Fracture of the entire posterior process of talus associated with subtalar dislocation: a case report

This is a case report of a 52-year-old woman who sustained a medial subtalar dislocation with fracture of the posterior process of the talus in a traffic accident. After closed reduction of the subtalar dislocation, tomography demonstrated that the talus fracture involved the entire posterior process and the posterior portion of the talar body. The fracture of the talus was treated with an open reduction and miniscrew fixation. At follow-up examination 32 months later, the functional and radiographic results were graded as good. The proposed mechanism of this case was a forced plantarflexion and inversion acting simultaneously on the subtalar joint. This was different from an isolated medial subtalar dislocation, which was caused by an inversion.

Treatment of giant cell tumor of long bone

From 1981 to 1991, sixty-eight patients with giant cell tumors of their long bones were treated and followed-up at Chang Gung Memorial Hospital. Thirty-three males and thirty-five females between the ages of 14 and 76 (average, 32 years) were followed for an average duration of 3.5 years (range, 2.5 years to 7.3 years). Forty-five primary lesions and 23 cases of recurrent lesions were diagnosed. Seventeen patients were classified as grade II while 51, as grade III. Surgical procedures included intralesional curettage and wide resection. The local recurrent rate following surgery was 13% (9/68). The overall outcome was 85% (58/68) good or excellent results. Complications included one superficial infection, 9 local recurrences and 3 fractures of fixation devices. In addition, one patient with a lung metastasis was noted. In the primary lesion group, there were 9 grade II and 10 grade III lesions treated by curettage and grafting. Of these 4 grade II and 5 grade III patients had local recurrences. The recurrent rate was 47% (9/19) following intralesional curettage with cancellous bone graft (8/16) or bone cement (1/3). The average period before local recurrence was 10.4 months. Seven of the 9 recurrent patients received radical resections and allograft reconstruction with good results at short-term follow-up. The other two patients were lost in follow-up. The cases in the curettage group had shown low recurrent rate (1/10) after 1989 and high recurrent rate (8/9) before 1989 (p < 0.001). The most important factor for local recurrence appeared to be inadequate curettage with similar recurrence rates regardless of the type of bone graft used. A careful approach to the surgical margin including use of a dental burr and local adjuvant treatment with phenol, the rate of local recurrence may be decreased. There were no recurrences in the wide resection group. Although radical resection yield a best chance for cure, the sacrifice of the joint with subsequent arthroplasty resulted a compromise of the joint function.

Efficiency of heating during radiofrequency catheter ablation of accessory atrioventricular pathways

Adequate heating with myocardial thermal injury is necessary for successful ablation. This study was designed to examine the relationship between power, temperature, and efficiency of heating during radiofrequency catheter ablation of accessory pathways in 76 patients. During each application of radiofrequency energy, temperature was continually monitored by use of an ablation catheter with a thermistor embedded in the tip of the distal electrode. The efficiency of heating varied by location, with the greatest efficiency of heating for posteroseptal energy applications (2.7 +/- 2.3 degrees C/W), which were significantly greater than for left-sided (2.1 +/- 1.9 degrees C/W, P < 0.01) or right-sided (1.0 +/- 1.1 degrees C/W, P < 0.01) applications. For patients with left free wall and posteroseptal pathways, the temperature, radiofrequency power, time to peak temperature and efficiency of heating were similar between the successful and unsuccessful pulses. However, the mean temperature (53.5 +/- 4.5 vs. 45.1 +/- 5.1 degrees C, P < 0.01) and radiofrequency power (49.6 +/- 5.2 vs. 40.3 +/- 10.2 watt, P < 0.05) differed significantly between the successful and unsuccessful ablation pulses in patients with right free wall pathways. To achieve greater efficiency of heating and higher temperature, it is reasonable to use higher power outputs (40-50 W) in radiofrequency ablation of right free wall pathways, whereas less power outputs (30-40 W) are likely to produce adequate heating of posteroseptal and left free wall pathways, and minimize the risk of impedance rise and coagulum formation.

Comparison of antiepileptic drugs on cognitive function in newly diagnosed epileptic children: a psychometric and neurophysiological study

Using a randomized parallel group study design, we compared the cognit ive effects of carbamazepine (CBZ), phenobarbital (PB), and valproate (VPA) in children with epilepsy. Seventy-three children with newly diagnosed epilepsy were tested with the Wechsler Intelligence Scale for Children-Revised (WISC-R), Bender-Gestalt test, and auditory event-related potentials (P 300) before and 6 and 12 months after antiepileptic drug (AED) treatment. There were no significant differences in WISC-R IQs and Bender-Gestalt scores for children in any group at any of the three sessions. P 300 latencies were increased in the children receiving PB but not in children receiving CBZ and VPA. P 300 amplitudes were significantly reduced in treated children in all three groups, but amplitudes were not significantly different among the three groups. These findings suggest that PB may affect cognitive function of epileptic children and that the P 300 may be a sensitive additional procedure that can be used to assess the cognitive effect of AEDs.

