Human chondrocyte apoptosis in response to mechanical injury

OBJECTIVE

The effect of mechanical injury on chondrocyte viability and matrix degradation was studied. It was proposed that mechanical injury to human cartilage explants results in chondrocyte apoptosis with associated loss of glycosaminoglycans.

DESIGN

Full thickness human cartilage explants, 5 mm in diameter were subjected to a single static mechanical stress of 14 MPa for 500 ms under radially unconfined compression. Glycosaminoglycan (GAG) release and percentage of cells undergoing apoptosis were measured at 96 h after injury. To establish the time course of apoptosis, explants were subjected to 30% strain and cultured for varying intervals up to 7 days after injury. A group of loaded explants were also treated with the broad spectrum caspase inhibitor z-Vad.fmk after injury.

RESULTS

Internucleosomal DNA fragmentation as one indicator of apoptosis was observed in 34% (S.D.+/-11) of chondrocytes at 96 h in response to mechanical loading at 14 MPa, compared to 4% (S.D.+/-2) in the non-loaded explants. Evidence for cell death induction via apoptosis was also obtained by electron microscopy and caspase cleavage of cytokeratin. GAG release was also higher for the loaded explants, mean 1.9% (S.D.+/-0.14) of total GAG content, compared to control explants, mean 0.8% (S.D.+/-0.28). The percentage of apoptotic cells also correlated with the level of GAG release into the culture media. The percentage of apoptotic chondrocytes demonstrated a progressive increase from 6 h to 7 days post-injury. When loaded explants were cultured in z-Vad.fmk after injury, a 50% reduction in apoptosis rates was seen.

CONCLUSIONS

These results demonstrate that mechanical injury induces chondrocyte apoptosis and release of GAG from the matrix. The time course suggests that a therapeutic window may exist where apoptosis could be inhibited. This potentially identifies a new approach to chondroprotection.

Impact of mechanical trauma on matrix and cells

Posttraumatic arthritis is one of the most common causes of secondary osteoarthritis. The contribution of cell death to matrix degradation has not been characterized fully. The current study was designed to determine the effect of mechanical injury on chondrocyte viability and matrix degradation. Full-thickness bovine and human cartilage explants, 5 mm in diameter were subjected to mechanical loads representative of traumatic joint injury. Glycosaminoglycan release and percent apoptotic cells were measured. Unilateral patellas in eight anesthetized rabbits were subjected to an impact load. Rabbits were euthanized at 96 hours after injury and patellar cartilage was harvested for analysis. The effect of a pan-caspase inhibitor, z-VAD.fmk [benzyloxycarbonyl-Val-Ala-Asp (OMe) fluoromethylketone] in preventing chondrocyte apoptosis in human articular cartilage explants was determined. A significant increase in the number of apoptotic cells was observed in response to mechanical loading. The mean in vivo apoptotic rates were 1% in control rabbits and 15% in impacted patellas. Caspase inhibition reduced chondrocyte apoptosis from 34% to 25% after mechanical injury and was associated with reduction in glycosaminoglycan release. Mechanical injury induces chondrocyte apoptosis that is sensitive to pharmacologic inhibition. This identifies a new approach to limit traumatic cartilage injury and the subsequent development of secondary osteoarthritis.

Protein kinase C and changes in manganese superoxide dismutase gene expression in cultured glial cells

1. To study the role of protein kinase C (PKC) in the increase in manganese superoxide dismutase (Mn-SOD) gene expression following transient hypoxia in glial cells, we examined the mRNA levels of Mn-SOD using northern blot analysis. 2. The Mn-SOD mRNA levels were markedly increased after exposure to nitrogen gas for 5 min. 3. Pretreatment with chelerythrine or GF109203x, inhibitors of PKC, attenuated the increase in Mn-SOD mRNA following hypoxia in a concentration-dependent manner. 4. Incubation with phorbol 12-myristate 13-acetate, the PKC activator, enhanced the increase in Mn-SOD gene expression in response to transient hypoxia. 5. The results suggest that hypoxia increases Mn-SOD gene expression in cultured glial cells mainly through activation of a PKC pathway.

