Primary iliac muscle abscess due to Staphylococcus aureus

A 55-year-old man presented with a 3-day history of lower back pain and right thigh pain. A diagnosis of discogenic pain had been made at two other hospitals. He had been admitted to a medical center for acute hepatitis 5 months prior to this admission. Large doses of parenteral hydrocortisone were used for 13 days to treat acute hepatitis. At the present admission, he was unable to stand and refused to move his right leg. There was mild tenderness in the right lower abdomen on deep palpation. Passive flexion and rotation of the right hip produced mild pain, while passive extension of the right hip produced severe pain and resistance. The Patrick test was positive and the psoas sign was present on the right side. The erythrocyte sedimentation rate (ESR) was 66/hr. The C-reactive protein (CRP) level was 0.161 g/L. Abdominal sonography showed a lobulated mass in the right iliac fossa. Magnetic resonance imaging showed severe swelling of the right iliac muscle with a central heterogeneous mass. Debridement, drainage of the abscess, and application of a septopal chain were performed via an anterior retroperitoneal approach, and parenteral cephazolin and gentamicin were administered. A culture of the abscess grew Staphylococcus aureus. The ESR and CRP concentrations decreased to within the normal ranges 3 weeks later. Awareness of this disease entity, careful physical examination, and appropriate imaging studies such as ultrasonography and magnetic resonance imaging are key to making a correct diagnosis.

Open bedside tracheotomy in the intensive care unit

OBJECTIVE

To demonstrate that open bedside tracheotomy is an efficient, safe, and cost-effective procedure.

STUDY DESIGN

Retrospective review of more than 200 open bedside tracheotomies performed at UCLA Medical Center, Harbor-UCLA Medical Center, and West Los Angeles VA Medical Center from 1995 to 1998.

METHODS

The only personnel required for the procedure were an attending or senior resident and a junior resident or intern, as well as the respiratory therapist to withdraw the endotracheal tube. No anesthetist or scrub nurse was present for any of the procedures. The procedure took an average of 15 to 25 minutes. Patients were followed for 30 days after surgery to determine the incidence of complications.

RESULTS

The incidence of major complications related to the procedure, including hemorrhage and myocardial infarction, was less than 1%. The incidence of minor complications, including moderate bleeding at the tracheotomy site, was 4%. Overall mortality within 30 days was 8%, but was not related to the tracheotomy for any patients in this series. The charge for the procedure was $233 for the tracheotomy tube supplies and instruments. This cost compares favorably with an average charge of more than $3000 for the procedure in the operating room and about $1000 for a percutaneous tracheotomy kit.

CONCLUSION

Review of our experience demonstrates that open bedside tracheotomies can be performed more efficiently and economically than operating room tracheotomies. The safety of this procedure is comparable to percutaneous tracheotomy but at a decreased cost.

Revised memory and behavior problems checklist in Taiwanese patients with Alzheimer's disease

The Revised Memory and Behavior Problems Checklist (RMBPC) is a 24-item caregiver report that measures observable behavioral and memory problems in dementia patients and their caregivers' reaction to these problems. The purpose of the present study was to evaluate the applicability of the RMBPC for use in Taiwanese patients with Alzheimer's disease (AD). The subjects included 76 AD patients (39 men and 37 women, mean age 72.3) and their caregivers (34 men and 42 women, mean age 53.5) who participated in a comprehensive assessment at the Veterans General Hospital-Taipei. The Chinese version of the Cognitive Abilities Screening Instrument was administered to the patients. Their caregivers rated the RMBPC and the short version of the Geriatric Depression Score (GDS). To assess the test-retest reliability, 30 caregivers rated a second RMBPC 3 days after the first evaluation. The mean score for the frequency rating on the RMBPC was 32.63 (SD = 12.44, range = 5-61) and the mean reaction score was 10.96 (SD = 11.53). The reaction score was significantly correlated with the GDS score (r = .363, p = .001). The Cronbach's alpha coefficients for frequency and reaction scores were .816 and .895 respectively. The test-retest reliabilities of total frequency and reaction scores were significantly correlated; overall correlations were .89 for frequency (p < .001) and .74 for reaction (p < .001). These findings suggest that the RMBPC be recommended as a reliable tool to assess behavioral and memory disturbance in Taiwanese AD patients.

