Detection of hepatitis B virus DNA by polymerase chain reaction in plasma of volunteer blood donors negative for hepatitis B surface antigen

Plasma samples from 206 volunteer blood donors were tested for hepatitis B virus (HBV) DNA by dot blot hybridization and polymerase chain reaction (PCR). All donors were negative for hepatitis B surface antigen (HBsAg) and had normal serum alanine aminotransferase levels. None of the 206 plasma samples was positive for HBV DNA by dot blot hybridization assay. However, nine samples were positive for HBV DNA by PCR using two primer pairs specific for surface and core regions. Nine persons received the HBV-DNA-positive plasma, and one developed posttransfusion non-A, non-B hepatitis; the others remained well 6 months later. Therefore, approximately 4% of blood donors in Taiwan have low titers of HBV DNA, and a more sensitive method to screen donors may be needed in the future, although the current serologic test remains the most practical at present.

[Clinical application of Chinese forearm flap: 5-year review]

Twenty-nine patients treated with the Chinese forearm flap from 1985 to 1989 were reviewed. This flap was used for soft tissue defect reconstruction in 19 cases, and phallus reconstruction in 10 patients. There were two cases of total flap failure and two cases of partial failure. Twenty cases used sensory flaps. Donor site complications included partial loss of the skin graft with tendon exposure in one patient (3.4%), limitation of range of movement of the wrist joint in one case (3.4%), and paresthesia over the radial site of the hand in 12 patients. On functional evaluation, 20 patients demonstrated no significant loss of strength in the donor extremity.

Basis for natural resistance to methotrexate in human acute non-lymphocytic leukemia

The basis of intrinsic resistance of blasts from patients with acute non-lymphocytic leukemia (ANLL) to methotrexate was studied. MTX polyglutamate formation was measured in blast cells from 19 patients with ANLL and in 7 pediatric patients with acute lymphocytic leukemia (ALL), after in vitro incubation for 24 h with 3H-methotrexate. There was no significant differences seen in the total amount of MTX plus polyglutamates measured between ANLL and ALL blasts, indicating that transport defects do not account for intrinsic MTX resistance in ANLL. However, there were significant differences between the amounts of long chain MTX polyglutamates found in ANLL cells as compared to ALL cells. Most, but not all, ANLL blasts were unable to form long chain polyglutamates. In as much as the level of MTX polyglutamates found in blast cells after MTX administration allows for retention of this drug, this property may explain, at least in part, the refractoriness of most patients with ANLL to methotrexate.

Solid state ultraviolet laser (213 nm) ablation of the cornea and synthetic collagen lenticules

We used a Q-switched Nd:YAG laser with non-linear optical crystals to produce the 5th (213 nm) and the 4th (266 nm) harmonic frequencies. Using these two wavelengths, we ablated fresh porcine corneas and type I collagen synthetic epikeratoplasty lenticules. For the 213-nm ablation, radiant exposure was 1.3 J/cm2. The ablation rate was 0.23 micron per pulse for the epikeratoplasty lenticules. We examined all tissues with light microscopy, transmission electron microscopy, and scanning electron microscopy. Histology for the 213-nm ablation showed a clean ablation crater with minimal collagen lamellae disruption and a damage zone less than 1 micron. In comparison, the 266 nm radiation showed more charring at the edges with a damage zone approximately 25 microns deep with disruption of the stromal lamella. Our results show that this solid state UV laser is a potential alternative to the excimer laser for cornea surgery.

Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B

BACKGROUND AND METHODS

The effect of intensive lipid-lowering therapy on coronary atherosclerosis among men at high risk for cardiovascular events was assessed by quantitative arteriography. Of 146 men no more than 62 years of age who had apolipoprotein B levels greater than or equal to 125 mg per deciliter, documented coronary artery disease, and a family history of vascular disease, 120 completed the 2 1/2-year double-blind study, which included arteriography at base line and after treatment. Patients were given dietary counseling and were randomly assigned to one of three treatments: lovastatin (20 mg twice a day) and colestipol (10 g three times a day); niacin (1 g four times a day) and colestipol (10 g three times a day); or conventional therapy with placebo (or colestipol if the low-density lipoprotein [LDL] cholesterol level was elevated).

