Effect of felbamate on the pharmacokinetics of lamotrigine

To assess the possible interaction between lamotrigine and felbamate, a double-blind, randomized, placebo-controlled, two-way crossover study was conducted in 21 healthy male volunteers. Volunteers were given lamotrigine (100 mg every 12 hours) and felbamate (1,200 mg every 12 hours) or matching placebo for 10 days during each period of the crossover. After morning administration on day 10, blood samples were obtained over 12 hours for measurement of lamotrigine. Felbamate increased the maximum concentration (Cmax) and and area under the concentration-time curve from time 0 to 12 hours (AUC0-12) of lamotrigine by 13% and 14%, respectively, compared with placebo. The 90% confidence intervals of the log-transformed pharmacokinetic parameters were within the 80-125% bioequivalance limits, however. Felbamate had no significant effect on the urinary excretion of lamotrigine (total), unconjugated lamotrigine, or the N-glucuronide. One volunteer discontinued the study after developing a rash while taking lamotrigine and placebo. All other adverse events were primarily related to the central nervous system and gastrointestinal tract, with a higher incidence reported during coadministration of lamotrigine and felbamate than with placebo. Overall, felbamate appears to have no clinically relevant effects on the pharmacokinetics of lamotrigine.

Clinical response of tuberculous pericarditis to medical treatment: a retrospective survey

BACKGROUND

The prevalence of tuberculosis has declined with advanced antituberculous chemotherapy. However, the occurrence of subsequent constrictive pericarditis in tuberculosis has not reduced. Clinical progress of tuberculous pericarditis was investigated in patients receiving antituberculous chemotherapy.

METHODS

Thirteen patients with tuberculous pericarditis (11 men and 2 women aged 14 to 86 years [mean 60.0 +/- 17.0]), treated initially with antituberculous medications were analyzed. All patients underwent pericardiocentesis on admission following echocardiography.

RESULTS

Dyspnea was the most common clinical pictures. Bloody effusion fluids were noted in 10 patients. Moreover, the lymphocytic fluids were present in 78% of all patients. The neutrophilic fluids tended to have a bloody color, and there was progress to constrictive pericarditis even for those on anti-tuberculous chemotherapy. Five patients with subsequent constrictive pericarditis received pericardiectomy within 3.5 months of admission. Three of them received pericardiectomy later, despite pericardial window procedure.

CONCLUSIONS

Follow-up by echocardiogram is necessary within three months after commencing medical treatment because of the high incidence of progression constrictive pericarditis despite aggressive medical treatment. Pericardiectomy seems to be the only solution to the catastrophic outcome of constrictive pericarditis.

Patient satisfaction with nursing care as an outcome variable: dilemmas for nursing evaluation researchers

Evaluation is one of the most critical phases of the nursing process because it supports the basis of the usefulness and effectiveness of nursing practice. Nursing practice is patient driven and patient centered. Accordingly, patient satisfaction has been strongly advocated by nursing professionals to be an important indicator of quality of nursing care delivery. This article discusses the conceptualization and measurement of patient satisfaction with nursing care. Also, this article examines numerous dilemmas related to conceptualization and methodology that nursing evaluation researchers confront when attempting to use patient satisfaction as an outcome variable. Based on the current knowledge regarding the nature of patient satisfaction, implications for future nursing evaluation research are proposed and discussed to overcome these dilemmas in measuring patient satisfaction as an indicator of quality of nursing care.

Hepatoprotective effects of emodin from Ventilago leiocarpa

A major component of ethyl acetate (EtOAc) and chloroform (CHCl3) fractions of Ventilago leiocarpa Bunge (Rhamnaceae), emodin, was isolated and exhibited hepatoprotective effects on carbon tetrachloride (CCl4) as well as D-galactosamine (D-GalN)-induced liver damage. The histopathological examination also clearly showed that emodin reduced lymphocyte cells, Kupffer cells, ballooning degeneration, cell necrosis and hyaline degeneration on CCl4 and D-galactosamine-induced tests.