Effect of reaction conditions on preparations of rhenium-188 hydroxyethylidene diphosphonate complexes

Rhenium-186 (Re-186) hydroxyethylidene diphosphonate (HEDP) has been shown to localize in metastatic foci within bone in a manner similar to Tc-99m bone-seeking agents. Usually, in the preparation of diagnostic Tc-99m radiopharmaceuticals, the concentration of Tc is at trace level (10(-8) M). However, large amounts of carrier are included in the preparation of Re-186 radiopharmaceuticals (10(-4) M), which may significantly affect the preparation of Re-HEDP. In this study, Re-188 was used as an Re tracer. The effects of pH and concentrations of Re carrier on the preparation of Re-HEDP were investigated. Re-188-Sn-HEDP was prepared by reconstitution of a kit of lyophilized HEDP mixture, and tin chloride with a radioactive solution of perrhenate in saline. The total concentration of Re present in this work ranged from 10(-8) to 10(-3) M. The results showed that high labeling efficiency was obtained for each preparation. Although the chemical behaviors of the Re-188 HEDP complexes, with and without carrier, were similar, the biodistribution patterns of carrier free Re-188 HEDP in rats were found to differ from the biodistribution patterns of carrier-added Re-188 HEDP.

The caregiving burden scale among Chinese caregivers of Alzheimer patients

From April 1996 to January 1997, a total of 76 Alzheimer's disease (AD) patients and their caregivers were recruited for participation in a comprehensive assessment at the Veterans General Hospital-Taipei, a 2,198-bed tertiary-care teaching hospital in Taipei, Taiwan. The AD patients responded to the Chinese version of the Cognitive Abilities Screening Instrument. Primary caregivers rated the patients using the Symptom Check List-90 (SLC-90) and the Revised Memory and Behavior Problems Checklist and then rated themselves with the caregiving burden scale (CBS), coping strategies scale and the short version of the Geriatric Depression Score (GDS-S). The internal consistency of the CBS, as assessed by Cronbach's alpha, was 0.849. The correlations between the CBS, SCL-90 and GDS-S ranged from 0.435 to 0.698. The CBS scores increased with disease progression and were higher among spouse caregivers than adult children caregivers. Multiple-regression analysis revealed that caregivers with higher CBS scores were more likely to have lower education levels and to use the meaning subscales of coping strategies, and that these caregivers' patients had greater disruptive behavior and were older (R2 = 0.727, p = 0. 001). The current study establishes the reliability and validity of the Chinese version of the CBS for assessment of Chinese caregivers of AD patients.

Botulism: heart rate variation, sympathetic skin responses, and plasma norepinephrine

BACKGROUND

Botulism may involve the autonomic nervous system.

METHODS

We assessed the autonomic function of 6 botulism patients with heart rate variations, sympathetic skin responses, and plasma norepinephrine.

RESULTS

Two weeks after onset, all the patients had absent sympathetic skin response in the palm and sole. Compared with controls, the heart rate variation of botulism patients was significantly decreased at rest (3.1 +/- 1.2% vs. 20.9 +/- 2.0%, p = 0.0018) and during deep breathing (4.3 +/- 2.3% vs. 29.7 +/- 2.6%, p = 0.0018). The botulism patients had significantly lower plasma norepinephrine levels (supine 29.2 +/- 10.1 pg/ml vs. 257.5 +/- 65.8 pg/ml, p = 0.0018; standing 40.3 +/- 13.1 pg/ml vs. 498.5 +/- 85.6 pg/ml, p = 0.0018). The heart rate variation and sympathetic skin response was greatly improved 6 months after onset.