Environmental and developmental regulation of the wound-induced cell wall protein WI12 in the halophyte ice plant

A wounded gene WI12 was used as a marker to examine the interaction between biotic stress (wounding) and abiotic stress (high salt) in the facultative halophyte ice plant (Mesembryanthemum crystallinum). The deduced WI12 amino acid sequence has 68% similarity to WUN1, a known potato (Solanum tuberosum) wound-induced protein. Wounding, methyl jasmonate, and pathogen infection induced local WI12 expression. Upon wounding, the expression of WI12 reached a maximum level after 3 h in 4-week-old juvenile leaves, whereas the maximum expression was after 24 h in 8-week-old adult leaves. The temporal expression of WI12 in salt-stressed juvenile leaves was similar to that of adult leaves. The result suggests that a salt-induced switch from C3 to Crassulacean acid metabolism has a great influence on the ice plant's response to wounding. The expression of WI12 and the accumulation of WI12 protein were constitutively found in phloem and in wounded mesophyll cells. At the reproductive stage, WI12 was constitutively found in petals and styles, and developmentally regulated in the placenta and developing seeds. The histochemical analysis showed that the appearance of WI12 is controlled by both environmental and developmental factors. Immunogold labeling showed WI12 preferentially accumulates in the cell wall, suggesting its role in the reinforcement of cell wall composition after wounding and during plant development.

Correlations between theoretical and experimental determination of heat of formation of certain aliphatic nitro compounds

Heats of formation of energetic materials were calculated by Dewar's AM1 and Stewart's PM3 methods. In order to compare the theoretical results with the experimental ones, some correlation models were proposed in this study. Correlations were evaluated by multivariable linear regression method, considering the number of nitro groups and the use of quadratic relations involving the number of carbon, hydrogen, nitrogen, and oxygen atoms. Results indicated very precise correlations. Based on these correlations, heats of formation of some aliphatic nitro compounds can be predicted at 95% predictive interval without experimental analysis.

In vivo proton MR spectroscopy of chorea-ballismus in diabetes mellitus

The most common cause of chorea-ballismus (CB) is a vascular lesion; it is also associated with nonketotic hyperglycaemia in diabetes mellitus (DM) and may be the first manifestation of this disorder. We describe the CT, MRI and proton MR spectroscopy (1H-MRS) of CB in eight patients. Six had hemichorea-hemiballismus (HC-HB) and two bilateral CB. Single-voxel (SV) 1H-MRS was performed using point-resolved spectroscopy (PRESS). Voxels were positioned in the basal ganglia of the patients and control subjects. PRESS was also used to obtain spectroscopic imaging (1H-MRSI) of the slice of interest in two patients. CT showed a slightly dense striatum in all the patients with CB, and T1-weighted images revealed high signal. The CB correlated well with the neuroimaging findings. SV 1H-MRS showed the mean (+/- SD) N-acetylaspartate (NAA)/ creatine (Cr) ratio to be 1.45 +/- 0.19 in HC-HB and 1.82 +/- 0.06 on the opposite normal side (P = 0.01). The choline (Cho)/ Cr ratio was 1.3 +/- 0.12 in HC-HB and 1.11 +/- 0.13 on the opposite normal side (P = 0.005). A lactate peak was seen in seven patients. The NAA/Cr ratio was 1.44 +/- 0.15 in bilateral CB and 1.74 +/- 0.16 in the controls (P = 0.017); the Cho/Cr ratios were 1.36 +/- 0.1 and 1.19 +/- 0.07 (P = 0.015). The low NAA/Cr suggests neuronal loss or damage and the high Cho/Cr probably indicates gliosis. The presence of lactate may suggest mild ischaemia due to acute vascular events during hyperglycaemia and underlying chronic focal cerebrovascular diseases in DM.

Correlation of abnormal intracranial vessel velocity, measured by transcranial Doppler ultrasonography, with abnormal conjunctival vessel velocity, measured by computer-assisted intravital microscopy, in sickle cell disease

The Stroke Prevention Trial has confirmed that utilization of transcranial Doppler ultrasonography (TCD), which examines blood flow in large intracranial vessels, can identify children with sickle cell disease (SCD) who are at high risk of developing a premature stroke. It is not known to what extent the vasculopathy in SCD involves small vessels and whether the abnormalities, if present, correlate with large-vessel vasculopathy. Eighteen children with SCD were examined with TCD to determine middle cerebral artery (MCA) velocity and computer-assisted intravital microscopy (CAIM) to determine bulbar conjunctival vessel velocity during the same visit for vasculopathy correlation. High MCA velocity (≥ 200 cm/sec) was found by TCD in 4 patients who also showed abnormal conjunctival velocity (< 0.2 mm/sec or intermittent trickle flow) by CAIM. Three patients had conditional (≥ 170 cm/sec and < 200 cm/sec) MCA velocity: 2 showed abnormal (trickle) and 1 showed normal conjunctival velocity (1.9 mm/sec). One patient with unmeasurable MCA velocity had abnormal (trickle) conjunctival velocity. Of the remaining 10 patients who had normal MCA velocity, 2 showed abnormal (0.05 mm/sec and 0.1 mm/sec) and 8 showed normal conjunctival velocities (1.1-2.4 mm/sec). The MCA velocities correlated significantly with bulbar conjunctival flow velocities (P ≤ .008, Fisher exact test). A correlation exists between MCA (large-vessel) and conjunctival (small-vessel) flow velocities. CAIM is a noninvasive quantitative technique that might contribute to the identification of SCD patients at high risk of stroke. Small-vessel vasculopathy might be an important pathological indicator and should be further explored in a large-scale study.