Prevascularized bone graft cultured in sintered porous beta-Ca2P2O7 with 5 wt% Na4P2O7.10H2O addition ceramic chamber

Autogenous bone transfer is an important part of reconstructive plastic surgery. Presently available techniques have the disadvantages of limitation of available donor site, loss of donor tissue and the possibility of donor defect or deformity. In the present study, a vascularized bone graft was created and cultured in the groin area of the New Zealand rabbit. The cylindrical ceramic chambers, 15 mm in length, 6 mm in outer diameter and 3 mm in inner diameter, were prepared by the addition of sintered porous beta-Ca2P2O7 with 5 wt% Na4P2O7.10H2O. In the first group, the chambers impregnated with autogenous bone fragments and allogenous demineralized bone matrix with volume ratio 1:1 were cultured in the rabbit's groin area with saphenous vessels passing through. In the second group, the chambers were treated by the same procedures as the first group but without saphenous vessels passing through. In the third group, the chambers were not impregnated, and were cultured in the groin area with saphenous vessels. After 2, 4, 6, 8 and 12 wk of operation, the animals were killed with an overdose of intravenous pentobarbital. The viability of the osseous tissue in the chamber was evaluated by histological examination, microangiograms and fluorochrome incorporation for the three groups. The autogenous bone chips could survive and retain their osteogenic properties while packed into the sintered porous beta-Ca2P2O7 (with 5 wt% Na4P2O7.10H2O addition) ceramic chamber and implanted in the rabbit groin area up to 12wk. However, even at the longest time periods, considerable amounts of dead bone were present in the chambers. In addition, we observed bone resorption in the three groups up to 12 wk, which might be attributed to lack of physiological stress. There were significant differences in new bone formation and osseous cell viability among the three groups. The prevascularized vessels and autogenous bone chips were both necessary for the formation of new bone and osteogenic property in the chamber under these heterotopic circumstances. The biodegradable ceramic used in this study was gradually absorbed and dissolved in the physiological environment. However, the degradation debris of the ceramic caused no injury to the new bone formation. These findings support the concept of creating a preformed vascularized bone graft to reconstruct segmental bone defects.

Carcinosarcoma of the renal pelvis: a case report with immunohistochemical study

The clinicopathologic feature of one carcinosarcoma of the renal pelvis is reported. The tumor occurred in a 51-year-old woman with a long standing history of renal calculi. The epithelial component was consistent with squamous cell carcinoma, whereas the sarcomatous component was composed of pleomorphic spindle cells. The immunohistochemical studies demonstrated obvious epithelial and mesenchymal reactivity respectively. The tumor progressed rapidly with widespread metastases and the patient died one month after operation.

Circulating intercellular adhesion molecule-1 and E-selectin in patients with acute coronary syndrome

To characterize the role of circulating intercellular adhesion molecules (ICAM-1) and E-selectin in patients with acute coronary syndrome, serum levels of ICAM-1 and E-selectin were measured by enzyme-linked immunosorbent assay (ELISA). Group 1 comprised 17 patients with acute myocardial infarction; group 2 included 17 patients with unstable angina; and group 3 included 19 control subjects. These 53 patients all had prolonged chest pain within 24 h and all underwent coronary angiography. Group 1 and 2 patients had significant coronary artery disease, while group 3 had normal coronary arteries. Blood samples were collected at the emergency department before antiplatelet agents were given. Serum levels of 1CAM-1 were higher in group 1 and 2 (383 +/- 27 and 337 +/- 11 ng/mL, respectively) as compared with group 3 (282 +/- 18 ng/mL) (group 1 vs 3, p<0.01; group 2 vs 3, p<0.05). The serum levels of ICAM-1 were not significantly different between group 1 and 2. Serum levels of E-selectin in group 1, 2, and 3 were 58 +/- 8, 51 +/- 4, and 58 +/- 5 ng/mL, respectively. The serum levels of E-selectin showed no significant difference among the three groups. In conclusion, serum levels of ICAM-1 were elevated in patients with acute coronary syndrome within 24 h, while the E-selectin levels did not change significantly. This finding suggests that adhesion molecule may play an important role in the postrolling process of leukocyte-endothelial cell interaction in acute coronary syndrome.

