Behçet's disease with inferior vena cava occlusion--a case report

Behçet's disease is a chronic relapsing inflammatory process affecting mucocutaneous, ocular, intestinal, articular, vascular, urogenital, and neurologic systems. Vascular lesions include superficial thrombophlebitis, large vein thrombosis and arterial aneurysm. The underlying pathologic feature was thought to be vasculitis. We report a case of a 37-year-old male patient suffering from frequent attacks of leg swelling and tenderness. Progressive engorgement of abdominal superficial veins was observed. Venography demonstrated evidence of deep vein thrombosis in both limbs. MRI of the abdomen showed thrombosis of the inferior vena cava with collateral circulation. The above symptoms improved after treatment.

[Acute amphetamine intoxication with catatonia: a case report]

A marked increase of cases of amphetamine intoxication has been witnessed in Taiwan over the past two years, and poisoning accounts for the direct cause of death in some cases of them. We report a case of 30-year-old woman, who developed immobility, rigidity, mutism and staring after the intake of four grams of amphetamine powder. She initially had generalized twitching, but finally came to a state of total immobility. One hour after admission, apnea and cyanosis occurred suddenly and she died about half an hour later. Chronic amphetamine intoxication with catatonia has been reported in Japan, but acute amphetamine intoxication with catatonia has never been reported in the literature. In this report, we explore the possible mechanisms of catatonia in amphetamine intoxication and its clinical significance. Catatonia is supposed to be one of the poor prognostic signs of acute amphetamine intoxication that requires intensive care.

The effects of Chinese herbs on improving survival and inhibiting anti-ds DNA antibody production in lupus mice

Systemic lupus erythematosus (SLE) is an important autoimmune disease with multiple organ system involvement. From preliminary studies, we have found that six Chinese herbs: Atractylodes ovata, Anqelica sinensis, Cordyceps sinensis, Liqustrum lucidum, Codonopsis pilosula and Homo sapiens can improve defective in vitro interleukin-2 (IL-2) production in patients with SLE. In order to investigate the in vivo effects of these herbs, we used NZB/NZW F1 mice, a typical lupus animal model used to test these herbs. It was found that C. pilosula, H. sapiens and C. sinensis could prolong the life span of female NZB/NZW F1 mice and inhibited anti-ds DNA production. Although A. sinensis could prolong the life span of experimental mice, it did not inhibit the production of anti-ds DNA antibody. These herbs may have great potential for the management of human SLE in the future.

Correlation of tumor necrosis factor alpha levels with disease activity of rheumatoid arthritis

In this study, positive correlations were found between tumor necrosis factor alpha (TNF alpha) levels in the sera of rheumatoid arthritis (RA) patients and the duration of morning stiffness, joint tenderness count, the Ritchie articular index and erythrocyte sedimentation rate. Further, higher mean grades of disease activity of RA were accompanied by correspondingly higher levels of serum and synovial TNF alpha. In the longitudinal study, when the disease activity of RA decreased after treatment, serum TNF alpha levels also decreased. This suggests that the levels of serum and synovial TNF alpha correlate positively with RA disease activity. The levels of TNF alpha in synovial fluid were significantly higher in RA and acute gouty arthritis (GA) patients than in osteoarthritis (OA) patients. This suggests that joint inflammation in inflammatory arthritis related to local production of TNF alpha in the joint cavities. Serum TNF alpha levels in RA patients were significantly higher than those in the OA patients; no statistical difference was found between acute GA and OA patients.

[Ethanol intoxication treated with flumazenil: a case report]

Ethanol possesses anxiolytic and anticonflict effect in low dose, but exhibits consciousness depression in higher serum level. It also has addictive effects on benzodiazepines (BZD) and its mechanism has been thought to be closely related to GABA-BZD receptor complex. Flumazenil is a well-known potent antagonist in benzodiazepine intoxication. It can restore the patients' consciousness in case of BZD overdose in comatose condition. In the treatment of ethanol intoxication, flumazenil has not been well-accepted as an antidote. We report a case of severe ethanol intoxication (serum level: 512 mg/dl) with deep coma. Flumazenil 0.5 mg restored her consciousness 90 mins after antidote had been administrated. According to the literature, improvement of conscious level was not due to decay of serum ethanol level but flumazenil itself, which has potential benefit to the condition of ethanol intoxication. This effect is delayed as compared with its using in BZD overdose.