Ultrastructural changes in the pulmonary arterioles in acute hypoxic pulmonary hypertension in the rat

This study was planned to obtain ultrastructural details of the early changes in intra-acinar arterioles in acute hypoxic pulmonary hypertension that could lead to understanding the mechanisms in the development of chronic hypoxic hypertension. In the anesthetized rat, using 5-10% normobaric O2, within minutes after hypoxia, there are changes in endothelial cells characteristic of activation: prominence of cell body and protuberance of the nucleus, electron-dense membrane-bound bodies adluminally, increasing pseudopodia of the adluminal cell membrane, edema within (vacuoles) and beneath the endothelial cells with separation of the endothelial cells from the basal lamina. There is activation of platelets and leucocytes in the lumen and accumulation of platelets at the endothelium. Arteriolar wall edema rapidly increases, is excessive within 1 h, with dissection of the basal lamina and wall and cytolysis of wall components. At 24 h edema is reduced, the number of platelets is increased at the endothelium and fibroblasts are newly aligned within the arteriolar wall. At 48 h platelets further increase, a basal lamina develops in fibroblasts termed transitional cells and myofibrils occur subsequently to form smooth muscle. These findings suggest that activation of the endothelial cell is the initial event in a cellular cascade in the arteriolar hypoxic responses with fibroblast-to-smooth muscle transformation, which results in pulmonary arteriolar hyperplasia and vascular remodeling in hypoxic chronic pulmonary hypertension.

Effects of hemoglobin variants and chemically modified derivatives on assays for glycohemoglobin

BACKGROUND

Glycohemoglobin (gHb), measured as hemoglobin (Hb) A(1c) or as total gHb, provides a common means for assessing long-term glycemic control in individuals with diabetes mellitus. Genetic variants and chemically modified derivatives of Hb can profoundly affect the accuracy of these measurements, although effects vary considerably among commercially available methods. The prevalence of genetic variants such as HbS, HbC, and HbE, and chemically modified derivatives such as carbamyl-Hb among patient populations undergoing testing is not insignificant. Clinical laboratories and sites responsible for point-of-care testing of gHb need to be aware of the interferences produced in assays by these Hbs.

APPROACH

We conducted a review of the literature describing the effects of variant Hbs on gHb assay methods commonly used in clinical laboratories.

CONTENT

This review summarizes the documented effects of both common and uncommon Hb variants and derivatives on the measurement of gHb. Where known, we discuss mechanisms of interference on specific assays and methodologies. We specifically address effects of commonly encountered Hbs, such as carbamyl-Hb, HbS, HbC, HbE, and HbF, on assays that use cation-exchange chromatography, immunoassays, or boronate affinity methods for measuring gHb.

SUMMARY

A variety of patient- and laboratory-related factors can adversely affect the measurement of gHb in patients harboring Hb variants or derivatives. Identification of the variant or derivative Hb before or during testing may allow accurate measurement of gHb by the selection of a method unaffected by the given variant or derivative. However, laboratories should make available alternative, non-Hb-based methods for assessing long-term glycemic control in individuals with HbCC, HbSS, or HbSC disease, or with other underlying disorders where the concentration of gHb does not accurately reflect long-term glycemic control.

Triple therapy with clarithromycin, omeprazole, and amoxicillin for eradication of Helicobacter pylori in duodenal ulcer patients in Asia and Africa

BACKGROUND

Studies assessing the efficacy of triple therapy containing clarithromycin and amoxicillin for the eradication of Helicobacter pylori infection and healing of duodenal ulcers in Asian and African countries are limited.

AIM

To determine the efficacy and safety of 1-week triple therapy with omeprazole, amoxicillin and clarithromycin for eradicating H. pylori infection in patients with active duodenal ulcer living in Asian and African regions.

METHODS

This was an open-label, multicentre study in 11 centres in Asia and Africa. Patients with endoscopy-proven duodenal ulcer and who were H. pylori-positive were treated with clarithromycin 500 mg, omeprazole 20 mg, and amoxicillin 1000 mg, all given twice daily for 7 days. Upper endoscopy was repeated at week 6 to check for ulcer healing and H. pylori status.