Protection of mouse bone marrow by Si-WU-Tang against whole body irradiation

The ability of Si-Wu-Tang to eliminate bone marrow damage after radiation was assessed using both a clonogenic assay (survival of colony forming units spleen--CFUs) of stem cell survival and a hematopoietic functional assay including the changes of hemograms and hematocrit. Cell survival curves and dose-response curves for radiation alone and Si-Wu-Tang administration with radiation were constructed over the dose range of 1 to 9 Gy. Si-Wu-Tang was given 7 days before irradiation at a consecutive fractionated dose of 20 mg/20 g body weight. The radioresistance of stem cells treated by Si-Wu-Tang was higher than that of those treated by irradiation alone. However, the anti-radiation effect of leukocytes was not as significant as that of erythrocytes, thrombocytes and hematocrit. These data suggest that the anti-radiation effect by Si-Wu-Tang is dependent on dose and will be less after 4 Gy irradiation. Hemograms with a short turnover period, such as leukocytes, may be less affected after Si-Wu-Tang administration.

Propofol anesthesia in a patient with myasthenia gravis--a case report

Experience with the use of propofol for induction and maintenance of anesthesia in patients with myasthenia gravis is limited in the literature. We report, in this case, the well prepared and successful use of continuous propofol infusion without conventional neuromuscular blocking agents in a patient with Ossermann stage IIb of myasthenia gravis undergoing laparoscopic cholecystectomy.

Characterization of the regulatory regions of murine alpha 2C2 adrenoceptor subtype gene

In order to delineate the regulatory mechanisms underlying the control of alpha 2 adrenoceptor expression, the sequence of 5' (1145 bp) and 3' (2682 bp) flanking regions of murine alpha 2C2 subtype gene were determined and characterized from a genomic phage clone MA2C2. The 5' flanking region has no TATA box yet with high GC content. The 3' flanking region is marked by the presence of a polyadenylation signal 2.3 kb down stream from the stop codon. The transcription start site was mapped by 5' rapid amplification of cDNA ends (RACE) and primer extension assays at nucleotide A, 415 bp upstream from the first initiation codon and resides in a motif resembling the consensus sequence of initiator found in many TATA-less promoters. An NcoI fragment (4.7 kb) immediately upstream from the translation initiation site was linked to a reporter gene lacZ. Using an in vitro transfection assay, cell lines of renal or neural origin were identified as permissive hosts for alpha 2C2 subtype expression. With its core promoter clearly defined and sequence of the regulatory regions at hand, this in vitro gene transfer system will facilitate the identification of putative cis-elements and transcription factors key to alpha 2C2 adrenoceptor expression.

Gene assignment, expression, and homology of human tropomodulin

Tropomodulin is a newly characterized pointed end capping protein for actin filaments. It binds specifically to the N terminus of tropomyosin and blocks the elongation and depolymerization of tropomyosin-coated actin filaments. A 1.9-kb human tropomodulin cDNA clone was used to map its gene by fluorescence in situ hybridization. The tropomodulin gene was assigned to human chromosome 9q22.2-q22.3, a region that is also known to contain several other genes and disease loci and is proximal to the loci for gelsolin and alpha-fodrin. The gene for tropomodulin is expressed in major human tissues at different levels in the following order: heart and skeletal muscle much greater than that in brain, lung, and pancreas, which is greater than that in placenta, liver, and kidney. Human tropomodulin and a 64-kDa autoantigen in Graves disease (1D) are related: tropomodulin has 42 and 41% identity with the Graves protein in the N-terminal (69 residue) and C-terminal (194 residue) regions, respectively. The insertion of several homologous repeats in the midsection of the Graves protein, together with the extension of a proline-rich C terminus, accounts for the differences in length between the Graves protein (572 residues) and tropomodulin (359 residues). The significant sequence identity indicates that these two genes are evolved from a common ancestral gene.

Digital ischemia associated with lung cancer: a case report

Digital ischemia or necrosis has unusually been associated with neoplasm. The occurrence of cryoglobulinemia and lung cancer with digital ischemia has been extremely rare in the past. This report concerns a case with adenocarcinoma of the lung associated with cryoglobulinemia, with rapidly developing digital ischemia of the tips of fingers and toes. Following concurrent chemoradiotherapy, there was improvement in digital ischemia and disappearance of serum cryoglobulin. The mechanisms of neoplasm-associated digital ischemia are complex; however, the cryoglobulinemia and probable arteritis may have played important roles in producing the ischemic symptoms in this case.

