[Utilizing the PRECEDE model to predict health examination behavior of the elderly]

Health examination of the elderly in Taiwan, the reported rates of health examination of the elderly were always below 30%. In order to explore the predictors related to the behavior of health examination of the elderly, the PRECEDE model was adopted for this study. Both the 1200 participants and spare samples were recruited from eleven districts of Kaohsiung city. 1193 participants had been completed by home interview. Sample size was based on the distribution of the elderly in the whole city and the stratified sampling method was applied. There was no significant difference after comparing the rates of gender, age, and examination between sample and population. The results showed that seven factors could be used to predict the behavior of health examination of the elderly. In the individual predisposing factors, "numbers of chronic diseases", "knowledge of health examination", "previous health examination", and "health promotion behavior" were related to the behavior of health examination of the elderly. In reinforcing factors, "attitude of family members for health examination", and in enabling factors "the guide and the convenience of health-examined services" also showed significantly affecting examination behavior. Therefore, referring to the improvement to be the examination rate, we can intervene or do something through academic, practical and administrative approaches.

Optimal control of blood pressure can reverse left ventricular hypertrophy in uremic hypertensive hemodialysis patients

We investigated the effects of antihypertensive treatment on left ventricular hypertrophy (LVH) of long-term hemodialysis patients. In uremic patients, it is still controversial in antihypertensive effect to the regression of LVH. The left ventricular size and function of 39 uremic hypertensive long-term hemodialysis patients (27 men, 12 women, mean age 58.3) was evaluated with M-mode, 2-dimensional and Doppler echocardiography before, and 12 months after, the start of combined antihypertensive therapy. This therapy included angiotensin II converting enzyme inhibitors, beta-blockers and calcium antagonists. Patients were classified as responders or nonresponders, depending upon whether their systolic blood pressure (SBP) decreased by more than 10 mmHg after antihypertensive treatment for 12 months. Before treatment, 36 (92%) patients had LVH and diastolic dysfunction and three (8%) had systolic dysfunction. At the end of 12 months, only 25 (64%) patients had LVH, 30 (77%) had diastolic dysfunction and 2 (5%) had systolic dysfunction. Left ventricular mass index (LVMI) also decreased from 203.63 +/- 70.47 g/m2 to 178.57 +/- 67.31 g/m2. LVMI correlated with systolic blood pressure (SBP) but did not correlate with diastolic blood pressure (DBP). There were 26 responders and 13 non-responders. Among responders, both the SBP (153.91 +/- 13.24 mmHg vs 134.43 +/- 14.21 mmHg, p < 0.01) and DBP (90.39 +/- 7.89 mmHg vs 79.98 +/- 7.35 mmHg, p < 0.01) decreased significantly after antihypertensive therapy. Responders also exhibited progressive regression of LVH (LVMI decreased significantly from 208.52 +/- 72.03 g/m2 to 168.52 +/- 55.53 g/m2, p < 0.05). However, LVH regression was not found in nonresponders (LVMI showed 194.84 +/- 64.36 g/m2 vs 193.66 +/- 77.67 g/m2). We conclude that good control of blood pressure can reverse LVH in hypertensive hemodialysis patients.

Serous cystic neoplasm involving the pancreas and liver: an unusual clinical entity

Serous cystic neoplasm of the pancreas is typically considered to represent a benign pancreatic neoplasm. We present a case where the tumor displayed unusually aggressive behavior with metastatic disease to the liver and pancreatic bed. Although serous cystic neoplasms should be considered a benign lesion and will be cured in most cases by surgical excision, the radiologist should be aware that on occasion they can exhibit aggressive behavior.

Analytical modeling of the periodic nonlinearity in heterodyne interferometry

The periodic nonlinearity that arises from nonideal laser sources and imperfections of optical components limits the accuracy of displacement measurements in heterodyne interferometry at the nanometer level. An analytical approach to investigating the nonlinearity is presented. Frequency mixing, polarization mixing, polarization-frequency mixing, and ghost reflections are all included in this investigation. A general form for the measurement signal, including that of the distortions, is given. The analytical approach is also applicable to homodyne interferometry.