CONCLUSIONS

Heart rate variation, absence of sympathetic skin response, and low plasma norepinephrine are all manifestations of autonomic dysfunction in botulism patients.

Human very-long-chain acyl-CoA synthetase: cloning, topography, and relevance to branched-chain fatty acid metabolism

Very-long-chain acyl-CoA synthetases (VLCS) activate very-long-chain fatty acids (VLCFA) containing 22 or more carbons to their CoA derivatives. We cloned the human ortholog (hVLCS) of the gene encoding the rat liver enzyme (rVLCS). Both hVLCS and rVLCS contain 620 amino acids, are expressed primarily in liver and kidney, and have a potential peroxisome targeting signal 1 (-LKL) at their carboxy termini. When expressed in COS-1 cells, hVLCS activated the VLCFA lignoceric acid (C24:0), a long-chain fatty acid (C16:0), and two branched-chain fatty acids, phytanic acid and pristanic acid. Immunofluorescence and immunoblot studies localized hVLCS to both peroxisomes and endoplasmic reticulum. In peroxisomes of HepG2 cells, hVLCS was topographically oriented facing the matrix and not the cytoplasm. This orientation, coupled with the observation that hVLCS activates branched-chain fatty acids, suggests that hVLCS could play a role in the intraperoxisomal reactivation of pristanic acid produced via alpha-oxidation of phytanic acid.

Prevalence of paraesophageal varices and gastric varices in patients achieving variceal obliteration by banding ligation and by injection sclerotherapy

BACKGROUND

The impact of banding ligation and injection sclerotherapy on paraesophageal varices and gastric varices has received scarce attention. We conducted a study using endoscopic ultrasound (EUS) to visualize paraesophageal varices and gastric varices in patients who underwent sclerotherapy and banding ligation.

METHODS

Patients with esophageal variceal bleeding whose varices were obliterated by ligation (44 patients) and by sclerotherapy (35 patients) were enrolled. EUS was used to compare the prevalences of paraesophageal varices and gastric varices between the treatment groups. The correlation between paraesophageal varices and esophageal variceal recurrence and recurrent bleeding was assessed.

RESULTS

The prevalence of paraesophageal varices was 86% in the ligation group compared with 51% in the sclerotherapy group (p = 0.002). The prevalence of gastric varices was slightly higher in the ligation group than in the sclerotherapy group (43% vs. 26%, p = 0.18). Esophageal varices recurred in 70% of the ligation group and 43% of the sclerotherapy group (p = 0.04). Patients in both groups with more severe paraesophageal varices had a significantly higher rate of variceal recurrence (p = 0.002 in ligation group and p = 0.001 in sclerotherapy group). Bleeding recurred in 6 patients in the ligation group and 4 patients in the sclerotherapy group. All patients with recurrent bleeding had paraesophageal varices. The rate of recurrent bleeding was significantly higher in patients with paraesophageal varices (p < 0.0001).

CONCLUSIONS

EUS was helpful in the imaging of paraesophageal and gastric varices after sclerotherapy or banding ligation. Paraesophageal varices were more frequently noted in patients undergoing ligation. The presence of paraesophageal varices may predict the recurrence of esophageal varices and recurrent bleeding.

Radiotherapy followed by neck dissection for small head and neck cancers with advanced cervical metastases

Patients with small or occult primary carcinomas of the head and neck with advanced cervical metastases present a difficult problem for the otolaryngologist. A retrospective review was performed of patients who presented to UCLA Medical Center between January 1986 and June 1996 with small or occult primary tumors of the head and neck with advanced cervical metastases. The treatment algorithm consisted of initial radiotherapy to the primary site and the neck, followed in 6 to 8 weeks with endoscopy and biopsy of the primary tumor site. As long as the repeat biopsy of the primary tumor site was negative by frozen section, an immediate neck dissection was performed, even if no residual neck disease was present. Almost 40% of patients with no clinical evidence of neck disease following radiotherapy had evidence of metastatic cancer on histopathologic examination. While some would consider a watchful waiting policy when there is no clinically detectable neck disease following radiotherapy, we believe it is preferable to perform immediate surgery in such patients, in light of the high incidence of microscopic metastatic disease.

