Intertrochanteric fractures in adults younger than 40 years of age

This study reviewed 66 intertrochanteric fractures in patients younger than 40 years old (average 33.0 years old; range 17-40 years old). In contrast to the usual population with intertrochanteric fractures, the factors male predominance (46/66), less pre-injury comorbidity (9/66), more outdoor high energy trauma (47/66), and more associated injuries (32/66) were evident. The distribution of associated injuries was wide. Some of them were life threatening. According to Boyd's classification, 20 were type I, 24 were type II, 13 were type III, and 9 were type IV. Twenty-nine were stable, and 37 were unstable. Stratified by the mechanism of injury, the difference in distribution between the subgroups was significant (p = 0.027, two-tail Fisher's exact test). Simple falls only caused Boyd type I and II fractures. Boyd type III or IV fractures were found more often after vehicular trauma or falls from a height. All the intertrochanteric fractures healed on average 70.5 days (range 31-213 days) after operation. The fractures resulting from vehicular trauma or fall from a height healed significantly more slowly (p = 0.02, univariant log-rank test). There were 6 intertrochanteric fracture-related complications. The mechanism of injury determines the character of intertrochanteric fractures in young adults. Given tougher bone stock, better healing ability, and less co-morbidity, proper management can lead to healing of all intertrochanteric fractures. The extent of functional recovery was also determined by the associated injuries.

Cefuroxime-impregnated cement at primary total knee arthroplasty in diabetes mellitus. A prospective, randomised study

We have performed a prospective single-blinded randomised study to evaluate the role of antibiotic-impregnated cement in the prevention of deep infection at primary total knee arthroplasty (TKA) in patients with diabetes mellitus. We studied prospectively 78 arthroplasties performed for osteoarthritis in such patients. They were randomly separated into two groups. In group 1 (41 knees), cefuroxime-impregnated cement was used while in group 2 (37 knees) cefuroxime was not added to the cement. The preoperative, intraoperative and postoperative management was the same for both groups. The mean follow-up was 50 months (26 to 88). There were no cases of deep infection in group 1, but five (13.5%) occurred in group 2 (p = 0.021). We conclude that cefuroxime-impregnated cement is effective in the prevention of deep infection at primary TKA in patients with diabetes mellitus.

Characterization of the replication region of the Lactobacillus reuteri plasmid pTC82 potentially used in the construction of cloning vector

A 3.2 kb DNA fragment containing the replication region (RR) from pTC82 was cloned, sequenced, and found to contain elements typical of plasmids that replicate via a rolling-circle mechanism of replication (RCR), including double-strand origin (DSO), replication protein gene (rep), and single-strand origin (SSO). The DSO of pTC82 contains two domains showing 55.5% and 84.6% similarities in nucleotide (nt) sequence to the conserved functional elements bind and nic, respectively, which are required for the initiation of the leading strand typical of the pC194-RCR family. Although the predicted rep gene product of pTC82 (Rep82) shares little identity (less than 24%) with other known Reps, a region containing three motifs, characteristic of the pC194-family Reps, was identified, indicating the Rep82 as a novel Rep protein of this family. Downstream of the rep82 gene, strong similarity to the typical palT type-SSO could be detected. This is the first palT type-SSO to be identified from Lactobacillus. Through a series of deletion studies, the minimal replicon of the cloned RR was found to be 2.66 kb in size including the DSO region and rep gene. This RR was further identified as being highly stable in L. reuteri and also bearing a very narrow host-range property, suggesting it to be a good replicon potentially useful in vector construction for developing L. reuteri as a vaccine carrier.

A series of enediynes as novel inhibitors of topoisomerase I

A series of acyclic enediynes, 2-((6-substituted)-3-hexen-1,5-diynyl)benzonitriles (8--11), display potent inhibition against topoisomerase I without the formation of active biradical intermediates and show inhibitory activity against topoisomerase I at 10 microM, which is five times that of camptothecin from the results of agarose gel electrophoresis.