Breast carcinoma metastatic to the esophagus. CT findings with pathologic correlation

The common sites of metastasis from breast carcinoma include local and distant lymph nodes, lung parenchyma, bone, liver and brain. While less common, gastrointestinal carcinoma, involving everything from the tip of the tongue to the rectum, secondary to metastatic breast carcinoma have been reported. Many of these lesions occur years after treatment of the primary breast cancer and they can be confused with a second primary. We present a case of breast cancer metastatic to the esophagus which produced symptoms of progressive dysphagia in a women thirteen years after mastectomy and radiation therapy for breast cancer.

Radiologic evaluation of the acute abdomen in the patient with acquired immunodeficiency syndrome (AIDS): the role of CT scanning

Abdominal complaints are common in the HIV-infected patient, and the signs and symptoms of disease may be masked by concurrent illness and a weak immune response, making accurate diagnosis difficult. Patients with acquired immunodeficiency syndrome (AIDS) are susceptible to diseases common to the general population; however, their generalized state of immunodeficiency places them at increased risk for many unusual disorders, predominately infectious and neoplastic. Radiologic evaluation, in particular, computed tomography (CT) with its ability to image the entire abdomen and pelvis, plays a crucial role in the prompt and accurate diagnosis and treatment of these patients.

Musculoskeletal complications of the patient with acquired immunodeficiency syndrome (AIDS): CT evaluation

Musculoskeletal disorders are infrequent complications of HIV infection in this country. However, AIDS patients are susceptible to a wide range of musculoskeletal complications, from the common to the otherwise uncommon. The following is a summary of some of the more frequently encountered musculoskeletal manifestations of these disorders within the HIV-positive community and their associated imaging characteristics.

Significance of nm23 mRNA expression in human hepatocellular carcinoma

It has been proposed that nm23-H1, a candidate suppressor gene for metastasis, plays an important role in the metastasis of human tumors. In order to investigate its role in the human hepatocellular carcinoma (HCC), 18 matched pairs of tumorous and adjacent nontumorous liver tissues of hepatectomy from patients with HCC were studied by quantitative reverse transcription-PCR. Further analyses of the nm23-H1 gene were also done. The results of these molecular studies were correlated with the clinicopathologic features of the patients. Nm23-H1 transcript was expressed in all neoplastic and adjacent nontumorous liver tissue. The level of expression, however, did not correlate well with the extension or metastatic potential of the tumors. Instead, in 15 (83.3%) of 18 HCC, nm23-H1 expression was higher in the tumorous tissues, compared with the adjacent nontumorous tissues; and significantly higher levels of nm23-H1 mRNA expression was detected in HCC with poor differentiation (Edmonson classification, III and IV) than those with moderate differentiation (I and II). Southern blot analysis of nm23-H1 gene revealed neither amplification nor loss of heterozygosity of all HCC tissues examined. Direct sequencing of the nm23-H1 gene in all HCC tissues detected no mutations. Our findings suggested that increased nm23-H1 mRNA expression is correlated with HCC tumor progression.

A technique for extracting physiological parameters and the required input function simultaneously from PET image measurements: theory and simulation study

Positron emission tomography (PET) is an important tool for enabling quantification of human brain function. However, quantitative studies using tracer kinetic modeling require the measurement of the tracer time-activity curve in plasma (PTAC) as the model input function. It is widely believed that the insertion of arterial lines and the subsequent collection and processing of the biomedical signal sampled from the arterial blood are not compatible with the practice of clinical PET, as it is invasive and exposes personnel to the risks associated with the handling of patient blood and radiation dose. Therefore, it is of interest to develop practical noninvasive measurement techniques for tracer kinetic modeling with PET. In this paper, a technique is proposed to extract the input function together with the physiological parameters from the brain dynamic images alone. The identifiability of this method is tested rigorously by using Monte Carlo simulation. The results show that the proposed method is able to quantify all the required parameters by using the information obtained from two or more regions of interest (ROI's) with very different dynamics in the PET dynamic images. There is no significant improvement in parameter estimation for the local cerebral metabolic rate of glucose (LCMRGlc) if the number of ROI's are more than three. The proposed method can provide very reliable estimation of LCMRGlc, which is our primary interest in this study.

