Vitamin B-6 status indices are lower in pregnant than in nonpregnant women but urinary excretion of 4-pyridoxic acid does not differ

The cause of reduced plasma pyridoxal-5'-phosphate (PLP) concentration and the validity of plasma PLP concentration as a vitamin B-6 status indicator during pregnancy are not well understood. In this study, pregnant and nonpregnant women consumed a controlled diet for 5 d to exclude dietary intake as a factor in altered vitamin B-6 metabolic utilization. Plasma PLP and pyridoxal (PL) concentrations were significantly lower and higher, respectively, and plasma PL+PLP concentration was significantly lower during pregnancy. When plasma PLP and PL concentrations were normalized based on plasma albumin concentration, the differences were less marked but were still significant. The erythrocyte aspartate aminotransferase activity coefficient was significantly greater in pregnant women which is a further indication of reduced vitamin B-6 concentrations in the blood. No difference was observed in the urinary excretion of 4-pyridoxic acid between the pregnant and nonpregnant women. Results of this study demonstrate that vitamin B-6 status indices are lower during pregnancy without differences in the urinary excretion of 4-pyridoxic acid.

Intraarterial cisplatinum and intravenous adriamycin for primary hypervascular bone tumor: experience of seven cases

Seven consecutive cases of primary hypervascular bone tumor, encountered between January 1991 and September 1992, were treated with intraarterial cisplatinum and intravenous adriamycin infusion. There were four osteosarcomas, one malignant fibrous histiocytoma, one chondrosarcoma and one case of primitive neuroectodermal tumor. Local symptoms were markedly relieved, or disappeared, in 71% (5/7) of cases after the first course of treatment. Sclerotic changes of bone tumor occurred in 100% (6/6) of cases after two courses of chemotherapy. Progressive decrease of tumor stains was noted in 100% (6/6) of patients during angiographic assessments. On exploration, no gross tumors were found in 80% (4/5) of the cases that received limb-sparing surgery. Although disappearance of symptoms and sclerotic changes of bone tumor predicted a good response to treatment, the degree of decrease of tumor stains corresponded best with the extent of tumor necrosis. Our study verified the effectiveness of intraarterial cisplatinum and intravenous adriamycin infusion in treating primary hypervascular bone sarcomas. Further studies with more cases are necessary to define the optimal duration of postoperative adjuvant chemotherapy.

Allograft transplantation in aggressive or malignant bone tumors

Twenty-three patients with aggressive benign or malignant bone tumors had segmental allograft replacements after resection of the tumors. The mean age of the patients was 30 years of age. The mean length of the allografts was 14 cm. The allografts consisted of intercalary allograft (5), allograft arthrodesis (12), and allograft-prosthetic composite (6). Intramedullary fixation with or without additional compression plate was used to osteosynthesize all the osteotomy sites with the exception of one in which a long nail plate was used. A supplement of autogeneic bone grafts at the allograft-host junction was performed in 18 patients. Seven patients received preoperative and postoperative chemotherapy for high grade sarcomas. At an average follow-up period of four years, 78% of the patients had excellent or good results. The union rate of the grafts was 86%. Supplement with autografts shortened the union time of the allograft from 15 to eight months. One patient had a tumor recurrence and one died of the disease. Other complications included one delayed union, two nonunions of the allograft, two late infections, and one neuropathy. Allograft transplantation is an acceptable method for tumor reconstruction. The adjuvant chemotherapy did not have significant adverse effects on its outcome. Complications that relate to allografting are common, but most of them are salvageable.

Prognostic factors in 43 cases of osteosarcoma

Osteosarcoma is the most common primary bone malignancy. The purpose of this study was to investigate the prognostic factors in the overall and disease-free survival rates by using univariate methods and Cox's multivariate regression model. Patients from Tri-Service General Hospital and Chang Gung Memorial Hospital in Kaohsiung with pathologically proven high-grade osteosarcoma were recruited for this study. There were 29 (67.4%) men and 14 (32.6%) women with a mean age of 17.8 years (range 8 to 35 years). Twenty-five cases (58.1%) were stage IIB, and 18 cases (41.9%) were stage III. The overall five-year survival rate was 15% for these 43 cases. Additionally, the disease-free survival rate was 20% at five years for the 25 stage IIB cases. Univariate and multivariate analyses showed that male gender, stage III disease, surgery only, radiotherapy only, chemotherapy only, no treatment and proximal extremity location were the unfavorable factors associated with death in these 43 cases; while male gender, radiotherapy only, chemotherapy only, no treatment and an elevated serum alkaline phosphatase level were the unfavorable factors associated with recurrence for stage IIB cases.