[Effect of early intervention on the interaction of developmentally delayed infants and their mothers]

The purpose of this study was (1) to examine the interaction patterns of mothers and their developmentally delayed infants during free play and instructional episodes; (2) to investigate the influence of an early intervention program on the interaction patterns of mothers and their developmentally delayed infants; and (3) to investigate to what extent the maternal perceptions and expectations, perceived stress and involving motivation were associated with maternal behavior while interacting with their developmentally delayed infants. The participants of this study were twenty-one developmentally delayed infants and their mothers. Each mother-child dyad was videotaped in a laboratory playroom for 10-minutes of free play and a 5-minute instructional session. Mental and psychomotor development of the child were measured by Bayley scale. The perception of child development, expectation, and the stress of mothers were measured by a self-report questionnaire which was designed by a researcher in this study. The mothers' motivation of involvement was evaluated by teachers. On year after early intervention, it was found that (1) developmentally delayed infants increased locomotion, (2) mothers demonstrated more positive emotional expression during mother-child interaction, and (3) the score of HOME, mother's involvement, and the quality of mother-child interaction which was evaluated by teachers were significantly increased. Furthermore, the differences between situations indicated that the developmentally delayed infants were more toy-oriented during play than instruction. The mothers tended to be more helpful in attitude while they instructed their children. The mother's perception of child development and stress were found to be the critical factors affecting maternal teaching, controlling, and caring behavior.

Molecular basis of spinal muscular atrophy in Chinese

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Complete fracture-dislocation of the thoracic spine with spontaneous neurologic decompression: a case report

Fracture-dislocations of the thoracic spine without spinal cord injury are very rare. We report a case of a complete T6-7 fracture-dislocation without neurologic deficit in a 61-year-old male Taiwanese. Complicating neurological deterioration on the fifth post-injury day during a nonoperative treatment with a Gardner-Wells skull tong and pelvic belt traction on a Stryker frame was noted. Emergent open reduction and posterior instrumentation with dual Harrington rods of T3 to T9 was performed. At 2-year follow-up examination, a good reduction was maintained and the patient had resumed full activities.

Surgical indications in low lumbar burst fractures: experiences with Anterior Locking Plate System and the reduction-fixation system

A study of 14 surgically treated patients with low lumbar burst fractures (L3 to L5) is reported. Initially, 13 patients presented with incomplete neurologic deficits below the level of injury. The follow-up period ranged from 24 to 40 months, with an average of 30 months. In group 1, seven patients underwent one-stage anterior decompression, fusion, and Anterior Locking Plate System (ALPS) fixation. In Group 2, seven patients had posterior surgery with decompression, portero-lateral fusion, and a short segment fixation, one above and one below the injuried level, with the reduction-fixation transpediculate system. Indications for one-stage anterior surgery consisted of patients with incomplete neurologic deficits, segmental kyphotic deformity caused by loss of anterior vertebral height (< 50%), or canal encroachment < 50%. When there is significant radiologic evidence of lamina fractures, displaced or greenstick type, or injuries that occurred at the L5 level, the posterior approach was undertaken initially. This may be followed by anterior surgery if satisfactory vertebral height restoration or canal clearance was not achieved. Five dura tears (36%) were noted during surgery: two tears in group 1 and three tears in group 2. There were two patients in group 2 (29%) who had screws broken; however, none in group 1 demonstrated implant failure. In the low lumbar region, the step-off ALPS plate is preferable to the straight plate because of the increasing size of the vertebral body toward the caudal area. A low profile and easy application were its advantages. However, the ALPS could not be distracted or compressed anteriorly.

Posterior tibial tendon tear combined with a fracture of the accessory navicular: a new subclassification?

A 58-year-old woman with a diagnosis of a tear of the posterior tibial tendon associated with the os accessory navicular fracture was treated surgically. We believe that the dysfunction of the posterior tibial tendon was associated with an os accessory navicular fracture. This case is proposed as a new subclassification that was separate from the traditional classification of the tear of the posterior tibial tendon.

Innovative culture shock prescribed for health care

Finally, organizations must accept that inefficiencies are often present in creative cultures. Resources that were devoted to operating and revenue-generating functions must be shifted to finance the capacity to be creative. The short-term focus of today's organizations blinds them from envisioning the long-term benefits of fostering creative changes and improvements. When creativity is properly managed, meaningful risks may be taken with reasonable costs occasionally yielding monumental results.

Effects of bilirubin on visual evoked potentials in term infants

To determine bilirubin-induced neurotoxicity, serial visual evoked potentials (VEPs) of 72 infants with neonatal hyperbilirubinaemia and 22 controls were evaluated and compared in four sessions for 8 weeks after birth. The levels of maximal serum bilirubin were found positively related to the wave latencies of first VEP. Within 8 weeks after birth, the wave latencies were significantly prolonged in infants in the severe and moderate groups than in the controls. The amplitudes of VEPs were apparently lower in severe and moderate groups than in the control group only in the 1st week after birth. At 1 year, 4 of the 18 infants in the severe group had poor motor skills and one had general hypotonia.

CONCLUSION

These results suggest that bilirubin may affect the visual pathways, and that VEP is a useful adjunct to the neurological assessment of neonatal hyperbilirubinaemia.

