The evaluation of hepatoprotective effects of Taiwan folk medicine 'teng-khia-u'

'Teng-khia-u' is a folk medicine of Taiwan, derived from the entire plants of Elephantopus scaber L., E. mollis H.B.K. and Pseudoelephantopus spicatus (Juss.) Rohr. The hepatoprotective effects of water extracts of these three plants against beta-D-galactosamine (D-GalN)- and acetaminophen (APAP)-induced acute hepatic damage were determined in rats. The results indicated that the serum glutamate-oxalate-transaminase (sGOT) and the serum glutamate-pyruvate-transaminase (sGPT) levels caused by D-GalN and APAP decreased after treatment with crude extracts of 'teng-khia-u' (P < 0.005). The pathological changes of hepatic lesions, caused by D-GalN and APAP, improved following treatment with the drug extracts mentioned above.

Ultrasound-guided percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy: a new trial in the treatment of severe acute suppurative cholecystitis

Seven cases of acute suppurative cholecystitis underwent percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy at the Tainan Municipal Hospital. All the patients had frank septic phenomena clinically, including fever, jaundice, leukocytosis and unstable blood pressure. Organisms were cultured from both blood and bile specimens. Ultrasound-guided transhepatic puncture of the gallbladder was performed for bile drainage, and laparoscopic cholecystectomy was subsequently performed two to five days later after the patients had stabilized. No procedure-related complications from either percutaneous transhepatic gallbladder drainage or laparoscopic cholecystectomy were observed. All patients had early recovery, shortened hospital stay and good cosmetic results. These preliminary results show that laparoscopic cholecystectomy is a safe method and can be employed in those patients with symptomatic gallstone associated with suppurative cholecystitis after preoperative biliary drainage.

Immunocytochemistry of Kaposi's sarcoma-like tumor cells from pigtailed macaques with simian AIDS

Some macaques infected with SRV-2 developed SAIDS and RF, a Kaposi's sarcoma (KS)-like tumor. We investigated the immunophenotypic markers of this SAIDS-associated retroperitoneal fibromatosis (RF). RF tumor is characterized by proliferation of spindle cells accompanying inflammatory cell infiltrates, fibroblasts, and endothelial cells. RF spindle cells in tumor tissues revealed several immunobiologic characteristics similar to vascular smooth-muscle cells or myofibroblasts based on positive immunoreactivity of smooth-muscle alpha-actin and desmin. The majority of cultured RF spindle cells also expressed specific markers for vascular smooth muscle. These results suggest that the RF spindle cells are derived from vascular smooth-muscle cells. Furthermore, RF tissues and cells were persistently infected with SRV-2, which may play an important role in viral etiology of AIDS-associated neoplasm in this macaque model.

Intrarectal inoculation of macaques by the simian immunodeficiency virus, SIVmne E11S: CD4+ depletion and AIDS

Macaca nemestrina and Macaca fascicularis were inoculated with various doses of a single-cell clone of SIVmne-infected HuT 78 cells (E11S) by both the intravenous and intrarectal routes. Animals inoculated intravenously at each dose seroconverted and virus was isolated from peripheral blood mononuclear cells, but only the high-dose intrarectally exposed macaques became viremic and seroconverted. However, some seronegative, virus isolation negative intrarectally inoculated macaques showed evidence of infection and disease.

The topography of the furcation entrance in Chinese molars. Furcation entrance dimensions

The purpose of the present study was to document the furcation entrance dimensions (FEDs) of the maxillary and mandibular 1st and 2nd molars and relate them to the choice of periodontal therapy. Study samples consisted of 89 maxillary molars (49 1st and 40 2nd molars) and 93 mandibular molars (50 1st and 43 2nd molars). All the FEDs of the molars were examined and measured under a stereomicroscope at 2.5 x equipped with a Bioscan OPTIMAS Image Analyzer (BOIA). The results may be summarized as follows. (1) The mean FEDs in the buccal, distal and mesial furcations of maxillary 1st and 2nd molars were 0.74 mm, 0.99 mm and 1.04 mm in the 1st molars, and 0.63 mm, 0.67 mm, 0.90 mm in the 2nd molars, respectively. In the buccal and lingual furcations of mandibular 1st and 2nd molars, they measured 0.88 mm and 0.81 mm, and 0.73 mm and 0.71 mm, respectively. (2) The %s of FEDs of 0.56 mm or less (the tip width of a Cavitron tip being 0.56 mm) in the buccal, distal and mesial furcations of maxillary 1st and 2nd molars, accounted for 32%, 8% and 6% of 1st molars, and 40%, 40% and 18% of 2nd molars. In the buccal and lingual areas of mandibular 1st and 2nd molars, they accounted for 16% and 26%, and 35% and 33% of the furcations, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