RESULTS

The levels of LDL and high-density lipoprotein (HDL) cholesterol changed only slightly in the conventional-therapy group (mean changes, -7 and +5 percent, respectively), but more substantially among patients treated with lovastatin and colestipol (-46 and +15 percent) or niacin and colestipol (-32 and +43 percent). In the conventional-therapy group, 46 percent of the patients had definite lesion progression (and no regression) in at least one of nine proximal coronary segments; regression was the only change in 11 percent. By comparison, progression (as the only change) was less frequent among patients who received lovastatin and colestipol (21 percent) and those who received niacin and colestipol (25 percent), and regression was more frequent (lovastatin and colestipol, 32 percent; niacin and colestipol, 39 percent; P less than 0.005). Multivariate analysis indicated that a reduction in the level of apolipoprotein B (or LDL cholesterol) and in systolic blood pressure, and an increase in HDL cholesterol correlated independently with regression of coronary lesions. Clinical events (death, myocardial infarction, or revascularization for worsening symptoms) occurred in 10 of 52 patients assigned to conventional therapy, as compared with 3 of 46 assigned to receive lovastatin and colestipol and 2 of 48 assigned to receive niacin and colestipol (relative risk of an event during intensive treatment, 0.27; 95 percent confidence interval, 0.10 to 0.77).

CONCLUSIONS

In men with coronary artery disease who were at high risk for cardiovascular events, intensive lipid-lowering therapy reduced the frequency of progression of coronary lesions, increased the frequency of regression, and reduced the incidence of cardiovascular events.

Hepatitis C virus in a prospective study of posttransfusion non-A, non-B hepatitis in Taiwan

Using an enzyme-linked immunosorbant assay for antibody against hepatitis C virus (anti-HCV), serial serum samples from 26 non-A, non-B (NANB) posttransfusion hepatitis (PTH) patients were studied in a prospective study in Taiwan. Sixteen (61.5%) of the 26 patients were positive for anti-HCV antibodies. Two of the 16 patients were positive for anti-HCV before transfusion. The remaining 10 patients were negative for anti-HCV antibodies. The rate of anti-HCV seroconversion is, therefore, 58.5%. Of the 14 patients with anti-HCV seroconversion, three were hepatitis B surface antigen (HBsAg) carriers. The time of seroconversion for anti-HCV ranges from 2 to 24 weeks after the first elevation of ALT (mean: of 8.7 weeks,) or 6-32 weeks from the date of transfusion (mean: 13 weeks). Twelve (85.7%) of the 14 anti-HCV seroconverted patients had persistent abnormal ALT 6 months after the onset of hepatitis in contrast to 30% of chronicity in the anti-HCV-negative patients. The results suggest that HCV is the major causative agent in NANB PTH in Taiwan, and patients positive for anti-HCV have a higher risk of chronicity.

Complete agenesis of the dorsal pancreas--a case report and review of the literature

A case of agenesis of the dorsal pancreas associated with diabetes mellitus and dilated biliary trees was reported. Preoperative diagnosis was made by endoscopic retrograde cholangiopancreatography and computed tomography. Laparotomy revealed a normal head of the pancreas but complete agenesis of the body and tail. Biopsy specimens removed from the head showed normal pancreatic tissue but only fat tissue from the presumed body and tail. This anomaly has rarely been reported in the literature. A thorough review of the literature was made and consideration of differential diagnosis was discussed.