MG160, a membrane protein of the Golgi apparatus which is homologous to a fibroblast growth factor receptor and to a ligand for E-selectin, is found only in the Golgi apparatus and appears early in chicken embryo development

While over 20 intrinsic proteins of the Golgi apparatus have been identified and sequenced, there is no information on their developmental history, i.e., whether all Golgi proteins are expressed simultaneously or whether there is a hierarchical or stage-specific order of their expression during embryonic development. In this study we have examined the emergence and distribution of MG160 during the development of chicken embryos. MG160 is a conserved membrane sialoglycoprotein of the Golgi apparatus of most cells displaying over 90% amino acid sequence identities with two apparently unrelated molecules, namely CFR, a chicken fibroblast growth factor receptor, and ESL-1, a ligand for E-selectin (Gonatas et al., J. Biol. Chem. 1989, 264, 646-653; Burrus and Olwin, J. Biol. Chem. 1989, 264, 18647-18653; Burrus et al., Mol. Cell Biol. 1992, 12, 5600-5609; Gonatas et al., J. Cell Sci. 108, 457-467; Steegmaier et al., Nature 1995, 373, 615-620). This study was carried out by in situ hybridization, using a 56-mer antisense probe for the chicken homologue of MG160 which differs only by four bases from the corresponding segment of the rat cDNA and by immunocytochemistry and Western blotting using a polyclonal antiserum against MG160. The protein was ubiquitously and exclusively localized in the Golgi apparatus and appeared early in development within the ectoblast and primitive endoblast prior to the formation of the primitive streak. At 2 to 3 days, MG160 was particularly prominent in the notochord, neural tube, somites, and cartilage cells. In organs with central lumens, such as the neural tube, the Golgi apparatus, visualized by immunostaining for MG160, was elongated and it was located at the apical pole of cells. In 6-day-old embryos, the ongoing physiologic degeneration of the notochord was accompanied by fragmentation of the immunostained Golgi apparatus and decreased labeling of the mRNA for MG160. In order to gain information on possible interactions between MG160 and basic fibroblast growth factor (bFGF), the localization of both molecules was studied by immunocytochemistry in 3-day-old chicken embryos. While MG160 was ubiquitous in the Golgi apparatus of all cells and tissues, endogenous bFGF was no detected, while exogenous bFGF bound only to basement membranes. These results indicate that MG160 is a primordial protein of the Golgi apparatus and are consistent with the hypothesis that the binding of MG160 to fibroblast growth factors and E-selectin is not related to the still unknown principal function of MG160 in the Golgi apparatus.

Intramedullary spinal cord metastasis: a case report

Intramedullary spinal cord metastasis is a rare condition of systemic malignancy. We report a case of breast cancer with thoracic spinal cord intramedullary metastasis. The patient suffered from neurological deficit in both lower extremities. Magnetic resonance imaging (MRI) examination showed two soft tissue lesions located in the medullary region of thoracic spinal cord at T3 to T5 vertebral level. She was treated with local radiotherapy and systemic corticosteroid treatment with much improvement of the symptoms.

Soluble interleukin-2 receptor as a clinical parameter for nasopharyngeal carcinoma

We evaluated whether the serum soluble interleukin-2 receptor (sIL-2R) may be a parameter to monitor the efficacy of treatment for nasopharyngeal carcinoma (NPC). There were 177 NPC patients and 24 healthy controls. The level of sIL-2R was measured with a sandwich ELISA kit. Higher levels of sIL-2R than for controls were found in NPC patients before treatment and in patients with distant metastasis (p < 0.001). There was, however, no difference in sIL-2R levels between controls and NPC patients after radiotherapy in relapse-free or in primary relapse. The sIL-2R levels in sequential testing revealed good correlation with clinical response. The sIL-2R levels were found to be elevated when distant metastasis was detected. Two patients had elevated sIL-2R level up to 5 months before clinical detection of metastasis. These results indicate that serial measurements of sIL-2R levels are worthwhile for NPC patients in their clinical course. The sIL-2R level proved to be an adjunct clinical parameter to monitor the efficacy of treatment of NPC.

Chromosome painting analysis of early oogenesis in human trisomy 18

We have used chromosome 18-specific painting probes to analyze early stages of oogenesis in two human trisomy 18 fetuses. At leptotene, a diffuse, nonlinear chromosomal fluorescence was detected as one (27%), two (42%), or three (31%) signals in 534 cells. The variation in size of these signals implies the possibility of associations between homologs prior to zygotene. At pachytene, about 75% (339/453) of the cells had a trivalent configuration, and almost half of these cells exhibited almost complete triple synapses. Approximately 24% of the pachytene cells demonstrated a bivalent:univalent configuration, and 1% exhibited complete asynapsis. Our data imply that triple synapses may be a regular feature of meiosis involving multivalents.

Right ventricular myxoma in a 12-year-old child: a case report

Cardiac myxoma especially of the right ventricle, is rare in children. A 12-year-old boy with right ventricle myxoma is reported. His heart murmur was found incidentally when he visited the Outpatient Department (OPD) because of upper respiratory infection symptoms. There was no exertional dyspnea, no palpitation, no syncope and no skin lesion. The echocardiogram revealed a heart tumor of about 4 x 3 cm in the right ventricle (RV) extending to the right atrium (RA). The tumor grew from the interventricular septum, resulting in an RV outlet and inlet obstruction. Magnetic resonance image (MRI) revealed a well-defined mass in the RV ventricle, with good enhancement after injecting a contrast medium. The patient received right atriotomy and total excision of the tumor with repairing of the interventricular septum base. Pathology revealed myxoma with gelatinous whitish color and central hemorrhage. At post-operative follow-up, the patient's condition was good.