Effect of functional groups of humic substances on uf performance

The role of different functional groups present in humic substances on the membrane flux is unclear. This study is undertaken to (1) separate the carboxyl and phenolic groups from a humic solution, and (2) evaluate the effect of each fractionated humic substances on the ultrafiltration (UF) performance. A weak-base amine resin was used for the adsorption (pH 7) and the subsequent desorption (pH 13) of the phenolic groups from a commercial humic solution. These fractions were evaluated qualitatively (via Fourier transform infrared spectroscopy) and quantitatively (titration); they were further subjected to the analyses of the trihalomethane formation potential (THMFP) and ultrafiltration performance. Although, a complete separation of the phenolic and carboxyl groups is not possible, the results nevertheless provide useful information about their effects on UF performance. The fraction with a higher content of the phenolic OH group exhibits the highest THMFP (190 microg/mg C), whereas the fraction with a higher content of the carboxyl groups exhibits more flux decline. The UF system evaluated is unable to remove a significant portion of THM precursors, resulting in high THMs in permeate. The use of powdered activated carbon for the pretreatment of these fractions fails to improve membrane fouling. The pore size of UF membrane does not appear to affect the membrane flux, and the switch from the hydrophobic to hydrophilic membrane only slight improves the permeate flux.

Determination of source contributions to ambient PM2.5 in Kaohsiung, Taiwan, using a receptor model

Ambient particulates of PM2.5 were sampled at three sites in Kaohsiung, Taiwan, during February and March 1999. In addition, resuspended PM2.5 collected from traffic tunnels, paved roads, fly ash of a municipal solid waste (MSW) incinerator, and seawater was obtained. All the samples were analyzed for twenty constituents, including water-soluble ions, organic carbon (OC), elemental carbon (EC), and metallic elements. In conjunction with local source profiles and the source profiles in the model library SPECIATE EPA, the receptor model based on chemical mass balance (CMB) was then applied to determine the source contributions to ambient PM2.5. The mean concentration of ambient PM2.5 was 42.69-53.68 micrograms/m3 for the sampling period. The abundant species in ambient PM2.5 in the mass fraction for three sites were OC (12.7-14.2%), SO4(2-) (12.8-15.1%), NO3- (8.1-10.3%), NH4+ (6.7-7.5%), and EC (5.3-8.5%). Results of CMB modeling show that major pollution sources for ambient PM2.5 are traffic exhaust (18-54%), secondary aerosols (30-41% from SO4(2-) and NO3-), and outdoor burning of agriculture wastes (13-17%).

Generation of IgM anti-platelet autoantibody in dengue patients

Dengue virus infection causes a wide range of diseases from dengue fever to life-threatening dengue hemorrhagic fever and dengue shock syndrome (DHF/DSS). The mechanisms involved in DHF/DSS pathogenesis remain unclear. Patient sera collected from an outbreak in southern Taiwan from November 1998 to January 1999 were studied. The presence of antibodies which cross-reacted with platelets could be detected in patient sera, and the isotype of these autoantibodies was IgM. The anti-platelet IgM levels were higher in DHF/DSS than in dengue fever patient sera in disease acute phase. These autoantibodies were still detectable in convalescent stage (1-3 weeks after acute phase) and even eight to nine months after illness. The platelet binding activity was not observed in other virus-infected patient sera tested. Further investigation showed that dengue patient sera caused platelet lysis in the presence of complement. The platelet cytotoxicity induced by DHF/DSS patient sera was higher than that by dengue fever sera. Dengue patient sera also inhibited platelet aggregation which, however, appeared to be not related to DHF/DSS development.