RESULTS

A total of 117 patients were recruited. H. pylori eradication rates were 85% by per protocol analysis and 80% by intention-to-treat analysis. Ulcer healing was found in 94% of subjects (per protocol analysis). Clinical success, measured by change of pre-treatment ulcer symptoms, was strongly supported by complete resolution or improvement in 100% of the evaluable patients (per protocol analysis). Since treatment-related adverse events, when present, were largely mild or moderate, the triple therapy regimen was considered safe.

CONCLUSION

Seven-day triple therapy with omeprazole, amoxicillin, and clarithromycin was efficacious for treating Asian and African patients with duodenal ulcer disease associated with H. pylori infection, and the treatment regimen was well-tolerated.

Role of alpha1A-adrenoceptor in the regulation of glucose uptake into white adipocyte of rats in vitro

In an attempt to know the functional role of alpha1A-adrenoceptors in adipose tissue, white adipocytes (WAT) of Wistar rats were used to investigate the change of glucose uptake after pharmacological activation of alpha1-adrenoceptors. Methoxamine enhanced the uptake of radioactive glucose into isolated WAT in a concentration-dependent manner. Translocation of glucose transporter (GLUT4) from cytosol to membrane was also stimulated with methoxamine. Action of methoxamine to raise glucose uptake was abolished in WAT pre-incubated with the antagonists, both tamsulosin and WB 4101, at concentrations sufficient to block alpha1A-adrenoceptors. However, chlorethylclonidine (CEC). the antagonist of alpha1B-adrenoceptors, showed the inhibition of methoxamine-induced action only at a higher concentration. Even under the treatment with maximal concentration of CEC, methoxamine can produce action about 80% of the vehicle-treated control. The major role of alpha1A-adrenoceptors in the stimulation of glucose uptake by methoxamine can thus be considered. In the presence of specific inhibitor of phospholipase C (PLC), U73312, methoxamine-stimulated glucose uptake into WAT was reduced in a concentration-dependent manner and U73343, the negative control of U73312, did not affect the action of methoxamine. Moreover, chelerythrine and GF 109203X diminished the methoxamine-stimulated glucose uptake at a concentration sufficient to inhibit protein kinase C (PKC). Inhibition of phosphoinositide-3 kinase (PI-3 kinase) by LY294002 also abolished methoxamine-stimulated glucose uptake. Therefore. the obtained data suggest that an activation of alpha1A-adrenoceptors, presence in WAT, by agonist and/or neurotransmitter may increase the glucose uptake via PLC-PKC pathway and the activation of PI-3 kinase.

Increased lymphocyte sister chromatid exchange frequency in workers with exposure to low level of ethylene dichloride

The genotoxicity of low-level exposure to ethylene dichloride (EDC) and vinyl chloride monomer (VCM) in humans is not clear. We used lymphocyte sister chromatid exchange (SCE) frequency as a parameter to investigate the genotoxicity of low level EDC and VCM in VCM-manufacturing workers. The SCE frequency was determined for 51 male workers with exposure to VCM and/or EDC and for 20 male workers devoid of such exposure. Epidemiological data were obtained by questionnaire, and included history of smoking, drinking, and any medication taken, as well as a detailed occupational history. Personal- and area-sampling and analysis were conducted in order to calculate the time-weighted average (TWA) contaminant-exposure level corresponding to different job categories. Moderate EDC exposure around 1 ppm corresponded to a significantly greater SCE frequency than was the case for the low EDC exposure group (p<0.01). However, VCM exposure of similar level was not associated with increased SCE. We conclude that EDC may cause genotoxicity at a relatively low level of exposure.

Hypotriglyceridemic effect of Anka (a fermented rice product of monascus sp.) in rats

Experimental rats with hypertriglyceridemia were prepared by feeding a high-fructose diet. Dried Anka powder (2%), a rice product fermented with Monascus sp., was mixed with basic high-fructose (30%) or basal-diet feed. Serum and liver lipids were measured after 6 months. The concentrations of serum triglycerides, total cholesterol, VLDL-C, and LDL-C had significantly decreased, whereas that of HDL-C had slightly increased in 30% fructose-Anka-fed rats as compared with the 30% fructose-fed rats, but hepatic lipase activity had increased in the Anka-fed groups. The ratio of lipoprotein lipase/hepatic lipase was not significantly different between 30% fructose-Anka-fed rats and 30% fructose-fed rats. The dietary intake and weight of these two groups were approximately the same. Similar results were obtained in noninduced hypertriglyceridemic rats. The concentrations of triglycerides and cholesterol did not significantly differ in the liver. Interestingly, Anka can suppress serum triglycerides in rats with induced hypertriglyceridemia. The antioxidant enzyme SOD activity was also measured in serum, and no significant change was observed. On the basis of these findings, we suggest that Anka may be used to suppress hypertriglyceridemia and hyperlipidemia in rats and possibly in man.