A substance isolated from Cornus officinalis enhances the motility of human sperm

The effects of a Chinese herb, Cornus officinalis, on the motility of human sperm was studied. An aqueous extract was prepared from the dried fruits of the herb and used in this study. The crude extract at a final concentration of 0.5 microgram/microliter in phosphate buffered saline (pH 7.4) increased sperm motility from 25.8 +/- 7.7% to 42.8 +/- 10.3% (i.e. 68% increase, n = 7), as determined by the computer-aided-sperm-analysis (CASA) method. The crude extract was fractionated by high-performance liquid chromatography (HPLC) into four fractions: C1, C2, C3 and C4. Their effects on sperm motility were further studied by CASA. Only the C4 fraction showed substantial stimulatory effects on sperm motility. At a concentration of 5 ng/microliter, C4 increased the sperm motility from 15.7 +/- 3.8% to 34.5 +/- 6.4% (i.e. 120% increase, n = 6) by CASA and from 14.9 +/- 4.3 to 28.5 +/- 8.1 (i.e. 91% increase, n = 8) by transmembrane migration ratio (TMMR) method. This result suggests that C4 is the active component in Cornus officinalis that enhances sperm motility.

Corticotropin-releasing hormone stimulates the expression of the steroidogenic acute regulatory protein in MA-10 mouse cells

We have previously demonstrated that corticotropin-releasing hormone (CRH) treatment of MA-10 mouse Leydig tumor cells results in a dose-dependent stimulation of progesterone production. In view of this observation we wished to determine the effects of CRH on the synthesis of the steroidogenic acute regulatory (StAR) protein in these cells. StAR is a steroidogenic tissue-specific, hormone-induced, rapidly synthesized protein previously shown to be involved in the acute regulation of steroidogenesis, probably by promoting the transfer of cholesterol to the inner mitochondrial membrane and the cytochrome P450 side-chain cleavage enzyme. Treatment of MA-10 cells with the cAMP analogue dibutyryl cAMP (dbcAMP) resulted in a dose- and time-dependent increase in the levels of StAR protein that reached a maximum at 800 microM dbcAMP and within a time period of 6 h. Further, treatment of MA-10 cells with CRH also resulted in a dose-dependent increase in the synthesis of the StAR protein with a maximal response observed at 1 microM. Slightly different from that observed with dbcAMP, the maximal response to 1 microM CRH was seen at 4 h following stimulation. These results indicate that the observed increase in steroid production in response to CRH in MA-10 Leydig tumor cells is similar to that previously seen with trophic hormone stimulation acting through the cAMP second messenger pathway, and that it occurs as a result of an increase in the synthesis of the StAR protein.

A subpopulation of reactive astrocytes at the immediate site of cerebral cortical injury

