[Lennox-Gastaut syndrome with band form heterotopia: a case report]

A 10-year-old girl with developmental delay, mental retardation and intractable seizures is reported. She manifested clinically as Lennox-Gastaut syndrome with unknown etiology before admission. Brain MRI revealed a band-like lesion over the bilateral subcortical region being later recognized as band-form heterotopia. This type of heterotopia may be overlooked easily due to its symmetrical distribution and mild degree of cortical convolutional anomaly. As it is often associated with intractable seizures and psychomotor retardation, the prognosis is poor. This patient responded poor to ketogenic diet and anticonvulsants. We present this case and review the related articles.

MR imaging evaluation of bone marrow signal change in post-irradiation patients with nasopharyngeal carcinoma

BACKGROUND

The normal distribution of red and yellow marrow can be altered by therapeutic irradiation, which causes a well-documented sequence of bone marrow changes. This study measured the T1 signal intensity of the clivus and cervical vertebral bodies of NPC patients who had received a complete course of radiation therapy.

METHODS

There were 3 categories of patients: Group I: NPC patients who had radiation myelitis; 14 persons which a total 20 times of MRI. Group II: NPC patients, without radiation myelitis; 6 patients, which a total 6 times of MRI. Group III (control group): patients who received MRI of the cervical spine because of cervical spondylosis or HIVD, were total of 45 patients. In the sagittal section of T1WI, the signal intensity of the bone marrow of clivus and C2 to T1 vertebral bodies was measured.

RESULTS

1). There were homogeneous increases of signal intensity of the bone marrow of clivus and C2 to T1 in Groups I and II. 2). There was no statistical difference between Groups I and II. 3). The increased signal intensity of bone marrow after radiation showed no difference in short and long duration between radiation therapy and MR examinations, indicating that bone marrow signal intensities were increased in NPC patients whether or not they had radiation myelitis.

CONCLUSIONS

Signal change in bone marrow may have occurred soon after radiation therapy, and may have persisted for several years. The radiation myelitis always involved the low medulla oblongata to C5 level; however, the bone marrow signal change always extended downward to the T1 level, so bone marrow is more sensitive than the spinal cord and is prone to be affected by irradiation.

Community-acquired methicillin-resistant Staphylococcus aureus endocarditis with septic embolism of popliteal artery: a case report

A 20-year-old man presented with a 14-day course of fever. Physical examination showed petechiae of the conjunctivae, Janeway lesions on both hands, a grade III/VI systolic murmur over the apex, pulseless dorsal pedal artery and posterior tibial artery of the right leg, and a pale right foot. Femoral arteriogram of the right leg revealed total occlusion of the popliteal artery with collateral circulation of the posterior tibial artery. Transthoracic echocardiogram showed trace mitral regurgitation. Embolectomy of the right popliteal artery was done, and penicillin and gentamicin treatment was administered. However, postoperative fever developed intermittently. Transesophageal echocardiogram disclosed vegetation over the anterior leaflet of the mitral valve. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from all three cultures of blood drawn at admission and from the septic embolus during operation. He had neither evidence of underlying heart disease, nor history of intravenous drug abuse or hospitalization. Exploratory cardiotomy with removal of vegetation on the mitral valve was performed followed by a 4-week treatment with intravenous vancomycin. After discharge, he was well at 2-year follow-up.

A 1 log N parallel algorithm for detecting convex hulls on image boards

By finding the maximum and minimum of {yi-mxi|1=or<i=or<N} for certain slopes m, we propose here a simple and fast parallel algorithm to obtain the convex hull of N arbitrarily given points on an image board, The mathematical theory needed is included, and computation time is 1 log N.