Initial results of solitary pancreas transplants performed without regard to donor/recipient HLA mismatching

BACKGROUND

We hypothesized that solitary pancreas transplants could be performed successfully even in the presence of poor HLA matching if an aggressive approach were taken with regard to immunosuppressive protocol and the performance of allograft biopsy.

METHODS

Seven pancreas-after-kidney transplants and seven pancreas transplants alone were performed without consideration given to the degree of HLA mismatching (MM) using tacrolimus (FK506)/mycophenolate mofetil (MMF)/prednisone maintenance therapy. Mean (+/-SD) total HLA MM was 4.8+/-1.2. All patients were followed for at least 6 months. The first four cases were induced with ATGAM for 7 to 10 days. In the remaining 10 cases, an ultrasound-guided percutaneous needle biopsy was attempted on a protocol basis 10 days after completing induction with OKT3 for 7 (n=2) or 14 (n=8) days.

RESULTS

Overall patient survival, graft survival, and incidence of acute rejection requiring treatment were 86, 79, and 50%, respectively. Two patients receiving ATGAM developed grade III-IV rejection at 3 weeks. Both patients receiving OKT3 for 7 days developed early grade III rejection. However, only three of eight patients receiving OKT3 for 14 days developed rejection requiring treatment. Protocol biopsy was successfully performed in six of seven patients and uncovered three cases of otherwise undetectable grade III-IV rejection.

CONCLUSIONS

Although based on a small number of cases, our results suggest that solitary pancreas transplants with a poor HLA match can be performed with an acceptable rejection incidence and graft survival rate using an OKT3/FK506/MMF/prednisone regimen with protocol biopsy.

Inhibition of xanthine oxidase and suppression of intracellular reactive oxygen species in HL-60 cells by theaflavin-3,3'-digallate, (-)-epigallocatechin-3-gallate, and propyl gallate

The inhibitory effects of five tea polyphenols, namely theaflavin (TF1), theaflavin-3-gallate (TF2), theaflavin-3,3'-digallate (TF3), (-)-epigallocatechin-3-gallate (EGCG), and gallic acid, and propyl gallate (PG) on xanthine oxidase (XO) were investigated. These six antioxidant compounds reduce oxidative stress. Theaflavins and EGCG inhibit XO to produce uric acid and also act as scanvengers of superoxide. TF3 acts as a competitive inhibitor and is the most potent inhibitor of XO among these compounds. Tea polyphenols and PG all have potent inhibitory effects (>50%) on PMA-stimulated superoxide production at 20 approximately 50 microM in HL-60 cells. Gallic acid (GA) showed no inhibition under the same conditions. At 10 microM, only EGCG, TF3, and PG showed significant inhibition with potency of PG > EGCG > TF3. The superoxide scavenging abilities of these six compunds are as follows: EGCG > TF2 > TF1 > GA > TF3 > PG. PG was the most potent inhibitor of PMA-stimulated H(2)O(2) production in HL-60 cells. The order of H(2)O(2) scavenging ability was TF2 > TF3 > TF1 > EGCG > PG > GA. Therefore, the antioxidative activity of tea polyphenols and PG is due not only to their ability to scavenge superoxides but also to their ability to block XO and related oxidative signal transducers.

Pseudomelanosis duodeni: case report

Pseudomelanosis duodeni is a rare benign condition. It manifests endoscopically as discrete, flat, small brown-black spots in the duodenal mucosa. It produces no symptoms and may be reversible. The cause and natural history of the pigmentation have not been clarified, although it is associated with a variety of systemic illnesses and medications. With electron microscopy and electron-probe energy dispersive X-ray analysis, the pigment corresponds principally to an accumulation of ferrous sulfide (FeS) in macrophages within the lamina propria. We report the case of a 56-year-old female patient with a past history of diabetes mellitus and hypertension. She was admitted because of nausea, vomiting, and diarrhea and underwent esophagogastroduodenoscopy because of stool occult blood test results of 3+. Endoscopy revealed diffusely scattered black spots in the bulb and second portion of the duodenum. Histological examination showed numerous pigment-laden macrophages in the lamina propria of mucosal villi. The diagnosis requires further confirmation by electron microscopy and electron-probe energy dispersive X-ray microanalysis. No special therapy is indicated for this rare lesion.