Modeling Competitive Adsorption of Molybdate, Sulfate, and Selenate on gamma-Al(2)O(3) by the Triple-Layer Model

Competitive adsorption of molybdate, sulfate, and selenate onto gamma-Al(2)O(3) was investigated in the present study. Binary solute systems of MoO(2-)(4)+SO(2-)(4), MoO(2-)(4)+SeO(2-)(4), and SO(2-)(4)+SeO(2-)(4) and a ternary solute system of MoO(2-)(4)+SO(2-)(4)+SeO(2-)(4) were evaluated to determine their relative effects on competitive adsorption on the gamma-Al(2)O(3) surface. Anionic competitive adsorption efficiency was pH dependent. The higher the pH, the lower the efficiency of MoO(2-)(4) in preventing SO(2-)(4) and SeO(2-)(4) adsorption; similar results were found in SeO(2-)(4) depressing SO(2-)(4) adsorption. This research found that more sites are occupied in mixed anionic adsorbate systems than when either ion is present alone. The results suggest that the gamma-Al(2)O(3) surface is composed of many groups of binding sites. Because of the heterogeneity of adsorption sites, the triple-layer model (TLM) predicted the competitive effects qualitatively but not quantitatively. TLM gave reasonable descriptions of molybdate adsorption in the presence of sulfate and selenate, indicating that the model may be useful in predicting molybdate adsorption on gamma-Al(2)O(3). Copyright 2001 Academic Press.

Sludge dewatering using centrifuge with thermal/polymer conditioning

Sludge dewatering is preceded by a conditioning operation to enhance water removal efficiency. In the conditioning operation, chemical coagulants or polymers are added to promote sludge particle aggregation for easier dewatering. In this study, an alternative conditioning method for sludge thermal treatment at temperatures up to 80 degrees C was extensively investigated. Dewatering characteristics such as sludge capillary suction time and specific resistance to filtration, sludge viscosity and concentration of solid cakes were examined thoroughly. A good correlation between capillary suction time and specific resistance to filtration was established for sludges from water treatment, but not for biological sludge. Cationic polymer exhibits the best enhancement on sludge moisture removal. The sludge rheogram varies from 60 to 5 cP as temperature changes from 20 to 80 degrees C for sludges from water treatment plant. The dewatering ability of sludge can be greatly enhanced by thermal treatment in conjunction with the use of polymers.

Surgical treatment of full thickness rotator cuff tear in patients younger than 40 years

BACKGROUND

Full thickness tear of the rotator cuff is a well-known entity in the middle-aged and elderly population and the results of surgical repair are well documented. Rotator cuff tear in patients under the age of 40 years is unusual and the cause and treatment are not well established. The present study reports 12 young patients with full thickness tear of the rotator cuff treated surgically.

METHODS

Open anteroinferior acromioplasty and cuff repairs were performed on every patient after failure of nonsurgical treatment. The average follow-up was 59.5 months (range, 36-100 months).

RESULTS

The average patient age at the time of surgery was 30.2 years (range, 17-39 years). Symptoms included pain and dysfunction in all patients and weakness in eight patients. The duration of symptoms before surgery ranged from 6 to 60 months (average, 22.8 months). Ten patients were able to return to their preinjury status within an average of 4.5 months (range, 3-9 months) after surgery. Three athletes were able to return to previous levels of competition. Nine patients had excellent functional results with regard to pain, motion, strength, function and satisfaction. Eleven patients were satisfied with the operation and had significant pain reduction compared with their preoperative status.

CONCLUSIONS

An acute traumatic event was the etiology of the rotator cuff tears in this study. The results of surgical treatment in this younger group of patients were satisfactory and were comparable to the outcomes reported for surgical treatment of rotator cuff tears in older patients and athletes.

Purification and properties of ornithine racemase from Clostridium sticklandii

Ornithine racemase has been purified to homogeneity from Clostridium sticklandii, as shown by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. This is the first racemase known to be highly specific to ornithine. This PLP-dependent enzyme has an M(r) of 92, 000, with a K(m) for L-ornithine of 0.77 +/- 0.05 mM and a k(cat) of 980 +/- 20 s(-1).