The reverse lateral arm flap, based on the interosseous recurrent artery, for cubital fossa burns

The reverse lateral arm flap based on the interosseous recurrent artery was used successfully to reconstruct cubital fossa defects caused by high voltage electric burn in two cases. The flap is nourished by the septocutaneous perforators of the posterior radial collateral artery which anastomoses around the lateral epicondyle with the interosseous recurrent artery. The primary benefits of this flap are that it is an easy and rapid one-stage procedure, with no necessity of sacrificing a main artery or local muscle, and it requires no immobilisation of the involved joint.

Surface modifying additives for improved device-blood compatibility

Copolymers composed of polar and nonpolar blocks, when blended with a base polymer in low concentrations, migrate to the base polymer surface during and after fabrication. Migration of these surface modifying additives (SMAs) dramatically changes the outermost surface molecular layers that comprise the region that determines biocompatibility. The blood compatibility of cardiopulmonary bypass and hemodialysis components have been improved by using SMA blended polymers or SMA coated surfaces. The particular SMAs used were a series of triblock copolymers with a general formulation of polycaprolactone-polydimethylsiloxane-polycaprolactone. X-ray fluorescence (XRF), fourier transform infrared (FTIR), refractive increments (RI), and gel permeation chromatography (GPC) were used to characterize the molecular weight of SMA and the bulk concentration of SMA after blending. Electron spectroscopy for chemical analysis (ESCA) proved that the surface of blended polymers was highly saturated with SMA. Results of in vitro experiments with human blood demonstrated that SMA blended polymers delay contact activation (kallikrein-like activity), reduce coagulation activity (thrombin-antithrombin [TAT] generation), and do not adversely affect complement activation (terminal complement complex [TCC] generation) or mononuclear cells activation (IL-1 beta production). Ex vivo canine AV shunt studies showed improvement of platelet compatibility of SMA blended polymers. Reduction of cellular and protein system activation by using components fabricated with SMA blood contacting surfaces can potentially result in reduced morbidity associated with extracorporeal circulation.

The morphology of root fusion in Chinese adults (I). Grades, types, location and distribution

The purpose of the present study was to investigate the morphology, extent, and distribution of root fusions in 1st and 2nd permanent molars in a Chinese population. The sample consisted of 158 maxillary and 151 mandibular extracted 1st and 2nd molars. Root fusion in molars was assessed by direct viewing and measuring the length of the root and root trunk with stereoscopic microscopy. Root fusion was graded by the extent of fusion and the number of affected surfaces. The main results were as follows: (1) the majority of root fusions affected upper and lower 2nd molars (39.7% and 28.1%, respectively); (2) the prevalence of maxillary roots with 1, 2 and 3 fusions was 55.2%, 31.3% and 13.4% respectively, and most of the root fusions affected the maxillary 2nd molars (65.7%); (3) the majority of mandibular root fusions affected the 2nd molars (89.2%), and were of grade III (48.7%); (4) in order of decreased prevalence, the grades of root fusion in 2nd molars were grades III, II and I; whereas in 1st molars they were grades I, II and III; (5) there were 44 (41.5%) and 19 (51.4%) complete root fusions (grade III) among 106 fused roots in maxillary molars and 37 fused roots in mandibular molars, respectively.

