Significance of hemoptysis following thrombolytic therapy for acute myocardial infarction

PURPOSE

To describe the occurrence, cause, and significance of hemoptysis following thrombolytic therapy for acute myocardial infarction.

PATIENTS AND METHODS

We retrospectively reviewed 2,634 patients presenting with acute myocardial infarction who received thrombolytic therapy to determine the incidence of hemoptysis. Chart and radiographic review included the type, dose, and route of thrombolytic therapy. In addition, the onset, duration, and severity of hemoptysis were recorded and correlated with radiographic and bronchoscopic findings.

RESULTS

Eleven patients (0.4%) developed hemoptysis following administration of thrombolytic therapy for an acute myocardial infarction. The duration and severity had a wide range, although no patient had significant hemodynamic compromise. The source of hemoptysis was identified in only one patient who had a tongue laceration following cardiopulmonary resuscitation, and blood was seen within the oropharynx and trachea. No definitive cause was identified in all other patients. There was no correlation between the different types or doses of thrombolytic therapy and the duration or severity of hemoptysis. Chest radiographs were nonspecific and demonstrated resolution within 11 days following hemoptysis. CT of the thorax in one patient and bronchoscopy in two patients confirmed chest radiographic findings and in no patient was an underlying pulmonary abnormality identified.

CONCLUSIONS

Pulmonary hemorrhage and hemoptysis are unusual complications of thrombolytic therapy in patients with acute myocardial infarction. Although hemoptysis may be the first indicator of an underlying pulmonary abnormality, we found no case in which a significant abnormality was unmasked. This study suggests that follow-up chest radiographs are recommended and further evaluation may be unnecessary if complete resolution is demonstrated.

Effects of paraquat on the substantia nigra of the wistar rats: neurochemical, histological, and behavioral studies

Effects of paraquat on the substantia nigra of the male Wistar rats we re studied pharmacologically by a intracerebral injection of paraquat. The neurochemical, morphological, and behavioral changes observed after a unilateral intranigral injection of paraquat (1-5 microgram) were as follows: (1) neurochemically, paraquat caused dose-dependent depletion of dopamine in the ipsilateral striatum starting 2 weeks after treatment; this effect was long-lasting and irreversible. The ipsilateral striatal dopamine level in animals treated with 3 microgram paraquat was even decreased by 91.5%. (2) Morphologically, 2 microgram of paraquat produced marked loss of Nissl substances and prominent glial reaction in the substantia nigra, while 3 microgram of paraquat caused a severe loss of neurons. (3) Behaviorally, paraquat caused a vigorous rotational behavior in rats contralateral to the lesioned side in response to apomorphine administration (0.5 mg/kg, sc). This effect was dose-dependent and lasted for the entire 16-week experimental period. Taken together, these data indicate that intranigrally injected paraquat may possess marked neurotoxicity and induce degeneration of the rat nigrostriatal dopaminergic system.

Frequency of linear hyperechogenicity over the basal ganglia in young infants with congenital rubella syndrome

Five young infants with congenital rubella syndrome (CRS) underwent cranial ultrasonographic examinations and/or computed tomographic examinations. Only two of these infants were small for their gestational age, and none of them were microcephalic at birth. Deafness and ocular lesions were found in four patients, and congenital heart disease was found in three. All had abnormal ultrasonographic findings: linear-shaped hyperechogenicity over the basal ganglia was noted for five patients, periventricular punctate hyperechogenicity was noted for three, and subependymal cysts were observed in two. Follow-up ultrasonograms for two of the patients showed progressively enlarging hyperechogenic lesions. Calcification was found in both patients examined by means of computed tomography. All patients became microcephalic, with profound global developmental delay. Intracranial calcifications are common findings in patients with CRS. Ultrasonography should be performed for high-risk neonates, regardless of their symptoms. The finding of linear hyperechogenicity over the basal ganglia should prompt a search for all congenital infections, including CRS.