Modulation transfer function and critical flicker frequency in high-myopia patients

BACKGROUND AND PURPOSE

Critical flicker frequency (CFF) decreases due to optic nerve and retinal damage in patients with optic neuritis or glaucoma. Because retinal degeneration is also found in high myopia, we investigated whether the modulation transfer function (MTF) and CFF are altered in patients with high myopia.

METHODS

Forty-six patients with high myopia (< -8 diopters, D) were recruited from our outpatient department. The control group comprised 21 young volunteers with myopia of 0 to -2 D. The myopic and control groups were similar in terms of age and sex.

RESULTS

At all frequencies tested, the myopic group had lower CFF and higher modulation values than the control group. The mean CFF was significantly lower in myopic patients (46.8 +/- 9.0 Hz) than in control subjects (52.5 +/- 4.4 Hz). Patients with extremely high myopia (< -10 D) had significantly greater modulation values at 5, 10, 15, 55 and 60 Hz than those with moderately high myopia (-8 D to -10 D). The CFF did not differ significantly between those with extremely high (46.3 +/- 8.8 Hz) and those with moderately high (49.0 +/- 6.9 Hz) myopia.

CONCLUSIONS

The findings of this study support that the CFF decreases and MTF increases in patients with high myopia, and that the alternation of MTF is related to the degree of myopia. CFF and MTF may, therefore, have potential as indexes to evaluate the severity of retinal degeneration in patients with high myopia.

Surveillance of antibiotic resistance in Taiwan, 1998

For the first national surveillance of antibiotic resistance in Taiwan, we collected in 1998 from 22 hospitals (6 medical centers, 15 regional hospitals, and 1 local hospital) 3,211 isolates in all parts of the country. Besides 50 random successive isolates from inpatients, each hospital was requested to collect 25 isolates each from positive blood cultures, hospital-acquired infections, outpatients and the pediatric department. We re-speciated all the submitted specimens and determined their antibiotic susceptibility patterns. The most common isolates were Enterobacteriaceae (Escherichia coli, Klebsiella pneumoniae), Staphylococcus aureus, and Pseudomonas aeruginosa. Among hospital-acquired infections, Acinetobacter spp. were among those which accounted for over 10% of the isolates. The oxacillin resistance of S. aureus was 82% in isolates from hospital-acquired infections, and 40% from outpatients. Among Enterococcus spp., 85% were either E. faecalis or E. faecium. They were 14% resistant to vancomycin. Among gram-negative bacteria, K. pneumoniae and Acinetobacter baumanii were hospital-acquired isolates that were most clearly more resistant than community acquired isolates. This difference was less apparent in the case of Enterobacter cloacae, Serratia marcescens, and P. aeruginosa. These bacteria were generally more resistant from all sources. Fifty-one percent of Salmonella were resistant to ampicillin; however, these were all sensitive to ciprofloxacin. Isolates from the East were least resistant. Plotting the disc zone diameters of antibiotics within the susceptible range, we identified subpopulations with smaller diameters in the case of vancomycin against S. aureus, ciprofloxacin against E. coli, and ciprofloxacin against Salmonella spp. These findings represent one of the purposes of this surveillance as they may portend developing resistances which bear careful watching in the future.

Short-term effect of ozone on the pulmonary function of children in primary school

The objective of this study was to evaluate the short-term effect of ambient air pollution on the pulmonary function of schoolchildren. We sampled 941 children in primary school in three communities in Taiwan (Sanchun, Taihsi, and Linyuan). The nearby stations of the Taiwan air quality monitoring network provided the hourly ambient concentrations of sulfur dioxide, carbon monoxide, ozone, particulate matter < or = to 10 microm in aerodynamic diameter, and nitrogen dioxide. Spirometry was performed once for each sampled child. We also obtained the status of indoor air pollution and chronic respiratory disease history by using a structured questionnaire. Multivariate linear model analysis was used to evaluate pulmonary function effects of each pollutant in addition to determinants of indoor air pollution and meteorologic conditions. We found a significantly negative association of peak O(3) concentration on the day before spirometry with individual forced vital capacity and forced expiratory volume in 1 sec. The decrease in children's lung function can occur at peak hourly O(3) concentrations < 80 ppb. The slope of lung function decrease for Taiwanese children is approximately 1 mL/ppb for peak hourly O(3) exposure.