[The urinary screening and identification of amphetamines in clinical toxicology laboratory--VGH]

Amphetamines abuse has recently become a problem in this country. Four case identification, we used Emit-d.a.u. amphetamine assay to screen the amphetamines in human urine, and then confirmed them by gas chromatography-ion trap detector (GC-ITD). From January 1989 to August 1990, 267 urinary samples were requested by the physicians for amphetamine identification. Six samples were accompanied with drug powders used by the patients. Among the 267 samples, 79 were confirmed for the presence for both of methamphetamine and amphetamine. Neither the presence of amphetamine nor methamphetamine itself was detected. Among the six packs of drug powder tested, methamphetamine but not amphetamine was detected in four. We found that fenfluramine and diethylpropion would have false positive amphetamine reactions in Emit-d.a.u. assay. All the samples originated from 34 hospitals were widely distributed in the country. Other drugs concomitantly used included ethanol, morphine, flunitrazepam and ephedrine. Since methamphetamine can be metabolized to amphetamine but not vers versa, our study confirmed the abuse of methamphetamine not amphetamine in this country.

Amphetamine poisoning in infant: report of two cases

Amphetamine poisoning is rare in children. Here we report two male infants with acute poisoning due to accidental amphetamine ingestion. One infant had a family history of drug abuse and the other was due to poor supervision of the parents. Although typical clinical symptoms and signs (including restlessness, hyperactivity, hypertension, tachycardia and tachypnea....etc.) were found, both were completely recovered after treatment. The principle of management of amphetamine poisoning are presented.

[Clinical experience in benzodiazepine antagonist]

Flumazenil, a potent benzodiazepine antagonist, is a newly synthetic imidazo-benzodiazepine, which blocks the neurological effects of benzodiazepines. The purpose of this study was to evaluate the effects of this agent in reversal of benzodiazepine overdose and differentiation of comatous patients with drug overdose. Fifteen comatous patients with suspected sedatives/hypnotics overdose were included in this study and flumazenil 0.25 mg per dose was administrated intravenously. The average score of Glasgow Coma Scale increased from 7.13 +/- 2.92 to 10.93 +/- 3.67 after one dose of flumazenil. Clear consciousness was restored after multiple doses of flumazenil administration. Three cases with different drug history and variant response after flumazenil treatment were also illustrated and discussed. The dosage of flumazenil used in this study ranged from 0.25 mg to 3 mg (average 0.87 +/- 0.74 mg). We concluded that flumazenil is an excellent antidote for benzodiazepine overdose and valuable for differentiating the patients in comatose.

Taiwan National Poison Center survey of glyphosate--surfactant herbicide ingestions

Between January, 1986 and September, 1988, the Taiwan National Poison Center recorded 97 telephone consultations (49 male, 48 female) on cases of ingestion of glyphosate-surfactant herbicide concentrate containing the isopropylamine salt of glyphosate (N-phosphonomethyl glycine, CAS 1071-83-6) and a non-ionic tallow amine surfactant. Eleven of the cases resulted in fatalities, all among those attempting suicide. The average amount ingested by survivors was 120 +/- 112 mL and by nonsurvivors was 263 +/- 100 mL (p less than or equal to 0.0001). The average age of survivors was 35 +/- 15 years compared to 54 +/- 11 years for fatalities (p less than or equal to 0.0002). Irritation of the oral mucous membrane and gastrointestinal tract was the most frequently reported effect. Other effects recorded were pulmonary dysfunction, oliguria, metabolic acidosis, hypotension, leukocytosis and fever. Fourteen patients received either atropine or pralidoxime plus atropine despite the fact that glyphosate does not inhibit acetylcholinesterase. Thirteen percent of patients received a urine test for paraquat or treatment customarily used for paraquat ingestion, possibly reflecting similar initial presentations following ingestion of these two herbicides. Laboratory differentiation is essential if any doubt exists about which herbicide was ingested. Patients ingesting large volumes of concentrated glyphosate-surfactant herbicide formulations require close observation and supportive treatment.