[Sensory action potentials of ring finger in the diagnosis of carpal tunnel syndrome]

Amplitudes and latencies of sensory action potentials (SAPs) recorded over the index, middle, little and ring fingers by antidromic stimulation of the median or ulnar nerve at wrist were measured in 65 normal adults and 78 patients with clinically and electrophysiologically verified carpal tunnel syndrome. In the normal adults, there was no significant difference among the SAP latencies of the index, middle, ring and little fingers. Among these 65 normal adults, the difference between median and ulnar SAPs of ring finger was less than 0.4 msec in 64 subjects, but 0.7 msec in one. In the patient group, the median distal sensory latency of the ring finger was significantly longer than that of the ulnar nerve which was recorded over the ring and little fingers. Six cases (7.7%) of 78 patients diagnosed as CTS by conventional electrophysiological studies was false negative by using the ring finger sensory action potential study. It is suggested that the SAP study of the ring finger by stimulation of the median and ulnar nerves at the wrist can not replace the conventional electrodiagnostic methods for the diagnosis of carpal tunnel syndrome.

Sex differential and dose dependence of phenobarbital-promoting activity in N-bis(2-hydroxypropyl)nitrosamine-initiated thyroid tumorigenesis in rats

Studies were made on the dose and sex dependence of thyroid tumor development in rats pretreated with N-bis(2-hydroxypropyl)nitrosamine (DHPN) followed by exposure to various doses of phenobarbital (PB). A direct dose-response relationship in induction of thyroid tumors was found in both male and female rats. Upon feeding the DHPN-treated rats with basal diet containing 20, 100, 500, and 2500 ppm of PB, the incidences of follicular adenoma were, respectively, 8, 45, 70, and 66% in male rats and 12, 17, 50, and 58% in female rats. Development of papillary adenomas in male rats was observed only at the higher doses of PB, at incidences of 12 and 20% for doses of 500 and 2500 ppm. Follicular carcinoma was also seen at higher doses of PB, at 16 and 12%, respectively, for the 500- and 2500-ppm groups. Neither follicular nor papillary carcinomas were induced in female rats; only a low incidence of papillary adenoma (4%) was observed with a PB concentration as high as 2500 ppm. A single injection of DHPN resulted in production of approximately 1 tumor/female rat and 2.5 tumors/male rat. DHPN combined with posttreatment with PB at doses up to 500 ppm did not increase tumor yield in female rats, whereas a 3-fold increase was observed in male rats for the 500-ppm-treated groups. When PB was increased to 2500 ppm a marked increase (8-fold) in tumor yield in male rats was observed, in contrast to a less than 3-fold increase in similarly treated female rats.

Renal osteodystrophy

The term "renal osteodystrophy" is used to include skeletal disorders of patients with chronic renal failure: osteitis fibrosa, osteomalacia, osteosclerosis, osteoporosis and the frequently associated extraskeletal calcifications. It is the chronic glomerular disease with phosphate retention and resultant hyperphosphatemia on one hand and deficient 1,25 (OH)2 D3 and resultant hypocalcemia on the other to induce secondary hyperparathyroidism. The three most common causes of chronic renal failure in our patients are chronic glomerulonephritis, diabetic nephropathy, hypertensive nephropathy in decreasing frequency, polycystic renal disease occurs in five patients. Other miscellaneous causes include nephrotic syndrome, chronic pyelonephritis, systemic lupus erythematosus, periarteritis nodosa, interstitial nephritis and renal stones. The bone changes are similar in primary and secondary hyperparathyroidism and the incidence of brown tumor is about 3% in the former and 1.5 to 1.7% in the latter. We present one among the 94 dialyzed patients who has long-standing severe chronic renal failure from polycystic kidney disease and develops brown tumor in the mid ulna after 7 years on maintenance hemodialysis. The incidence of brown tumor in our series is about 1.1%. Because of increased longevity of the dialyzed patients, brown tumor from secondary hyperparathyroidism is now more commonly observed. Hyperphosphatemia with serum calcium-phosphate products exceeding plasma solubility of 60 to 75 mg/dl may induce soft tissue and vascular calcification. This explains the much higher incidence of soft tissue calcification in secondary than primary hyperparathyroidism; two of our patients with generalized Monckeberg's type arterial calcification and multiple periarticular calcifications in five patients have been observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Establishment of estrogen receptor-positive transplantable rat thyroid tumor cell lines in vivo