Evaluation of choledochojejunostomy with subcutaneous jejunostomy for treatment of intrahepatic stones

Twenty-nine patients, 16 males and 13 females, with intrahepatic stones were treated by choledochojejunostomy with subcutaneous jejunostomy after choledocholithotomy in cases where the common bile duct was dilated more than 2 cm in diameter. This surgical technique consists of putting a segment of jejunum in the subcutaneous area with a jejunostomy after finishing the choledochojejunostomy. If the stone recurs years later, this loop of jejunum will offer a route for inserting the scope while producing the fistulotomy under local anesthesia. These patients became symptomless soon after removal of the residual stone by postoperative choledochoscope. After more than five years of follow-up study, seven cases (24.1%) had reflux cholangitis and among them, four patients had recurrent stones. Reopening of the fistulotomy was carried out under local anesthesia, and the choledochoscope was inserted into the bile duct through the jejunum for removal of those recurrent stones. We believe that this surgical technique is very effective for the treatment of patients with recurrent intrahepatic stones without the necessity of major laparotomy.

An easy way to prepare microskin grafts

The conventional technique to produce microskin grafts is a relatively time-consuming procedure. We developed an easy method by using a trimmed circular dermacarrier with the non-grooved side up and driving forward in the meshgraft instrument through six different angles that were 30 degrees apart. The tiny skin particles obtained by this method not only saved operation time but also survived well in the grafted wounds.

Reconstruction of soft tissue defects of the lower leg with the distally based medial adipofascial flap

A distally based medial adipofascial flap, based on the lower perforator originating from the posterior tibial vessels, is described. It has been used successfully to cover tibial bone and/or plate exposure on the lower leg in 5 patients.

Magnetic resonance imaging of the kidneys in paroxysmal nocturnal hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (PNH) is a blood cell disorder characterized by repeated intravascular hemolysis. Histologically, there is hemosiderin deposition in the proximal tubular cells of the renal cortex. We report a case of PNH with characteristic magnetic resonance findings. The signal intensity of the renal cortex was markedly decreased in various pulse sequences because of the T2-shortening paramagnetic effect of hemosiderin. The significance of signal intensity ratios between renal cortex and medulla, renal cortex and skeletal muscle are discussed. These ratios of the PNH patient are significantly different from those of normal controls (p = 0.0000).

Comparison of the efficacy of AZT and PMEA treatment against acute SIVmne infection in macaques

The antiretroviral drugs azidothymidine (AZT) and 9-(-2-phosphonyl-methoxyethyl)adenine (PMEA) were individually tested for prevention of simian immunodeficiency virus (SIVmne) infection in macaques (Macaca fascicularis). Macaques were pretreated with either drug before inoculation with SIVmne, and drug treatment was continued for four weeks. The virus, antibody, and clinical status of the macaques was monitored for up to 36 weeks following inoculation. While AZT prophylaxis resulted in reduced virus load in some macaques, PMEA prophylaxis was highly efficacious in preventing acute SIVmne infection.

Bilateral hepatic duct decompression via a single percutaneous tract using a 'mother-baby' drainage catheter

Decompression of the right and left hepatic ducts using a 'mother-baby' self-made drainage system via a single percutaneous tract was performed successfully in 15 of 21 patients with benign (n = 4) and malignant (= 17) hilar obstruction. The 'mother-baby' drainage system was composed of an 18 F catheter placed through the right hepatic duct into the distal common bile duct which was designated as the 'mother' catheter, while a second 10 F baby catheter was placed through the first catheter into the left hepatic ducts. This was achieved by a three-stage procedure: (1) percutaneous transhepatic biliary drainage; (2) balloon dilatation of the tract; and (3) intubation of the contralateral hepatic duct and placement of the 'mother-baby' drainage catheters. The mean interval of stent clogging was 5 months, with a range of 2-9 months. In 12 malignant cases, average survival time was 9.8 months. The technique avoided a second percutaneous hepatic puncture in centrally obstructing lesions and afforded bilateral biliary decompression.

Preexposure prophylaxis with 9-(2-phosphonylmethoxyethyl)adenine against simian immunodeficiency virus infection in macaques

A reverse transcriptase inhibitor, 9-(2-phosphonylmethoxyethyl)adenine (PMEA), was evaluated for efficacy against acute simian immunodeficiency virus (SIV) infection in juvenile macaques (Macaca fascicularis). Macaques were pretreated subcutaneously with PMEA for 48 h before SIV inoculation. Drug treatment continued for an additional 28 days. Efficacy of PMEA was determined by detection of SIV in blood, SIV DNA in peripheral blood mononuclear cells, and SIV antibodies. Protection from acute SIV infection occurred in 83% of macaques treated with 20 mg/kg/day versus 50% of macaques treated with 10 mg/kg/day. Several PMEA-treated macaques developed mild dermatitis that disappeared when the 4-week therapy ended. The results of these experiments indicate that preexposure prophylaxis with PMEA can prevent acute SIV infection in macaques. Since PMEA demonstrates profound inhibition of retrovirus infection, it may have utility as a chemoprophylactic agent for humans exposed to SIV or human immunodeficiency virus.