Growth, pigment production and protease activity of Monascus purpureus as affected by salt, sodium nitrite, polyphosphate and various sugars

The effect of different levels of salt, sodium nitrite, polyphosphate and various sugars on growth, pigment production, protease activity and culture pH caused by Monascus purpureus was studied in broth medium and ground meat. The addition of sodium chloride (> 50.0 g l(-1)) and polyphosphate (> 3.0g l(-1)) to broth medium decreased mycelial growth, pigment production and protease activity of M. purpureus, whereas low concentrations of sodium nitrite (< 0.2 g l(-1)) promoted mycelial growth and pigment production. When the basal medium and ground meat contained salt, 150.0 g l(-1), the mould growth was stopped. The medium with fructose as carbon source proved to be the most suitable for mycelium growth and pigment production, with maltose and glucose being the second most productive. When sucrose and lactose were used as carbon sources, mycelium growth and pigment production were inhibited but the protease activity increased significantly. The mould showed more tolerance to salt and polyphosphate in ground meat than in broth medium and used sucrose as a carbon source as well as glucose for growth and pigment production in the meat mixture.

Use of alternative therapy among pediatric oncology patients in Taiwan

Both alternative medicine and western medicine have been commonly used to treat pediatric cancer patients in Taiwan. Each has its own intrinsic strengths and weaknesses and they can be complementary. Little is known about medical help-seeking behaviors of parents of pediatric cancer patients, especially those related to alternative therapies. This study investigated the extent and parental expectations on use of alternative therapies. All primary caregivers of 63 eligible patients were interviewed. Use of alternative therapies, regardless of education level or social status of their families, is prevalent (n = 46, 73%) in Taiwan. Commonly used alternative therapies included, in order of popularity, formulated functional food (n = 22, 48%), temple worship/shamanism (n = 19, 40%), traditional Chinese medicine (n = 9, 20%), secret recipes/herbs (n = 13, 28%), and diet supplements (n = 9, 19%). Such practices generally occur without medical guidance from oncologists, largely because of poor interactions between parents and oncologists. Future efforts should be made to encourage both parents and oncologists to discuss this issue. Nurses may serve as mediators by developing mutual trust and a sharing relationship between these groups.

Double Anionic Cycloaromatization of 2-(6-Substituted-3-hexene-1,5-diynyl)benzonitriles Initiated by Methoxide Addition

[reaction: see text] Treatment of 2-((3Z)-undecene-1,5-diynyl)benzonitrile with 5 equiv of sodium methoxide in refluxing methanol for 16 h gave 1-pentyl-6-methoxyphenanthridine in 12% yield, 1-pentyl-6-phenanthridone in 6% yield, and 2-(2-pentyl-6-methoxyphenyl)benzonitrile in 4% yield. Under the same reaction conditions, methanolysis of several other benzonitriles gave similar results. Phenanthridine and biphenyl derivatives were obtained as the major products. A mechanism for this novel cycloaromatization reaction of enediynes is proposed.

Cloning of erythromycin-resistance determinants and replication origins from indigenous plasmids of Lactobacillus reuteri for potential use in construction of cloning vectors

Lactobacillus reuteri L1 and N16 strains contain a 7.0-kb plasmid (pTE80) and a 15-kb plasmid (pTE15), respectively, encoding resistance to erythromycin (Em(r)). Physical maps of both plasmids were established. Nucleotide sequences of the genetic determinants encoding Em(r) on pTE80 and pTE15 revealed the existence of a very similar (ca. 99% nucleotide sequence and ca. 98% amino acid sequence identity) open reading frame for an Em(r) transmethylase gene (erm) in both plasmids. These structural erm genes, 753 and 750 bp in length, respectively, were highly related (ca. 98% nucleotide sequence and ca. 97% amino acid sequence identity) to the erm gene of L. fermentum plasmid pLEM3. Sequence analysis showed that these two erm genes from pTE80 and pTE15 could be categorized under the ermB (ermAM) class. These are the first members of the ermB (ermAM) class of Em(r) determinant from L. reuteri to be characterized at the nucleotide sequence level. The Em(r) gene from pTE80 (erm80) was then ligated into pUC18/19 to construct replication origin (RO)-screening vectors pUE80(+) and pUE80(-) (pUE80(+/-)). These plasmids contain the pUC18/19-derived multiple cloning site, ampicillin-resistance trait, and the LacZ' gene, which enable direct screening for recombinants in Escherichia coli. Once the recombinant contains a RO from L. reuteri, the Em(r) trait of erm80 is used as a selection marker for the replication of the chimeric plasmid as it is transformed into L. reuteri using the cloned RO as a replicon. Replication regions from pTE80 and pTE15 were successfully cloned into the constructed vector pUE80(-). The RO cloned from pTE80 was further identified as being highly stable in L. reuteri and also bearing a relatively narrow host range compared with that of pTE15. The Em(r) determinant (erm80) and RO cloned from pTE80 could be used in the future construction of derivatives of cloning vectors for this microbe. Moreover, the pUE80(+/-) and pTE80-RO constructed in this study have the potential to be developed as a suicide vector and an E. coli-L. reuteri shuttle vector, respectively.

