Correlating Reiff scores with clinical, functional, and prognostic factors: characterizing noncystic fibrosis bronchiectasis severity: validation from a nationwide multicenter study in Taiwan

BACKGROUND

Our study aimed to confirm a simplified radiological scoring system, derived from a modified Reiff score, to evaluate its relationship with clinical symptoms and predictive outcomes in Taiwanese patients with noncystic fibrosis bronchiectasis (NCFB).

METHODS

This extensive multicenter retrospective study, performed in Taiwan, concentrated on patients diagnosed with NCFB verified through high-resolution computed tomography (HRCT) scans. We not only compared the clinical features of various types of bronchiectasis (cylindrical, varicose, and cystic). Furthermore, we established relationships between the severity of clinical factors, including symptom scores, pulmonary function, pseudomonas aeruginosa colonization, exacerbation and admission rates, and HRCT parameters using modified Reiff scores.

RESULTS

Data from 2,753 patients were classified based on HRCT patterns (cylindrical, varicose, and cystic) and severity, assessed by modified Reiff scores (mild, moderate, and severe). With increasing HRCT severity, a significant correlation was found with decreased forced expiratory volume in the first second (FEV1) (p < 0.001), heightened clinical symptoms (p < 0.001), elevated pathogen colonization (pseudomonas aeruginosa) (p < 0.001), and an increased annual hospitalization rate (p < 0.001). In the following multivariate analysis, elderly age, pseudomonas aeruginosa pneumonia, and hospitalizations per year emerged as the only independent predictors of mortality.

CONCLUSION

Based on our large cohort study, the simplified CT scoring system (Reiff score) can serve as a useful adjunct to clinical factors in predicting disease severity and prognosis among Taiwanese patients with NCFB.

[Efficacy of compound pholcodine syrup and compound codeine phosphate oral solution on lung cancer-related cough]

Objective: To assess the clinical efficacy of compound pholcodine syrup and compound codeine phosphate oral solution on lung cancer-related cough. Methods: A total of 60 patients diagnosed with middle-advanced stage lung cancer and had lung cancer-related cough in the Department of Geriatric Oncology of Chongqing University Cancer Hospital from January to May 2022 were prospectively enrolled. According to the random number table method, the patients were divided into two groups: observation group and control group. The observation group [n=30, with 21 males and 9 females, and aged (62.3±10.4) years] received compound pholcodine syrup treatment, while the control group [n=30, with 21 males and 9 females, and aged (62.0±8.1) years] received compound codeine phosphate oral solution treatment. The dosage of the two drugs was 15 ml each time, 3 times a day, and the treatment course was 5 days. The antitussive effectiveness, cough severity and quality of life (Leicester Cough Questionnaire in Mandarin-Chinese scale) were observed and compared between the two groups 3 days and 5 days after the treatment. Results: All 60 patients completed the study. Both regimens were effective in controlling lung cancer-related cough. After 3 days treatment, the antitussive effective rate of the observation group and the control group was 83.3% (25/30) and 73.3% (22/30), respectively, with no statistically significant difference (P=0.347). Likewise, after 5 days treatment, the antitussive effective rate of observation group and control group was 90.0% (27/30) and 86.6% (26/30), respectively, with no statistically significant difference (P=0.687). There was no statistically significant difference in the cough severity between observation group [moderate and severe cough: 56.7% (17/30)] and control group [moderate and severe cough: 67.7% (20/30)] (P=0.414). After 3 days treatment, cough symptoms were relieved in both groups. Patients with mild cough accounted for 73.3% (22/30) in the observation group and 56.7% (17/30) in the control group, and the difference was not statistically significant (P=0.331). Moreover, after 5 days treatment, there was also no significant difference in mild cough between observation group [86.7% (26/30)] and control group [66.7% (20/30)] (P=0.067). Meanwhile, there were no significant differences in the physiological score, psychological score, social score and total score of the Leicester Cough Questionnaire in Mandarin-Chinese scale before the treatment, after 3 days and 5 days treatment between the two groups (all P>0.05). The incidence of both xerostomia and constipation in the observation group was 0, which was lower than those of the control group [20.0% (6/30) and 20.0% (6/30)] (both P<0.05). Conclusions: Both compound pholcodine syrup and compound codeine phosphate oral solution are effective in treating lung cancer-related cough with similar antitussive effectiveness. Compound pholcodine syrup has a lower incidence of xerostomia and constipation than control group, with a better safety profile.

[Efficacy of early interdisciplinary palliative care based on WARM model in non-small-cell lung cancer]

Objective: To assess the therapeutic effect of the early interdisciplinary palliative care based on WARM model (whole, assessment, revaluation, management) on the quality of life, psychological state, pain and nutritional status in patients with non-small-cell lung cancer (NSCLC). Methods: A total of 60 patients from Chongqing University Cancer Hospital with newly diagnosed advanced NSCLC from Oct 15, 2019 to Jun 12, 2020 were enrolled. According to the method of random number table, the patients were divided into two groups: standard oncologic care group (SC, n=30) and early palliative care group (EPC, n=30). SC group only received standard oncological care, while EPC group received standard oncological care and additional comprehensive treatment from a MDT consisted of medical oncologists, palliative care nurses, dietitians and psychologists. The quality of life [functional assessment of cancer therapy-lung (FACT-L) scale], psychological state [hospital anxiety and depression scale (HADS) and patient health questionnaire-9 (PHQ-9)], nutritional status [patient-generated subjective global assessment (PG-SGA)], and cancer pain status [numerical rating scale (NRS)] were observed and compared between the two groups before and after the 6 months treatment, respectively. Results: A total of 45 patients completed 6 months treatment, including 24 males and 21 females, aged 38-82 (60.5±1.7), with 23 patients in the EPC group and 22 patients in the SC group. Patients assigned to EPC group had a better quality of life than those assigned to SC group [FACT-L scale: (122.3±1.6) vs (111.8±2.1), P<0.001]. Fewer patients had anxiety and depressive symptoms in the EPC group than those in the SC group [HADS anxiety subscale: (1.1±0.3) vs (2.9±0.4), P<0.001; HADS depression subscale: (0.7±0.3) vs (3.6±0.4), P<0.001]. The PHQ-9 results showed that 100.0% (23/23) patients were free of depression in the EPC group, while 45.5% (10/22) patients were free of depression in SC group (P<0.001). Furthermore, patients in the EPC group had a better nutritional status [moderate malnutrition: 60.9% (14/23); no malnutrition: 39.1% (9/23)] than those in the SC group [severe malnutrition: 40.9% (9/22); moderate malnutrition: 50.0% (11/22); no malnutrition: 9.1% (2/22)] (P<0.001). There was no significant difference in NRS score between EPC group and SC group (P=0.140). Conclusion: Early interdisciplinary palliative care based on WARM model can improve the quality of life, psychological state and nutritional status in NSCLC patients.