We established 17 transplantable rat thyroid tumor cell lines from the primary thyroid tumor of rats induced by N-bis(2-hydroxypropyl)nitrosamine. Among the 17 tumor cell lines established, only two of them (D1 and G1) were estrogen receptor (ER) positive. These two cell lines were characterized with respect to transplantability, histological features, ER contents and cellular localization, and expression of ER message. The ER contents, determined by dextran-coated charcoal assay, were 13.3 and 20.7 fmol/mg protein for D1 and G1 cell lines, respectively. Scatchard plot analysis indicates that the dissociation constants (Kd) were 0.17 and 0.4 nM, respectively, for D1 and G1 cell lines. Sucrose density centrifugation analysis detected a hormone-receptor complex which sedimented at the 4S region, characteristic for ER. Immunohistological staining revealed that the ER was localized in the nuclei. The presence of ER in D1 and G1 cell lines was further confirmed by reverse transcriptase-polymerase chain reaction to detect the ER mRNA. These results demonstrated that ER is expressed in some thyroid tumors. The ER-positive transplantable tumor cell lines are useful for studying the direct effect of estrogen on thyroid tumors in vitro and in vivo.

The development of human exposure standards for radio-frequency fields

Biological effects and health implications of radio frequency (RF) electromagnetic fields have been a subject of scientific investigation for more than 50 years. It has become a focus of attention because of the expanded use of RF radiation in the frequency range between 300 MHz and 6 GHz for wireless communication over the past decade. Another cause for the attention is the uncertainty of some observed responses and lack of understanding of the mechanism of interaction of RF electromagnetic fields with biological systems. At present, considerable efforts are devoted to developing and revising RF exposure standards. Each of these efforts should aim to make explicit the philosophy and process by which they reason and decide guidelines for deeming exposure as safe. Furthermore, the reconciliation of philosophies of protection will definitely be an asset, in practice, to those interested in international harmonization of RF exposure standards.

Purification and partial characterization of a preneoplastic antigen in liver carcinogenesis

A preneoplastic antigen has been isolated from the microsomal fraction of the hyperplastic nodules of rat liver. During the purification, the presence of preneoplastic antigen was monitored by microcomplement fixation test and double immunodiffusion plate following reaction with antiserum specific for this antigen. The antigen was purified by seven steps with a purification factor of 167 and 11% yield. It migrated as a single protein band, both in nondenaturing and denaturing polyacrylamide gel electrophoresis; showed a single sharp peak in an isoelectric focusing column at pH 4.75; and had a single serine amino-terminal amino acid. In the absence of detergent during purification, this protein tends to form molecular aggregates. It appears to be a glycoprotein based on the positive periodic acid-Schiff stain and absorption by concanavalin A:Sepharose affinity column chromatography. Amino acid analysis indicated that the protein is acidic, having acidic amino acids (aspartate and glutamate) and basic amino acids (lysine, arginine, and histidine) in a ratio of 6.8. An estimate of the molecular weight by gel filtration gave a value of 145,000 and a calculated Stokes radius of 41.5 A. Electrophoresis under denaturing conditions on sodium dodecyl sulfate-polyacrylamide gel indicated that this protein is a dimer consisting of two subunits of equal molecular weight (M.W. 74,000). Circular dichroism spectra indicated alpha-helix contents at 298 and 222 nm of 25.5 and 28.3%, respectively. A similar protein is present in the endoplasmic reticulum of normal rat liver, but in a much lower concentration.