Secretion of active subtilisin YaB by a simultaneous expression of separate pre-pro and pre-mature polypeptides in Bacillus subtilis

Alkaline elastase YaB, produced by alkalophilic Bacillus YaB, is an extracellular serine protease having 55% homology to subtilisin BPN' and thus could be called subtilisin YaB. It is synthesized as a 378-amino acid preproenzyme and secreted into the culture medium as a 265-amino acid mature protease. To examine if the pro-peptide of subtilisin YaB functions in trans to guide the folding of secreted subtilisin YaB in vivo, we made genes encoding the pre-pro, pro and pre-mature portions and placed them under the control of the spac-1 promoter on a multi-copy plasmid. When simultaneous expression in Bacillus subtilis of both the pre-pro and pre-mature genes was induced with 0.5 mM isopropyl-1-thio-beta-D-galactopyranoside (IPTG), protease activity was detected in the medium. On the other hand, we could not detect protease activity when the expression of either the pre-mature gene alone or both the pro and pre-mature genes was induced. From these results, we concluded that the pro region functions in trans and outside the cells for the proper folding and activation of the enzyme.

RGB calibration for color image analysis in machine vision

A color calibration method for correcting the variations in RGB color values caused by vision system components was developed and tested in this study. The calibration scheme concentrated on comprehensively estimating and removing the RGB errors without specifying error sources and their effects. The algorithm for color calibration was based upon the use of a standardized color chart and developed as a preprocessing tool for color image analysis. According to the theory of image formation, RGB errors in color images were categorized into multiplicative and additive errors. Multiplicative and additive errors contained various error sources-gray-level shift, a variation in amplification and quantization in camera electronics or frame grabber, the change of color temperature of illumination with time, and related factors. The RGB errors of arbitrary colors in an image were estimated from the RGB errors of standard colors contained in the image. The color calibration method also contained an algorithm for correcting the nonuniformity of illumination in the scene. The algorithm was tested under two different conditions-uniform and nonuniform illumination in the scene. The RGB errors of arbitrary colors in test images were almost completely removed after color calibration. The maximum residual error was seven gray levels under uniform illumination and 12 gray levels under nonuniform illumination. Most residual RGB errors were caused by residual nonuniformity of illumination in images, The test results showed that the developed method was effective in correcting the variations in RGB color values caused by vision system components.

Diagnosis and follow-up of carotid-cavernous fistulas by carotid duplex sonography and transcranial color Doppler imaging

To investigate the suitability of extracranial carotid duplex (ECD) and transcranial color Doppler imaging (TCDI) in the diagnosis and follow-up of treatment in patients with carotid-cavernous fistulas (CCF), combined ECD and TCDI examinations were studied in seven patients with traumatic CCF. According to angiography, four patients had direct CCF, two indirect CCF and one both direct and indirect CCF. In ECD, hemodynamic parameters of the feeding artery showed an abnormally increased flow volume and decreased resistivity indices in five direct CCFs from the internal carotid artery and one indirect CCF from the external carotid artery. Direct visualization of the CCF was achieved in patients with direct CCF only, and revealed itself as a heterogeneous mosaic flash resulting from high flow velocities and turbulence. Patterns of venous drainage were detected via the transorbital and transforaminal windows in seven and five patients (four direct and one indirect CCF patients), respectively. These abnormal findings were improved or even normalized after successful treatment. In conclusion, combined ECD and TCDI examinations appear to be useful for the diagnosis and follow-up of CCF.

Detection and sequence analysis of a new herpesvirus-like agent in AIDS and non-AIDS Kaposi's sarcoma in Taiwan

A new herpesvirus-like DNA sequence (KSHV) has been recently identified in Kaposi's sarcoma from acquired immunodeficiency syndrome (AIDS) and non-AIDS patients. In order to verify the role of this new viral agent in Taiwan, a series of Kaposi's sarcoma specimens obtained from AIDS and non-AIDS patients in three medical centers representing different geographic locations of Taiwan were surveyed. A total of seven specimens from AIDS patients and 22 specimens from non-AIDS patients were tested for the presence of this herpesvirus-like agent by polymerase chain reaction (PCR) using the published Kaposi's sarcoma 330-233 primers. The tumor DNA was also tested for cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpes-virus type 6 (HHV-6). The Kaposi's sarcoma specimens from AIDS and non-AIDS patients were positive for KSHV except in one case. Only occasional specimens were positive for CMV and EBV, with a slightly higher positive rate for HHV-6 in AIDS and non-AIDS patients. Cloning and sequence analysis of the PCR products from two cases of Kaposi's sarcoma (one each for AIDS and non-AIDS) revealed only minor differences in this DNA sequence, as compared with the published data from north America. These results further support the assumption that this new KSHV is strongly associated with Kaposi's sarcoma in AIDS and non-AIDS patients in Taiwan.