Risk of Aortic Aneurysm and Dissection in Patients with Tuberculosis: A Nationwide Population-Based Cohort Study

Tuberculosis (TB) can cause chronic inflammation. The occurrence of aortic aneurysm (AA) and aortic dissection (AD) may be associated with chronic inflammatory disease, but whether TB increases the risk of AA and AD remains to be determined. This study aimed to investigate the association between TB and the development of AA and AD. We conducted a population-based cohort study using data obtained from the Taiwan National Health Insurance Database. We selected 31,220 individuals with TB and 62,440 individuals without TB by matching the cohorts according to age, sex, and index year at a ratio of 1:2. Cox regression analysis revealed that the TB cohort had a 1.711-fold higher risk of AA and AD than the non-TB cohort after adjustment for sex, age, socioeconomic status, and comorbidities (adjusted hazard ratio = 1.711; 95% confidence interval = 1.098–2.666). Patients with pulmonary, extrapulmonary, and miliary TB had a 1.561-, 1.892-, and 8.334-fold higher risk of AA and AD, respectively. Furthermore, patients with TB at <6 months, 6–12 months, and 1–5 years of follow-up had a 6.896-, 2.671-, and 2.371-fold risk of AA and AD, respectively. Physicians should consider the subsequent development of AA and AD while treating patients with TB.

[Clinical manifestations of 10 cases of imported human Zika virus disease in Jiangmen city of China]

Objective: To study the clinical manifestations and detection method for imported patients of Zika virus disease. Method: The records of symptoms, signs and laboratory results were collected and analyzed. The specimen of blood, saliva and urine from patients were collected. Results: Two of ten patients had mild fever. The visible cutaneous maculopapular rash of the trunk and extremities was observed in all patients. Seven patients were observed congestive conjunctivitis and only one patient gave an account of itching. No patient had symptoms of myalgia or arthralgia. The laboratory results of patients were normal except two patients had mild leucopenia and another one had thrombocytosis. The Zika virus RNA was detected in urine samples for a longest period. The detection rates of Zika virus RNA from the samples of blood, saliva and urine that collected in seventh day after disease onset were 0, 5, 8 cases, respectively. Conclosion: Epidemiology history, maculopapular rash, congestive conjunctivitis and Zika virus RNA being detected in urine can be considered as the important clinical criterion for making a definite diagnosis as Zika virus disease.

Spontaneous intracranial hypotension with cerebrospinal fluid leakage at 2 sites treated by epidural blood patch

PURPOSE

Spontaneous intracranial hypotension (SIH) is a relatively uncommon cause of headache, which usually presents as orthostatic cranial pain and is relieved by recumbency. The precise cause of spontaneous spinal cerebrospinal fluid leakage related SIH remains unknown.

CASE REPORT

We report the case of a 32-year-old man who presented with an orthostatic headache. Brain magnetic resonance imaging (MRI) revealed typical pachymeningeal enhancement. Radionuclide cisternography revealed leakages in the cervicothoracic and upper cervical areas. The patient was successfully treated by lumbar epidural blood patch (EBP).

CONCLUSION

The diagnosis of SIH involves the assessment of the characteristic clinical presentations and non-invesive neuroimaging studies. The latest diagnostic criteria with more broadened spectrum due to variable manifestations are discussed. EBP is an effective treatment for SIH if conservative management fails.

An inter-subspecies cloned buffalo (Bubalus bubalis) obtained by transferring of cryopreserved embryos via somatic cell nuclear transfer

The aim of this study was to explore the feasibility of cryopreservation of inter-subspecies cloned embryos in buffalo. In our experiment, river buffalo ear fibroblast nucleus was fused into swamp buffalo oocyte cytoplasm. The blastocyst formation rate for nuclear transfer of freshly thawed cells was not different from those of growing cells, confluent or serum-starved cells. A total of 122 cloned blastocysts derived from cryopreserved fibroblasts were cryopreserved and thawed, 37 were survived, the cryosurvival rate was 30.3%. The survived blastocysts were transferred into 15 recipient buffalos. Five of the recipients established pregnancy, but four of them aborted on day 53, 59, 145 and 179 of gestation respectively. One cross-bred buffalo (Murrah × Swamp buffalo (2n = 49) received three embryos delivered a 40.5 kg female calf by natural delivery on day 320 of gestation. Up to now (13-month old), the cloned calf has been growing well with no abnormity observed. These results demonstrated that cryopreservation of inter-subspecies cloned embryos is feasible to produce buffalo offspring.

A case of phlebosclerotic colitis with involvement of the entire colon

Phlebosclerotic colitis is a rare type of ischemic colitis caused by obstruction of the veins in the intestinal wall and adjacent mesentery, and is most commonly seen in the ascending colon. We report a 56-year-old woman presenting with intermittent abdominal pain and diarrhea for three years. She had a liver abscess and two episodes of pancreatitis during this time and experienced progressive body weight loss. Initial radiologic findings showed multiple tortuous threadlike calcifications in the region of the right side of the colon and transverse colon on plain abdominal radiographs and computed tomography images. A colonoscopy demonstrated brownish-black pigmentation on the right side of the colon with scattered hyperemic patches. The more distal along the colon, the more normal the color of the bowel appeared. Follow-up studies revealed calcifications not only alongside the colonic and mesenteric veins, but also extending into the superior and inferior mesenteric veins. These findings have not been reported previously. As noted in our patient, this disease entity may not be confined to the tributaries of the superior mesenteric vein. The entire colon may be involved in advanced disease.

Study on the inter-subspecies nuclear transfer of river buffalo somatic cell nuclei into swamp buffalo oocyte cytoplasm

The objective of this study was to explore the feasibility of inter-subspecies somatic cell nuclear transfer (SCNT) of river buffalo (50 chromosomes) somatic cell nuclei into swamp buffalo (48 chromosomes) oocyte cytoplasm. The enucleated swamp buffalo oocytes were fused with four different types of river buffalo cells: freshly thawed ear fibroblasts, serum-starved ear fibroblasts, cumulus cells and ear fibroblasts from a cloned buffalo calf. As a result, the developmental competence of embryos reconstructed with freshly thawed ear fibroblasts was the poorest (P<0.01), while those of the other three types were not different from each other. Furthermore, the efficiency of swamp-swamp buffalo, swamp-river buffalo and bovine-buffalo SCNT were also compared. The results showed that the blastocyst rate of swamp-river reconstructed embryos was not different from swamp-swamp embryos, while significantly higher than that of bovine-buffalo embryos (P<0.01). A total of thirty cloned blastocysts derived from freshly thawed ear fibroblasts were transferred into thirteen recipient buffaloes, four recipients established pregnancy, while three of them aborted on Days 65, 75 and 90 of gestation, respectively. One cross-bred buffalo (Murrah x swamp, 49 chromosomes) receiving three embryos delivered a 39 kg female calf on Day 335 of gestation. These results indicate that the inter-subspecies SCNT is feasible to produce swamp-river buffalo embryos, and these can develop to full term and result in live buffalo calves.

pH-sensitive intracellular photoluminescence of carbon nanotube-fluorescein conjugates in human ovarian cancer cells

To add to the understanding of the properties of functionalized carbon nanotubes in biological applications, we report a monotonic pH sensitivity of the intracellular fluorescence emission of single-walled carbon nanotube-fluorescein carbazide (SWCNT-FC) conjugates in human ovarian cancer cells. Light-stimulated intracellular hydrolysis of the amide linkage and localized intracellular pH changes are proposed as mechanisms. SWCNT-FC conjugates may serve as intracellular pH sensors.