Irreversible inhibition of renal Na(+)-Pi cotransporter by alpha-bromophosphonoacetic acid

We investigated the suitability of alpha-bromophosphonoacetic acid (alpha-BrPAA) to act as a possible irreversible inhibitor of Na(+)-dependent transport of Pi across renal brush-border membrane (BBM). When added directly into the Pi uptake medium, alpha-BrPAA causes specific, competitive [apparent inhibition constant (Ki) = 0.33 mM; no change in maximum velocity (Vmax)], and reversible (by washing) inhibition of Na+ gradient [Na+o greater than Na+i]-dependent uptake of Pi by BBM vesicles (BBMV). Next, BBMV were preincubated with 5 mM alpha-BrPAA in alkaline (pH 9) medium for 30 min, then twice washed by 1:100 dilution and recentrifugation, and tested for transport and other properties. This preincubation of BBMV with alpha-BrPAA in alkaline medium resulted in a different type of inhibition [lower Vmax; no change in Michaelis constant (Km)] of the Na+ gradient-dependent uptake of 32Pi, whereas the uptakes of D-[3H]glucose and other solutes were not altered. This inhibition of Pi transport was not reversed by dilution and washing of BBMV. The BBMV Na(+)-dependent binding of [14C]phosphonoformic acid, but not of [3H]phlorizin, was decreased; activities of BBM marker enzymes were not changed. Results suggest that alpha-BrPAA binds onto the same locus on luminal surface of BBM on which Pi and Na+ bind and inhibits Na(+)-Pi cotransporter similar to phosphonoformic acid. Furthermore, after a 30-min incubation in alkaline medium, alpha-BrPAA apparently forms a more stable association with BBM in the vicinity of the Na(+)-Pi cotransporter. We thus suggest that alpha-BrPAA acts under these conditions as an apparently irreversible inhibitor of Na(+)-Pi cotransporter in BBM.(ABSTRACT TRUNCATED AT 250 WORDS)

Non-surgical radical treatment of early gastric cancer by endoscopic contact Nd-YAG laser: report of a case

A case of flat-elevated type (IIa) early gastric cancer completely eradicated with contact Nd-YAG laser is reported. The patient was diagnosed as having early gastric cancer (type IIa) by endoscopic examination. Biopsy revealed a well-differentiated adenocarcinoma. He declined surgery and subsequently received 4 sessions of contact Nd-YAG laser treatment with a total output of 1245 watt-sec. An ulceration was created by the end of the third session of laser treatment. He finally agreed to surgery and a subtotal gastrectomy was performed after completion of four sessions of therapy. Meticulous histologic examination of the resected specimens revealed no residual cancer cells. This is the first report of endoscopic curative treatment of gastric cancer by contact Nd-YAG laser in Taiwan. This technique may provide an alternative for patients with early gastric cancer, who have a high surgical risk.

Hereditary pancreatitis in a Chinese family

In a Chinese family with hereditary pancreatitis, two members are proven to have chronic pancreatitis. The propositus, a 31-year-old man, had epigastric pain since the age of 18. Multiple calcifications in the region of the pancreas were seen on plain film of the abdomen, ultrasonography, computed tomography, and endoscopic retrograde pancreatography. Pancreatolithotomy and side-to-side pancreatojejunostomy gave symptomatic improvement. His 60-year-old mother also had pancreatic calcifications in addition to diabetes. Known causes of secondary pancreatitis, such as hyperlipidemia, hyperparathyroidism, and amino aciduria, were ruled out in both patients.