Malignant soft tissue sarcoma of the hypopharynx successfully treated by radiotherapy alone

Sarcoma of the hypopharynx has been reported very rarely in the literature, only six cases having been found among all head and neck malignancies reported to SEER (Surveillance, Epidemiology, and End Results) during 1973-1987. We report a 14-year-old boy with a huge malignant soft tissue sarcoma arising from the hypopharynx. Tracheostomy and feeding gastrostomy were performed as emergency life-saving procedures. Surgical resection had been attempted, but abandoned. Because of the rapidity of tumor growth, we gave the patient a course of accelerated radiotherapy (170 cGy/fraction, two fractions per day) with a total dose of 7140 cGy within one month. A series of endoscopy and imaging studies demonstrated complete regression of the tumor, and the patient is currently alive without evidence of disease 3.5 years after treatment. We conclude that for an unresectable tumor without distant metastasis, radiation therapy may be tried. The time, dose, and fractionation of radiotherapy should be carefully designed and individualized.

Changes in intratumor pH by two heatings

It is a known fact that pH in rodent tumors decline significantly upon heating most likely due to breakdown of the tumor blood circulation. We recently observed that tumor blood vessels become thermotolerant after being heated with a sublethal thermal dose. The purpose of the present study was to reveal whether heating can reduce intratumor pH when the tumor vessels are thermotolerant. When the SCK tumors of A/J mice were heated at 42.5 degrees C for 1 h, the tumor vessels became most thermotolerant at 18 h postheating, as measured with the 86Rb uptake method. The intratumor pH in the control SCK tumors was 7.05 +/- 0.14 (SD), and it significantly decreased to 6.70 +/- 0.08 (P less than 0.001) after heating at 44.5 degrees C for 1 h. However, when the tumor vessels were thermotolerant, i.e., 18 h after heating at 42.5 degrees C for 1 h, reheating at 44.5 degrees C for 1 h could not reduce the intratumor pH. We concluded that such a failure to increase tumor acidity by a second heating at temperatures as high as 44.5 degrees C was due to vascular thermotolerance developed by the first heating.

Microwave-induced hearing: some preliminary theoretical observations

Pulsed microwaves impinging on the head of animals and man produce auditory sensations. Theoretical analyses indicate a series of resonant frequencies occurring inside the head. This is supported by previous observations of characteristic oscillations recorded from the round window of mammals during pulsed microwave irradiation.

P2564Levosimendan shortens action potential duration, decreases alternans threshold and prevents ventricular arrhythmia during therapeutic hypothermia in isolated rabbit hearts

Background

Therapeutic hypothermia (TH) increases the susceptibility to ventricular arrhythmias (VA) by prolonging action potential duration (APD) and facilitating arrhythmogenic spatially discordant alternans (SDA). The calcium sensitizer levosimendan has been reported to shorten APD by enhancing ATP-sensitive K current. We hypothesize that levosimendan might shorten the already prolonged APD during TH, decreasing SDA threshold, and prevent the occurrence of VA.

Methods

Langendorff-perfused isolated rabbit hearts were subjected to 15-min TH (30°C) followed by 30-min treatment with levosimendan (0.5 μM, n=9) or vehicle (n=8). Using an optical mapping system, epicardial APD was evaluated by S1 pacing. SDA threshold was defined as the longest pacing cycle length (PCL) that induced SDA phenomenon. Ventricular fibrillation (VF) inducibility was evaluated by burst pacing for 30 s using the shortest PCL that achieved 1:1 ventricular capture.

Results

Levosimendan shortened the ventricular APD (at PCL 300 ms, from 229±9 ms to 211±18 ms, p=0.02) and decrease the SDA threshold (from 327±88 ms to 311±68 ms, p=0.001) during TH. The VF inducibility was decreased by levosimendan from 39±30% at 30°C to 14±12% after levosimendan infusion. In control hearts, the APD (p=0.75), SDA threshold (p=ns) and VF inducibility (p=0.12) were not changed by vehicle during TH.