Structural evolution and adhesion of titanium oxide film containing phosphorus and calcium on titanium by anodic oxidation

This study investigated the microstructure evolution and defects of the titanium oxide layer containing calcium (Ca) and phosphorus (P) formed by anodic oxidation in a solution containing Ca and P compounds. Results show that the anodic film exhibited a two-layer structure: a pore-containing amorphous titanium oxide layer dispersed with nano-sized crystallites formed prior to sparking, and a porous overlay dotted with craters formed after sparking. Ca and P were predominantly incorporated in the porous overlay, in which the amorphous region contained more Ca and P than the crystalline region regardless of the anodizing voltages. Moreover, the ratio of amorphous to crystalline regions in the porous overlay changed insignificantly with anodizing voltage. Increasing anodizing voltage enhanced the incorporation of Ca and P in the anodic film, but deteriorated the adhesion of the anodic film to the substrate. This deterioration was related to two inherent adhesive weaknesses: the aligned pores in the titanium oxide layer and the craters in the major overlay, signifying that a new anodic oxidation process that can produce high Ca- and P-containing oxide film at relatively-low anodizing voltages, i.e. approximately 200 V, is a necessity.

Complex partial status epilepticus as a manifestation of Hashimoto's encephalopathy

Epileptic seizures are a frequent manifestation of Hashimoto's encephalopathy. However, status epilepticus associated with Hashimoto's encephalopathy are not well characterized in medical literature. We described here a 16-year-old girl who presented with complex partial status epilepticus associated with elevated anti-thyroid antibodies. Ictal EEG showed lateralized high amplitude rhythmic delta waves over the right hemisphere and ictal single-photon emission computed tomography revealed regional hyperperfusion of the right parietal and temporal lobes. The patient was unresponsive to antiepileptic drug therapy but responded to intravenous steroid treatment. Screening of serum anti-thyroid antibodies for unexplained encephalopathy with epileptic seizures is suggested, as early recognition and prompt steroid treatment may lead to a favorable prognosis.

Metastatic Eccrine Porocarcinoma Detected on FDG PET/CT

Eccrine porocarcinoma is an uncommon neoplasm of the sweat gland duct and poses a significant risk of cutaneous, regional lymph node, or visceral metastases. A 62-year-old woman with a history of eccrine porocarcinoma in the left flank area underwent an F-18 FDG PET/CT scan, which revealed increased FDG uptake in left pelvic (SUV 6.34) and left axillary regions (SUV 4.02). Wide excision of left axillary and left pelvic lymph nodes was performed, and histopathologic findings were consistent with eccrine porocarcinoma. PET/CT detects metastases accurately and is helpful in the management of patients with eccrine porocarcinoma.

Hypoglossal schwannoma presenting as hemi-atrophy of the tongue

Schwannoma of the hypoglossal nerve is extremely rare. We report the clinical manifestations of a patient with Schwannoma of the hypoglossal nerve with hemi-atrophy of the tongue and numbness in the lip. Magnetic resonance image study of the brain showed a lobulated mass at the right posterior fossa with an extension to the right upper neck. Surgical intervention was performed with right occipital craniotomy and a partial resection of C1 and occipital condyle. Pathological studies confirmed a Schwannoma with hemorrhages and necrosis.

Contribution of somatic cell-associated activation of plasminogen to caseinolysis within the goat mammary gland

Functional regression of the mammary gland is partly reflected by proteolysis of milk protein and tissue protein. The involvement of the plasminogen activation system in degradation of milk protein and mammary tissue damage has been demonstrated under inflammatory conditions. In this study, mammary secretion from 23 dairy goats primarily grouped as lactation (milking twice daily) or involution (milking once daily or less) was used to determine the ratio of gravity-precipitated casein to total milk protein (casein ratio) as an index of caseinolysis, and activities of components of plasminogen activation system as well as their expressions on somatic cells. Based on the casein ratio, lactation goats were subcategorized as very active (71.8 +/- 1.0%) or less active (29.9 +/- 1.0%) in mammary function; involution goats were subcategorized as gradual (21.7 +/- 1.0%) or acute (5.9 +/- 0.2%) involution. This result suggests that caseinolysis occurred during regular lactation as well as during involution. On the other hand, activities of components of the plasminogen activation system in mammary secretion were increased along with the decreasing casein ratio, in contrast to the similar activities of their counterparts in circulation throughout various mammary statuses. Correlation analysis between casein ratio and activities of plasminogen activation system of goat milk indicated a significant negative relationship for plasmin (r = -0.64), plasminogen (r = -0.69), and urokinase-type plasminogen activator (uPA; r = -0.78) during involution but not during lactation. As for the cellular components of plasminogen activation system, there was an increase in immunoreactivity on somatic cells toward both monoclonal antibodies of human uPA and human uPA receptor under involution conditions suggesting their upregulation relative to lactation condition. Collectively, these results suggest that plasminogen activation system within the mammary gland differentially contribute to milk caseinolysis along the various stages of goat lactation. Meanwhile, a somatic cell-mediated local elevation of plasmin activity may be committed to extensive caseinolysis during involution.

A paraspinal abscess following spinal anaesthesia for caesarean section and patient-controlled epidural analgesia for postoperative pain

We present a rare case in which a healthy parturient developed a paraspinal abscess after spinal anaesthesia for caesarean section and epidural analgesia for postoperative pain management. The catheter was in situ for 58 h. Backache was the initial and major symptom. A concealed course with no neurological deficit resulted in a delayed diagnosis and treatment in this case. The infection was not diagnosed until 20 days after the removal of the epidural catheter when there was a purulent discharge from the epidural puncture site. Surgical drainage was required. Anaesthesiologists should be aware that serious epidural analgesia-related infections can happen in extra spinal-epidural spaces. Vigilance for these infections, especially in postpartum patients with backache, is needed.