Structural requirement of monophosphates for inhibition of Na+-Pi cotransport in renal brush border membrane

Using the chemical structural analogs of phosphonoacetic acid (PAA) and related phosphonate compounds, we investigated which structural features are required for competitive inhibition of Na+-Pi cotransport in rat renal cortical brush border membrane (BBM) vesicles (BBMV). The effects of compounds on [Nao+ greater than Nai+]-gradient-dependent 32Pi uptake by BBMV were examined using various inhibitor-to-32Pi concentration ratios in the transport assay medium. The replacement of a phosphono-group with an arsono-group in PAA, or the substitution of a carboxylic group in PAA by an amino or hydroxyl group, totally abolished the inhibitory action on Na+-Pi cotransport. Decreased electronegativity of carboxyl in PAA by coupling with hydrazine or hydroxylamine lowered the inhibitory potenty of PAA. Substitution of H at the alpha-carbon of PAA with ethyl or p-Cl-phenyl groups completely abolished the inhibitory activity, whereas alpha-halogenation with Br greatly increased the inhibitory potency of PAA, close to that of phosphonoformic acid (PFA). The inhibition by all the active tested monophosphates was strictly competitive. The tested compounds displaced [14C]PFA pre-bound onto BBMV in the presence of 100 mM NaCl. The ability of monophosphates to inhibit Na+-Pi cotransport across BBM and the binding of [14C]PFA were closely correlated (r = 0.925; P greater than 0.001). These results show that: (a) strong electronegativity at both ends of the PAA molecule is needed for inhibitory action, (b) an alpha-aliphatic or aromatic substituent at the alpha-carbon probably hinders the access of the inhibitor to the Pi-binding site of the Na+-Pi cotransporter in BBM, whereas (c) an alpha-electrophilic substituent--Br--enhances the inhibitory potency of PAA. The tested compounds inhibited Na+-Pi cotransport by binding, in the presence of Na+, on the same site on the luminal surface of BBM as did PFA and, by extension, Pi.

Effect of Ca on Na-D-glucose cotransport across isolated renal brush-border membranes

Brush-border membrane vesicles were prepared from rat kidney cortex by Mg precipitation. Using quin2 (free acid), intravesicular [Ca2+] was found to be 44 microM and less than 300 nM when vesicles were incubated in 0.2 mM CaCl2 or Ca-free buffer, respectively. In Ca-loaded vesicles, the initial D-glucose uptake, measured in the presence of 150 mM Na+ and 0.1 mM D-glucose inward gradients, was reduced to 30% of the control uptake. This reduction persisted when the extra-vesicular Ca2+ was chelated by ethylene glycol-bis(beta-amino-ethyl ether)-N,N,N',N'-tetraacetic acid but was abolished in the presence of saturating concentrations of D-glucose. Whereas KG0.5 (g) for D-glucose at constant [Na] in the Ca-loaded membranes increased by approximately 50% of the control value (0.5 +/- 0.1 mM), no significant change in Jmax was observed. In contrast, both Jmax and KG0.5 (Na) for glucose, measured as a function of [Na] in the extravesicular fluid, were found to be significantly reduced. Na uptake, determined in the presence of 0.5 mM amiloride, was found to increase by approximately 30% of the value for control membrane. This increase was abolished when vesicles were preincubated with 0.5 mM neomycin or 0.5 mM phlorizin. The results suggest that the effect of Ca2+ on Na entry may be mediated in part by activation of phospholipase C and are consistent with a model of cotransport in which Ca2+ increases the mobility of the binary Na-sugar-translocator complex, thus leading to uncoupling of Na transport from glucose uptake ("slipping") and in part with Ca-induced Na entry by nonmediated leakage.

Multiple-hormone-producing islet cell carcinoma: report of a case

Although part of pancreatic endocrine tumors may be multihormonal by immunohistochemical study, the clinical manifestations are often related to hypersecretion of only one type of peptide hormone. Only a few cases have shown two or more syndromes simultaneously or transition of one type of syndrome to another with the passage of time. The case reported here is an islet cell carcinoma with liver metastases. The clinical manifestations changed from Zollinger-Ellison syndrome to hypoglycemic syndrome with the secretion of gastrin, insulin and serotonin. The immunohistochemical study confirmed multihormonal production. The elevation of growth hormone with acromegaly was also noted in this case. It remains to be seen if the excessive production of growth hormone was due to growth hormone-releasing hormone secreted by the endocrine pancreatic tumor or to the possible presence of a pituitary microadenoma as a component of the multiple endocrine neoplasia type I syndrome.