An analysis of the relative occurrence of N-demethylation and N-oxidation in xenobiotic metabolism using structure-reactivity maps

The relative occurrence of N-demethylation and N-oxidation in a structurally diverse set of N-methyl tertiary amines was examined using structure-reactivity maps. A structure-reactivity map of the data indicated important structural features useful for predicting the relative occurrence of these reactions. A steric index which describes the degree of steric hinderance at the N-methyl reaction site is defined. A QSAR between the relative occurrence of N-demethylation and N-oxidation of N-methyl tertiary amines and the steric index was developed.

Cortical renal leiomyoma with extension to renal pelvis

We describe a case of renal leiomyoma in a 21-year-old woman who presented with flank pain and hematuria. Urographic and computed tomographic (CT) studies revealed a large right renal mass with polypoid outgrowth protruding into the renal pelvis. Cortical renal leiomyoma with this radiographic manifestation is extremely rare.

Gas-containing liver abscess: radiological findings and clinical significance

Sixty-two cases of verified gas-containing pyogenic liver abscess were reviewed to study the radiological and clinical prognostic factors. A mortality rate of 37.1% (23 cases) was observed. Among these patients, the survival time of 13 patients with alveolar gas pattern or pneumoperitoneum (6.15 +/- 7.36 days) was significantly shorter than that of the other 10 patients (17.70 +/- 13.32 days) despite immediate diagnosis and aggressive treatment. The poor radiological prognostic signs were: (1) alveolar gas pattern and pneumoperitoneum as viewed on radiographs; and (2) globular configuration, shaggy margin, alveolar internal structure, and total gas content on computed tomographic (CT) scans. High serum creatinine and glucose levels and a short time to diagnosis were the poor clinical prognostic factors. The aggressive treatment did not change the outcome. We conclude that, in addition to the clinical evaluation, meticulous radiological study of the abscess morphology should be done in cases of gas-containing liver abscess in an effort to provide further aggressive treatment for those patients with poor radiological prognostic signs.

Prevalence and characteristics of areca nut chewers among junior high school students in Changhua county, Taiwan

Some studies indicate that betel quid and its ingredients chewing can produce cell mutagenicity and tumorigenicity. In Taiwan studies, betel quid chewing is the main cause of submucous fibrosis and oral cancer. Understanding the distribution and characteristics of the areca nut chewing population is one of the first steps in the effort to prevent these oral diseases. A stratified cluster random sample of 2442 junior high school students in Changhua county, Taiwan, were surveyed for the habit of areca nut chewing. Significantly more male students chewed areca nut than female students (9.2% vs 0.9%). The proportion of students who were chewing areca nuts increased with increasing (seventh to ninth) grades. Areca nut was used by junior high school students at a higher rate in village (rural) areas as compared to town (semi-urban) and city (urban) areas (6.4%, 3.7% and 3.0%, respectively). More students in the ordinary achievement classes were chewing areca nuts than those in the high achievement classes (8.4% vs 1.6%). Areca nut chewing students tended to have users in their families. Cigarette smoking and alcohol drinking were positively associated with areca nut chewing. More than half (53.6%) of the areca nut chewing students first experimented with this habit with a family member, most often the father or grandfather.