Determinants of parental decisions on 'drop out' from cancer treatment for childhood cancer patients

Little is known about the psychosocial process of parental decisions on 'drop out' from cancer treatment for paediatric patients in Taiwan. This study, based on structured in-depth interviews, attempted to document the determinants of parental decisions on drop out. A total of 19 parents of paediatric cancer patients who dropped out from a cancer treatment for at least a month within 3 years since first treatment were interviewed. Content analysis of qualitative data revealed six categories of determinants associated with parental decisions: suffering severe pain from medical treatments and adverse side-effects; desire for better and less painful treatments; adverse effect of other patients' experiences; searching for possible explanations for disease after prolonged denial of diagnosis; lack of empathy from health care professionals; and misinterpretation of improved prognostics. These findings reflected the deficiency of psychological and emotional support for parents from health care professionals prior to and during cancer treatment.

Requirement of I-E molecule for thymocyte apoptosis induced by staphylococcal enterotoxin B in vivo

In vivo administration of bacterial superantigen staphylococcal enterotoxin B (SEB) to BALB/c mice led to thymus atrophy resulting from thymocyte apoptosis. In this study, we demonstrated that SEB induced a substantial reduction in thymocyte numbers in BALB/c, B10. D2 (H-2(d) haplotype), B10.BR, C3H/HeJ, C3H/HeN (H-2(k)), and (BALB/c x B6)F1 (H-2(dxb)), but caused little or no effect in I-E- strains such as B6, B10, A.BY (H-2(b)), and A.SW (H-2(s)) mice. Elimination of CD4(+)CD8(+) cells predominantly accounted for the thymocyte loss, although the numbers of other subpopulations may also be reduced. Thymocyte apoptosis was shown by an increase in the level of DNA fragmentation in BALB/c but not in B6 mice after SEB administration. Treatment with anti-I-Ed monoclonal antibody to BALB/c mice blocked SEB-induced thymocyte apoptosis when anti-I-Ad exerted less effect. In contrast to SEB, staphylococcal enterotoxin A led to comparable levels of thymus atrophy in BALB/c and B6 mice. Studies on the surface marker expression indicated that CD25 expression was upregulated on BALB/c mouse thymocytes but with only a moderate increase in B6 mice. The CD4(+)CD8(+) cells were the major (>90%) population that expressed elevated levels of CD25 in BALB/c mice. An increase in the expression of TCRalphabeta, CD3, and CD69 surface markers was also observed on thymocytes from BALB/c mice, but not from I-E- strains. The differential response of I-E+ and I-E- mice to SEB may be exploited as a model for the study of apoptosis in the thymus.

Percutaneous A1 pulley release for trigger digits

BACKGROUND

Recently, percutaneous trigger digit release has been reported as a safe, effective office procedure. The purpose of this study was to further assess the safety and efficacy of this technique.