Conserved structure and adjacent location of the thrombin receptor and protease-activated receptor 2 genes define a protease-activated receptor gene cluster

BACKGROUND

Thrombin is a serine protease that elicits a variety of cellular responses. Molecular cloning of a thrombin receptor revealed a G protein-coupled receptor that is activated by a novel proteolytic mechanism. Recently, a second protease-activated receptor was discovered and dubbed PAR2. PAR2 is highly related to the thrombin receptor by sequence and, like the thrombin receptor, is activated by cleavage of its amino terminal exodomain. Also like the thrombin receptor, PAR2 can be activated by the hexapeptide corresponding to its tethered ligand sequence independent of receptor cleavage. Thus, functionally, the thrombin receptor and PAR2 constitute a fledgling receptor family that shares a novel proteolytic activation mechanism. To further explore the relatedness of the two known protease-activated receptors and to examine the possibility that a protease-activated gene cluster might exist, we have compared the structure and chromosomal locations of the thrombin receptor and PAR2 genes.

MATERIALS AND METHODS

The genomic structures of the two protease-activated receptor genes were determined by analysis of lambda phage, P1 bacteriophage, and bacterial artificial chromosome (BAC) genomic clones. Chromosomal location was determined with fluorescent in situ hybridization (FISH) on metaphase chromosomes, and the relative distance separating the two genes was evaluated both by means of two-color FISH and analysis of YACs and BACs containing both genes.

RESULTS

Analysis of genomic clones revealed that the two protease-activated receptor genes share a two-exon genomic structure in which the first exon encodes 5'-untranslated sequence and signal peptide, and the second exon encodes the mature receptor protein and 3'-untranslated sequence. The two receptor genes also share a common locus with the two human genes located at 5q13 and the two mouse genes at 13D2, a syntenic region of the mouse genome. These techniques also suggest that the physical distance separating these two genes is less than 100 kb.

CONCLUSIONS

The fact that the thrombin receptor and PAR2 genes share an identical structure and are located within approximately 100 kb of each other in the genome demonstrates that these genes arose from a gene duplication event. These results define a new protease-activated receptor gene cluster in which new family members may be found.

[The practicability of preceptorship in the curriculum of medical education]

Physicians who have graduated from traditional medical education curriculum focus on technological and organ system training, and are deficient in modern community health care concepts and skills. A preceptorship course integrates at various medical educational periods is one of the important goals at education reform in America. In this study, we attempt to ascertain the opinions of family physicians about the current family medicine curriculum and the practicability of preceptorship in Taiwan. The result can be a reference for future medical curriculum design. Two hundreds and thirty-five (40.8%) questionnaires were collected and analyzed. They showed most respondents were dissatisfied with the current curriculum of family medicine, and most agree that primary care physicians involvement would be helpful in producing efficient and well-qualified physicians. They suggested that preceptorship should best be first integrated in a basic knowledge course. We suggest that faculties who are responsible for curriculum design should evaluate the current curriculum and the appropriateness of preceptorship in Taiwan. Prior to the reform, faculty development and evaluation are the essential and crucial tasks.

Skin metastases from follicular thyroid carcinoma: a case report

Thyroid carcinomas metastasizing to the skin are rare. We report a case of skin metastases from a follicular thyroid carcinoma. A 73-year-old man developed multiple painless skin nodules about 6 years after thyroidectomy for the primary thyroid carcinoma. A biopsy disclosed a dermal tumor composed of small thyroid follicular structures with colloid material. The diagnosis was confirmed by immunohistochemistry using monoclonal antithyroglobulin antibodies performed on the skin biopsy specimens. The patient died 9 months later with multiple metastases after the development of skin lesions.

Diagnostic value of transbronchial lung biopsy under fluoroscopic guidance in solitary pulmonary nodule in an endemic area of tuberculosis