Henoch-Schoenlein purpura due to streptokinase

The syndrome of Henoch-Schoenlein purpura developed in a 74-year-old woman after receiving streptokinase as thrombolytic therapy for an acute myocardial infarction. Renal biopsy revealed mesangial hypercellularity with deposits of IgA. Skin biopsy also revealed IgA deposition. Immunological studies showed evidence of sensitization to streptokinase. Elevated IgG, IgA, IgM, and IgE antistreptokinase antibodies were detected in the acute serum. Positive immediate skin reactivity to streptokinase was also present. Serum precipitins to streptokinase disappeared when IgA was removed from the serum. Positive staining with biotinylated streptokinase was seen in the skin in the same pattern of distribution as IgA. These findings strongly support the role of streptokinase and IgA in the pathogenesis of Henoch-Schoenlein purpura in this patient. A control group of streptococcal-infected patients showed no immune response to streptokinase. Another control group of streptokinase-treated patients, who had no untoward reaction, had elevated immunoglobulin classes and precipitins to streptokinase. However, the precipitating antibody was IgG and streptokinase skin tests were negative.

Percutaneous choledochoscopic biliary tract stone removal: experience in 645 consecutive patients

Our experience in non-operative retrieval of biliary tract stones through PTCS (percutaneous transhepatic cholangioscopy, n = 103) and POC (post-operative choledochoscopy, n = 542) plus the use of Dormia basket and EHL (electrohydraulic lithotripsy) is presented. The results of transhepatic and T-tube routes are compared, with emphasis on the technical difficulties encountered. The success rates were 96% and 97% in POC and PTCS, respectively. No mortality was related to these procedures. Intrahepatic duct angulation and stricture were the factors most often responsible for failure. Postoperative choledochoscopic stone removal is safe and the method of choice for retained biliary tract calculi, while PTCS is highly indicated for those high-risk patients with or without previous biliary surgery. POC and PTCS have, therefore, their own indications and differ in their clinical applications.

Infectivity and pathogenesis of titered dosages of simian immunodeficiency virus experimentally inoculated into longtailed macaques (Macaca fascicularis)

The 50% macaque infectious dose (MID50) and pathogenesis of uncloned simian immunodeficiency virus (isolated from a pigtailed macaque, SIVmne) was determined in longtailed macaques (Macaca fascicularis). Five pairs of macaques were inoculated with 10-fold dilutions of the virus stock, and one macaque was mock-infected. The virologic and clinical status of these macaques was monitored for up to 80 weeks. The MID50 of SIVmne was determined to be 10(2) cell culture infectious dose of the original virus stock. In order to test the infectivity and pathogenesis of an established viral dose, six additional macaques were inoculated with 10x MID50 (10(3) cell culture infectious dose) of the SIVmne. The virologic and clinical status of these macaques was monitored for 40 weeks. All of the macaques inoculated with 10x MID50 or greater became infected as evidenced by seroconversion and consistent virus isolation from peripheral blood mononuclear cells. Macaques infected with SIVmne had an initial sharp decrease in CD2, CD20, CD4, CD8, and CD4CD29 lymphocyte subsets, whereas the CD4:CD8 ratio increased. Viremic macaques developed persistent slight to moderate peripheral lymphadenopathy approximately 3 to 4 weeks after inoculation. Four macaques subsequently died of AIDS-like disease at 29, 33, 42, and 80 weeks after inoculation. Data obtained from the viral titration study and the acute infection model will aid in the development of animal trials to evaluate antiretroviral therapies and preventive vaccines against human immunodeficiency virus infection.

Effect of dosing frequency on ZDV prophylaxis in macaques infected with simian immunodeficiency virus

The effect of dosing frequency on zidovudine (ZDV) prophylaxis against simian immunodeficiency virus (SIV) infection was examined in long-tailed macaque monkeys (Macaca fascicularis). The results indicate that dosing frequency is extremely important for drug efficacy. The monkeys were divided into three groups based on dosing frequencies of 6-, 8-, or 12-h intervals. All were given a total daily dose of 100 mg/kg of ZDV. The drug was administered subcutaneously starting 24 h before SIV inoculation, and treatment continued for an additional 28 days. With the total daily dose held constant, ZDV was most therapeutic when administered at 12-h intervals, less effective at 8-h intervals, and least effective at 6-h intervals. These results indicate that early ZDV treatment based on infrequent but high dosages may increase the antiretroviral effect of the drug. These findings could serve as a model for ZDV chemoprophylaxis in humans. In cases involving accidental exposure to SIV or human immunodeficiency virus (HIV-1 or HIV-2), immediate, high-dosage therapies may be most therapeutic.