Further analysis of the CAP59 locus of Cryptococcus neoformans: structure defined by forced expression and description of a new ribosomal protein-encoding gene

Cryptococcus neoformans (Cn) produces an extracellular polysaccharide capsule that is an essential factor for virulence. We previously isolated a gene, CAP59, which is necessary for capsule formation. To dissect the functional region of CAP59, we placed it under control of the Cn GAL7 promoter (pGAL7). Among the several pGAL7::CAP59 fusion constructs, only the one containing the entire open reading frame of CAP59 was able to complement the acapsular phenotype under galactose induction. A missense mutation in the coding region abolished complementation by the fusion construct. We also found that the CAP59 locus is contiguous to a convergently transcribed L27 ribosomal protein-encoding gene (CL27). The distance between the cDNA ends of these two genes is only 25 bp. CL27 has two introns near its N terminus. The translated CL27 protein is 183 amino acids (aa) in length with an estimated molecular mass of 20 kDa, and the first 34 aa at the N terminus may be a targeting peptide for mitochondria. A high degree of restriction-fragment-length polymorphism was detected in the DNA sequence containing CAP59 and CL27.

Cumulative injury rate and potential workdays and salary lost

OBJECTIVES

The purpose of this study was to examine alternative methods for quantifying occupational injuries and to estimate the costs of foregone earnings due to these injuries.

METHODS

A model based on the three possible outcomes of occupational injuries (premature death, permanent disability, and temporary dysfunction) was proposed, and several new indices were developed to measure the frequency and severity of occupational injuries. In the calculations, the human capital method was employed to measure potential salary lost due to occupational injury. An example was adopted from a steel corporation to demonstrate these indices.

RESULTS

The cumulative injury rates, based on age and duration of employment, represented the average cumulative risk of acquiring occupational injuries by lifetime work duration and by employment duration, respectively. The severity index revealed the rate of estimated potential workdays lost by incorporating both the age at which an injury occurred and the severity weighting factors of various disabilities into the formula. After the estimated potential workdays lost was divided by the total employees' potential affordable workdays, the proportion of potential workdays lost showed a result that adjusted for the varied age distribution in each year implicitly. The potential loss in salary calculated the foregone earnings of occupational injuries, which could be considered as a lower limit of the monetary cost estimated by the willingness-to-pay method.

CONCLUSIONS

Such indices supplement disabling frequency and severity rates. They cannot only be applied to occupational safety monitoring, but also to the policy-making process in occupational safety and health.

Metabolites of daidzein and genistein and their biological activities

A number of metabolites of daidzein and genestein have been synthesized and their biological activities determined. Equol [3], 5,7,4'-trihydroxyisoflavan [5], 4,7,4'-trihydroxyisoflavan [6], dihydrodaidzein [8], and dihydrogenistein [9] were synthesized either from daidzein [1] or genistein [2] by hydrogenation. Similarly, the derivatives 4, 7, and 11 were synthesized from 3, 6, and 10, respectively. During acetylation and nmr experiments, 9 was converted to a novel enol intermediate [10]. Antifungal, antibacterial, mosquitocidal, nematocidal, and topoisomerase inhibition activities of these compounds were evaluated, with equol [3] being the most active of the compounds tested against topoisomerase I.

Metabolism of daidzein and genistein by intestinal bacteria

The isoflavones daidzein [1] and genistein [2] were fermented with human fecal bacteria under anaerobic conditions. Dihydrodaidzein [3], benzopyran-4,7-diol,3-(4-hydroxyphenyl) [4], and equol [5] were isolated from the fermentation broth of 1. Only one metabolite, dihydrogenistein [6], was isolated and characterized from the fermentation broth of 2. Metabolites 3-6 were identified by spectral methods.