In the endemic area of tuberculosis, there are many cases that present tuberculosis as a solitary pulmonary nodule (SPN) on chest radiographs. The objective of this study is to evaluate the diagnostic yield of transbronchial lung biopsy (TBLB) under fluoroscopic guidance in SPNs such as lung cancer or pulmonary tuberculoma in areas with high prevalence of tuberculosis. One hundred and seventy patients with SPNs on chest radiographs were included in the study; all had negative sputum smears for tubercle bacilli and no malignancy by sputum cytology before bronchoscopy. Transbronchial lung biopsy and brushing were performed, routinely, under fluoroscopic guidance. Of 170 patients, 120 (70.6%) had lung cancer (including three with metastatic cancer), 40 (23.5%) patients had pulmonary tuberculosis (Tb), and the remaining 10 (5.9%) patients had other benign pulmonary lesions. The overall diagnostic rate in SPNs was 62.4% (106 of 170). Transbronchial lung biopsy and brushing revealed a diagnostic sensitivity of 70.0% in lung cancer (84 of 120) and a sensitivity of 55% in Tb (22 of 40). In addition, TBLB and brushing also provided rapid microscopic identification of Tb in 18 of 40 patients (45%, including 15 by TBLB, one by brushing smear, and two by postbronchoscopic sputum). The percentage of positive diagnosis correlated with diameter of the SPN. Solitary pulmonary nodules with diameter less than 2 cm were diagnosed in only 35.3% of cases (6 of 17; cancer 40% vs. Tb 29%). In contrast, the diagnostic rates in SPNs with diameters 2-4 cm and greater than 4 cm were 64.5% (78 of 121; cancer 72.0% vs. Tb 62.5%) and 68.8% of cases (22 of 32), respectively. Diagnostic bronchoscopy under fluoroscopic guidance is a useful tool in evaluation of patients with a peripheral pulmonary nodule since it may provide additional information to minimize unnecessary thoracotomy and give way for proper medication as early as possible.

Pyogenic liver abscesses complicated with abscess-duodenum fistula in a child: report of one case

A 12-year-old girl with liver abscesses was confirmed to have a rare complication, abscess-duodenal fistula formation, which was demonstrated on performing fluoroscope-guided percutaneous drainage. She was successfully treated with percutaneous drainage and antibiotics. The incidence, etiology, diagnosis and clinical management of pyogenic liver abscess in children are discussed.

The hepatoprotective effects of Taiwan folk medicine ham-hong-chho in rats

Bidens pilosa L. var minor (Blume) Sherff, B. pilosa L. and B. chilensis DC (compositae), commonly known as "Ham-hong-chho" in Taiwan, have been traditionally used for medicinal purposes. To clarify and compare the hepatoprotective effects of these three plants, we evaluated their potential effectiveness on CCl4- and acetaminophen-induced acute hepatic lesions in rats. The results indicated that the increase in SGOT and SGPT activities caused by CCl4 (3.0 ml/kg, s.c.) and acetaminophen administration (600 mg/kg, i.p.) could be significantly reduced by treating with the extracts of all the three kinds of "Ham-hong-chho" and the extract of B. chilensis exhibited the greatest hepatoprotective effects. These phenomena were also confirmed by histological observation. Liver damage induced by CCl4 and acetaminophen was markedly improved in the extract of B. chilensis treated groups, while groups treated with the extracts of B. pilosa var minor and B. pilosa demonstrated only moderate protective effects. The pharmacological and pathological effects of these three crude groups were compared with Bupleurum chinense, which has been reported previously as a treatment criteria in the CCl4 model, and with silymarin as a standard reference medicine in the acetaminophen model. The results suggest that B. pilosa var minor, B. pilosa and B. chilensis can protect liver injuries from various hepatotoxins and have potential as broad spectrum antihepatic agents.

Anti-inflammatory and radical scavenge effects of Arctium lappa

The effects of Arctium lappa L. (root) on anti-inflammatory and free radical scavenger activity were investigated. Subcutaneous administration of A. lappa crude extract significantly decreased carrageenan-induced rat paw edema. When simultaneously treated with CCl4, it produced pronounced activities against CCl4-induced acute liver damage. The free radical scavenging activity of its crude extract was also examined by means of an electron spin resonance (ESR) spectrometer. The IC50 of A. lappa extract on superoxide and hydroxyl radical scavenger activity was 2.06 mg/ml and 11.8 mg/ml, respectively. These findings suggest that Arctium lappa possess free radical scavenging activity. The inhibitory effects on carrageenan-induced paw edema and CCl4-induced hepatotoxicity could be due to the scavenging effect of A. lappa.