Hypertension as an unusual feature in an outbreak of tetrodotoxin poisoning

We report an outbreak of tetrodotoxin poisoning resulting from consumption of ovaries of an unidentified species of fish. Thirty victims manifested the typical neurologic symptoms of tetrodotoxin poisoning. Although hypotension is the classically described blood pressure reaction, eight individuals developed hypertension (average blood pressure 192/110 mm Hg); one died of acute pulmonary edema. Semi-quantitative tetrodotoxin bioassay of two uneaten ovaries revealed tetrodotoxin concentrations of 54 Mouse Units/gm and 287 Mouse Units/gm, respectively. To gain insight into the unusual phenomenon of hypertension observed in our outbreak, we interviewed the victims, performed a funduscopic exam for hypertensive retinopathy and checked their blood pressure periodically in the ensuing year. Mild hypertension evidenced by retinopathy and elevated blood pressure was found in all seven who manifested hypertension during the acute event and survived. We postulate that individuals with pre-existing hypertension responded to the relatively small doses of tetrodotoxin with a dramatic rise in blood pressure. This resulted in the fatal outcome for one individual with severe coronary artery disease. Hypertension should be recognized as a possible feature of tetrodotoxin poisoning, especially in predisposed individuals.

Lactoferrin in rheumatoid arthritis and systemic lupus erythematous

Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are prototypes of autoimmune diseases. In order to assess the inflammatory status in these conditions, lactoferrin, stored in specific granules of neutrophils, was measured in serum samples of patients with SLE and RA. In RA, the mean serum lactoferrin level (1221.397 +/- 289.476 ng/ml) was significantly higher than that in normal individuals (753.364 +/- 124.063 ng/ml). Surprisingly, there were no significant differences between active SLE (672.682 +/- 356.154 mg/ml) and inactive SLE (642.267 +/- 270.456 ng/ml). Still, no differences were found between normal volunteers, active SLE and inactive SLE. Serum lactoferrin in SLE correlated significantly with CRP (Rs = 0.4089, p less than 0.01), but not with complement level and ANA titers. Thus in RA serum lactoferrin was highly elevated and this indicated that PMN in systemic circulation was activated. In SLE the correlation of CRP with lactoferrin reflected the role of later protein in inflammation.

Lymph node blast crisis of chronic myelogenous leukemia. One case report

We present a patient with philadelphia chromosome (ph')-positive CML with extramedullary blast crisis in the lymph nodes before the bone marrow blast crisis. The morphological and cytochemical studies of lymph node touch preparation, and cytogenetic studies of lymph node tissue confirmed the extramedullary lymphoid blast transformation of CML, while the bone marrow continued to show the chronic phase of CML. When we changed our treatment to use Vincristine-Prednisolone therapy, the lymphadenopathy disappeared gradually. This case shows that the clinical and prognostic features of extramedullary disease can strongly affect disease acceleration in CML, and the therapy should be changed promptly. Besides, cytogenetic study of extramedullary tumor tissue in CML can be useful for accurate diagnosis.

Circulating immune complexes in patients with hematologic diseases

Circulating immune complexes (CIC) were measured by C1q-solid phase method in ninety-five patients with various hematologic diseases. The results showed significantly higher CIC levels in patients with acute myelocytic leukemia, chronic myelocytic leukemia, aplastic anemia and idiopathic thrombocytopenic purpura (ITP) than CIC levels in normal controls. However, there was no significant difference in such levels in patients with acute lymphocytic leukemia, non-Hodgkin's lymphoma and multiple myeloma when compared to normal controls. In this study, the level of CIC did not relate to prognosis for patients with non-Hodgkin's lymphoma. The findings demonstrated that a high level of CIC in patients with ITP usually responded poorly to steroid treatment. Other immunosuppressive agents were indicated in these cases. Therefore, the CIC level may serve as a therapeutic guide for the treatment of patients with ITP.