[A study of automatic activity and morphology of guinea-pig aortic vestibule]

The automatic activity of aortic vestibule was studied in 82 guinea-pig heart preparations with intracellular microelectrode. Spontaneous activity could be recorded in 16 preparations (19.5%), while in 61 preparations (74.4%) automatic activity could be induced by electrical stimulation. Of these preparations, they were all found a very small region below the right and the poster valves, the response showed a slow and low rising phase and a marked spontaneous depolarization in phase 4. The response could be blocked by Mn2+ and nifedipine. Outside of the specialized valve region, all recorded vestibule action potentials pertain to the fast type. Light and electron microscopic examination showed that the structure of the specialized local aortic vestibule region was similar to that of ordinary myocardium possessing slow automatic activity instead of the ordinary ventricular musculature.

Fracture of the posterior process of the talus associated with subtalar dislocation: report of a case

Although subtalar dislocation is not common in foot trauma, fracture of the entire posterior process of the talus is even rarer. The concomitant injury of a subtalar dislocation associated with a fracture of the posterior process of the talus has not yet been reported in the medical literature. A 52-year-old woman involved in a traffic accident had her right foot twisted into an inversion deformity. An X-ray revealed a medial subtalar dislocation associated with a fracture of the entire posterior process of the talus. Tomography demonstrated that the posterior process was incongruent to the ankle and the subtalar joints. The subtalar dislocation was treated with a closed reduction. The fracture of the posterior process was treated with an open reduction and internal fixation. After the anatomic reduction of both injuries, the patient recovered and returned to her previous activities.

The intra-articular migration of the broken wire: a rare complication of circumferential wiring in patellar fractures

Patellar fractures are frequently encountered in emergency situations. With proper treatment, the outcome is usually favorable. This study focuses on a rare complication of circumferential wiring in a case of patellar fracture treated by open reduction. A technical error which may have caused this complication is analyzed.

Effect of aminophylline on brain stem auditory evoked potentials in preterm infants

To determine the neurophysiological effects of aminophylline on apnoea of prematurity, the brain stem auditory evoked potentials (BAEPs) of 30 apnoeic infants and 34 age matched controls were evaluated and compared. After six days of treatment with aminophylline, the brain stem conduction time (interpeak latency of I-V) in apnoeic infants decreased compared with controls of a similar postconceptional age. The mean latencies of the peaks and interpeaks of all waves except wave I were significantly lower in the apnoeic infants after than before receiving aminophylline. No significant differences were found in the latencies of BAEPs between the apnoeic infants who responded and those who did not respond to aminophylline treatment, however. These results suggest that aminophylline may enhance conduction along central auditory pathways and stimulate the regulatory effect on the respiratory centre of the brain stem.

A murine model for bone marrow metastasis established by an i.v. injection of C-1300 neuroblastoma in A/J mice

A reproducible tumor model for bone marrow metastasis has been developed by an injection of murine C-1300 neuroblastoma (C-1300 NB) cells into the tail vein of syngeneic A/J mice. The animals died with liver metastases at 18-21 days after an injection of 10(5) tumor cells and often had bone marrow metastasis in the femur. N-methylformamide (NMF), a maturational agent, was administered to inhibit liver metastases and to extend survival in mice with advancing bone metastasis. Histological examination of bone marrow metastasis, demonstrated lesions varying from a few small colonies of C-1300 NB cells either in metaphysis or diaphysis to large foci replacing normal hematopoietic bone marrow, simultaneously invading epiphysis or cortex of bone as bone metastasis. This assay demonstrated the ability to detect neuroblastoma cells in the bone marrow histologically and could determine bone marrow TD50 by extraction of bone marrow cells after treatment with various doses of drug. Fifty per cent of mice injected with cyclophosphamide (CY) developed bone marrow metastasis without liver metastasis. Treatment with tamoxifen, an anti-calmodulin drug, suppressed tumor takes in the recipient mice with tamoxifen-dose-dependent fashion. This experimental system allows for investigations into the therapeutic response and biology of neuroblastoma metastases in the bone marrow.

Effects of prenatal exposure to PCBs on the neurological function of children: a neuropsychological and neurophysiological study

To determine the long-term neurotoxicity of prenatal exposure to polychlorinated biphenyls (PCBs), 54 children--27 'Yu-Cheng' ('oil disease') children and 27 controls--were administered a battery of tests, including the WISC-R, auditory event-related potentials (P300), pattern visual evoked potentials (P-VEPs) and somatosensory evoked potentials (SSEPs). Full-scale IQ scores on the WISC-R were lower for the Yu-Cheng group than for the control group. Mean P300 latencies were significantly longer, and P300 amplitude significantly more reduced, in the Yu-Cheng group than in the control group at Cz and Pz. There were no significant difference in peak latencies and amplitudes between the two groups for P-VEPs and SSEPs. These findings suggest that prenatal exposure to PCBs tends to affect high cortical function rather than the sensory pathway in the developing brain.

Infective endocarditis in infants and children during the past ten years

BACKGROUND

Infective endocarditis occurs infrequently in the general pediatric population, but is often associated in patients with underlying heart disease. Even today it remains a serious threat leading to relevant mortality in all pediatric groups, in spite of better antibiotic treatment and prophylactic measures for endangered persons. This retrospective analysis reports experience here with infective endocarditis in children.

METHODS

The clinical and laboratory findings in 28 children with 30 episodes of infective endocarditis, from July 1984 to June 1993, were reviewed retrospectively.