Type IV hyperlipoproteinemia and moderate instability of CAG triplet expansion in the androgen-receptor gene. Lipid, sex hormone and molecular study in a Chinese family with Kennedy-Alter-Sung disease

Kennedy-Alter-Sung (KAS) disease in a hereditary lower motor neuron disease. In this study, we investigate 2 KAS patients presenting with progressive muscle weakness and wasting, action tremor, perioral fasciculation and gynecomastia. Three carriers and 5 healthy members from this 3-generation KAS Chinese family and 60 normal Chinese controls were included in this study. Hormone studies revealed normal serum level in thyrotropin, prolactin, testosterone, leuteinizing hormone, follicle stimulating hormone, and estradiol. Lipid study disclosed type IV hyperlipoproteinemia in 2 KAS patients and 3 healthy members. Molecular studies revealed that the number of CAG triplet repeats in the first exon of androgen receptor gene of the normal allele is in the range of 15-19 and 12-25 in this family and normal controls, respectively. However, the number of CAG repeat of androgen receptor gene were unstable in the mutant alleles with a range of 41-45 and increased from generation to generation (genomic anticipation) in the 2 KAS patients and 3 female carriers. We conclude that the CAG triplet repeats in mutant allele were unstable in the family with the KAS disease. Furthermore, type IV hyperlipoproteinemia may be a co-transmitted syndrome in the family with KAS disease.

Female genital tuberculosis: report of seven cases

Seven cases of histologically proven genital tuberculosis (TB) encountered at the National Taiwan University Hospital in the past 16 years were reviewed. From a total of 54,576 gynecologic specimens submitted for pathologic examination, the occurrence of genital TB was 0.01%. Of these seven patients, one suffered from primary infertility and one from secondary infertility. The patient with primary infertility had been married for 29 years. The patient with secondary infertility underwent a tuboplasty due to bilateral hydrosalpinx. Genital TB was not diagnosed preoperatively in any of the seven cases. The preoperative diagnoses included: postmenopausal spotting, ovarian malignancy, cervicitis, ectopic pregnancy and hydrosalpinx with secondary infertility. This review suggests that genital TB is becoming rare in Taiwan. It is difficult to diagnose from clinical symptoms and is usually discovered on pathologic examination.

Overexpression of P-glycoprotein in untreated AFP-producing gastric carcinoma

P-glycoprotein (P-gly), which is responsible for the phenotypic expression of multidrug resistance in cancerous tissue was stained immunohistochemically in previously untreated alpha-fetoprotein (AFP)-producing (n = 20) and nonproducing gastric cancers (n = 20). P-gly, AFP, and carcinoembryonic antigen(CEA) were stained in formalin-fixed paraffin-embedded tissue sections immunohistochemically using the monoclonal antibody JSB-1, anti-AFP, and anti-CEA, respectively. DNA ploidy pattern was determined by Fluorescence Activated Cell Sorter (FACS) analyzer. P-gly was significantly overexpressed in AFP producing gastric cancers (60%) than in AFP nonproducing ones (20%) (P < 0.01). When the result of P-gly staining was analyzed among the AFP-positive cases, P-gly positivity did not emerge either as a significant prognostic factor or as a predictor of the metastatic potentiality of the tumor. The intrinsic overexpression of P-gly in AFP producing gastric cancers proves its biological and morphological similarities to hepatocellular carcinoma. The significantly (P < 0.05) higher incidence of P-gly in diploid tumors indicate that expression of this phenotype might be related to the differentiation of the tumor. P-gly was overexpressed in AFP producing gastric carcinoma and the existing drug resistance, frequent recurrence, and poor prognosis might be explained by presence of P-gly in this carcinoma.

Left ventricular thrombi in children with dilated cardiomyopathy

To define the nature and course of left ventricular (LV) thrombi in pediatric patients, the charts and echocardiographic records of 32 pediatric patients with dilated cardiomyopathy from 1986 to 1991 were retrospectively reviewed. Five patients who were identified according to echocardiographic evidence of LV thrombi fulfilled the criteria of dilated cardiomyopathy. Systemic embolization occurred in three patients with LV thrombi who invariably died despite anticoagulant treatment. Although it was not statistically significant, patients with LV thrombi tended to have a lower ejection fraction compared to patients without LV thrombi. The morphology of LV thrombi in patients with systemic embolization showed nonprotruding features. Thus, children with dilated cardiomyopathy are at risk of developing LV thrombi and systemic embolization. Although it was not possible to identify the risk factors, the risk of developing LV thrombi and systemic embolization may be higher in patients with lower ejection fraction of the left ventricle.