Multiple schwannomas of the foot: report of a case

Schwannoma, a relatively common tumor of the nerve sheath, rarely involves the foot. A review of the literature disclosed that most reports of schwannoma of the foot were solitary tumors. There has been only one reported case of multiple schwannomas of the foot. We report a case of multiple schwannomas involving both the medial and lateral plantar nerves of the right foot. The patient had been treated for plantar fasciitis for the previous eight years. After excision of one tumor, magnetic resonance imaging (MRI) was used in the diagnosis, revealing four additional tumors. These tumors were also successfully excised and the patient's symptoms relieved. Patients with prolonged intractable pain and tenderness of the foot may require examination by MRI or sonography to search for deep tumors impinging upon the plantar nerves.

A case of massive osteolysis after knee prosthesis polyethylene failure

A case of massive osteolysis of the distal femur in response to particulate polyethylene from a broken uncemented tibial component is described. The osteolysis was so extensive that it made the revision arthroplasty extremely difficult. Early detection and early revision is recommended.

First alveolar-arterial oxygen gradient (AADO2) in mechanical ventilation as a predictor for duration of intubation in respiratory distress syndrome

From January 1988 to May 1992, 33 premature infants (inborn, gestational age less than 35 weeks), put on respirator therapy (before six hours of age) due to severe respiratory distress syndrome (RDS), were studied to examine if the first alveolar-arterial oxygen gradient (AaDO2) after initiating mechanical ventilation could be used as a predictor of intubation duration. They were divided into three groups: nine cases without associated diseases or severe complications who were successfully extubated (group I), 10 cases with associated diseases or severe complications who were successfully extubated (group II), and 14 cases where death occurred before extubation (group III). After intubation, the relationship between the first AaDO2 and the intubation duration thereafter was examined. A significant correlation between AaDO2 and the number of days of intubation was demonstrated only in group I (r = 0.93, p < 0.001). Among the groups, the means of the gestational ages, Apgar scores, data of the first arterial blood gas sample and ventilator settings after intubation, and AaDO2 were not statistically different. The results suggest that the first AaDO2 cannot be used to predict mortality and morbidity, but it can be used as a predictor of the number of days of intubation in surviving RDS infants without associated diseases or severe complications. If a surviving patient with RDS is not extubated by the expected date, one should search for possible associated diseases or severe complications.

Treatment of recurrent adamantinoma of the tibia by wide resection: report of three cases

Three cases of recurrent adamantinoma of the tibia were treated by wide resection and frozen allograft reconstruction. After an average follow-up period of 4.5 years (from 3.5 to 5.5 years), all allografts were found to have united to both ends of the host bone and none of the patients suffered further recurrence. According to Enneking's criteria for functional evaluation, two patients had excellent results and one had a good result. Therefore, it appears that amputation is not the only solution for recurrent adamantinoma of the long bone. In selected cases, wide resection and allograft replacement can achieve a satisfactory result.

Unusual clinical features of neonatal anemia due to fetomaternal transfusion

Fetomaternal transfusion occurs in about 50 percent pregnancies. However, it can cause severe neonatal anemia at birth. A one-day-old baby girl, small for gestational age, was born to a G1P1 woman without perinatal blood loss or obstetric complication. Pallor and mild tachypnea were noted after birth. Laboratory examination revealed severe anemia, (Hb: 4.8 gm/dl, Hct: 14.7%), reticulocytosis and normoblastemia. Direct coombs' test was negative. Brain echo examination was normal. Maternal peripheral blood smear stained with Kleihauer-Betke technique demonstrated presence of fetal cells. Following packed red blood cells transfusion, the baby's symptoms improved. The unusual clinical features were described and discussed. Kleihauer-Betke test should be performed in unexpected neonatal anemia after birth.

Bioavailability of vitamin B-6 in pregnant rats

The cause for reduced plasma pyridoxal phosphate (PLP) concentration during pregnancy is not well understood. In this study, nonpregnant (control) and pregnant rats were gavaged with [3H]pyridoxine for assessment of the intestinal absorption, tissue distribution, metabolic utilization and urinary excretion of the vitamin. In addition, plasma PLP and pyridoxal levels and erythrocyte aspartate aminotransferase (EAST) activity were measured. There was 50% lower plasma PLP concentration and 50% greater EAST activity in the pregnant rats and no difference in the stimulation of EAST with exogenous PLP. There was no difference in the intestinal absorption, hepatic uptake and retention or urinary excretion of the radioisotope. Less than 3% of the oral dose was detected in fetal/uterine tissue of the pregnant rats. Results of this study indicate that reduced plasma PLP concentration during pregnancy is not a result of diminished total vitamin B-6 body pools or fetal sequestration of vitamin B-6. Low plasma PLP during pregnancy may be a result of altered distribution of PLP between the plasma and erythrocytes.