We have identified an early-appearing intermediate filament-associated protein (IFAP-70/280 kDa) in radial glia and their immediate derivatives. This IFAP is absent in the adult CNS. In this study, we examined the reexpression of this early glial differentiation trait in rat reactive astrocytes induced by stab injury of the cerebrum. Double-label immunofluorescence microscopy demonstrated that by 36 h postlesion, IFAP-70/280 kDa was present in a few GFAP-positive astrocytes in the area adjacent to the wound. As the gliotic reaction progressed, the number of IFAP-positive reactive astrocytes increased and by 5-6 days postlesion, IFAP-70/280 kDa was present in most of the hypertrophied astrocytes in tissue immediately adjacent to the wound. By 8 days postlesion, while the number of IFAP-negative reactive astrocytes away from the wound diminished, the IFAP-containing reactive astrocytes close to the wound persisted. Concurrently, they began to change from a stellate form to an elongated shape, with their longitudinal axes radiating from the wound. The immunoreactivity of this IFAP started to diminish at 20 days postlesion, and by 30 days postlesion, it was not observed in the remaining gliotic cells. These results demonstrate that reactive astrocytes induced by stab-wound injury can be divided into two subtypes: persistent IFAP-70/280 kDa-containing cells which are close to the wound in the area of the glial scar and transient IFAP-70/280 kDa-negative cells which are farther from the wound. The reappearance of IFAP-70/280 kDa also suggests that some reactive astrocytes have the capacity to recapitulate early developmental stages.

Transthoracic endoscopic sympathectomy for treatment of hyperhidrosis palmaris

The objective of this study was to determine the effectiveness of modified transthoracic endoscopic sympathectomy (TES) being used in our institute for treatment of hyperhidrosis palmaris (HP). One hundred and eight cases of HP were treated using TES from June 1991 to June 1992. All underwent TES bilaterally. Palmar temperature was monitored during the operation as an indicator of a successful lesioning of the sympathetic trunk at the T2-level. The ages of the patients ranged from 10 to 61 years. Fifty-one percent of these patients had a positive family history. Seventy-three percent had onset during childhood. Eighty-nine percent had excessive plantar sweating in addition to hyperhidrosis palmaris. The increase in palmar temperature after lesioning the sympathetic trunk was inversely related to the preoperative temperature of the palms (r = 0.81, p < 0.005). Our treatment resulted in improvement of palmar sweating in all of the patients. Decrease of plantar sweating was also noted in 68% of the patients at follow up. No neurological deficits were found. Transient post-operative chest discomfort and compensatory hyperhidrosis (87%) were the most common complications. TES is an effective method for treating patients with HP, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the dorsal approach for thoracic sympathectomy.

[Immune interference of enteroviruses to immune response of TOPV in subtroptical areas]

To study whether enteroviruses interfere with the immunoeffect of TOPV in subtroptical areas, a total number of 188 children were investigated 82 in summer, 106 in winter in two townships of Hui Dong County from 1992 to 1993. The carrier rates of enteroviruses and serum nutralization antibody titres of polio were tested before and after the children were vaccinated with TOPV. Data showed that the GMTs of poliovirus type I, II, III in winter were 2 to 7.1 times as much as those in summer after administration of one and three doses TOPV. Enterovirus carrier rates were 75.6% and 38.8% respectively in summer and winter before vaccination in health children. The GMTs of polio serum antibody in children without enteroviruses was 1.5 to 1.7 times as much as the GMTs of those with enteroviruses, and the difference was statistically significant. Overall, the results demonstrated that enterovirus infection interfered the immune response of vaccinates to TOPV to some extent. It was also suggested that supplemental immunization was the key measure in polio eradication program and should be conducted in winter or spring seasons.

Fluorescein as an easy, low-cost, indirect, or reverse intraoperative marker to rule out perilymph versus local injection