RESULTS

Twenty-one children (75 percent) had congenital heart disease, three (11 percent) had rheumatic heart disease and four (14 percent) had no underlying cardiac abnormality prior to presentation. Twenty-six (87 percent) of the 30 episodes had positive blood cultures. The most common organism isolated was streptococcus viridans (14 percent), followed by staphylococcus aureus (7 percent). Echocardiography identified vegetation in 21 of 28 (75 percent) patients. Twenty children were successfully treated medically. Four developed complications requiring surgery, of whom two died. A total of six children (21 percent) died of the disease or its complications. There were a high case fatality rate for children below the age of two years (75 percent), and children without an underlying cardiac abnormality (50 percent).

CONCLUSIONS

It was concluded that patient survival is dependent on several factors which include early diagnosis, appropriate antimicrobial therapy and aggressive surgical intervention.

The altered expression of cytokeratin polypeptides in carcinomas of human bladder

After extraction in high salt buffers and Triton X-100, cytokeratin polypeptides could be isolated from normal epithelium and transitional cell carcinoma of the human bladder in the southwestern coast of Taiwan. The polypeptides were solubilized via lysis buffer, separated by two-dimensional gel electrophoresis, and identified by immunoblot. Five cases of normal epithelium expressed cytokeratin No. 5 (58 kd), 7 (54 kd), 18 (45 kd) and one case further expressed cytokeratin No. 19 (40 kd) in addition to the above cytokeratins. Combined patterns of cytokeratin polypeptides were observed among various Grades of transitional cell carcinoma of bladder. Comparing the patterns between the normal epithelium and the transitional cell carcinoma of bladder, 88% (14/16) of carcinomas expressed cytokeratin No. 8 (52.5 kd) and 63% (10/16) expressed No. 17 (46 kd), which were not seen in the normal epithelium. Some other cytokeratin polypeptides particular to carcinomas were No. 4 (59 kd), No. 10 (56.5 kd), No. 13 (54 kd) and No. 14 (50 kd) and were only present in less than 50% (ranging from 31-56%) of the examined specimens. Thus cytokeratin No. 8 and 17 could be helpful markers for diagnosis of bladder carcinoma.

A case of simultaneous multiple gastric cancers with p53 gene mutation

Simultaneous multiple gastric cancers are rarely observed in clinical practice, and its association with p53 gene mutation has not been mentioned in any previous reports. We report a case of advanced gastric cancer with two primary lesions in the stomach who received total gastrectomy. Tumor and surrounding normal tissues from the surgical specimen were studied by using polymerase chain reaction-single strand conformation polymorphism analysis, restriction enzyme digestion method and direct sequencing. Point mutations of p53 gene at codon 248 (CGG-->TGG) were found in both primary tumor foci. The patient developed cancerous peritonitis eight months after the operation and expired six months later. This report suggests that p53 gene mutation can occur at an earlier stage in the tumorigenesis of gastric cancer than previously reported and it might be associated with an unusual clinical and pathological presentation.

Mutation analysis of K-ras oncogenes in gastroenterologic cancers by the amplified created restriction sites method

A rapid, simple, and nonradioactive method for diagnosing point mutations of c-K-ras oncogenes in gastroenterologic cancers is described. This method involved the selective amplification of DNA fragments from cancer tissues of surgical specimens with specific oligonucleotide primers, followed by digestion with restriction enzymes that recognized artificially created or naturally occurring restriction sites. To detect codon 12 mutations, an artificial Msp I site was created by introducing a single nucleotide mismatch into the 5' mutagenesis primer. Using a similar approach, an Hae III site was created to detect codon 13 mutations. Bal I and MBo II sites were used to detect codon 61 mutations. A total of 61 gastroenterologic cancer cases were studied. Of 35 cases of colorectal cancer, 7 showed mutations: 6 at codon 12 and 1 at codon 13. In 1 of 2 cases of cholangiocellular carcinoma, point mutation at codon 12 was found. One case of duodenal cancer showed point mutation at codon 12. No mutations were found in the cases of hepatocellular carcinoma (4), gastric cancer (12), esophageal cancer (3), or pancreatic cancer (2).

Bacterial meningitis in infants and children in southern Taiwan: emphasis on Haemophilus influenzae type B infection

During a four-year period from November 1988 to October 1992, 41 cases of bacterial meningitis with a positive cerebrospinal fluid (CSF) culture and/or CSF antigen test were collected at the National Cheng Kung University Hospital. The ages of the subjects ranged from 32 days to 13 years, with a median of seven months. The male to female ratio was 2.4:1. The most common causative agent was Haemophilus influenzae type b (Hib, 29.3%), followed by group B beta-hemolytic streptococci (GBS, 24.4%), Streptococcus pneumoniae (22.0%), Escherichia coli (4.9%), Neisseria meningitidis (4.9%), Salmonella species (4.9%), Klebsiella pneumoniae (4.9%), Pseudomonas aeruginosa (2.6%), and viridans streptococci (2.6%). The onset of GBS meningitis was always prior to four months of age. Of the 41 cases studied, 27 (65.9%) were aged from two months to five years; 12 (44.4%) of these had meningitis caused by Hib. Most of the cases (90.2%) had a fever as the first clinical manifestation. Ampicillin combined with a third-generation cephalosporin was effective against most of the causative pathogens. The most frequently encountered short-term sequelae were seizures (64.7%), subdural effusion (55.9%) and ventriculomegaly (44.1%). Observations on long-term sequelae are ongoing. While the case-fatality rate was as high as 33.3% in S. pneumoniae, and 25% in Hib-infected patients, the overall mortality rate was 17.1%. There is a need for greater emphasis on prevention through the use of available vaccines, including the newly introduced conjugate vaccines against Hib which are capable of eliciting immune responses in infants as young as two months.