Cross-modulation of synaptic plasticity by beta-adrenergic and 5-HT1A receptors in the rat basolateral amygdala

Neurotransmitter receptors are often colocalized in a neuron with other receptors, and activation of one receptor can either amplify or antagonize the response to a colocalized receptor. The aim of this study was to investigate the cross-regulation of synaptic transmission by beta-adrenergic and serotonin 1A (5-HT1A) receptors and to elucidate their underlying mechanisms. Stimulation of presynaptic beta-adrenergic receptors with isoproterenol (Iso) in the basolateral amygdala resulted in a long-lasting increase in synaptic transmission. This effect was mimicked by forskolin, an activator for adenylyl cyclase and a cAMP analog. In addition, the effect of forskolin was blocked by catalytic and regulatory site antagonists for cAMP-dependent protein kinase (PKA), indicating a PKA-mediated mechanism. Application of 5-HT depressed the synaptic transmission and blocked Iso- and forskolin-induced potentiation. The effect of 5-HT was mimicked by the selective 5-HT1A agonist 8-hydroxy-dipropylaminotetralin and was blocked by the selective 5-HT1A antagonist 1-(2-methoxyphenyl)-4[4-(2-phthalimido)butyl]piperazine, indicating its mediation by 5-HT1A receptors. To determine the locus of interaction, Sp-cAMPS, a membrane-permeable activator of PKA, was applied, and the potentiation produced by Sp-cAMPS was completely blocked in slices pretreated with 5-HT. These results suggest that the interaction between the intracellular signaling pathways activated by 5-HT1A and beta-adrenergic receptors occurs at a step downstream from cAMP production.

Ossification of the posterior longitudinal ligament of the spine. A case-control risk factor study

STUDY DESIGN

A case-control study.

OBJECTIVES

To determine the risk factors for ossification of the posterior longitudinal ligament (OPLL) of the spine.

SUMMARY OF BACKGROUND DATA

Previous epidemiologic studies conducted in Japan showed consuming vegetable protein and salt was a risk factor for OPLL. Dietary habits of the Taiwanese and Japanese people are similar. Whether the similar dietary habits play an important role in the high prevalence of OPLL in Taiwan was of interest.

METHODS

A case-control study was conducted in a tertiary teaching hospital. The study included 98 consecutive cervical spine patients with OPLL, with 98 age-matched patients with cervical spondylosis serving as control subjects. Radiologic examinations, clinical interviews, physical examinations, and risk factor questionnaires were administered to all the participants.

RESULTS

Compared with incidence in the control patients, the frequency of the ossification of the anterior longitudinal ligaments was significantly higher in OPLL patients with OPLL (31% vs. 19%; P = 0.049), but there was no difference in incidence of ossification of the ligamentum flavum (13.3% vs. 16.3%; P = 0.546). More OPLL patients preferred a high-salt diet (OPLL/CS, no:somewhat:yes = 23/38:18/25:57/35;, X2 for trend = 6.3; P = 0.001) and pickled foods (OPLL/CS, no:somewhat:yes = 39/56:11/11:48/31; X2 for trend = 6.7; P = 0.0099). Fewer patients with OPLL consumed meat daily (63% vs. 79%; P = 0.018). High-salt diet (odds ratio = 2.62) and daily meat intake (odds ratio = 0.39) showed persistent association with OPLL in a multivariate logistic regression.

CONCLUSIONS

The similar dietary habits, particularly a high-salt and low meat intakes, may partially explain the high prevalence of OPLL in Taiwan and Japan. Modifying dietary habits may help prevent this disease, especially in those high-risk populations.