Clear fluid found in the dependent portions of the middle ear (round and oval windows) is generally assumed to be perilymph (PL). However, all clear fluid observed at middle ear exploration is not necessarily PL. PL should be distinguished from local injection. An accumulation of the local injection could be confused with perilymph fistula (PLF) diagnosis. There is no standard way of distinguishing perilymph from local injection, as both are clear, watery fluids. Fluorescein, tagged with a mixture of xylocaine and epinephrine (FLOTAX) was used as the local injection in 10 patients undergoing middle ear exploration for possible PLF.FLOTAX was injected into the vascular strip and ear canal skin in routine fashion. Transtympanic endoscopy and special Zeiss custom fluorescein filters were used to document any accumulation of fluid in the dependent portions of the middle ear and confirm whether any fluorescein (from the FLOTAX) was present. The middle ear was checked both before (endoscopically) and after raising the tympanomeatal flap. After the "local" injection, FLOTAX was observed to accumulate in dependent portions of the middle ear before raising the tympanomeatal flap in six of 10 ears. In the other four ears, FLOTAX slowly seeped into the middle ear cleft after the tympanomeatal flap was elevated and manipulated. Fluorescein can be used as an inexpensive, indirect intraoperative marker or "reverse test" for possible PLF. By eliminating a likely and common offender (local injection), any accumulation or reaccumulation of clear fluid that is not fluorescein tagged may more confidently be identified as possibly perilymph. The use of FLOTAX helps eliminate the confusion between the local injection and potential PLF. It does not in any way eliminate the possibility of other transudates from incisions, allergic reactions, or other manipulation of the tympanomeatal flap or middle ear mucosa.

[Brain abscess as a complication of ear malignancy: a case report]

Ear infection is the most common cause of brain abscess. A suppurative process in the ear has access to the central nervous system by direct extension or through preformed pathways, either developmental, traumatic or pathologic, or by retrograde spread along the thromobophlebitic vein. Squamous cell carcinoma of middle ear or mastoid cavity is a rare disease and often associated with chronic otitis or chronic draining ear. Ear malignancy easily produces the destruction of temporal bone which may serve as a route for coexistent infection spreading into the brain. This paper reports a case of brain abscess occurring in a patient with temporal bone cancer. To the best of our knowledge, no more than three similar cases have been reported in the literature. The authors suggest that if an otogenic brain abscess is concomitant with infection and granulomatous mass in the ear, biopsy should be performed to rule out malignancy.

Glass integrated optics circuit for 1.48/1.55- and 1.30/1.55-µm-wavelength division multiplexing and 1/8 splitting

We demonstrate the integration, in a single glass substrate, of a 1.48/1.55-µm-wavelength multiplexer and a 1.30/1.55-µm-wavelength multiplexer followed by a 1/8 splitter by using potassium- and silver-double-ion-exchange processes. The wavelength multiplexers are based on nonsymmetric three-port Mach-Zehnder interferometers, and symmetrical Y junctions are used for achromatic splitting. The facet-to-facet excess loss in both the 1.48/1.55-µm multiplexer and in the integrated 1.30/1.55-µ m multiplexer and 1/8 splitter is less than 2.7 dB. The device can be used, in connection with an erbium-doped fiber, in future wavelength division multiplexing subscriber networks in which amplification is needed in the 1.55-µm-wavelength region.

Changes of respiratory chain enzyme activities in growing rat muscle mitochondria

The activities of three mitochondrial respiratory chain enzymes, namely rotenone sensitive NADH-cytochrome c reductase (NCCR), succinate-cytochrome c reductase (SCCR), and cytochrome c oxidase (CCO) in the extensor digitorum longus muscle were determined in Wistar rats, twenty each, at 3, 4, 5, 6, 10 and 26 weeks of age. The activity of NCCR was extremely low from birth up to 10 weeks of age. The activity of SCCR was stable at 64% to 72% during the first 6 weeks of life and increased to 78% of the adult level at 10 weeks of age. The CCO activity was only 52% of the adult level at 3 weeks of age, increased to 78% to 86% during the next 3 weeks and reached 92% at 10 weeks of age which was not statistically different from the adult level. We conclude that the activities of these 3 respiratory chain enzymes, in muscle mitochondria in rats, were low during development and reached the adult levels at various ages. Before the normal values of these enzyme activities can be established in human pediatric population, age-matched control should be used as the reference value for evaluation of mitochondrial myopathy.