Osteofibrous dysplasia (ossifying fibroma of long bones). A report of four cases and review of the literature

Osteofibrous dysplasia (ossifying fibroma of long bones) is a rare fibroosseous lesion. Only about 64 cases have been reported in the English literature. It is most commonly found in the tibia and fibula of a child ten years of age or younger. Of the four cases reported in this study, however, only one patient was younger than ten years of age. In two cases, the lesions were unusually located in the radius and ulna respectively. The other two cases had the usual tibial involvement. The last case had two recurrences after curettage before the patient was ten years of age. The other three patients who were treated after the age of 18 years had uneventful healing, one after wide resection and two after curettage. Extensive histologic examination and immunostaining for keratin were performed in all cases. No epithelioid cells were found. Because of a high recurrence rate after curettage, the treatment of this disease in a child should be conservative if the diagnosis is confirmed by biopsy. Only curettage with bone grafting is necessary for those patients older than 15 years of age with symptomatic lesions.

Chondrosarcoma of bone: a statistical analysis of prognostic factors

From 1980 to 1988, 30 cases of chondrosarcoma of the bone were treated surgically. Twenty-seven cases were followed from 6 months to 8.7 years (mean, 3.2 years). In all cases, a clinicopathological review was performed and the significance of prognostic factors were analyzed. The five-year survival of total patients was 88%. The survival was related to adequacy of treatment and histologic grade of the tumor. The five-year survival of adequately treated patients was 100%, but in inadequately treated patients it was 68%. At 8.7 years, 100% of the patients with grade-1 or grade-2 tumors survived, compared to 50% of the six-month survival rate in patients with the grade-3 tumors. None of the grade-1 or grade-2 chondrosarcomas metastasized, while 75% of grade-3 chondrosarcomas metastasized. The incidence of local recurrence was influenced by adequacy of treatment. At the final follow-up, the recurrence rate in the adequately treated group was 7%, while in the inadequately treated group it was 57%.

Mycoplasma pneumoniae pneumonia: clinical analysis of 45 cases

Mycoplasma pneumoniae (M. Pneumoniae) is a primarily pathogen of the respiratory tract. The clinical characteristics, laboratory findings, and roentgenographic patterns of 45 patients with serologically proven M. pneumoniae pneumonia admitted to Chang Gung Hospital from 1981 to 1989 have been reviewed. There were 23 males and 22 females. Forty-one (91%) were below 40 years old and 13 patients (29%) were below 5 years old. Fever, cough and chest rales were the most common symptoms and signs. A transient mild elevation of liver enzymes was seen in 33% of the patients, most of whom were below the age of ten (73%). A leukocyte count over 15,000/cu mm was not rare (16%). Roentgenographic features included unilateral infiltration (84%), lower lobe predominance (60%), and either confluent (56%) or patchy (33%) consolidation. Pleural effusion occurred in 24% of the patients. Complete resolution of chest roentgenography took from 8 to 42 days with a mean of 20 days. The response of fever to treatment with erythromycin took from 1 to 6 days with a mean of 3 days. There were no life threatening pulmonic or extrapulmonic complications.

Evaluation of HemoQuant test and enteroclysis in estimating the sites of obscure gastrointestinal bleeding

The HemoQuant test includes the measurement of total fecal hemoglobin (Hb) or porphyrin derived from heme, and of intestinal converted fraction (ICF) which is the performed porphyrin probably by bacteria during enterocolic transit. The mean +/- SD of HemoQuant in 31 healthy subjects was 0.57 +/- 0.49 mg Hb/g stool, values above 2 mg Hb/g stool are considered to be positive. In patients with upper GI bleeding (n = 44), small bowel bleeding (n = 11) and large bowel bleeding (n = 16), the ICF ranged 0.03-23%, 0.09-20.20% and 0.35-11.0%, respectively. There was major overlap in individual ICF due to some influencing factors such as the quantity of fecal blood and the enterocolic transit. We conclude that HemoQuant is a sensitive assay for detection of fecal occult blood, but ICF is not helpful in estimating the anatomic site of bleeding. Seventy-one patients with GI bleeding of obscure origin underwent enteroclysis. The results showed 77.5% had definite lesions in the small bowel, but 22.5% still were undefined. It is suggested that enteroclysis should be performed without delay if upper and lower GI endoscopic studies are negative.