Decision support for clinical trial eligibility determination in breast cancer

We have developed a system for clinical trial eligibility determination where patients or primary care providers can enter clinical information about a patient and obtain a ranked list of clinical trials for which the patient is likely to be eligible. We used clinical trial eligibility information from the National Cancer Institute's Physician Data Query (PDQ) database. We translated each free-text eligibility criterion into a machine executable statement using a derivation of the Arden Syntax. Clinical trial protocols were then structured as collections of these eligibility criteria using XML. The application compares the entered patient information against each of the eligibility criteria and returns a numerical score. Results are displayed in order of likelihood of match. We have tested our system using all phase II and III clinical trials for treatment of metastatic breast cancer found in the PDQ database. Preliminary results are encouraging.

Gallium-67 scintigraphy to predict response to therapy in active lupus nephritis

Gallium-67-citrate has been used to detect inflammation for decades, and 67Ga uptake usually indicates an active, potentially curable lesion. In this study, we determined the value of 67Ga renal scintigraphy for predicting response to therapy in patients with lupus nephritis.

METHODS

Forty-seven patients with lupus nephritis and abnormal serum creatinine or elevated 24-hr urine protein were enrolled. Delayed 48-hr 67Ga imaging was performed to evaluate 67Ga uptake by the kidneys. Serum creatinine and 24-hr urine protein values were obtained at the beginning of this study and after 1 yr of treatment. Serum creatinine was considered abnormal at levels greater than or equal to 1.4 mg/dl and 24-hr urine protein at levels greater than or equal to 1.0 g/day. When the value of serum creatinine or 24-hr urine protein obtained 1 yr after treatment was in the normal range or was 50% of the initial abnormal value, the patient was considered to have good response to treatment.

RESULTS

Gallium-67 renal scan showed good correlation with the response to therapy in patients with lupus nephritis. In the negative 67Ga scan group, no significant changes in laboratory data were noted between onset of this study and after 1 yr of therapy. In the positive 67Ga scan group, there were significant decreases in serum creatinine and 24-hr urine protein levels 1 yr after treatment, especially in 24-hr urine protein, with p values of 0.019 and 0.0007 respectively, by Student's t-test for dependent samples. Moreover, 11.5% of patients with a negative 67Ga scan had a good response to treatment, whereas 71.4% of patients with a positive 67Ga scan had a good response to treatment.

CONCLUSION

We suggest that 67Ga renal scan is a valuable predictor of response to therapy in patients with lupus nephritis.

[The density and larval habitats of dengue vectors in Chungho city]

A survey was conducted to understand larval habitats and density of dengue vectors in Chungho city during the period of August 12 to September 13, 1996. Most villages (41 in the total of 93) were found to have the density figures of three for Aedes albopictus Skuse. The second common density figures were found at 2nd and 4th levels. The most common breeding containers found were less than 5 cm in water depth and less than 100 cm2 in water area. The number of breeding containers reduced when the water depth and size increased. The common breeding containers in villages were flower vases (30%) and water buckets (18%). In the mountains, water buckets (34%) and kitchen tools (11%) were common. In parks, water buckets (29%) and tires (15%) were commonly found. In cemeteries, the common breeding containers were flower vases (57%) and earthenware pots (17%). The average (2.05 containers per man-hour) of positive water containers in the mountains was significantly higher than that in parks (0.62). However, the average in cemeteries (1.29) was not significantly different from those collected in mountains and parks.