Renal tubular acidosis complicated with hypokalemic periodic paralysis

Three Chinese girls with hypokalemic periodic paralysis secondary to different types of renal tubular acidosis are presented. One girl has primary distal renal tubular acidosis complicated with nephrocalcinosis. Another has primary Sjögren syndrome with distal renal tubular acidosis, which occurs rarely with hypokalemic periodic paralysis in children. The third has an isolated proximal renal tubular acidosis complicated with multiple organ abnormalities, unilateral carotid artery stenosis, respiratory failure, and consciousness disturbance. The diagnostic evaluation and emergent and prophylactic treatment for these three types of renal tubular acidosis are discussed.

Host effects and sequences essential for accumulation of defective interfering RNAs of cucumber necrosis and tomato bushy stunt tombusviruses

Passage of cucumber necrosis virus (CNV) containing defective interfering (DI) RNAs through cucumber plants decreased the accumulation of DI RNAs to undetectable levels. Subsequent passages in two Nicotiana species (Nicotiana benthamiana or N. clevelandii) resulted in the appearance of DI RNA species that were larger than the DI RNAs observed during exclusive serial passages of CNV through the Nicotiana species. Sequence analysis of cloned cDNAs corresponding to the two DI RNA populations indicated that the smaller CNV-DI RNAs contained the four conserved regions (I through IV) of the genome typical of tombusvirus DI RNAs, whereas the larger DI RNAs were of similar organization but had a direct repeat of the middle portion of the molecule. This result suggests that the host has an influence on the type of DI RNA that accumulates during consecutive high multiplicity of infection passages. A comparative analysis of deletions targeting the individual conserved regions in both CNV and tomato bushy stunt virus (TBSV) DI RNAs revealed that only region III was completely dispensable for accumulation of either DI RNA species. More refined deletion analyses in regions I and II indicated that smaller segments of 75 and 35 nucleotides (nt), respectively, could be deleted without abolishing infectivity. The dispensable sequences in region II of both TBSV and CNV DI RNAs mapped to the top portion of a putative stem-loop structure. These studies indicate that both essential and nonessential sequences are conserved in DI RNAs. The essential sequences in regions I, II, and IV likely contain important cis-acting elements, whereas nonessential regions such as region III may play secondary roles such as optimally spacing cis-acting elements or maintaining the DI RNA at an overall size that is stable.

Combined electroneurographic and electromyographic studies in lead workers

OBJECTIVES

To evaluate the effects of chronic exposure to lead on the peripheral nervous system in lead workers.

METHODS

Nerve conduction velocity and electromyographic studies were performed on 31 lead workers of a battery recycling factory and 31 sex and age matched controls. 25 cases with mild distal extensor weakness of the upper limbs were classified as the lead neuropathy subgroup and the rest of the lead workers as the lead exposure subgroup. Blood lead concentrations and haematological and biochemical data were recorded. An index of cumulative exposure to lead was calculated by the summation of multiplying the average blood concentration of lead with the duration of exposure at various jobs.

RESULTS

Compared with the control group, the distal motor latency of the median nerve was significantly prolonged in the lead neuropathy subgroup, but not in the exposure subgroup. Only six of 31 workers had nerve conduction abnormalities, whereas electromyographic evidence of denervation was found in 93.5% of the lead neuropathy subgroup and 83.5% in the lead exposure subgroup. The electromyographic abnormalities found were neurogenic polyphasic waves in all 29 workers with abnormal electromyographic findings (grade in seven cases and grade ++ in the rest). Spontaneous activity was only recorded in seven workers, with grade + in four and grade ++ in three. There was a positive linear correlation between the index of cumulative exposure to lead and the distal motor latencies of the tibial nerve as well as a negative correlation with conduction velocities of the sural nerve after multivariate analysis and control of potential confounding by age and sex. No correlation could be found between the electrophysiological values and a simple duration of exposure or concentration of blood lead. A non-parametric analysis showed that there was a trend of higher index of cumulative exposure to lead with more severe electromyographic changes. Electromyographic abnormality also occurred in workers with blood lead concentrations between 17.4 and 58 micrograms/dl.