"Hot spots" mutation analysis of p53 gene in gastrointestinal cancers by amplification of naturally occurring and artificially created restriction sites

We developed a rapid, simple method to detect "hot spot" point mutations of the p53 gene. A DNA fragment from cancer tissue of a surgical specimen was selectively amplified with specific oligonucleotide primers and then digested with restriction enzymes that recognized artificial or naturally occurring restriction sites. To detect mutations in codons 273 and 245, we created artificial Bst U1 and BgI I sites by introducing a single nucleotide mismatch into the respective mutagenesis primers. We used the naturally occurring restriction sites of Msp I, Hae III, and Hha I to detect mutations in codons 248, 249, and 175, respectively. In 74 cases of gastrointestinal cancer, 5 of 35 colorectal cancers showed mutations; 1 of 15 cases of gastric cancers showed mutation; and 1 of 24 hepatocellular carcinomas showed mutation. This nonradioactive method is an accurate and clinically useful way to detect hot-spot point mutations of the p53 gene in gastrointestinal cancers.

"Hot spots" mutation analysis of p53 gene in gastrointestinal cancers by amplification of naturally occurring and artificially created restriction sites

We developed a rapid, simple method to detect "hot spot" point mutations of the p53 gene. A DNA fragment from cancer tissue of a surgical specimen was selectively amplified with specific oligonucleotide primers and then digested with restriction enzymes that recognized artificial or naturally occurring restriction sites. To detect mutations in codons 273 and 245, we created artificial Bst U1 and BgI I sites by introducing a single nucleotide mismatch into the respective mutagenesis primers. We used the naturally occurring restriction sites of Msp I, Hae III, and Hha I to detect mutations in codons 248, 249, and 175, respectively. In 74 cases of gastrointestinal cancer, 5 of 35 colorectal cancers showed mutations; 1 of 15 cases of gastric cancers showed mutation; and 1 of 24 hepatocellular carcinomas showed mutation. This nonradioactive method is an accurate and clinically useful way to detect hot-spot point mutations of the p53 gene in gastrointestinal cancers.

Modulation of cardiac performance by amiloride and several selected derivatives of amiloride

Amiloride and its derivatives (benzamil, dichlorobenzamil, 5-(N,N-dimethyl)-amiloride, 5-(N-ethyl-N-isopropyl)-amiloride, (N,N-hexamethylene)- amiloride and 5-(N-methyl-N-isobutyl)-amiloride) are commonly used as selective blockers of Na+/Ca++ exchange or Na+/H+ exchange. Very little information is currently available regarding their effects on cardiac performance. It was observed that addition of amiloride or any of the selected derivatives to the coronary perfusate of the right ventricular wall produced a potent depressive effect on peak developed tension and the rates of tension generation and dissipation. The concentrations at which this occurred are those that are commonly used in ischemia or hypoxia studies. Significantly, the depressive action of the drugs increased with the perfusion duration and never achieved a stable level. An initial, transient positive inotropic effect was observed with some of the drugs. If the drug concentration and perfusion time was limited, the effects were reversible. All of the drugs except amiloride produced extra systoles. The drugs were capable of blocking Ca++ transients in isolated cardiomyocytes but had little effect on intracellular pH. The drugs lengthened the action potential duration and decreased the action potential amplitude and upstroke velocity. Their effects on cardiac performance may involve a complex inhibition of Ca++ influx and K+ efflux in addition to a stimulation of a nonselective cation current. It is concluded that amiloride and its analogs have striking effects on cardiac performance which may be unrelated to their capacity to inhibit Na+/Ca++ or Na+/H+ exchange. In summary, the use of these drugs is not normally recommended in cell or tissue perfusion experiments because of their nonselectivity. However, if the drug concentration and perfusion time is controlled carefully, interpretable data may be obtained in some cases.

Protein splicing of the yeast TFP1 intervening protein sequence: a model for self-excision

Protein splicing is the protein analogue of RNA splicing in which the central portion (spacer) of a protein precursor is excised and the amino- and carboxy-terminal portions of the precursor reconnected. The yeast Tfp1 protein undergoes a rapid protein splicing reaction to yield a spliced 69 kDa polypeptide and an excised 50 kDa spacer protein. We have demonstrated that the 69 kDa species arises by reformation of a bona fide peptide bond. Deletion analyses indicate that only sequences in the central spacer protein of the Tfp1 precursor are critical for the protein splicing reaction. A fusion protein in which only the Tfp1 spacer domain was inserted into an unrelated protein also underwent efficient splicing, demonstrating that all of the information required for protein splicing resides within the spacer domain. Alteration of Tfp1p splice junction residues blocked or kinetically impaired protein splicing. A protein splicing model is presented in which asparagine rearrangement initiates the self-excision of the spacer protein from the Tfp1 precursor. The Tfp1 spacer protein belongs to a new class of intervening sequences that are excised at the protein rather than the RNA level.

Treatment of segmental femoral shaft fractures

In a prospective study, 35 segmental femoral shaft fractures were treated either with closed intramedullary nails (most were Grosse-Kempf interlocking nails) or an open method technique (most were open Küntscher nails with supplementary wires). The follow-up period was at least one year. There was an 82.9% (29/35) union rate and a union period of 6.1 +/- 1.9 months. Knee range of motion was on average 125 degrees. Although there was no statistical difference, the closed intramedullary nailing group showed superiority to the open method group. Complications were not particularly different from those in other type fractures, but could be managed better. Closed nailing technique can be improved with training and experience. Whenever possible, with adequate indications, closed intramedullary nailing is better than open treatment for segmental femoral shaft fractures.