In vivo extracellular recording of striatal neurons in the awake rat following unilateral 6-hydroxydopamine lesions

The purpose of this study was to further understand the functional effects of dopaminergic input to the dorsal striatum and to compare the effects of dopaminergic lesions in awake and anesthetized animals. We examined the effects of unilateral 6-hydroxydopamine (6-OHDA) lesions of the ascending dopaminergic bundle on the firing properties of dorsal striatal neurons in the awake freely moving rat using chronically implanted microwire electrode arrays. We recorded extracellular activity of striatal neurons under baseline conditions and following the systemic injection of apomorphine in awake and anesthetized subjects. Firing rates were higher in the hemisphere ipsilateral to the 6-OHDA lesion compared to rates of neurons from the contralateral unlesioned hemisphere. Striatal firing rates from sham and no-surgery control rats were, in general, higher than those from the contralateral unlesioned striatum of experimental subjects. Apomorphine (0.05 mg/kg, sc) normalized the differences in firing rates in lesioned animals by increasing firing of neurons within the contralateral unlesioned side, while simultaneously decreasing firing of neurons within the ipsilateral lesioned side. Mean firing rates were substantially higher in awake animals than in subjects anesthetized with chloral hydrate, perhaps reflecting anesthesia-induced decreases in excitatory input to striatal neurons. Chloral hydrate anesthesia decreased firing rates of neurons in the lesioned, unlesioned, and control striata to a similar degree, although absolute firing rates of neurons from the 6-OHDA-lesioned striata remained elevated over all other groups. Unilateral 6-OHDA lesions also altered the pattern of spike output in the awake animal as indicated by an increase in the number of bursts per minute following dopaminergic deafferentation. This and other burst parameters were altered by apomorphine. Our findings show that effects of dopaminergic deafferentation can be measured in the awake behaving animal; this model should prove useful for testing the behavioral and functional effects of experimental manipulations designed to reduce or reverse the effects of dopaminergic cell loss. In addition, these results suggest that the contralateral changes in striatal function which occur in the unilateral dopaminergic lesion model should be considered when evaluating experimental results.

The use of antibiotics critical to human medicine in food-producing animals in Taiwan

There are increasing public health concerns about antibiotics used in food-producing animals that may contribute to the development of resistance in human pathogens. Such resistance may be critical to human medicine when resistance develops to drugs that treat certain pathogens of which there is no good alternative therapy. We surveyed 10 farms, eight feed mills, and one animal drug distributor in Taiwan to determine the major antibiotics used in food-producing animals, and the extent of use of five drugs that may select for resistance to antibiotics that are critical for human medicine. The five animal drugs, and the resistance of human drug/class they may select for, included avoparcin (vancomycin/glycopeptides), avilomycin (ziracin/envirninomycins), enrofloxacin (ciprofloxacin/fluoroquinolones), virginiamycin (quinupristin and dalfopristin combination/streptogramins), and kanamycin (gentamicin/aminoglycosides). Tetracyclines were the class of antibiotic that was most widely used in the greatest amounts. Over the past 12 months, the number of farms, chicken feed mills, and pig feed mills, that have respectively reported the use of avoparcin was 1 (10%), 5 (63%), 0; avilomycin 0, 0, 3 (50%); enrofloxacin 4 (40%), 1 (13%), 3 (50%); virginiamycin 2 (20%), 5 (63%), 0; and kanamycin 3 (30%), 1 (13%), 1 (17%). We conclude that although the most commonly used antibiotics (ie tetracyclines) have little effect on human medicine, there is a widespread use of antibiotics that may select for critical forms of resistance in human pathogens in food-producing animals.

Acute leukemia presenting as diabetes insipidus and bilateral exudative retinal detachment--a case report

To report an unusual case of leukemia presenting as both bilateral exudative retinal detachment (ERD) and central diabetes insipidus (DI), we evaluate the clinical hematological records including bone marrow aspirations and CSF tapping, both osmolarity and electrolytes concentration of the serum and urine, brain MRI, fundus photographs and fluorescein angiographs in this 25-year-old female patient. Examinations of peripheral blood and bone marrow aspiration confirmed the diagnosis of acute myelogenous leukemia (AML-M0). Fluorescein angiography (FA) revealed bilateral ERD, dense choroidal leukemia cell infiltration with overlying retinal pigment epithelium (RPE) dysfunction and focal areas of choroidal infarction. Changes in both osmolarity and electrolytes concentration of the serum and urine from vasopressin test supported the diagnosis of central DI. Central DI and ERD may be presenting signs of acute leukemia and both may represent CNS involvement. In our case, dense choroidal leukemic cell infiltration results in devitalization of RPE and choroidal infarction. Leukemic disruption of hypothalamic pituitary area may lead to complete or partial deficiency of antidiuretic hormone (ADH). Rapid improvement in visual acuity and partial symptom relief of DI may ensue from appropriate chemotherapy and nasal DDAVP (1-desamino-8-D-arginine vasopressin) supply.

Wet air oxidation of a direct dye solution catalyzed by CoAlPO4 -5. Performance assessment and kinetic study

Wet air oxidation (WAO) of a prepared direct dye solution was tested by using the CoAIPO4 -5 catalyst. Addition of CoAIPO4 -5 could effectively improve rate of color removal and the activation energy of color removal could decrease from about 110 kJ/mole to about 75 kJ/mole as the catalyst loading was increased from 0.0 g/L to 3.0 g/L. Performance of WAO on color removal would somewhat increase with catalyst loading at 145 degrees C whereas the effect of catalyst loading was not significant at 135 degrees C. With no addition of CoAlPO4 -5, the chemical oxygen demand (COD) value was low. This was due to difficulty of exactly measuring the true COD value of dye solution if the dye was not degraded. Via CoAIPO4 -5, COD of dye solution could be effectively decreased. The rate of COD removal would increase with catalyst loading, oxygen pressure and reaction temperature. Furthermore, a maximum COD value observed, which was due to catalyzed degradation of dye molecule via CoAlPO4 -5, could be characterized by a consecutive reaction scheme. Kinetic study of color removal is expressed as follows: rate = k x [dye](0.8) x W(0.5) x P(n) (145 degrees C) or rate = k x [dye](0.8) x W(0) x P(n) (135 degrees C); where k means rate constant, [] means concentration, W means catalyst loading, P means oxygen pressure and n means uncertain number.

Characterization of visibility and atmospheric aerosols in urban, suburban, and remote areas

Visibility data from over the past four decades accumulated from urban areas of central Taiwan indicated that air pollutants have significantly degraded visibility in recent years. Currently, the annual average visibility in urban areas of the same region is approximately 8-10 km, while the visibility in remote areas is approximately 25-30 km. To understand how aerosols affect the visibility in this region, here we selected three sites in central Taiwan to measure the soluble ionic and carbonaceous species of PM(2.5) and PM(2.5-10) during 1997-1998. A MOUDI cascade impactor was used to measure the size distributions of atmospheric sulfate, nitrate, and carbonaceous particles. The aerosol data were then analyzed together with meteorological and air quality data. Comparing the results obtained from urban, coastal suburban and remote sites revealed that sulfate, carbonaceous species and local wind speed significantly affected the visibility in the urban area. However, sulfate concentration and humidity influenced visibility in the coastal area of central Taiwan. The particulate concentration at the remote station was roughly one-fifth of that in the city. Regression analysis results indicated that humidity is a dominant factor affecting remote visibility.

