of minor type (MiAU) and 20 age/sex-matched healthy subjects. RAU patients elicited normal T-cell and B-cell responses to mitogens in comparison with healthy subjects. Proliferative responses were neither enhanced during active episodes of oral ulceration nor suppressed during periods of remission. It seems unlikely that non-specific lymphocyte dysfunction plays a major role in the pathogenesis of RAU.

Study of peripheral T-cell subpopulations and lymphocyte proliferation in different phases of evolution of alopecia areata

The current hypothesis on the pathogenesis of alopecia areata is immunologically mediated, yet no conclusive data has been documented. To clarify the changes in various phases of disease evolution, analysis of T lymphocyte subpopulations was carried out in the peripheral blood of 34 patients and 27 healthy normal subjects by means of OKT-3, OKT-4, OKT-8 and Ia1 monoclonal antibodies. Study of lymphocyte proliferation in response to various mitogens was further carried out in 27 patients and 25 healthy normal subjects. Significant predominance (p less than 0.01) of OKT-8 positive (cytotoxic/suppressor) cells and diminution (p less than 0.01) of Ia1 positive cells were noted in the whole alopecia group and in various subgroups of disease evolution. Since diminution (p less than 0.05) of OKT-4 positive (inducer/helper) cells was also noted in the stable phase, it was postulated that these activated T cells migrated from circulation to the local site of primary event. Hence, it was evident that the predominance of cytotoxic/suppressor cells was a relative change, and the role of inducer/helper cells in the pathogenesis was implicated. No enhancement of lymphocyte proliferation was observed.

Benefits of rehabilitation for traumatic spinal cord injury. Multivariate analysis in 711 patients

The functional outcomes of 711 patients with traumatic spinal cord injuries who were admitted to a rehabilitation hospital during an eight-year period were studied. The modified Barthel index, a 100-point scale, was used to assess ability to perform self-care and mobility skills at rehabilitation admission and discharge. There were statistically significant improvements in self-care and mobility subscores of the modified Barthel index. Mean total modified Barthel index scores increased from 13.8 at admission to 46.1 at discharge for patients with quadriplegia, and from 37.7 to 74.4 for patients with paraplegia. Functional gains made by patients with incomplete spinal lesions were greater than those made by patients with complete lesions. This study documents improvement in ability to perform self-care and mobility skills among patients with spinal cord injuries who participate in comprehensive rehabilitation.

Seizures secondary to autonomic dysreflexia

Seizures are a little-recognized component of the syndrome of autonomic dysreflexia. Three patients who exhibited seizures during episodes of dysreflexia independent of intracerebral pathology are described. The presence of seizures in patients with traumatic myelopathy T-6 should alert the physician to a possible dysreflexic episode, and measures should be taken to avert such an episode.

[Epidemic dengue 2 on Liouchyou Shiang, Pingtung County in 1981]

During the summer of 1981, an outbreak of dengue occurred on Liouchyou Shiang, an islet about 15 km. southwest of Taiwan. More than 12, 500 people, approximately 80% of the inhabitants, were estimated to be affected in this epidemic which had been the first dengue outbreak in Taiwan since 1945. Neither shock nor fatal case was found. The epidemic subsided in October and there was no confirmed dengue case in Taiwan from 1982 to 1985. All the 21 virus strains isolated from the blood of patients were now identified as type 2 dengue virus and believed to be the first isolation in Taiwan. The pathogen was probably introduced from the Philippines.