Effects of antiglaucoma drugs on ocular blood flow in ocular hypertensive rabbits

Antiglaucoma drugs were studied systematically on the ocular blood flow in ocular hypertensive rabbits. As expected, pilocarpine, clonidine and acetazolamide were all found to increase the ocular blood flow in the retina and choroid. However, their use in the clinics was much less than the beta-blockers, such as L-timolol, levobunolol, betaxolol and metipranolol. It was surprising to find that all non-specific and beta 1-specific adrenergic blockers decreased the ocular blood flow in ocular hypertensive rabbits. If this finding holds true in human patients, the use of beta-blockers for glaucoma treatment should be reconsidered. Dopamine antagonists, such as droperidol, metoclopramide and loxapine, were found to increase the ocular blood flow. Therefore, they might be able to replace beta-blockers for glaucoma treatment.

[Catch up and follow up of natal teeth: report of 6 cases]

6 cases with natal teeth were found in 11930 live births.5 cases, in which eight natal teeth had been found, also had been followed-up for 38-54 months after birth and five crownless root-like mass were found in 4 cases out of 5 at the site where natal teeth had been extracted at the time of birth. The histological study was made in one natal teeth and one root-like mass.

Improvement of ocular blood flow with dopamine antagonists on ocular-hypertensive rabbit eyes

The eyedrops of the ocular-hypotensive dopamine antagonists, trifluperidol, moperone, lenperone, and spiperone, were instilled into an ocular-hypertensive rabbit eye. The blood flows in the choroid, retina, iris root-ciliary body, and iris were measured with colored microspheres at various time periods. It was found that all these dopamine antagonists, at a concentration of 0.5%, increased the blood flow in all eye tissues. Dopamine, at a concentration of 3%, produced a biphasic action by decreasing the blood flow initially at 30 min, then increasing it at 120 min and thereafter. But 1.5% dopamine produced a monophasic action which increased the blood flow after 180 min. Since dopamine antagonists are not cholinergics or adrenolytics, they are not supposed to produce the side effects induced by pilocarpine or timolol. It is hoped that they can become satisfactory drugs for glaucoma and ocular hypertension.

[Dento-facial structural characteristics in Angle Class II malocclusion associated with abnormal facial divergency]

Lateral cephalometric radiographs of 60 adult patients with Angle class 11 malocclusion associated with abnormal facial divergency were collected from the Orthodontic Department of the National Taiwan University Hospital. They were divided into a hyperdivergent group (35 cases) and a hypodivergent group (25 case), according to mandibular plane angle (SN-MP). The 19 landmarks on each cephalometric tracing were digitized into a computer, then computer-aided cephalometric analysis was performed to calculate the 17 skeletal measurements and 13 dentoalveolar measurements. The dento-facial structural characteristics of the hyperdivergent and hypodivergent groups were compared. It was found that the subjects of the hyperdivergent group revealed a greater tendency of divergency in the anterior cranial base plane, Frank-fort horizontal plane, palatal plane, occlusal plane, and mandibular plane. Hyperdivergent facial type, supposedly indicating an open bite or a tendency toward an open bite, has a longer lower anterior facial height, shorter posterior facial height, longer upper anterior and posterior dental height. While, the majority of dentofacial characteristics of the hypodivergent facial type observed in is study were directly opposite to those of the hyperdivergent facial type. The relationships of incisor overbite depth and other skeletal and dentoalveolar parameters were illustrated by Pearson's correlation coefficient and stepwise multiple regression analysis by means of the SPSS/PC statistic program. With the incisor overbite depth as the dependent variable, the independent variables included on the regression analysis were the 10 items of skeletal and dentoalveolar parameters. The compared parameters showed a statistically significant correlation with the incisor overbite depth (P < 0.001). By the stepwise method, the variables included on the regression equation were (1) N-Go-Gn, (2) A-Gn-Ar, (3) N-Ans/ans-Me, and (4) U1L1. The value of R square (R2) in the regression analysis was 0.543. It demonstrated that only a 54.3% variation in incisor overbite depth can be explained by variations in those skeletal and dentoalveolar variables.

Thromboxane/prostacyclin balance in type II diabetes: gliclazide effects

We studied serum thromboxane (TXB2), the prostacyclin metabolite, 6-keto-PGF1 (6KPGF1) glucose, insulin, and lipid/lipoprotein profiles in 27 patients with non-insulin-dependent diabetes mellitus (NIDDM) who were switched from therapy with glibenclamide (GLB) (with [GLBH] or without phenformin) to gliclazide for 3 months. We found that therapy with gliclazide was followed by a decrease in serum TXB2 (281.8 +/- 128.3 to 149.1 +/- 77.0 mg/L, P less than .001) and an increase in serum 6KPGF1 (60.5 +/- 19.1 to 96.0 +/- 40.3 mg/L, P less than .001). This was accompanied by a decrease in total and low-density lipoprotein (LDL) cholesterol and an increase in high-density lipoprotein (HDL) cholesterol, within the HDL3 cholesterol fraction. These changes were seen despite the fact that neither fasting plasma glucose nor insulin changed with therapy. These findings suggest that gliclazide may have beneficial actions on cardiovascular risk factors in these NIDDM patients.