Protective effects of manganese against lipid peroxidation

The aim of this study was to investigate the effects of chronic, daily, 30-d administration of manganese chloride (MnCl2) to male Sprague-Dawley rats on lipid peroxidation in various tissues. Rats were intraperitoneally injected with MnCl2 (20 mg/kg) once daily for 30 consecutive days. The Mn accumulated in liver, spleen, adrenal glands, heart, kidneys, lung, and testes. This was associated with decreased lipid peroxidation in liver, spleen, and adrenal glands and a decrease in the levels of Fe in these tissues. In a second group of animals, Mn (20 mg/kg/d) and glutathione (GSH, 15 mg/kg/d) were administered ip for 30 d. GSH counteracted the Mn-induced protective fall in lipid peroxidation, but Fe levels remained lower in liver and spleen. Mn decreases lipid peroxidation in certain tissues, which may involve lowering Fe content, but interaction with Fe is not the sole mechanism.

Concentration of vascular endothelial growth factor in the subretinal fluid of retinal detachment

The purpose of this study was to investigate the release of vascular endothelial growth factor (VEGF) within the subretinal fluid in eyes with retinal detachment. Subretinal fluid was collected from patients with retinal detachment undergoing surgery for scleral buckling. Serum samples were also collected. The concentration of VEGF in the subretinal fluid and serum was investigated by enzyme-linked immunospecific assay. The average concentration of VEGF in serum samples was 168 +/- 153 pg/ml (mean +/- standard deviation). It was lower than the VEGF concentration in the subretinal fluid (485 +/- 570 pg/ml) in the same 18 patients with retinal detachment (p < 0.05). The average concentration of VEGF was 355 +/- 373 pg/ml in 31 samples of the subretinal fluid collected from simple rhegmatogenous retinal detachment. It was lower than the average concentration of 901 +/- 385 pg/ml in 8 samples of the subretinal fluid from retinal detachment with proliferative vitreoretinopathy (p < 0.05). The results suggest that the relative retinal ischemia in detached retina increases the release of VEGF into the subretinal space. Also, the concentration of VEGF within the subretinal fluid in proliferative vitreoretinopathy was higher than in simple rhegmatogenous retinal detachment.

Prevalence of urinary incontinence and intention to seek treatment in the elderly

BACKGROUND AND PURPOSE

Urinary incontinence (UI) is a common, distressing, and often disabling condition in the elderly. The objectives of this study were to estimate the prevalence and clinical characteristics of UI among elderly individuals living at home and to explore their perceptions of UI and intention to seek medical care.

METHODS

A total of 504 elderly subjects aged 65 and older residing in Tungkang town (located in the southwestern part of Taiwan) were randomly sampled and surveyed face to face by registered nurses. The prevalence, clinical types, and perceptions of UI, and intention to seek treatment, were compared with chi-square statistics across various sociodemographic characteristics. Logistic regression analyses were conducted to identify factors associated with UI experience and intention to seek treatment.

RESULTS

About 22% of respondents reported that they had experienced involuntary loss of urine in daily life. Women, people who were overweight, and those who were aged 70 years or older were at higher risk of UI. While women were more likely to suffer from stress incontinence, men were at higher risk of urge incontinence. Women, illiterate individuals, and those who perceived UI as a normal part of the aging process showed low intention to seek treatment for UI.

CONCLUSIONS

The results of this study suggest that public awareness programs about UI and promotion of available treatment options are necessary to increase the intention to seek treatment among the elderly. Culturally sensitive programs should be designed, particularly for female and illiterate elderly, to provide incentives to seek medical care. The increasing availability of various treatment modalities coupled with education to correct commonly held misconceptions about UI might enable more elderly individuals to receive treatment for this common condition.

Peripheral retinal angioma presenting as macular pucker--case report

A 36-year-old Taiwanese male, who denied any history of ocular trauma, intraocular inflammation or surgery, had a macular pucker associated with a peripheral retinal angioma. The yellow-white macular pucker, which extended from the temporal disc to the macular area, was thicker and with more prominent retinal striaes than found among the elderly. Regression of the macular pucker did not occur with incomplete laser photocoagulation of the angioma. Retinal angioma should be considered in the differential diagnosis of macular pucker without posterior vitreous detachment (PVD) in healthy young patients. Management of this association is primarily complete obliteration of the angioma.

Sp1, steroidogenic factor 1 (SF-1), and early growth response protein 1 (egr-1) binding sites form a tripartite gonadotropin-releasing hormone response element in the rat luteinizing hormone-beta gene promoter: an integral role for SF-1

Recently, several cis-regulatory elements that play roles in LHbeta gene expression, and their cognate DNA-binding transcription factors, have been identified. These factors include Sp1, steroidogenic factor-1 (SF-1), and early growth response protein 1 (Egr-1). Using the GH3 pituitary cell line (which lacks SF-1) as a model, we demonstrate that expression of SF-1 or Egr-1 increases rat LHbeta gene promoter activity but has little effect on the fold response to GnRH. However, expression of both SF-1 and Egr-1 synergistically enhances LHbeta gene promoter activity and prevents further stimulation of activity by GnRH. Mutations in the Sp1 binding sites of the rat LHbeta gene promoter decrease GnRH responsiveness, whereas mutations in the SF-1 and/or Egr-1 binding sites alone have little effect on the GnRH response. Combinatorial mutations in both the Sp1 and Egr-1 binding elements result in almost complete loss of the GnRH response. In contrast, in GH3 cells cotransfected with SF-1, mutations in the Sp1, SF-1, or Egr-1 binding elements independently decrease GnRH responsiveness. In LbetaT2 cells, a gonadotrope-derived cell line that expresses SF-1 endogenously, mutations in either the Sp1 or Egr-1 binding elements decrease GnRH responsiveness. These data suggest that the Sp1, SF-1, and Egr-1 binding sites form a tripartite GnRH response element in the rat LHbeta gene promoter. Changes in the spacing between the upstream Sp1 binding sites and the downstream SF-1/Egr-1 binding elements reduce the response to GnRH. SF-1, while having little direct effect on GnRH responsiveness, has a critical role in integrating the effects of Sp1 and Egr-1.