Serum immunoglobulins, complements and circulating immune complexes in oral lichen planus

Serum IgG, IgM, IgA, C3, C4 concentrations and circulating immune complexes (CIC) were measured in a series of 46 patients with oral lichen planus (LP). This investigation revealed a significant increase in the level of serum IgG in patients with oral LP as compared with 36 healthy subjects. In erosive LP, serum IgM was also elevated as compared with healthy subjects and patients with the non-erosive type. The results of this study did not support the suggestion that a humoral immunodeficiency underlies oral LP. Elevated serum level of IgM may be considered to represent secondary oral infection during mucosal erosion. The study also demonstrated a significant reduction in serum C4 in both variants of oral LP, but the C3 level was normal. A 3% polyethylene glycol precipitation (PEG-ppt) method was used, no significant amount of CIC could be detected in the patients. It is tempting to speculate that oral LP reflects an immunologic disorder in which serum IgG and C4 is disturbed. However, further investigation is needed to clarify the pathogenesis of oral LP.

Inhibition of the external urethral sphincter and sacral reflex by anal stretch in spinal cord injured patients

Relaxation of both detrusor and external sphincter muscles by mechanical stretch instead of cutaneous stimulation of the anal sphincter has been recognized and applied clinically for bladder emptying and for aiding catheterization in patients with spastic urethral sphincter. In a three-year study anal stretch was included as part of urodynamic examination in patients who could potentially use this method for bladder management. Anal stretch was found to inhibit the bulbocavernosus reflex and to be a useful alternative technique for bladder emptying in patients having complete paraplegia with normal hand function and with detrusor-sphincter dyssynergia. It is recommended that anal stretch combined with Credé or Valsalva maneuvers be a part of the urodynamic study of such patients to determine whether or not these techniques can be utilized for bladder management.

User-friendly communication board for nonverbal, severely physically disabled individuals

The inability to communicate personal needs, feelings, and ideas is a frustrating barrier for nonverbal patients with severe physical disabilities. It hampers the physician-patient relationship and medical services. This problem has been diminished with the use of a new communication board for patients with brain stem involvement. The communication board display is comprised of 36 squares in a 6 X 6 matrix. The alphabet is arranged in this matrix according to the normal sequence, and each row begins with a vowel. Selection of a desired alphabet letter is done by naming the vowels vertically until the appropriate row is reached, then the individual consonants horizontally until the proper one is indicated by the patient. With this new arrangement, the patient, attendant, or staff can memorize and functionally use the new communication board in a few minutes.

Prospective studies on nasopharyngeal carcinoma in Epstein-Barr virus IgA/VCA antibody-positive persons in Wuzhou City, China

A serological mass survey was carried out in Wuzhou City in 1980, 1,136 IgA/VCA-positive persons being followed up for 4 years. Altogether 35 NPC cases were detected, of which 15 (43%) were in stage I and 17 (48.5%) in stage II, early cases (I + II) thus amounting to 91.5%. The detection rate of early cases was 2.9 times higher than in our outpatient clinic. IgA/VCA antibody could be detected 16-41 months prior to clinical diagnosis of NPC. We conclude that, if IgA/VCA-positive individuals are examined routinely once a year, NPC can be detected in the early stages of evolution. The annual detection rate of NPC in IgA/VCA antibody-positive individuals was 31.7 times higher than that of the annual incidence of NPC in the general population in the same age group, while during the 4-year follow-up period the incidence was 7.5 times higher than in the general population for the same age group. These results further indicate that EB virus plays an important role in the development of NPC, and that serological screening and follow-up studies are valuable for the early detection of NPC.

Pseudosimultaneous fast and slow pathway conduction: a common electrophysiologic finding in patients with dual atrioventricular nodal pathways