Diagnostic value of bone and Ga-67 imaging in skeletal tuberculosis

Tuberculosis (TB) remains a major cause of skeletal infection in many parts of the world. Bone scintigraphy is an excellent screening test for bone lesions and Ga-67 scintigraphy is a useful tool for detecting inflammatory lesions. This study determined the value of bone and Ga-67 scans in patients with skeletal TB. Tc-99m MDP and Ga-67 whole-body scans were performed in 24 patients with proved skeletal TB. Twenty-six TB lesions were found in these 24 patients, 8 in the spine, 5 in the knee, 5 in the wrist, 4 in the ankle, 2 in the elbow, 1 in the finger, and 1 in the sacroiliac joint. Of the 26 TB lesions, Tc-99m MDP bone imaging detected 24 and Ga-67 scans revealed 23. The sensitivity rates were 92% (24 of 26) and 88.5% (23 of 26) for bone scans and Ga-67 scans, respectively. When the scans were evaluated in combination, the detection sensitivity was 96.1% (25 of 26). Two lesions that the bone scan failed to detect were in the spine. Ga-67 imaging failed to detect two spinal lesions and one lesion in the knee. The detection sensitivities of bone and gallium scans were high for skeletal TB, although neither scan was specific for TB lesions. Either the bone or Ga-67 scan can be used in the clinical setting as a convenient screening test to detect multiple sites of bone involvement in TB, and to indicate the sites for further detailed evaluation by CT, MRI, or biopsy.

Local vaginal anesthesia during high-dose-rate intracavitary brachytherapy for cervical cancer

PURPOSE

To evaluate the clinical efficacy of local vaginal lidocaine application for pain relief during high-dose-rate (HDR) intracavitary brachytherapy for patients with cervical cancer, and to investigate sequential changes in serum levels of lidocaine during the procedures.

METHODS AND MATERIALS

This prospective study was designed to examine the analgesic effect, physical response, and side effects of local anesthesia during HDR intracavitary brachytherapy. Forty patients were enrolled. All patients received 10-15 MV X-rays to the pelvis with a total dose of 45-59.4 Gy 5-6 weeks before undergoing HDR intracavitary brachytherapy. All patients underwent first intracavitary brachytherapy under general anesthesia. These patients were randomly allocated to receive one of two different treatment protocols as follows: (1) treatment session - control session - treatment session - control session; or (2) control session - treatment session- control session - treatment session. In the treatment sessions, topical anesthesia was administered using 4 ml of 10% lidocaine solution sprayed liberally on the cervix and vagina during intracavitary brachytherapy. In the control sessions, a placebo was administered in the same manner during brachytherapy. The Hensche's applicators for brachytherapy were inserted into the cervix and vagina 5 min after lidocaine application. The visual analogue scale (VAS) was used to assess pain and discomfort during brachytherapy. Blood pressure and heart rates were measured to evaluate the physiological response. Another prospective study was then performed to investigate the sequential changes of serum lidocaine levels during the anesthetic procedure. Eleven additional patients with similar disease state and demographic characteristics were enrolled and blood samples were obtained before, and 5, 15, 30, and 45 min after the initiation of lidocaine application.

RESULTS

The mean VAS values recorded during the treatment sessions and control sessions were 49.9 +/- 24.1 versus 60.1 +/- 24.8, respectively. The value of VAS in the treatment session was significantly lower than that of the control session (p < 0.001). No statistically significant differences were found in the changes of blood pressure and heart rate and in the incidence of side effects during these two types of sessions (p > 0.05). In the drug-level study, serum levels of lidocaine reached a peak 5 min after the initiation of local anesthesia. The mean peak concentrations (Cmax) of lidocaine were 0.50 +/- 0.45 microg/ml.

CONCLUSION

Local vaginal anesthesia with 10% lidocaine solution can significantly decrease the degree of painful sensation during HDR intracavitary brachytherapy, and is safe to administer for the procedure for cervical cancer.

Intratumoral injection of rhenium-188 microspheres into an animal model of hepatoma

Intratumoral injection of 90Y microspheres is a potential alternative in the treatment of primary liver tumor. However, complicated preparation and lack of a gamma ray for imaging are the disadvantages of 90Y. In this study, we used 188Re, a generator-produced radioisotope with 155-keV gamma ray emission, to label microspheres. After intratumoral injection of 188Re microspheres into rats with hepatoma, biodistributions and survival times were analyzed.