Retinal arteriolar tortuosity with recurrent retinal hemorrhages--case report

Retinal arteriolar tortuosity with retinal hemorrhage was first described in 1958. A 45 year-old Taiwanese man had experienced recurrent retinal hemorrhages in each eye in the previous 20 years. The hemorrhages resolved spontaneously without any subjectively obvious sequelae. He has no history of hypertension or any vascular occlusive diseases. There were also no similar cases in his family. The medical examination and laboratory tests did not reveal any significant etiologic factors. Ophthalmologically, the retinal vein was normal but all retinal arterioles were tortuous from the posterior pole to the periphery. Fluorescein angiography revealed the same findings. To our knowledge, this is the first case report in Taiwan.

Choroidal retinal anastomosis in age-related macular degeneration as demonstrated by fluorescein angiography--a case report

Pathological choroidal retinal anastomosis is relatively rare. It has been described in age-related macular degeneration (AMD) with fibrous scarring or occult pigment epithelial detachment or actively proliferating classic choroidal neovascular membrane (CNV). We report a case of disciform macular scar with the occurrence of a choroidal retinal anastomosis, which directed blood flow from an occult choroidal neovascular membrane into a retinal vein through the fovea in a 52-year-old female with unilateral AMD. Fluorescein angiography (FA) clearly demonstrated the anastomosis.

Intralesional corticosteroid therapy in proliferating head and neck hemangiomas: a review of 155 cases

PURPOSE

The purpose of this paper is to review the effect of intralesional corticosteroid therapy in the treatment of 155 head and neck hemangiomas.

METHODS

In the past 10 years, we have treated 155 proliferating head and neck hemangiomas with intralesional corticosteroid injections. Three to 6 injections of triamcinolone acetonide (10 mg/mL) in monthly intervals were given. Using slides and chart review, the results were assessed 1 month after completion of the treatment.

RESULTS

Eighty-five percent of the lesions showed greater than 50% reduction in volume. Varied treatment response was noted in different classes of hemangioma. Eighty percent of the superficial, 75% of the deep, and 60% of the combined hemangiomas show more than 50% reduction in volume. Further growth was not found after treatment. The postinjection complication rate was 6.4% in this series. There were 2 patients with cushingoid appearance, 5 with cutaneous atrophy, and 3 suffered from anaphylactic shock. We found that lesions showing less than 50% reduction in volume were located mostly in the perioral area.

CONCLUSIONS

Intralesional corticosteroid injections are safe and effective in arresting hemangioma proliferation. Superficial hemangiomas yield the best results.

Growth, pigment production and protease activity of Monascus purpureus as affected by salt, sodium nitrite, polyphosphate and various sugars

The effect of different levels of salt, sodium nitrite, polyphosphate and various sugars on growth, pigment production, protease activity and culture pH caused by Monascus purpureus was studied in broth medium and ground meat. The addition of sodium chloride (> 50.0 g l(-1)) and polyphosphate (> 3.0g l(-1)) to broth medium decreased mycelial growth, pigment production and protease activity of M. purpureus, whereas low concentrations of sodium nitrite (< 0.2 g l(-1)) promoted mycelial growth and pigment production. When the basal medium and ground meat contained salt, 150.0 g l(-1), the mould growth was stopped. The medium with fructose as carbon source proved to be the most suitable for mycelium growth and pigment production, with maltose and glucose being the second most productive. When sucrose and lactose were used as carbon sources, mycelium growth and pigment production were inhibited but the protease activity increased significantly. The mould showed more tolerance to salt and polyphosphate in ground meat than in broth medium and used sucrose as a carbon source as well as glucose for growth and pigment production in the meat mixture.

Anterior cervical stabilization with the synthes cervical spine locking plate system

BACKGROUND

The Synthes cervical spine locking plate (CSLP) was originally designed by Mörscher and colleagues, who refined it to prevent the migration and loosening of a locking screw by using a cross-split screw head that could be locked into the plate. This eliminated the requirement of the posterior cortex purchase and thereby decreased the risk of spinal cord injury. The purpose of this report is to review our experience using the cervical spine locking plate system and to evaluate its ability to stabilize the cervical spine.

METHODS

Twenty patients with cervical trauma, cervical spondylosis of failed anterior interbody fusion underwent anterior cervical fusion with the Synthes CSLP system between August, 1993, and April, 1996. All patients were evaluated preoperatively and postoperatively by plain radiography and magnetic resonance imaging (MRI).

RESULTS

All 20 patients achieved solid bone fusion and 19 of them had neurologic improvement, by a mean follow-up period of 36 months. No patients suffered from neurologic injury as a result of the locking device. No patient demonstrated radiologic evidence of implant failure. The postoperative MRI examination disclosed minimal implant artifacts and adequate spinal cord decompression.

CONCLUSIONS

The Synthes CSLP system for anterior stabilization provides efficacy, safety and ease of use. It also caused less distortion and minimal artifacts on postoperative MRI.

Peripapillary arterial loop--case report

Peripapillary arterial loops are uncommon congenital retinal arterial anomalies, which are characterized by retinal arterial loops that originate and terminate on the retina beyond the optic disc borders. We report a case of peripapillary arterial loop associated with preretinal and vitreous hemorrhage. The fluorescein angiography demonstrates the arterial loop and leakage from the loop and its capillaries. The origin of hemorrhage of peripapillary arterial loop might result from the loop and its adjacent capillaries.

Emphysematous pyelonephritis: imaging diagnosis and follow-up

We conducted the study to evaluate the efficacy and roles of different imaging modalities in the diagnosis and follow-up of emphysematous pyelonephritis (EPN) and to correlate imaging findings with clinical outcome. Retrospective analysis of the imaging studies and clinical outcome were performed in 28 consecutive patients with EPN. They were all initially treated with CT-guided percutaneous drainage (PCD). The imaging studies performed included plain abdominal radiography (KUB) (n = 28), sonography (US)(n = 24), intravenous urography (IVU)(n = 5), retrograde pyelography (RP)(n = 20) and computed tomography (CT)(n = 28). Follow-up imaging studies included CT(n = 23) and renal scintigraphy (n = 15). The sensitivities of detecting abnormal gas in EPN on KUB and US were 66% and 88%. The mortality rate was 11%, not associated with different types, stages or renal involvement. On the follow-up CT performed within one month of PCD, type I EPN evolved into type II in 86% of the cases. On the long-term follow-up CT, renal atrophy and focal scarring were revealed in the diffuse and focal renal involvement of EPN. The mean split renal function shown on the follow-up scintigraphy was 30%. We concluded KUB and US were valuable for screening EPN, although CT was the most specific and sensitive. Follow-up CT studies not only demonstrate the response of treatment but also depict the different courses and the results of different types and renal involvement of EPN, although not associated with mortality rate.