[Pulmonary plasma cell granuloma: report of one case]

Pulmonary plasma cell granuloma is very rare in pediatric field. Most of them are asymptomatic, and are usually found to have lung tumor accidentally by chest X-ray examination. The granuloma is characterized by the proliferation of plasma cells along with other mesenchymal elements. We report a case of 10-year-old boy who suffered from dry cough, pale face and body weight loss for a long time. Chest X-ray and CT scan revealed a lung tumor which was proved to be plasma cell granuloma after wedge biopsy. He was regularly followed up at OPD with stationary status. He may receive surgical resection in future.

Changes in both calcium pool size and morphology of human platelets incubated in various concentrations of calcium ion. Calcium-specific bleb formation on platelet-membrane surface

In this study, the response of gel-filtered human platelets to extracellular Ca2+ at Ca2+ concentrations [Ca2+]o of 1-10 mM was investigated. The distribution of Ca2+ among various pools was studied using: (1) quin2, to estimate the cytosolic free Ca2+ concentration ([Ca2+]i); and (2) 45CaCl2 plus EGTA, to quantitate the sizes of the EGTA-releasable, EGTA-nonreleasable and surface-bound Ca2+ pools. The morphological changes were revealed by scanning electron-microscopy (scanning EM), and the effect on thrombin-stimulated aggregation was examined using an aggregometer. Platelets continuously sequestered Ca2+ into both EGTA-releasable and EGTA-nonreleasable pools to maintain a low [Ca2+]i level. The rate of sequestration to the EGTA-releasable pool was independent of [Ca2+]o, while that of the EGTA-nonreleasable pool exhibited first-order kinetics. The cell morphology changed gradually from discoid to the tadpole-like type, and finally to irregular forms. This morphological change correlated with the gradual increase in [Ca2+]i. The EGTA-nonreleasable pool saturated at about 3000 pmol/10(8) cells. This saturation resulted in a drastic increase in the EGTA-releasable pool size, and the cell was lysed concomitantly. The maximum safety capacity of the EGTA-releasable pool was estimated to be 1100 pmol/10(8) cells. The contribution of the cellular compartments to these two pool sizes is extensively discussed. The surface-bound pool size also increased continuously. When two different capacities were reached, i.e., 160 and 600 pmol/10(8) cells, the binding rate increased above the initial rate by 7- and 11-fold, respectively. Hence, the surface-binding capacity might be a critical factor which alters the membrane structure and exposes more binding sites. The cell surface appeared to have blebs, after the binding size had reached more than 600 pmol/10(8) cells. Bleb formation resulted in the inhibition of platelet function. Divalent cations, such as Mg2+, Sr2+ and Ba2+ did not cause bleb formation, which could mean that this formation is a Ca2+-specific phenomenon.

Different susceptibilities of platelet phospholipids to various phospholipases and modifications induced by thrombin. Possible evidence of rearrangement of lipid domains

On the membrane surface of the human platelet, phosphatidylcholine (PC) and phosphatidylethanolamine (PE) were hydrolyzed to different extents by the snake venom phospholipases A2 of varying pI values. The susceptibility of platelet phospholipids to basic phospholipase A2 of Naja nigricollis (pI 10.6) has been reported (Wang et al. (1986) Biochim. Biophys. Acta 856, 244-258). The susceptibilities of platelet phospholipids to acidic phospholipase A2 of Naja naja atra (pI 5.2) and to neutral phospholipase A2 of Hemachatus haemachatus (pI 7.3) were investigated in this study. In gel-filtered platelets, acidic phospholipase A2 hydrolyzed 35% PC and 10% PE, while neutral phospholipase A2 hydrolyzed 18% PC and 3% PE. In thrombin-induced shape-changed platelets, acidic phospholipase A2 hydrolyzed 20% PC and 10% PE, while neutral phospholipase A2 hydrolyzed 15% PC and 6% PE. In thrombin-activated platelets, acidic phospholipase A2 hydrolyzed 25% PC and 7% PE, while neutral phospholipase A2 hydrolyzed 25% PC and 10% PE. Sequential lipid hydrolysis experiments showed that basic phospholipase A2 of Naja nigricollis could hydrolyze the remaining PC and PE in the membrane previously treated with the neutral enzyme. The results may mean that: the PC and the PE domains exist on the platelet membrane surface; and the lipid domains on the membrane surface of resting platelets are rearranged by thrombin.