The influence of walking mechanics and time on the results of proximal tibial osteotomy

The current study describes the influence of the passage of time on the original findings. The mechanisms used by some patients to reduce loading at the knee (adduction moment) also were analyzed. We evaluated the gait of twenty-seven patients (thirty-two knees) who had had a proximal tibial osteotomy for a varus gonarthrosis. Twenty-four patients (twenty-eight knees) returned for follow-up at three to 8.9 years after the osteotomy. This is a follow-up to our original study (Prodromos et al.), which described a relationship between the magnitude of the adduction moment at the knee during walking and the outcome of proximal tibial osteotomy. The patients were divided into low and high adduction-moment groups on the basis of the magnitude of the adduction moment at the knee as measured preoperatively during walking. All fourteen patients in the low adduction-moment group and nine of the fourteen patients in the high adduction-moment group had a good or excellent result. The varus deformity recurred in ten patients in the high adduction-moment group and in three patients in the low adduction-moment group. All of the results degenerated over time. The adaptive mechanism that was used to lower the adduction moment during gait included shortening the stride and toeing-out. The significant correlation between the magnitudes of the inversion moment at the ankle and the adduction moment at the knee suggested that the toe-out gait reduced the adduction moment at the knee.(ABSTRACT TRUNCATED AT 250 WORDS)

Neonatal lupus erythematosus: report of a case

We present the first report of neonatal lupus erythematosus from Taiwan. A female baby, born to a mother with documented systemic lupus erythematosus (SLE), developed cutaneous lupus lesions after phototherapy for hyperbilirubinemia. She had additional clinical features of hemolytic anemia and thrombocytopenia. Detailed serological and immunogenetic studies were performed. Transplacental passage of both anti-SSA/Ro and anti-SSB/La antibodies were demonstrated and their disappearance at the age of 6 months correlated with regression of clinical symptoms. This patient inherited human leukocyte antigen (HLA) A11, Bw60 Cw3, DR2 and Aw33, Bw57, Cw7, DRw6 from her father and mother, respectively. A long-term follow-up is required for observing whether she will develop SLE in the future.

[Histamine and lung cancer. II. Human lung cancer cell line and histamine]

Using tissue culture and biochemical technique, the effects of autacoid-histamine and histamine H-2 receptor's antagonist-cimetidine on human lung cancer cell line were studied. It was shown that histamine at the concentration of 1.8 x 10(-7) M stimulated proliferation of the lung cancer cells, but histamine at the concentration of 1.8 x 10(-4) M or cimetidine at 1.76 x 10(-7) M inhibited growth of the lung cancer cells. Relation between histamine, histidine decarboxylase, histamine formation capacity and tumor proliferation is discussed.

[COMVp regimen in the treatment of small cell lung cancer--report of 106 patients]

One hundred and six consecutive small cell lung cancer patients were treated by a combination regimen COMVp (CTX 1,000-1,400 mg IV D 1,8; VCR 1-2 mg IV D 1,8; MTX 20-40 mg IV or IM D 3,5,10,12; VP-16 100 mg IV drip D 3-7; three weeks as a cycle and 2-3 cycles as a course) in our hospital during 1983 to 1984. Among the 95 patients who were evaluated, 10 (10.5%) gave CR, 57 (60%) PR, 19 (20%) no change and 9 (9.5%) progression. The overall response rate was 70.5%. In this paper, factors influencing the response and side effects are also analysed. The data show that COMVp regimen is one of the good front line combination chemotherapy regimens currently available in the management of small cell lung cancer.

Preliminary crystallographic studies on bacterioferritin from Azotobacter vinelandii

Bacterioferritin-cytochrome from Azotobacter vinelandii is an unusual protein containing haem groups as well as iron core like other ferritin. This paper reports the purification of bacterioferritin by affinity chromatography and the formation of brick-red crystals from a solution containing MgCl2. The crystals are optical isotropic with maximum dimensions of 0.4 X 0.4 X 0.1 mm3. The preliminary X-ray crystallographic studies have been performed. 1.5 degrees unscreened precession photographs show that the crystals of bacterioferritin belong to the cubic system, space group I432, with cell dimension 230 A. There are probably 8 molecules in one cubic unit cell and the molecule might have 32 symmetry. A molecular diameter of 115 A is derived from the packing of the molecules and a molecular weight of 826,000 is estimated for bacterioferritin.