[Changing trends of ureteral injuries]

Ureteral injury is a potential complication of any abdominal or pelvic surgery. Gynecological surgery has traditionally accounted for most injuries. In the last decade, there have been major advances in endoscopic surgery including ureteroscopy and laparoscopy, both of which may cause ureteral injury. Increased use of these procedures change the nature of ureteral injuries. From 1988 to 1997, 22 patients with 24 ureteral injuries were identified. The causes, diagnostic methods and treatments were reviewed. Ureteral injury was defined as any laceration, transection or ligation of the ureter that required an unexpected procedure for repair, stent or drainage. In 24 ureteral injuries, there were 20 unilateral cases and 2 bilateral cases eight men (33%) were 15 to 43 years old (mean age 30), and 14 women including 2 case of bilateral lesion (67%) were 30 to 75 years old (mean age of 46). The injuries were on the right side in 11 cases (46%), left side 13 cases (54%), and in the upper, and lower third of the ureter in 7 (29%) and 17 cases (71%), respectively. Bilateral injuries were all in the lower ureter and another 2 cases of lower ureteral injuries were combined with bladder injuries. In the cases of ureteral injuries, iatrogenic injuries accounted for 19 cases (79%). Of these, urological surgery, laparoscopic surgery, ureteroscopic procedures and gynecological surgery accounted for 1 (4%), 2(8%), 5(21%) and 11 cases (46%) respectively. Between 1988 and 1992, there were 7 cases, and after 1993, there were 17 cases of ureteral injuries. The injuries caused by trauma and gynecological surgery remained stable in the 2 period. The recent increases were caused by endoscopic procedures including ureteroscopy and laparoscopy. Of the 24 cases, 13 cases (54%) were managed by ureteroneocystostomy, 5 cases (21%) by nephrectomy, 4 cases (17%) by ureteroureterotomy, 1 case by PCN and 1 case by double-J catheter stenting only. The early recognition and repair at injury allow for better results with fewer complications. Delayed finding or commitant infection may lead to failure of reconstructive procedure and lead to nephrectomy.

Changes in the activities of mitochondrial enzymes in the progress of tumorigenesis of bladder cancer

To investigate changes in the activities of mitochondrial enzymes in the progress of tumorigenesis of bladder cancer, N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) carcinogen was administered orally to male Sprague-Dawley rats for eight weeks. The urinary bladders were harvested periodically for the evaluation of tumorigenesis. The activities of NADH cytochrome c reductase (NCCR), succinate cytochrone c reductase (SCCR) and cytochrome c oxidase (CCO) were measured. The NCCR and SCCR activities elevated significantly by the exposure of BBN and decreased rapidly when BBN was withdrawn. However, the CCO activity increased and reached plateau at 18 weeks in spite of the discontinuance of BBN. The results indicated that the NCCR, SCCR and CCO activities were significantly elevated in the tumorigenesis. However, the CCO enzyme may be more related to the progress of tumorigenesis of bladder cancer.

Sp1 binds to the rat luteinizing hormone beta (LHbeta) gene promoter and mediates gonadotropin-releasing hormone-stimulated expression of the LHbeta subunit gene

The hypothalamic hormone gonadotropin-releasing hormone (GnRH) plays a critical role in reproductive function by regulating the biosynthesis and secretion of the pituitary gonadotropins. Although it is known that GnRH induces luteinizing hormone beta (LHbeta) gene transcription, the mechanisms by which this occurs remain to be elucidated. We have shown previously that GH3 cells transfected with the rat GnRH receptor cDNA (GGH3-1' cells) support the expression of a cotransfected fusion gene composed of 797 base pairs of rat LHbeta gene 5'-flanking sequence and the first 5 base pairs of the 5'-untranslated region fused to a luciferase reporter (-797/+5LHbetaLUC) and respond to a GnRH agonist with a 10-fold stimulation of activity. Furthermore, we have shown that DNA sequences at -490/-352 confer GnRH responsiveness to the rat LHbeta gene. We have now identified two putative binding sites for Sp1, a three-zinc-finger transcription factor, within this region. Using electrophoretic mobility shift assay, DNase I footprinting, and methylation interference assays, we demonstrate that Sp1 can bind to these sites and that Sp1 is responsible for DNA-protein complexes formed using GGH3-1' and alphaT3-1 nuclear extracts. Mutations of the Sp1 binding sites, which block binding of Sp1, blunt the stimulation of the LHbeta gene promoter by GnRH. These data define GnRH-responsive elements in the LHbeta 5'-flanking sequence and suggest that Sp1 plays an important role in conferring GnRH responsiveness to the LHbeta subunit gene.

Balanced fluid exchange by volume homeostatic fluid-fluid exchanger--a new solution to postvitrectomy vitreous hemorrhage

We introduce a new device and a new technique that facilitate the clearance of postvitrectomy vitreous hemorrhage. We have developed a volume homeostatic fluid-fluid exchanger--Chen's Infusion/Aspiration (Chen's I/A) device. Due to reciprocal synchronized hydraulic action, Chen's I/A provides simultaneous infusion and aspiration of fluid of equal amounts. Therefore, it can be used to perform vitreous cavity lavage through smaller caliber needles and at the same time maintain a constant intraocular pressure. This improved vitreous cavity lavage technique is named Balanced Fluid Exchange. Performing Balanced Fluid Exchange with Chen's I/A can reduce trauma to the eyeball and decrease complications resulting from unstable intraocular pressure. Thus, it increases both the intra-operative and post-operative clearance rates of postvitrectomy vitreous hemorrhage, and is a promising method for the management of postvitrectomy vitreous hemorrhage.

Paraneoplastic elevation of serum alkaline phosphatase in renal cell carcinoma: incidence and implication on prognosis

PURPOSE

We investigated the incidence and prognostic significance of paraneoplastic elevation of serum alkaline phosphatase in patients with renal cell carcinoma.

MATERIALS AND METHODS

Clinical data of 365 pathologically proved renal cell carcinoma cases were reviewed. Serum alkaline phosphatase level greater than 100 units per 1., but without obvious conditions that may cause phosphatase elevation, including metastasis to or disease of liver or bone and pregnancy, was regarded as paraneoplastic serum alkaline phosphatase elevation. Survival was evaluated using the Kaplan-Meier method.

RESULTS

Of 365 patients 77 (21.1%) had paraneoplastic serum alkaline phosphatase elevation. The respective incidence from stage I to IV cases was 9.9% (16 of 161), 31.9% (15 of 47), 34.3% (23 of 67) and 25.6% (23 of 90). Patients with stage I disease had the lowest incidence but there were no statistically significant differences among stages II, III and IV disease. Of 77 patients with elevated serum alkaline phosphatase 48 had additional paraneoplastic manifestations. The disease specific 5-year survival rate in patients with normal serum alkaline phosphatase was significantly better than in patients with isolated phosphatase elevation, which in turn was better than in patients with multiple paraneoplastic syndromes (70.7 versus 50.5 versus 30.8%). Patients with persistent or recurrent elevation of serum alkaline phosphatase after radical nephrectomy had metastatic lesion or local recurrence. In some patients serum alkaline phosphatase returned to normal after nephrectomy but metastasis developed later without recurrent phosphatase elevation.