Superoxide anion scavenging effect of coumarins

The superoxide scavenging effects of fifteen coumarins were tested on the xanthine-xanthine oxidase-cytochrome C system. The results showed that fraxetin(10) displayed the strongest activity, and its percent inhibition at 100, 10 and 1 muM were 100, 100 and 53.13% respectively. Esculetin(4) showed the second strongest activity resulting in percent inhibition at 100 and 10 muM were 87.16 and 52.38% respectively. Both fraxetin(10) and esculetin(4) have been isolated from the plant, Fraxinus bungeana DC (Oleaceae) which has been used in folk medicine as an analgesic and anti-inflammatory medicine. It seems that two phenolic hydroxy groups in the ortho position in the molecule of coumarins play an important role in scavenging activity.

Metal-catalyzed oxidation and cleavage of octopus glutathione transferase by the Cu(II)-ascorbate system

Glutathione transferase (GST) from octopus hepatopancreas was rapidly inactivated by micromolar concentration of Cu(II) in the presence of ascorbate at neutral pH and 0 degree C. Omitting the metal ion or ascorbate, or replacing the Cu(II) with Fe(II) did not result in any inactivation. Glutathione or the conjugation product of glutathione and 1-chloro-2,4-dinitrobenzene offered complete protection of the enzyme from Cu(II)-induced inactivation. 1-Chloro-2,4-dinitrobenzene, however, did not provide any protection. The inactivation was time and Cu(II) concentration dependent. The dependence of inactivation rate on Cu(II) concentration displayed saturation kinetics, which suggests that the inactivation occurs in two steps with Cu(II) binding with the enzyme first (KdCu = 260 microM), then the locally generated free radicals modify the essential amino acid residues in the active center, which results in enzyme inactivation. The Cu(II)-ascorbate system is, thus, an affinity reagent for the octopus GST. The enzyme inactivation was demonstrated to be followed by protein cleavage. Native octopus GST has a subunit M(r) of 24,000. The inactivated enzyme was cleaved at the C-terminal domain (domain II) of the enzyme molecule and resulted in the formation of peptide fragment of M(r) 15,300, which has the identical N-terminal amino acid sequence as the native enzyme. The other half of the peptide with M(r) approximately 7700 was visible in the gels only after silver staining, which also revealed a minor cleavage site, also located at the domain II, to produce peptide fragments of M(r) approximately 11,300 and 8300. The oxygen carrier molecule in the cephalopods' blood is the copper-containing hemocyanin, which during turnover will release Cu(II). Our results indicate that Cu(II) catalyzes a site-specific oxidation of the essential amino acid residues at the C-terminus of GST causing enzyme inactivation. The modified-enzyme is then affinity cleaved at the putative metal binding site. The ability of octopus GST to bind with free Cu(II) may have important biological implications to enable cephalopods to avoid copper-induced cellular toxicity.

Dynamic three-dimensional display of common congenital cardiac defects from reconstruction of two-dimensional echocardiographic images

BACKGROUND

Two-dimensional echocardiography had long been a standard diagnostic modality for congenital heart disease. Further attempts of three-dimensional reconstruction using two-dimensional echocardiographic images to visualize stereotypic structure of cardiac lesions have been successful only recently. So far only very few studies have been done to display three-dimensional anatomy of the heart through two-dimensional image acquisition because such complex procedures were involved.

MATERIALS AND METHODS

This study introduced a recently developed image acquisition and processing system for dynamic three-dimensional visualization of various congenital cardiac lesions. From December 1994 to April 1995, 35 cases were selected in the Echo Laboratory here from about 3000 Echo examinations completed. Each image was acquired on-line with specially designed high resolution image grazmber with EKG and respiratory gating technique. Off-line image processing using a window-architectured interactive software package includes construction of 2-D ehcocardiographic pixel to 3-D "voxel" with conversion of orthogonal to rotatory axial system, interpolation, extraction of region of interest, segmentation, shading and, finally, 3D rendering.

RESULTS

Three-dimensional anatomy of various congenital cardiac defects was shown, including four cases with ventricular septal defects, two cases with atrial septal defects, and two cases with aortic stenosis. Dynamic reconstruction of a "beating heart" is recorded as vedio tape with video interface.

CONCLUSIONS

The potential application of 3D display of the reconstruction from 2D echocardiographic images for the diagnosis of various congenital heart defects has been shown. The 3D display was able to improve the diagnostic ability of echocardiography, and clear-cut display of the various congenital cardiac defects and vavular stenosis could be demonstrated. Reinforcement of current techniques will expand future application of 3D display of conventional 2D images.