Hydrolysis of cholesteryl ester in low density lipoprotein converts this lipoprotein to a liposome

Previously, we isolated and characterized unique liposomal-like, cholesterol-rich lipid particles that accumulate in human atherosclerotic lesions. Human plasma low density lipoprotein (LDL) has a molar ratio of total cholesterol to phospholipid (3:1) similar to that of this lesion cholesterol-rich lipid particle. However, LDL is enriched in cholesteryl ester while the lesion lipid particle is enriched in unesterified cholesterol. To examine a possible precursor-product relationship between LDL and the lesion lipid particle, we hydrolyzed the cholesteryl ester core of LDL with cholesterol esterase. Cholesteryl ester hydrolysis occurred only after LDL was treated with trypsin. Trypsin pretreatment was not required for cholesteryl ester hydrolysis of LDL oxidized with copper, a treatment that also degrades apolipoprotein B, the major protein moiety in LDL. In contrast to greater than 90% hydrolysis of cholesteryl ester in trypsin-cholesterol esterase-treated or copper-oxidized LDL, there was only 18% hydrolysis of cholesteryl ester in similarly treated high density lipoprotein. With a limited 10-min hydrolysis of LDL cholesteryl ester, LDL-sized particles and newly formed larger flattened films or discs were present. With complete hydrolysis of LDL cholesteryl ester, LDL particles converted to complex multilamellar, liposomal-like, structures with sizes approximately five times larger than native LDL. These liposomal-like particles derived from LDL were chemically and structurally similar to unesterified cholesterol-rich lipid particles that accumulate in atherosclerotic lesions.

Studies on differentiation-inducing activities of triterpenes

Differentiation-inducing activity of over 180 extracts of crude drugs and plants was tested using mouse myeloid leukemia cell line (M1). The methanol extracts of clove (Syzygium aromaticum Merrill et Perry, Myrtaceae) showed remarkable induction of differentiation of M1 cells into macrophage-like cells. From the extract, oleanolic acid (1) and crategolic acid (2) were isolated as the active components. We also tested other triterpenes, such as oleananes, ursanes and dammaranes, to investigate the structure-activity relationship. Some triterpene aglycones showed differentiation-inducing activity, but triterpene glycosides showed little activity. Furthermore, the differentiation-inducing activity of these triterpene compounds was tested against human acute promyelocytic leukemia cell line (HL-60).

Effects of dopamine agonist, bromocriptine, and some dopamine antagonists on ocular blood flow

A dopamine agonist, bromocriptine, and several dopamine antagonists, domperidone, haloperidol, floropipamide and chlofluperol, were studied for their effects on the ocular blood flow. Both domperidone and haloperidol are ocular hypotensive agents and are able to increase the ocular blood flow significantly. Floropipamide had little effect on the intraocular pressure (IOP), yet it reduced the ocular blood flow markedly. Chlofluperol is an ocular hypertensive agent, yet it increased the ocular blood flow significantly. Although bromocriptine lowered the IOP, it did not affect the ocular blood flow. These results indicate that the changes of ocular blood flow are independent of the changes of the IOP. Therefore, it is critical to develop antiglaucoma agents which can increase retinal and choroidal blood flow in addition to lowering the IOP.

Effects of D- and L-isomers of timolol on retinal and choroidal blood flow in ocular hypertensive rabbit eyes

An ocular hypertensive rabbit eye model was used to study the effect of L- and D-timolol on retinal and choroidal blood flow. Ocular hypertension was induced artificially by raising the intraocular pressure to 40 mmHg which reduced the ocular blood flow to 1/3 that of the normal blood flow. The effects of L- and D-isomers of timolol on the ocular blood flow of ocular hypertensive eyes were then determined using the colored microspheres technique over a range of 0-180 min after eyedrop instillation. It was found that L-timolol produced biphasic action on the blood flow in the iris, ciliary body and choroid by significantly reducing it initially at 30 min, then markedly increasing it later at 90 min and thereafter. Although L-timolol produced a tendency to reduce the blood flow in the retina, it was not statistically significant. At 90 min and thereafter, the blood flow in all ocular tissues was markedly increased by L-timolol. D-timolol did not reduce the blood flow of ocular tissues initially. There was a tendency to increase the blood flow in all ocular tissues from the very beginning by D-timolol. The increase of blood flow became significant at 90 min and thereafter, up to 3 hrs. D-timolol was less potent than L-timolol in increasing the blood flow in ocular tissues.

Molecular action of tricholin, a ribosome-inactivating protein isolated from Trichoderma viride

An extracellular protein was isolated from a species of soil-borne fungi (Trichoderma viride) and its amino acid composition has been determined. The protein is acidic with a molecular mass of 14,200 daltons and is given the trivial name tricholin. Tricholin is a potent inhibitor of cell-free protein synthesis. When rabbit reticulocyte lysate was incubated with tricholin at a concentration of 6.3 x 10(-7) M, it completely abolished the capacity of the lysate to support protein synthesis. The inhibition appears to be due to its reaction to ribosomes, since it generates a specific cleavage product, an alpha-sarcin RNA fragment, from reticulocyte ribosomal RNA. This reaction to ribosomes mimics that of alpha-sarcin. The antibody of alpha-sarcin strongly cross-reacts with tricholin, while the antibody of tricholin shows a weak reaction with alpha-sarcin.