METHODS

Twelve male rats with hepatoma were killed at 1, 24 and 48 hr (4 rats at each time point) after intratumoral injection of approximately 7.4 MBq 188Re microspheres. Samples of various organs were obtained and used to calculate the tissue concentrations. In addition, 30 male rats bearing hepatoma were divided into two groups (15 rats in each group) to evaluate survival time. Group 1 received intratumoral injection of 37 MBq 188Re microspheres, whereas Group 2 served as the control group and received an intratumoral injection of 0.1 ml normal saline only. Survival time was calculated from the day of injection to 2 mo after treatment.

RESULTS

Radioactivity in the tumor was very high throughout. Biological half-time was 170.8 hr. Radioactivity in the lung was 1.78% injected dose (i.d.)/g at 1 hr but declined rapidly over time. The concentration in the urine was approximately 6.14% i.d./ml after the first hour and rapidly declined thereafter. The concentrations of radioactivity in other organs, such as normal liver, muscle, spleen, bone, testis and whole blood, were quite low throughout the study. Twelve of 15 (80%) of rats survived over 60 days after intratumoral injection of 188Re microspheres, whereas only 4 of 15 (26.7%) survived more than 60 days after injection of normal saline only. The difference between the groups was significant (p < 0.05).

CONCLUSION

Rhenium-188 offers cost-effectiveness, on-site availability, short half-life, energetic beta particle, emission of gamma photons for imaging, easy preparation, easy clinical administration and apparent lack of radiation leakage from the treated tumor. Direct intratumoral injection of 188Re microspheres is extremely attractive as a clinical therapeutic alternative in hepatoma patients.

Prevalence and subtypes of dementia in a rural Chinese population

We conducted a single-stage community-based study of dementia on all registered residents > or =65 years in age in a rural Chinese community. Neurologists conducted semistructured interviews and examined all participants; they also interviewed family members in cases where dementia was suspected. The diagnosis was made by consensus according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd ed, revised (DSM-III-R). Among the 2,055 contacted individuals, 1,736 (84.5%) participated in the study and 44 ( 13 men and 31 women) were diagnosed as having dementia, including 35 (80%) with probable Alzheimer disease (AD) and 3 (7%) with vascular dementia (VsD). The rates of dementia were 0.5% for ages 65-74 years, 2.9% for ages 75-84 years, and 12.0% for ages 85-101 years. The overall rate was 2.5% for age > or =65 years. After controlling for age, neither a lack of formal education nor being a woman was a risk factor for dementia. At 2-year follow-up, 30 of the 44 demented participants had died, yielding a 2-year survival rate of 32%. The present results corroborated our previous findings of lower prevalence rates of dementia among the Chinese than among Western populations, and both genetic and sociocultural factors may have contributed to the low rates. The lack of neuroradiological imaging studies in the present study may have contributed to the finding of an unusually low rate of VsD.

Ga-67 scintigraphy in lupus nephritis

Lupus nephritis is a disease characterized by flareups and remissions. Evaluation of disease activity is important for therapeutic decisions and prognosis. In this study, 46 patients with lupus nephritis were evaluated by Ga-67 scintigraphy. Delayed 48-hour Ga-67 images were performed to evaluate kidney uptake. A patient with a 24-hour urinary protein excretion of 3 g or more or a serum creatinine level greater than 1.5 mg/dl was considered to have active lupus nephritis. Renal disease was active in 22 patients and inactive in 24 patients. Of the 22 patients with active renal disease, 18 (81.8%) showed positive Ga-67 results, whereas only 12.5% (3 of 24) of patients with inactive renal disease showed a positive Ga-67 study. The difference between the two groups was significant. Patients with positive Ga-67 scans had a significantly higher serum creatinine level and 24-hour urine protein value than patients with negative Ga-67 scans. In addition, all of the patients (100%) with a 24-hour urine protein greater than 4 g/day had a positive Ga-67 scan. It appears that Ga-67 scintigraphy is useful for the evaluation of disease activity in lupus nephritis.