METHODS

From November, 1996, to August, 1997, 69 consecutive patients with 71 primary trigger digits were treated with percutaneous A1 pulley release. The operations were performed using the tip of a 19-gauge needle, mounted on a 3-ml syringe. The mean age of the patients was 66 years. The mean duration of follow-up was 21 weeks. The patients were prospectively classified into two groups according to age, sex, digit involved, duration of symptoms and whether or not they had had previous local steroid injection.

RESULTS

Sixty-three digits were completely free of triggering. Residual triggering or inadequate release was found in eight digits at final follow-up. The success rate was not associated with sex, age, digit involved, duration of symptoms or history of local steroid injection. No major complications were found in this study, but minor complications included persistent local tenderness in nine digits and subcutaneous hematoma in six digits. Risk factors related to persistent local tenderness were female gender and trigger thumb.

CONCLUSIONS

Percutaneous A1 pulley release is an effective, safe and convenient procedure for the treatment of trigger digits.

Adsorption/Desorption Kinetics of MoO2-4 onto gamma-Al2O3 by the Pressure-Jump Technique

The kinetics and mechanisms of molybdate adsorption/desorption at the gamma-Al2O3/water interface were studied by using the pressure-jump apparatus with conductivity detection at 298 K. A double relaxation was observed due to the adsorption/desorption process. Adsorption data and triple-layer model (TLM) simulation results suggest the formation of both mono- and bidentate inner-sphere complexes (SMoO-4 and S2MoO4) at the gamma-Al2O3 surface. The intrinsic equilibrium constants (Kinteq) of the complexes were 10(6.5) M-2 and 10(16) M-4, respectively. Based on the relaxation theory and combined results of TLM simulation, a two-step process is proposed. The first step (k1, k-1) is the formation of an ion-pair complex through the electrostatic attraction between the reacting surface sites and MoO2-4 and H+. The second step (k2, k-2) involves a ligand exchange process, whereby one water molecule is replaced by one adsorbed MoO2-4 from the surface. The values of adsorption and desorption rate constants in the MoO2-4/gamma-Al2O3 system were determined to be kint1 = 5.23 x 10(6) M-2 s-1, kint-1 = 2.41 x 10 s-1, kint-2 = 1.74 s-1, and kint-2 = 3.26 x 10(-1) s-1. The intrinsic equilibrium constant from kinetic measurements (Kintkin) was 10(6) M-2, which was similar to the intrinsic equilibrium constant (Kinteq), 10(6.5) M-2, from the equilibrium studies. Copyright 1998 Academic Press.

Computerized tomography in the diagnosis of subluxation of the distal radioulnar joint

BACKGROUND

The diagnosis of distal radioulnar joint (DRUJ) subluxation is difficult. Routine radiographs are imprecise in clinical analysis. However, the anatomy and dynamic configuration of this articulation have been clearly defined utilizing computerized tomography (CT). Three CT criteria for the evaluation of DRUJ subluxation have been reported: Mino's criteria, the epicenter method and the congruity method. Previous reports discussed these criteria in the analysis of symptomatic DRUJ, but no clear conclusion has been reached. The purpose of this study is to investigate accurate criteria of CT in defining subluxation of the DRUJ.

METHODS

Eighty distal radioulnar joints in 40 patients with suspected DRUJ subluxation underwent CT scans of both symptomatic and asymptomatic wrists. The CT scan was obtained through the DRUJ with the forearm in neutral rotation, active full supination and active full pronation. Three CT criteria were used to assess the DRUJ in all positions of unstable and normal wrists.

RESULTS

Overall, 54 wrists were included in the final analysis. Seventeen symptomatic wrists had frank DRUJ instability diagnosed from true lateral radiographs, and 11 were reconfirmed from intraoperative pathology. The other 37 wrists had normal DRUJ. Among the three methods, the epicenter method had similar sensitivity to Mino's criteria and the congruity method. However, the epicenter method had much better specificity than Mino's criteria and the congruity method.

CONCLUSIONS

For accurate diagnosis of subluxation of the DRUJ, CT scan through the symptomatic DRUJ in neutral rotation, active full supination, active full pronation and analysis with the epicenter method are recommended.