Intestinal capillariasis: report of a case

Infection with Capillaria philippinensis has not been reported in Taiwan before. It is characterized by chronic diarrhea, abdominal pain and muscle wasting. Because the infection results in a severe disease with a high mortality, early diagnosis is very important. A 58-year-old housewife from Ar-Lien village, Kao-Hsiung County, was admitted to the National Taiwan University Hospital in July 1988, after suffering from diarrhea, lower leg edema and weight loss for one year. The initial symptom was epigastric pain followed by watery diarrhea. Thereafter borborygmus, frequent loose stool passage and weakness persisted. The cause of her malabsorption syndrome went undetected until the ova, larvae and adult worms of C. philippinensis were detected in the direct smear of the patient's stool in August 1988. She received mebendazole 200mg b.i.d. for 20 days. Capillaria ova were no longer detected following the third day of medication. At the second month follow-up, her body weight returned to her pre-morbid state and all laboratory findings returned to normal with the exception of mild anemia. The infection source was not clear.

The diagnostic value of endoscopic ultrasonography in pancreatic disorders

The introduction of endoscopic ultrasonography (EUS) makes it possible to demonstrate the pancreas in detail by intraluminal scanning. To assess the clinical usefulness of EUS in the diagnosis of pancreatic disorders, 33 patients with various pancreatic disorders were examined by conventional ultrasonography (US) and EUS concomitantly. There were 16 patients with pancreatic carcinomas: 7 chronic pancreatitis, 5 pseudocysts, 2 mucinous cystadenocarcinomas, one each serous cystadenoma, Von-Hippel-Lindau disease, and simple cyst of the pancreas. An Olympus EUS (Japan) radial type machine with a 7.5 MHz transducer with the balloon inflation method was used. The overall diagnostic sensitivity of conventional US (90.9%, 30/33) was as high as that of EUS (93.9%, 31/33), but the latter demonstrated pancreatic parenchyma more clearly. Three patients were misdiagnosed by conventional US. One patient with chronic calcifying pancreatitis, which was initially diagnosed as dilatation of the main pancreatic duct without evidence of calcifications by conventional US, was confirmed to have a trace of calcification by EUS and computed tomography. Two other patients, whose initial diagnosis was pseudocyst, were proved to have mucinous cystadenocarcinoma and serous cystadenoma respectively by EUS, as a result of improved image resolution. Two patients were misdiagnosed by EUS. One patient with carcinoma of the pancreatic head was missed by EUS because of a partially gastrectomized stomach which precluded successful observation. The other patient with cystadenocarcinoma of the pancreatic tail was misdiagnosed as pseudocyst by EUS due to non-visualization of a papillary crescent within a cystic tumor. We conclude that EUS and conventional US were complementary.(ABSTRACT TRUNCATED AT 250 WORDS)

Medical dissolution of gallstones by ursodeoxycholic acid: a clinical trial on 14 patients

Fourteen patients with radiolucent gallstones proved by oral cholecystography (OC) and ultrasonography were treated with daily doses of 600 mg of ursodeoxycholic acid (UDCA) for one year. Among them, 2 patients had complete dissolution of gallstones and another one had partial dissolution. The success rate was 21.4% (3/14). Of the remaining 11 patients who failed to respond to UDCA treatment, calcifications of varied degrees were demonstrated in every gallstone by computed tomography (CT). None of these 14 patients had statistically significant changes in serum lipids, liver function tests and hemograms during the course of treatment and only one (7.1%) patient had transient diarrhea. It was concluded that UDCA was effective and safe for medical dissolution of non-calcified gallstones. However, the underestimation of the calcification of gallstones by OC precluded successful medical dissolution by UDCA. Therefore, meticulous selection of non-calcified gallstones by CT rather than OC as candidates for dissolution may improve the success rate.