Two ventricular responses following termination of rapid atrial pacing were noted in 24 of 87 patients with dual atrioventricular (AV) nodal pathways and supraventricular tachycardia. In all 24 patients, the AH intervals of the first and second ventricular responses were comparable with those of the fast and slow pathways, respectively. Careful analysis of the whole pacing sequence revealed that, in 21 patients, this phenomenon resulted from sustained slow pathway conduction with long AH intervals. In these patients, as the AH interval of each paced beat was progressively lengthened during pacing, the corresponding His bundle and ventricular responses were pushed one cycle behind the current atrial paced beat, so that the last paced beat was followed by two His bundle and ventricular responses. In only three patients did double ventricular responses result from simultaneous fast and slow pathway conduction. One of these three patients also showed two ventricular responses resulting from sustained slow pathway conduction. Several factors predispose to the occurrence of this phenomenon in patients with dual AV nodal pathways. These include an ability to sustain slow pathway conduction, a longer slow pathway AH interval, a shorter sinus AH interval (fast pathway) and a shorter atrial paced cycle length that sustains slow pathway conduction. In conclusion, sustained slow pathway conduction with resultant long AH intervals is the mechanism of two ventricular responses following termination of atrial pacing in most patients with dual AV nodal pathways. This phenomenon should be distinguished from the rare occurrence of double ventricular responses to an atrial impulse due to simultaneous fast and slow pathway conduction.

Clinical findings and immunological abnormalities in Yu-Cheng patients

An outbreak of poisoning caused by ingestion of rice bran oil which was accidentally contaminated with polychlorinated biphenyls (PCBs) broke out in Taiwan in February 1979. Diagnosis, management, and follow-up of the patients were performed at special clinics, and subjective symptoms and cutaneous changes such as peculiar acneform eruptions and pigmentation were recorded. The patients were divided into six age groups of both essex, and the body surface of the patients was divided into 12 sections according to the nature of skin. The prevalence of each type of cutaneous change was proved statistically by the chi-square test. The examination of the immune system function in the patients at 1 year revealed: decreased concentration of IgM and IgA but not of IgG; decreased percentage of total T-cells, active T-cells, and helper T-cells, normal percentage of B-cells and suppressor T-cells; suppression of delayed type response to recalling antigens; enhancement of lymphocyte spontaneous proliferation; and enhancement of lymphocyte proliferation with PHA, PWM, and PPD stimulation but not ConA. Follow-up studies 3 years later showed decreased blood PCB levels; some improvement of subjective symptoms and cutaneous changes; recovery of skin testing response to PPD; normal percentage of total T-cells and increased percentage of suppressor T-cells; and enhancement of lymphocyte proliferation spontaneously or under the stimulation of various mitogens.

Clinical significance of anti-nDNA antibodies in ANA-positive systemic lupus erythematosus: comparison of the Farr radioimmunoassay and the Crithidia luciliae immunofluorescent technique

To evaluate the clinical applicability of anti-native DNA antibodies (anti-nDNA) in systemic lupus erythematosus (SLE), two conventional methods--the Farr radioimmunoassay (Farr assay) and the Crithidia luciliae immunofluorescent technique (CL-IF assay)--were compared in 180 sera of antinuclear antibody (ANA)-positive systemic lupus erythematosus (85 active and 95 inactive), 31 sera of ANA-positive non-SLE rheumatic diseases and 40 sera from healthy subjects. The results further appraised the clinical significance of anti-nDNA antibodies in the diagnosis of systemic lupus erythematosus, especially those patients with nephritis. The CL-IF assay was found less sensitive in the detection of anti-nDNA than the Farr assay. As a tool for differentiating SLE from non-SLE rheumatic diseases, the CL-IF assay is not as sensitive as the Farr assay (sensitivity of CL-IF and Farr assay = 38.3% versus 60.0%). But the CL-IF test is much more convenient and efficient in the detection of active stage SLE and lupus nephritis than the Farr assay. The efficiency of anti-nDNA tests by the CL-IF and Farr assays for diagnosing active SLE were 85.8% versus 79.6%, for lupus nephritis were 76.1% versus 64.4% and finally for both conditions were 81.7% versus 62.2%. As an index of disease activity during the course of treatment, titers of anti-nDNA antibodies by Farr assay proved much more reliable than those by Crithidia luciliae assay. For the detection of anti-nDNA antibodies, simultaneous utilization of these two methods for fresh cases and using the Farr assay alone during the course of treatment are recommended.