Improvements in diabetic microangiopathy after successful simultaneous pancreas-kidney transplantation: a computer-assisted intravital microscopy study on the conjunctival microcirculation

A computer-assisted intravital microscopy technology has been developed to noninvasively and objectively study diabetic microangiopathy in the conjunctival microcirculation of type-1 diabetics. Quantitative characterization of the conjunctival microcirculation was performed on 12 patients pre- and 18 months postsimultaneous pancreas-kidney transplantation (SPK). Healthy nondiabetic volunteers (n=12), solitary kidney (K) transplanted type-1 diabetics (n=5), and nontransplanted type-1 diabetics (n=12) served as controls. Pre-SPK diabetics showed abnormal-sized venules (diameter=66+/-7 microm) and reduced presence of arterioles (arteriole length/area=18+/-6 microm(-1)) compared with nondiabetic controls (53+/-4 microm; 31+/-8 microm(-1); P<0.05). The computed vascular perfusion capacity of the conjunctival microvasculature was diminished in the same patients (pre-SPK diabetics=49+/-9%; nondiabetic healthy controls=71+/-6%; P<0.05). Significant improvement in microangiopathy was observed in all post-SPK diabetics (diameter=58+/-6 microm; arteriole length/area=26+/-9 microm(-1); vascular perfusion=63+/-8%; P<0.05) 18 months post-SPK. Blood flow velocities in the conjunctival microcirculation in the same post-SPK patients showed noticeable but not significant improvements (nondiabetic controls=2.94+/-0.57 mm/sec; pre-SPK=1.23+/-0.49 mm/sec; post-SPK=1.65+/-0.42 mm/sec). The solitary kidney transplant controls (post-K) showed no significant improvements in diabetic microangiopathy, confirming the unique role of the pancreas in SPK. In general, significant improvements (P<0.05) in diabetic microangiopathy were observed in all 12 diabetics 18 months post-SPK but not in the controls.

Multiplex coherent anti-Stokes Raman spectroscopy by use of a nearly degenerate broadband optical parametric oscillator

Optical parametric oscillators (OPO's) provide low-maintenance solid-state alternatives to dye lasers. We present results from use of a nearly degenerate broadband OPO for multiplex coherent anti-Stokes Raman spectroscopy. The system described is capable of generating spectra that cover a range of approximately 1000 cm(-1).

Bone response to implant surface morphology

This study was designed to measure implant osseointegration using different surface treatments. Bilateral distal intramedullary implantation of titanium cylinders 25 mm x 5 mm was performed in 60 rabbits. The 3 surfaces tested were fiber mesh, mean pore size 400 microns; grit-blasted, mean surface roughness 6 microns; and acid-etched, mean surface roughness 18 microns. Scanning electron microscopy was used to measure the percentage of the surface of each implant in contact with bone at 2, 6, and 12 weeks postimplantation. Mechanical pull-out testing of the bone-implant interface was performed at 12 weeks. Overall, acid-etched surfaces demonstrated greater mean osseointegration than fiber mesh surfaces. All 3 surfaces demonstrated similar interface strengths. Acid etching has potential as a means of enhancing bony apposition in cementless fixation.

Does famotidine have similar efficacy to misoprostol in the treatment of non-steroidal anti-inflammatory drug-induced gastropathy?

The study aimed to evaluate the efficacy of famotidine, an H2 receptor blocker, and misoprostol, a prostaglandin E analogue, in the treatment of non-steroidal anti-inflammatory drug-induced (NSAID) gastropathy in arthritic patients. A total of 128 patients receiving piroxicam, sulindac, indomethacin, naproxen, tolmetin and aspirin were enrolled in the study. Gastroscopic examination was performed at the beginning and after eight weeks of randomised famotidine or misoprostol treatment. A standard scoring method for gastroscopic finding was applied. Forty-four patients with scores 1-3 were classified as group A; while the other 84 with score 4 (ulcer) were placed in group B. In group A, 26 received famotidine and 18 misoprostol. In group B, 36 received famotidine and 48 misoprostol. Biopsy specimens taken from the rim of the ulcer with adjacent normal mucosa were coded and tested for Helicobacter pylori. In group A, all but two patients taking famotidine recovered from NSAID gastropathy, and there was no statistical significance between the two drugs. In group B, all but four patients receiving famotidine improved and there was no statistical significance between the two subgroups for complete healing rate. The prevalence of H. pylori was 36.9%, lower than that in the general population. It was concluded that famotidine and misoprostol have similar efficacy in the treatment of NSAID gastropathy.