CONCLUSIONS

Paraneoplastic serum alkaline phosphatase elevation in renal cell carcinoma patients implies an unfavorable prognosis, and additional paraneoplastic syndromes further worsen the prognosis. Recurrent or persistent serum alkaline phosphatase elevation after radical nephrectomy suggests distant metastasis or residual tumor. However, the return of serum alkaline phosphatase to normal does not guarantee cure of the disease. Identification of paraneoplastic serum alkaline phosphatase elevation is valuable in the prediction of outcome and postoperative followup of renal cell carcinoma patients.

The correlation between ultrasound-detected renal parenchymal thickness and isotope-detected individual renal function

Ultrasound has been used as a convenient examination method to obtain an estimate of the kidney size and parenchymal thickness. The aim of this study was to determine the relationship between the renal parenchymal thickness and individual renal function. Renal ultrasonography to determine parenchymal thickness and 99mTc-DTPA renal scan to detect individual renal function were carried out on 30 patients. The statistic analysis showed poor correlation between these two factors. The correlation coefficients is 0.1 only. However, the correlation coefficients of the difference of bilateral renal parenchymal thickness and the difference of bilateral renal function in the same patient is much higher (r = 0.67). So, it is unreliable to predict the random single renal function based on parenchymal thickness only. However, in the same patient, it is sometimes worthwhile to differentiate bilateral renal function based on the difference of renal parenchymal thickness between the two kidneys.

Osteomyelitis and tenosynovitis due to Mycobacterium marinum in a fish dealer

Osteomyelitis caused by nontuberculous mycobacteria is rarely reported. We describe a case of tenosynovitis and osteomyelitis of the right middle finger and metacarpal bone caused by Mycobacterium marinum in a fish dealer. This 52-year-old woman suffered progressive pain, numbness, tenderness, and erythematous swelling of the right middle finger over a 2-month period. A radiograph of the right hand disclosed osteolytic lesions at the third metacarpal bone and the third proximal phalanx. She was treated successfully with repeated surgical debridement and antimicrobial agents, including clarithromycin, ethambutol, rifampin, and doxycycline for 1 month, followed by ethambutol and clarithromycin. Pathologic examination of the debrided tissue disclosed epithelioid granuloma, caseous necrosis, and numerous acid-fast bacilli, which were later identified as M. marinum using conventional biochemical tests and by the characteristic gas-liquid chromatogram of esterified cellular fatty acid. The wound healed completely after 7 months of treatment. The patient is still under treatment, and clarithromycin and ethambutol will be given for a total of 18 months.

Facial mutilation after an assault with chemicals: 15 cases and literature review

Facial mutilation after an assault with chemicals is rarely discussed in the literature even though it is a devastating injury that occurs worldwide and is not prohibited or punished by special laws. It is our purpose to describe the devastating outcome of facial mutilation after an assault with chemicals and to draw attention to this injury as a worldwide problem. We studied fifteen patients who sustained facial mutilation with chemicals. The common story was that the patient's spouse was the perpetrator, that sulfuric acid was used, and that the deed occurred after marital or financial discord. All victims were disfigured severely and most became reclusive and rarely left their homes. Six patients (40%) had total bilateral blindness and one suffered partial loss of vision. Lower eyelid ectropion (14), microstomia (12), cervical flexion contracture (10), ear deformity (8), and nostril stenosis (6) were common. Few of the perpetrators were prosecuted. We reviewed the literature and found that the problem has been described all over the world, and that the outcome is similar to that which we described. The problem deserves worldwide recognition and attention.

Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience

PURPOSE

We investigated the effect of percutaneous drainage for the treatment of emphysematous pyelonephritis.

MATERIALS AND METHODS

A retrospective analysis was done of 25 patients with emphysematous pyelonephritis who were treated initially with computerized tomography (CT) guided percutaneous drainage during a 10-year period. The patients were concomitantly treated with antibiotics, fluids, and correcting blood glucose and/or ureteral obstruction. We also compared our results of percutaneous drainage to CT findings.

RESULTS

CT identified 12 patients with emphysematous pyelonephritis who had gas with little fluid and 13 who had gas with renal or perirenal fluid collections. In 20 of 25 patients (80%) antibiotic therapy combined with percutaneous drainage constituted the only treatment required. Three patients (12%) whose clinical status improved after percutaneous drainage subsequently underwent elective nephrectomy without further complications. Two patients (8%) died of multiple organ failure. There was no correlation between the gas patterns of emphysematous pyelonephritis and initial success with the antibiotics and percutaneous drainage. There were no recurrences and no complications during a followup of 1 to 10 years (mean 5). Mean duration of treatment was 5.54 weeks (range 1 to 12.6).

CONCLUSIONS

CT is an efficient imaging method for diagnosis, guiding the drainage procedures and monitoring response to percutaneous drainage of emphysematous pyelonephritis. Antibiotic therapy combined with CT guided percutaneous drainage of emphysematous pyelonephritis is an acceptable alternative to antibiotic therapy with surgical intervention.

Relationships between beta-cell function and diabetic duration and albuminuria in type 2 diabetes mellitus

To clarify whether beta-cell function deteriorates with increasing albuminuria and duration of diabetes, we investigated the insulin and c-peptide response to oral glucose tolerance test in 47 healthy subjects and 75 normoalbuminuric (group 1), 30 microalbuminuric (group 2), and 35 macroalbuminuric (group 3) Type 2 diabetes mellitus patients. The total area under the insulin curve (AUCI) values of groups 1, 2, and 3 were 245 +/- 16, 193 +/- 17, and 88 +/- 8 pmol/L.h, respectively, significantly lower than that (624 +/- 34 pmol/L.h) of the healthy group. The mean total area under the c-peptide curve (AUCC-P) values of groups 1, 2, and 3, respectively, were 2.50 +/- 0.11, 2.05 +/- 0.15, and 1.73 +/- 0.07 nmol/L.h, respectively, significantly lower than that (5.47 +/- 0.19 nmol/L.h) of the healthy controls. The mean AUCI and AUCC-P values of group 3 were significantly reduced compared to those of group 1. The mean AUCI and AUCC-P values of patients with 0-5, 5-10, 10-15, and > 15 years' duration were significantly decreased compared to those of healthy subjects. The mean AUCI and AUCC-P values of patients with > 15 years' duration were significantly lower than those of patients with 0-5 years' duration. The mean hemoglobin Alc values of the three diabetic groups were not significantly different. These data suggest that beta-cell function deterioration was associated with increasing albuminuria and diabetic duration in Type 2 diabetic patients.