Conclusions

Levosimendan protects the hearts against VA during TH by shortening APD and decreasing SDA threshold. Enhancing ATP-sensitive K current with levosimendan might be a novel approach to prevent VA during TH.

Failure of screening to detect HIV in a foreign laborer who died of toxoplasmosis of the central nervous system

The most common neurologic complication in patients with acquired immunodeficiency syndrome (AIDS) is cerebral toxoplasmosis. Patients with cerebral toxoplasmosis have characteristic findings on clinical examination and neuroimaging. They require prolonged treatment and have a considerable mortality rate. We report a case of cerebral toxoplasmosis in a foreign laborer with AIDS, in whom a human immunodeficiency virus (HIV) screening test failed to detect-HIV infection. The patient, a 23-year-old man from Thailand, presented in a confused state 2 weeks after his arrival in Taiwan. Computed tomography showed a mass effect, and magnetic resonance imaging showed multiple ring-enhanced lesions in the cerebrum. Serologic tests were positive for anti-HIV antibody and also showed high anti-Toxoplasma immunoglobulin G titers. Although symptomatic treatment was initiated, the patient's condition deteriorated rapidly and he died of multiple organ failure due to brain stem herniation a few days after admission. As the number of foreign laborers working in Taiwan has increased dramatically in recent years, the issues raised by this case are the efficacy of our screening protocols for foreign laborers and the increased occupational hazards encountered by medical personnel in Taiwan.

Identification of two molecular forms of (Na+,K+)-ATPase in rat adipocytes. Relation to insulin stimulation of the enzyme

Two molecular forms of the (Na+,K+)-ATPase catalytic subunit have been identified in rat adipocyte plasma membranes using immunological techniques. The similarity between these two forms and those in brain (Sweadner, K. J. (1979) J. Biol. Chem. 254, 6060-6067) led us to use the same nomenclature: alpha and alpha(+). The K0.5 values of each form for ouabain (determined by inhibition of phosphorylation of the enzyme from [gamma-32P]ATP) were 3 X 10(-7)M for alpha(+) and 1 X 10(-5)M for alpha. These numbers correlate well with the K0.5 values for the two ouabain-inhibitable components of 86Rb+/K+ pumping in intact cells (1 X 10(-7) M and 4 X 10(-5)M). Quantitation of the Na+ pumps in plasma membranes demonstrated a total of 11.5 +/- 0.2 pmol/mg of membrane protein, of which 8.5 +/- 0.3 pmol/mg, or 75%, was alpha(+). Insulin stimulation of 86Rb+/K+ uptake in rat adipocytes was abolished by ouabain at a concentration sufficient to inhibit only alpha(+)(2-5 X 10(-6)M). Immunological techniques and ouabain inhibition of catalytic labeling of the enzyme from [gamma-32P]ATP demonstrated that alpha(+) was present in skeletal muscle membranes as well as in adipocyte membranes, but was absent from liver membranes. Since insulin stimulates increased Na+ pump activity in adipose and muscle tissue but not in liver, there is a correlation between hormonal regulation of (Na+,K+)-ATPase and the presence of alpha(+). We propose that alpha(+) is the hormonally-sensitive version of the enzyme.

In vivo growth of human bladder cancer cell lines

Two human bladder cancer cell lines grew predictably in rats immunosuppressed with antilymphocyte serum. Intraperitoneal inoculation of tumor cell suspensions resulted in diffuse intraabdominal carcinomatosis with consequent host death after 10 to 20 days. Subcutaneous inoculation of tumor cell suspensions resulted in local tumors which grew exponentially for 20 to 30 days before eventual regression after 40 to 50 days; lung metastases developed in at least 13 per cent of the animals with subcutaneous tumors. The histologic appearance of the xenografted tumors closely resembled that of the original tumors. Subsequent in vitro culture of the xenografted tumors provided cell lines that were morphologically identical to the primary lines and that retained a human karyotype. It is proposed to employ this model of human bladder cancer to evaluate chemotherapeutic agents for possible use in the clinical disease.