CONCLUSION

Electromyographic study in the distal extensors of the upper limbs may be used as a tool for biological monitoring of effect in lead workers.

Survey of public awareness, understanding, and attitudes toward epilepsy in Taiwan

A survey of public awareness and understanding of and attitudes toward epilepsy was made in Taipei City and Chin-San Village, Taiwan in 1992. In a population sample of 2,610 adults, 87% had read or heard about epilepsy, 70% knew someone who had epilepsy, 56% had seen someone having a seizure, 18% would object to having their children associated with persons with epilepsy, 72% would object to having their children marry a person with epilepsy, 31% believed that epileptic persons should not be employed in jobs as other persons are, 7% believed that epilepsy was a form of insanity, 34% did not know the cause of epilepsy, 13% did not know what an epileptic attack was like, and 18% did not know what to recommend if their friends or relatives had epilepsy. Youth, higher education, and upper levels of employment were correlated with answers that were more favorable concerning epilepsy in all survey questions except for the question regarding marriage, for which the reverse was noted. The attitudes toward epilepsy disclosed by this study were more favorable than those detected in a similar survey conducted in Henan Province, China. The comparison suggests that the exposure to Western culture and socioeconomic system in Taiwan might have helped reduce the discrimination against epilepsy.

Surface modifications of alginate/poly(L-lysine) microcapsular membranes with poly(ethylene glycol) and poly(vinyl alcohol)

Three different surface modifications were conducted on the membranes of double-layer alginate/poly(L-lysine) microcapsules with tosyl chloride-activated poly(ethylene glycol), cyanuric chloride-activated poly(ethylene glycol) and tosyl chloride-activated poly(vinyl alcohol), separately. All these surface modifications strengthen the microcapsular membranes. Of the three surface-modified microcapsules, those treated with cyanuric poly(ethylene glycol) and tosylated poly(vinyl alcohol) have mechanical strength higher than that treated with tosylated poly(ethylene glycol). The permeabilities of the proteins were only slightly affected by the surface modifications. When IW32 erythroleukaemia cells were entrapped inside these microcapsules, cells proliferated to a density of (1.0-1.5) x 10(7) cells cm-3 after 7 d culturing compared with 2 x 10(6) cells cm-3 attained by free cell culturing. The intracapsular concentration of erythropoietin which was secreted by the IW32 cells accumulated to concentrations of 5-7 U cm-3. In addition, 3T3 cells were found to have a very low tendency to attach to the microcapsular membranes of all three surface-modified preparations.

Effects of concanavalin A on desensitization kinetics of GABA responses in Achatina fulica neurons

The effects of the lectin concanavalin A (Con A), on the kinetics of desensitization of the responses of voltage clamped Achatina fulica LP5 neuron to microperfused acetylcholine (ACh) and GABA were compared. Both ACh and GABA elicited increases in chloride conductance which decayed biphasically during prolonged applications of these agonists; an initial rapid decay was followed by a later slow decay. Con A (5 micrograms/ml) accelerated both the fast and the slow decays of responses to ACh. Con A (5 micrograms/ml) also accelerated the fast decay of responses to GABA, but the slow decay was unaffected, even by 20 micrograms/ml or more of the lectin. It is suggested that, at least in the case of GABA receptor, the fast and slow decays involve distinct desensitization kinetics. The effects of Con A on the desensitization of the ACh and GABA responses were reversed by D-mannose, a competitive and specific inhibitor of Con A binding to membrane sugar residues. These results provide further evidence that receptor desensitization can be influenced by perturbing the sugar moieties associated with the subunits comprising these signalling macromolecules. The carbohydrate residues may play an important role in regulating desensitization of transmitter receptors.

Doppler echocardiography for detection of ventriculo-coronary communication: report of a case

Ventriculo-coronary communication is frequently encountered in pulmonary atresia patients who have an intact ventricular septum. Preoperative documentation is important to decide the feasibility of right ventricular decompression procedure. Experience of Doppler echocardiographic visualization of this anomaly in a case of critical pulmonary stenosis with intact ventricular septum is reported. Doppler echocardiography is a promising method of detection and should be used in every patient with a high-pressured hypoplastic ventricle before intervention.