Estimation of the phospholipid distribution in the human platelet plasma membrane based on the effect of phospholipase A2 from Naja nigricollis

Human platelets in three physiological states were prepared. These states were the gel-filtered, the thrombin-induced shape-changed, and the thrombin-activated platelets. The phospholipid distributions in these three types of membrane were probed by using the basic phospholipase A2 of Naja nigricollis. This enzyme could penetrate through these membranes to hydrolyze all of their accessible phospholipids and to cause cell lysis. The hydrolytic time-courses displayed three phases. The state of platelet in each lipid hydrolytic phase was examined by: (1) measuring the leakage of lactate dehydrogenase; (2) analyzing the morphology by both scanning and transmission electron microscopy (scanning EM and transmission EM); and (3) estimating the hydrolysis of the [32P]phosphate-labeled platelets. The existence of these three hydrolytic phases may signify that the phospholipase A2 sequentially hydrolyzed its substrates in the membrane outer leaflet, in the inner one, and in the cytosol. The content and the distribution of each phospholipid class in the plasma membranes of the resting and of the shape-changed platelets were similar. These membrane surfaces consisted mainly of phosphatidylcholine (PC) and phosphatidylethanolamine (PE). Phosphatidylserine (PS) was not exposed on the surface of the shape-changed platelet. The content of each lipid class in the activated platelet membrane was 10% more than that in the resting platelet. PS was found on the activated platelet cell surface. This implies that PS is exposed only during platelet secretion.

Serum lipids and lipoprotein abnormalities in patients with thrombotic stroke--with exploring the protective role of HDL subfractions

The main purpose of this report is to demonstrate the presence of subfractions in serum HDL and to explore their role in the pathogenesis of thrombotic stroke Preparative untracentrifugation was used to isolate the differing density fractions of serum lipoproteins, and 2-27% polyacrylamide gradient gel electrophoresis was used to identify the character of the HDL subfractions. The study was performed on 59 Chinese males, in whom 31 were patients with thrombotic stroke affecting the cerebral cortex diagnosed by neurological examination and computed tomography; and the others grouped as healthy control. The age and Broca index of both groups were similar. The serum levels of total cholesterol and LDL-cholesterol were normal. However, in the thrombotic stroke group HDL-cholesterol was significantly lower and correlated inversely with both significantly higher levels of VLDL-cholesterol (r=-0.5392, p less than 0.01) and VLDL-triglyceride (r=-0.5866, p less than 0.01). The serum levels of total triglycerides and LDL-triglyceride were also significantly higher in patient with thrombotic stroke. The mean area percentage of HDL2b subfraction measured in the diameter range as determined by gradient gel electrophoresis was significantly lower and HDL2 also showed the same tendency in patients with thrombotic stroke. Our finding was consistent with the postulation that HDL2 or HDL2b in in particular, probably played a more protective role than any other HDL subfractions against thrombotic stroke, one of the major atherosclerotic complications.

Effects of acupuncture on serum cortisol level and dopamine beta-hydroxylase activity in normal Chinese

Serum cortisol levels were determined in 40 normal Chinese and dopamine beta-hydroxylase activities were measured in 22 normal subjects before and after acupuncture treatment. All subjects were studied twice with an interval of one week or more. In the self-control study, the subjects were needled at 5 non-acupuncture loci. In the experimental study, they were needled at the following 5 traditional acupuncture loci--right side GB-20, both sides EH-6, and both sides St-36. Blood samples were withdrawn before acupuncture and 15 and 45 min. after acupuncture. No change of serum dopamine beta-hydroxylase activity was observed. Serum cortisol levels increased significantly after needling on the traditional acupuncture loci. After acupuncture for 15 and 45 min., the cortisol increase was 28 and 50%, respectively, as compared to the self-control studies. The beneficial effect of acupuncture in the treatment of functional disorders, therefore, may be mediated by cortisol or other hormones and neurohormones.