[Seroepidemiology of Toxoplasma gondii infection among Atayal aborigines and local animals in Nan-ao district, Ilan county and Jen-ai district, Nan-tou county, Taiwan]

In this study, latex agglutination test (LAT) was used to detect sera anti-toxoplasma antibodies of Atayal aborigines and local animals in Nan-ao district, Ilan county and Jen-ai district, Nan-tou county as a measure of exposure to the Toxoplasma gondii. Out of 422 Atayal aborigines and 64 different animals were tested in Nan-ao district and 82 Atayal children in Jen-ai district were also screened, the positive rates for sera anti-toxoplasma antibodies were 21.8%, 17.2% and 15.9%, respectively. In Nan-ao district, neither were the positive rates significantly different in males (22.1%) and females (21.4%), nor in humans (21.8%) and dogs (19.6%) (P > 0.05). The seroprevalence in adults (28.3%) was significantly higher than that in children (18.7%) (P < 0.05), and the highest seropositive rate (38.1%) was in the age group 50-59 years and the lowest (7.7%) was in the age group 1-9 years. In general, the age pattern of prevalence is consistent with increasing duration of exposure to Toxoplasma gondii with age. For animals, the seropositive rate in dogs (19.6%) was also significantly higher than that in wild rats (7.7%) (P < 0.05). No significant difference in seropositive rate of Atayal children was observed between Nan-ao and Jen-ai districts (P > 0.05).

Seroprevalence of Toxoplasma gondii antibodies among Atayal aboriginal people and their hunting dogs in northeastern Taiwan

Atayal aborigines, living at an altitude of 1,500-1,600 m in northeastern Taiwan, still hunt for wild animals with the help of hunting dogs. In this study, the latex agglutination test (LAT) was used to detect sera anti-toxoplasma antibodies in this community as a measure of their exposure to Toxoplasma gondii. The positive rates for sera anti-toxoplasma antibodies were 21.8% and 19.6%, respectively, in 422 Atayal and 51 hunting dogs tested. Neither of the positive rates were found to be significantly different between male (22.1%) and female Atayal (21.4%), or between humans (21.8%) and dogs (19.6%) (P > 0.05) when compared by the Chi-Squared test (chi 2-test). A significant difference was observed between the positive rates in adults (28.3%) and children (18.7%) (P < 0.05), and the age pattern of prevalence is consistent with an increasing duration of exposure to Toxoplasma gondii with age. The consumption of raw liver of wild animals or insufficiently cooked meat may be the major mode of transmission of toxoplasmosis in Atayal.

Views of obstetric patients who refuse regional anesthesia in cesarean section

BACKGROUND

Regional anesthesia for cesarean section has gained widespread popularity. However, there are still a good few of obstetric patients who refuse it. This study was to investigate the reasons for refusing regional anesthesia in order to gain some insights into the attitudes and concerns of patients.

METHODS

Three hundred and twenty-four obstetric patients scheduled for Cesarean section were interviewed just before entering the operating room. They were asked to give one or two reasons for refusing regional anesthesia.

RESULTS

Two hundreds of them refused regional anesthesia. The most frequent reasons were apprehension of witnessing the operation (auditory or visional) (45.42%) and fear of backache following regional anesthesia (14.58%).

CONCLUSIONS

Anesthesiologists should be aware of patients' feeling or concern and could be capable and willing to discuss with them the relevant problems.

Effects of en bloc esophagectomy on nutritional and immune status in patients with esophageal carcinoma

BACKGROUND AND OBJECTIVES

En bloc esophagectomy has been established as the treatment of choice for patients with resectable esophageal carcinoma. However, an extensive surgical procedure may result in further impairment of the patient's nutritional status and immune system. Thus a prospective study was undertaken to evaluate the perioperative sequential changes in patients' nutritional and immune status and the timing to institute postoperative adjuvant therapy.