[Hemophilus aphrophilus meningitis: report of one case]

Hemophilus aphrophilus, a gram negative, capnophilic slow growing bacillus, is a rarely recognized pathogen in meningitis and is most frequently seen in patients with either endocarditis or brain abscess. This article reported one case with Hemophilus aphrophilus meningitis. A 10-year-old boy presented at the emergency room with chief complaint of fever for 2 days and sudden onset of loss of consciousness. Hemophilus aphrophilus was isolated from the blood and cerebrospinal fluid. Aqueous penicillin and chloramphenicol were given for three weeks. The patient discharged without any sequelae. Three months later, fever and consciousness disturbance were noted again. No pathogen was isolated from the cerebrospinal fluid and blood culture this time, but CSF finding was consistent with bacterial meningitis. Aqueous penicillin and chloramphenicol were readministered for 30 days. The patient recovered smoothly. Because the patient had no history of CSF rhinorrhea or hypogammaglobulinemia, recurrence of the bacterial meningitis could be due to incomplete treatment during the first admission. Brain computed tomography (CT) done during the two admissions showed focal cortical enhancement in the fronto-temporo-parietal region. This is presumed to indicate infarction over these regions. The findings of brain CT are in accordance with the development of hemiplegia in the patient. It is still unknown, however, whether Hemophilus aphrophilus meningitis also causes a higher incidence of brain infarction, which was frequently noted in patients with Hemophilus influenzae meningitis.

External ear canal schwannoma: an unusual case report

To the best of our knowledge, this is the first report of external ear canal schwannoma in the English literature. Several detailed clinical and pathological features were demonstrated. We suggest that if a tender, encapsulated mass is found in the external ear canal, the diagnosis of schwannoma should be taken into consideration.

[Giant cystic hygroma: a case report]

Cystic hygromas are congenital malformations of the lymphatic system appearing as single or multiloculated, fluid-filled cavities found mainly in the neck and axilla region. Antenatal ultrasound examination done in this case showed a suspicious giant cystic mass over the neck and chest area. At birth, the mass turned out to be a rare giant cystic hygroma measuring about 25cm x 26cm covering neck, anterior chest, axilla, proximal right upper limb, upper abdomen and upper back area. Because of some compromise to the infant's breathing, an emergency resection was done, and the infant tolerated the procedure well. Pathology report confirmed the diagnosis.

An experimental model of mitochondrial myopathy: germanium-induced myopathy and coenzyme Q10 administration

In skeletal muscles from rats treated with germanium for 23 weeks, there were numerous ragged-red fibers and cytochrome-c oxidase (COX)-deficient fibers. Biochemically, germanium reduced the enzyme activities in the mitochondrial respiratory chain. Rotenone-sensitive NADH-cytochrome-c reductase as well as COX activities were markedly reduced, while succinate-cytochrome-c reductase was less severely, but significantly, affected. The histopathological findings in these muscles were similar to those seen in patients with mitochondrial encephalomyopathy, suggesting that germanium-induced myopathy may be a useful experimental model. Coenzyme Q10 administration appeared to be ineffective in preventing this experimental myopathy.

Heterotopic ossification in children with burns: two case reports

Heterotopic ossification is the formation of ectopic bone in soft tissue, and has been reported as a rare complication in pediatric burn patients. At our hospital, two 86% body surface area burn patients developed heterotopic ossification in the shoulder, elbows, distal femur, proximal tibia, fibula, and ribs approximately four months after the burn injury. These two rare and unusual cases are presented documenting the clinical involvement, radiological studies, laboratory data, as well as treatment of their heterotopic ossification. Discussion will focus on the incidence, diagnosis, pathophysiology, and treatment of heterotopic ossification in burn patients and how this information relates to the specific diagnosis and management of the complication of heterotopic ossification in the burn child.

A long-standing cystic lymph node metastasis from occult thyroid carcinoma--report of a case

The authors describe a patient with a cervical cystic mass present for 14 years which proved to be a cystic metastasis from a papillary carcinoma of the thyroid gland. This is probably the first case report of a long-term lateral cervical cyst caused by an occult thyroid carcinoma.