Clinical findings and immunological abnormalities in Yu-Cheng patients

An outbreak of poisoning caused by ingestion of rice bran oil which was accidentally contaminated with polychlorinated biphenyls (PCBs) broke out in Taiwan in February 1979. Diagnosis, management, and follow-up of the patients were performed at special clinics, and subjective symptoms and cutaneous changes such as peculiar acneform eruptions and pigmentation were recorded. The patients were divided into six age groups of both essex, and the body surface of the patients was divided into 12 sections according to the nature of skin. The prevalence of each type of cutaneous change was proved statistically by the chi-square test. The examination of the immune system function in the patients at 1 year revealed: decreased concentration of IgM and IgA but not of IgG; decreased percentage of total T-cells, active T-cells, and helper T-cells, normal percentage of B-cells and suppressor T-cells; suppression of delayed type response to recalling antigens; enhancement of lymphocyte spontaneous proliferation; and enhancement of lymphocyte proliferation with PHA, PWM, and PPD stimulation but not ConA. Follow-up studies 3 years later showed decreased blood PCB levels; some improvement of subjective symptoms and cutaneous changes; recovery of skin testing response to PPD; normal percentage of total T-cells and increased percentage of suppressor T-cells; and enhancement of lymphocyte proliferation spontaneously or under the stimulation of various mitogens.

Report of a family with mal de Meleda in Taiwan: a clinical, histopathological and immunological study

A family in Taiwan is reported to have Mal de Meleda with possibly autosomal recessive inheritance among 5 of its members. The glove- and sock-like erythrokeratosis and the hyperkeratotic plaques of the knees and elbows are the common features. Erythema of the nose, cheeks, and the perioral area in 4 affected members, actinic elastosis in 2 severely affected members, and partially impaired cell-mediated immunity in vitro in both affected and unaffected members are notable findings. Tigason (etretinate) treatment was beneficial in regard to hyperkeratinization, but not to erythema.

Altered distribution of lymphocyte subpopulations and augmentation of lymphocyte proliferation in chronic PCB poisoned patients

To clarify the mechanism of immunotoxicity of polychlorinated biphenyls (PCB), delayed type hypersensitivity skin test, lymphoproliferative responses, and lymphocyte subpopulations defined by monoclonal antibodies were performed on 30 patients and 38 age/sex-matched healthy individuals. Three years ago the patients had ingested rice bran oil accidentally contaminated by PCB. Except for lymphocyte proliferation, the chronic effect of PCB and its derivatives upon cell-mediated immunity (CMI) in these patients was not so evident when compared to that found within one year of exposure. Delayed type hypersensitivity skin response to purified protein derivative (PPD) and the numbers of peripheral T and B lymphocytes were within normal range. The enumeration of lymphocyte subsets demonstrated decreased T4 (inducer/helper) cells and increased T8 (cytotoxic/suppressor) cells. The abnormally augmentated spontaneous proliferation and proliferation responses to phytohemagglutinin (PHA), concanavalin A (Con A), pokeweed mitogen (PWM) and PPD implicated that both T and B lymphocytes were functionally affected. This may well be the result of the immunotoxicity rather than the enhancement of cell-mediated immunity by these toxic compounds. While there was no correlation between the results of those assays and blood PCB levels, it appears that the lymphoproliferative assay may be applied as a sensitive test in reflecting the severity of PCB immunotoxicity.

A Report on the National Bureau of Standards pH Standards

In 1980, the research program in pH was re-established at the National Bureau of Standards (NBS). This report describes the state of this research, as well as the state of the NBS pH standards. The thermodynamic definition and the determination of pH are elaborated. The problems of liquid junction potentials encountered in the practical determination of pH are discussed. The goal of the research program in pH is to develop and maintain a unified pH scale based on clearly stated thermodynamic criteria, with a wide range of applicability to practical pH measurements.

Total bladder care for the spinal cord injured patient

The neurogenic bladder and urinary tract infection is a common complication following spinal cord injury. The author discusses a new concept in the bladder defense mechanism against infection and two new simplified sterile intermittent self catheterisation procedures.