Concomitant chemoradiotherapy for advanced epidermoid carcinoma of the uterine cervix: a preliminary report

BACKGROUND

Because the prognosis of advanced carcinoma of the uterine cervix is poor, and has improved very little in the last 20 years, a prospective study was initiated to evaluate the feasibility, response and toxicities of concomitant chemoradiotherapy for such cervical cancer.

METHODS

From May 1992 to December 1992, 22 patients entered the study, 21 of them completed the entire treatment. Their ages ranged from 47 to 72 years, median 57. There were 16 FIGO stage IIIB, and 5 stage IIB. Radiotherapy was administered using 1.8 Gy/day, five days a week, to the whole pelvis (50.4 Gy/28 fractions) with or without parametrial boost according to the tumor response. Intracavitary brachytherapy 5 Gy x five to six times was given after one or two weeks of rest. Chemotherapy consisted of etoposide 100 mg/m2 day 1 + cisplatin 50 mg/m2 day 1 + bleomycin 25 mg/m2/day day 2-3, repeated every two weeks during external irradiation.

RESULTS

All 21 eligible patients achieved complete response, sustaining during a median follow-up time of 12 months. All the initially elevated tumor markers (SCC, CEA, CA-125) returned to normal range after treatment. The toxicity was well tolerated.

CONCLUSIONS

Concomitant chemoradiotherapy for advanced cervical carcinoma is both feasible and effective, with acceptable toxicities. Long-term follow-up is mandatory, and a randomized trial to confirm the superiority of this protocol will be started soon.

Rat bladder isograft model for focal carcinoma

A model for focal bladder carcinoma in rats was developed with the use of an isograft technique. Bladder tumors developed by carcinogen induction with FANFT or MNU were grafted to bladders of syngeneic rats. Ninety-six per cent (56 our of 58) of the grafts were taken and 83 per cent (34 out of 41) of the grafted tumors remained neoplastic. Most of the grafts from FANFT-induced tumor remained localized at the original site whereas many from the MNU-induced tumor spread beyond the original graft area. The model system may be useful for the evaluation of chemotherapeutic agents as well as for the studies of basic mechanisms of tumor growth and spreading.

[The study of anatomic factors in difficult intubations]

Endotracheal intubation is a common procedure in anesthesia which can usually be accomplished easily. However if the attempt is unexpectedly difficult the patient may be seriously at risk. If all difficult airways can be predicted confidently in the pre-operative period, anesthesiologists can plan the safest and most effective way of managing tracheal intubation. The purpose of this study was to analyze not only the incidence, anatomic factors, immediate complications and management of difficult intubation cases but also the view obtained at laryngoscope which was graded according to the Cormack's and Lehane's description. Patients who received general anesthesia with endotracheal tube within 1 year's period from November 1, 1991 to October 31, 1992 in Show Chwan Memorial Hospital were collected. All difficult intubations were performed by senior anesthesiologists. 3925 patients were intubated, 92 cases were noted to have difficult intubations and their overall incidence were 2.3%. Among the 92 patients, those with 2 anatomic factors (41 patients, 44.6%) represented the majority for patients with difficult intubations. On the other hand, the four most common anatomic factors and their incidences in order of frequency included short neck (48.9%), protruding teeth (38.0%), receding mandible (27.2%) and limited opening mouth (26.1%). According to Cormack's and Lehane's laryngoscopic grading, the results were shown respectively as follow: 4 cases (4.4%) for grade 1;2 cases (2.2%) for grade 2;82 case (89%) for grade 3 and 4 cases (4.4%) for grade 4. We also found that tachycardia/hypertension (70.7%), bleeding (37.0%) and esophageal intubation (33.7%) were the three most frequent immediate complications during difficult intubations.(ABSTRACT TRUNCATED AT 250 WORDS)