METHODS

Thirty-seven patients (34 male, 3 female) who had undergone en bloc esophagectomy with gastric institution for epidermoid carcinoma of the esophagus were studied. The mean age was 62.3 years. The nutritional and immune assessments were performed preoperatively, on the third postoperative day, in the first week, second week, third week, and at the end of the first and third month. The biochemical studies for nutritional evaluation included serum albumin, cholesterol, iron, transferrin, magnesium, zinc, total iron binding capacity (TIBC), and nitrogen balance. Evaluation of the immune status consisted of: (1) total lymphocyte count, (2) lymphocyte subpopulation, (3) immunoglobulins, (4) complements (C3 and C4), (5) lymphocyte blastogenic responses, (6) tumor necrosis factor-alpha and interleukin-2 secretion activity from mononuclear cells, and (7) C-reactive protein (CRP) level.

RESULTS

All the parameters in nutritional assessment declined profoundly by the third postoperative day (P < 0.05). The most severe deterioration was in serum iron, followed by transferrin, TIBC, cholesterol, and zinc. Most of them returned to the preoperative levels within 2-3 weeks after surgery. However, the serum levels of iron, transferrin, and TIBC required a longer period of time (> 1 month) to return to normal. A remarkable increase of serum CRP was detected in the first postoperative week (P < 0.05), but immunoglobulins and complements decreased significantly yet variably (P < 0.05) in the second or third postoperative week before gradually returning to preoperative levels. Moreover, during the first week after surgery, CD3 and CD8 diminished following esophageal surgery, whereas CD20, CD4/CD8 ratio, and lymphocyte blastogenic responses increased significantly (P < 0.05).

CONCLUSIONS

Except for iron-related parameters, all the other nutritional parameters returned to the preoperative level by the third postoperative week. An adequate supplementation of iron and protein for 1-3 months after surgery is needed. En bloc esophagectomy might have only a mild and temporarily adverse effect on the host immune defense. Regarding the postoperative recovery of a patient's nutritional and immune status, postoperative chemo-radiotherapy is optimally instituted after the third postoperative week, instead of within 2 weeks of surgery.

Comparison of local infiltration of tenoxicam and intravenous tenoxicam for postoperative analgesia in herniorrhaphy

BACKGROUND

The major complaint of herniorrhaphy is postoperative pain which occurs during the first 24 h after operation. Tenoxicam has a long half-life of 60-80 h. Local infiltration of the drug concentrates the pain control effects in the local area. The local infiltration dose can be smaller than the recommended systemic dose needfully to reach the target area to be effective. Therefore we studied the effect of preoperative local infiltration of tenoxicam on postoperative pain.

METHODS

Sixty patients, belonging to ASA classes I and II, undergoing unilateral herniorrhaphy, were randomly assigned to 4 groups. General anesthesia was induced with thiamylal 5 mg/kg, fentanyl 2 micrograms/kg, and atracurium 5 mg/kg. Group 1 (G1) patients were preoperatively injected with 10 mg of tenoxicam in 10 ml normal saline or distilled water, in the operative area. Group 2 (G2) and Group 3 (G3) patients were preoperatively given intravenous tenoxicam, 20 mg and 10 mg, respectively. Group 4 (G4) patients were not given preoperative local infiltration or intravenous tenoxicam to serve as control group. The pain score was assessed at 2 h, 9 h, 24 h postoperatively in all groups. We recorded the total amount of acetaminophen used and the form of administration of the analgesic drug. All patients received general anesthesia in uniform technique.

RESULTS

Pain score and amount of analgesic drug required in G1 (local infiltration group) patients were significantly decreased compared with the other groups. The postoperative pain score of Visual Analog Scale (VAS) and analgesic requirement in the four groups were ranked as follows: G1 < G2 < G3 < G4. No significant difference was observed between G2, G3 and G4. Only the pain score in G2 patients significantly decreased (p < 0.05) during the late postoperative period (24 h) when compared with G4 patients.

CONCLUSIONS

Preoperative local infiltration of tenoxicam can decrease postoperative pain score significantly during the most painful period (24 h) in herniorrhaphy.