Lamotrigine inhibits depolarization-evoked Ca++ influx in dissociated amygdala neurons

Spectrophotometry with the Ca(++)-sensitive dye fura-2 was used to study the effect of lamotrigine (LAG) on the depolarization-evoked Ca++ influx in the acutely isolated basolateral amygdala neurons. Depolarization of the neurons with high K+ resulted in the elevation of intracellular Ca++ concentration [Ca++]i in a concentration-dependent manner. The K(+)-induced Ca++ influx was completely blocked in the Ca(++)-free solution or by Cd++, indicating that depolarization-induced increases in [Ca++]i were triggered largely, if not at all, by Ca++ entry from extracellular space and Ca++ entry occurred through voltage-dependent Ca++ channels. Application of LAG reduced the depolarization-evoked Ca++ influx in a concentration-dependent manner. The effect of LAG was markedly reduced in the presence of N-type Ca++ channel blocker omega-conotoxin-GVIA (omega-CgTX). These results suggest that the action of LAG is mediated, at least in part, by the modulation of N-type Ca++ channels.

Influence of age and gender on quantitative sacroiliac joint scintigraphy

The value of quantitative sacroiliac joint scintigraphy for detecting sacroiliitis is controversial. Age and gender may contribute to this discordance. In previous reports, the number of control groups has been small and might not exactly reflect the change of sacroiliac/sacral (SI/S) ratios related to different age. In addition, the selection of control subjects was not strict. In most studies, care was not taken to ensure that control subjects did not have a history of back pain or any other relevant conditions. In addition, there was no requirement for a normal radiograph as a condition of inclusion. The aim of our study was to evaluate the consequent changes in SI/S ratios, according to age (in 10-yr intervals) and gender.

METHODS

Over a period of 5 yr, 413 control subjects without a history of back pain, scoliosis, kyphosis, joint pain, arthritis, lesions within the pelvis, chemotherapy or systemic disease such as diabetes or systemic lupus erythematosus were included in this study. A posterior planar film of the pelvis was obtained to calculate SI/S ratio 3 hr after injection of 740 MBq 99mTc-methylenediphosphonate. Our data showed that: (a) the change in SI/S ratios related to age was significant in both females and males; (b) the SI/S ratios were higher in males younger than 30 yr and higher in men in the 41-50-yr age group and in females in other groups; (c) the SI/S ratios declined steadily with increasing age in females, whereas there were two plateaus in men aged 21-40 yr and 41-70 yr; (d) there were significant differences of SI/S ratios between the genders in certain age groups; and (e) no differences were found between left SI/S ratios and right SI/S ratios.

CONCLUSION

The influence of age and gender on SI/S ratios are substantial, and it is essential for each department to establish its own values for SI/S ratios based on gender and age (in 10-yr intervals).

Idiopathic intracranial hypertension without papilledema: a case-control study in a headache center

OBJECTIVE

To compare the clinical features of patients with chronic daily headache (CDH) with idiopathic intracranial hypertension without papilledema (IIHWOP) to those with normal CSF pressure.

METHODS

A case-control study was conducted at a tertiary headache center. Cases consisted of 25 consecutive patients (24 women, 1 man, 38 +/- 6 years) with IIHWOP diagnosed between June 1989 and June 1996. IIHWOP was diagnosed if pressure was 200 mm CSF on two occasions and there was no papilledema. Control subjects consisted of patients with refractory CDH who had normal CSF pressure on lumbar puncture performed between June 1992 and June 1996 (n = 60, 50 women, 10 men, 36 +/- 11 years). A structured telephone follow-up was done from July 1996 to March 1997. Comparisons made between the two groups included demographics and headache profiles, both at the initial evaluation and at follow-up.

RESULTS

The initial headache characteristics did not differ between the two groups: most had transformed migraine with analgesic overuse. Significant predictors of IIHWOP included pulsatile tinnitus (odds ratio [OR] = 13.0) and obesity (OR = 4.4). Visual symptoms did not differ significantly. The prognosis of the two groups of patients was similar.

CONCLUSIONS

Pulsatile tinnitus and obesity suggest possible IIHWOP in patients with CDH. Treatment of patients with increased intracranial pressure was not satisfactory.