[Changes in lung compliance and maximal expiratory flow-volume curves when breathing air and an He-O2 mixture in light smokers]

Lung compliance (CL) and maximal expiratory flow-volume curves (MEFV) breathing air and helium-oxygen mixture in 34 healthy nonsmokers and 55 young light smokers were studied. The difference of FEV1%, PEFR and MMEF between smokers and nonsmokers were statistically significant. The results of small airway function tests were compared and analysed. In the 55 smokers, 38(69.1%) showed frequency dependence of dynamic compliance (FDC), only 5(9.1%) had an abnormal V25/HT and 4(7.3%) showed an abnormal MMEF. of 48 smokers (31.3%) had an abnormal volume of isoflow (VisoV), We concluded that among the small airway function tests FDC is the most sensitive one in light smokers.

A modified formula of GIK (glucose-insulin-potassium) therapy for treatment of extensive burn injury in dogs

The effectiveness of a modified glucose-insulin-potassium (GIK) formula, which was derived from the results of a previous study (the maximal glucose disposal rate of 400 mg/M2/min required an insulin infusion rate at 1,200 mU/M2/min and KCl supplement rate at 0.08 mEq/M2/min), was evaluated in the treatment of extensive acute burn injury (EABI) in dogs. Under anesthesia initially with intravenous sodium pentobarbital 35 mg/kg followed by a maintenance dose of 5 mg/kg/hr, a third-degree burn of about 50% of the total body surface was created by acetylene torch over the ventral wall of the chest and abdomen. Cardiovascular parameters including heart rate, mean arterial blood pressure, pulmonary wedge pressure, cardiac index, and cardiac contractility (dP/dt of left ventricular pressure), as well as blood chemical data of pH value and K+ concentration were monitored. The present GIK therapy in EABI dogs effectively prevented a decrease in cardiac function, markedly enhanced cardiac function, steadily prolonged cardiac enhancement, and safely avoided hypoglycemic attack.

Progression of coronary atherosclerosis in patients with probable familial hypercholesterolemia. Quantitative arteriographic assessment of patients in NHLBI type II study

A computer-assisted method for quantitatively assessing progression and regression of coronary atherosclerosis has been applied, in a fully blinded fashion, to a set of 116 5-year-interval coronary arteriograms obtained between 1972 and 1981 in the National Heart, Lung, and Blood Institute (NHLBI) Type II Study. Coronary changes are described in 54 of these patients who had tendinous xanthomata and hypercholesterolemia consistent with the diagnosis of familial hypercholesterolemia. Among 468 patent lesions of all degrees of severity and among 25 total occlusions identified on the initial arteriogram, 11% progressed by the 95% confidence criterion for assessing change in percent stenosis (+/- 17%), and 1% regressed by using the same criterion. Among 54 patients, 50% had progression only, 6% had regression only, and 4% had mixed progression and regression. Because half of these patients were treated with cholestyramine, these frequencies may underestimate the natural history of their disease progression. Comparable frequencies were obtained by using the 95% confidence criterion for change in stenosis resistance (Rp ratio outside range, 0.35 to 2.9). In properly obtained arteriograms, the Rp parameter is physiologically relevant and is a sensitive index of lesion change with a high signal-to-noise ratio; we advocate its use for detection of progression and regression. Morphologic features, including luminal irregularity and ulceration, increased the likelihood of progression by 1.8- to 5-fold. Surprisingly, significant arterial flexing at the site of the lesion predicted anatomic stability. A lumen narrowed by visible thrombus was 100-fold more likely to regress than were those without it. The initial severity of stenosis correlated strongly with new total occulusion and with disease progression as assessed by Rp change. Because lesion-specific features are important determinants of lesion change, intervention trials that statistically account for the contributions of lesion morphology are likely to provide a more insightful assessment of the therapeutic benefit.