Free echogenic pelvic fluid: correlation with hemoperitoneum

Echogenic fluid is an important extrauterine finding of ectopic pregnancy. The purpose of this study was to determine how accurately echogenic fluid correlates with hemoperitoneum at surgery. Transvaginal sonography was performed in 831 consecutive patients referred to rule out ectopic pregnancy over a 36 month period. Scans were retrospectively evaluated for the presence or absence and echogenicity of free pelvic fluid. Subsequently, 185 patients had a laparotomy or laparoscopy and had documentation of the presence or absence of hemoperitoneum. On transvaginal sonography 125 patients had echogenic fluid, 30 patients had anechoic fluid, and 30 patients had no fluid. Of the 125 patients with echogenic fluid, 122 (98%) patients had hemoperitoneum; none of the patients with anechoic fluid or no detected fluid had hemoperitoneum (0%). Echogenic fluid had a sensitivity of 100%, specificity of 95%, positive predictive value of 98%, and an accuracy of 98% for detecting hemoperitoneum. This study demonstrates that echogenic fluid detected by transvaginal ultrasonography accurately correlates with hemoperitoneum detected at surgery in patients with suspected ectopic pregnancy.

Adverse effect of air pollution on respiratory health of primary school children in Taiwan

This study is a part of the Study On Air Pollution and Health In Taiwan (SOAP&HIT), an ongoing research project involving cooperation of several universities in Taiwan. In this study, the objective was to evaluate the effects of ambient air pollution on respiratory symptoms and diseases of school children, in addition to considering indoor air pollution. Six communities were selected: one community located in a rural area (Taihsi), two in urban areas (Keelung and Sanchung), and the other three in petrochemical industrial areas (Toufen, Jenwu, and Linyuan). We sampled 5,072 primary school students in six communities from the main study population of SOAP&HIT. Respiratory health was assessed by evaluation of the children's respiratory symptoms and diseases using a parent-completed questionnaire. Data were analyzed using logistic regression analysis to compute odds ratios of adverse effect. The school children in the urban communities had significantly more respiratory symptoms (day or night cough, chronic cough, shortness of breath, and nasal symptoms) and diseases (sinusitis, wheezing or asthma, allergic rhinitis, and bronchitis) when compared with those living in the rural community. However, only nasal symptoms of children living in the petrochemical communities were more prevalent than in those living in the rural community. Although the association with ambient air pollution is suggestive, the cross-sectional study cannot confirm a causal relationship; thus further studies are needed.

Respiratory symptoms of primary school children living in a petrochemical polluted area in Taiwan

In 1994-1995 a cross-sectional epidemiological study investigating the respiratory health of school children in two Taiwan areas was conducted; one area was located in a region with petrochemical manufacturing complexes (Linyuan), and the other was situated in a reference area with no local industrial emissions (Taihsi). All primary school children residing in the two areas were involved in the study. Four hundred seventy children were studied in the area with high exposure to industrial emissions, and 611 children lived in the reference area. Respiratory health was assessed by evaluation of the children's respiratory symptoms and illnesses, using a parent-completed questionnaire. Particulates, sulfur dioxide (SO2), nitrogen dioxide (NO2), and acid aerosols levels were significantly higher in the exposed area than in the reference area. The school children in the petrochemical area had significantly more upper respiratory symptoms and asthma compared with the children living in the control area. Although the association with known petrochemical air pollution is suggestive, this cross-sectional study cannot confirm a causal relation and further studies are needed.

Sonographic detection of echogenic fluid and correlation with culdocentesis in the evaluation of ectopic pregnancy

OBJECTIVE

Because the presence of echogenic fluid on transvaginal sonography has been shown to correlate well with hemoperitoneum in patients with possible ectopic pregnancy, the aim of this study was to compare echogenic fluid on sonography with the results of culdocentesis in predicting hemoperitoneum.

MATERIALS AND METHODS

Free fluid on transvaginal sonography and the results of culdocentesis were correlated with the presence or absence of hemoperitoneum in 46 patients at surgery. Forty ectopic pregnancies and six nonectopic pregnancies were found. Echogenic fluid was the criterion used to establish hemoperitoneum on sonography. For statistical analysis, negative and nondiagnostic culdocentesis results were combined. The sensitivity, specificity, and positive and negative predictive values of each diagnostic technique were compared.

RESULTS

In 40 of 46 patients with ectopic pregnancy, the sensitivity and specificity of echogenic fluid for establishing hemoperitoneum were 100% and 100%, respectively, compared with 66% and 80%, respectively, for culdocentesis. More important, the negative predictive value of a nondiagnostic culdocentesis was 25% compared with 100% for echogenic fluid in the ectopic subgroup of patients. In two patients with incomplete abortions, sonography failed to detect small amounts of hemoperitoneum at surgery performed 4 hr and 7 days after sonography.

CONCLUSION

Sonography is more sensitive than culdocentesis in the detection of hemoperitoneum. Culdocentesis is invasive, and nondiagnostic results cannot be used to exclude hemoperitoneum. Culdocentesis should play no role in the evaluation of ectopic pregnancy except in the unusual circumstance in which high-resolution sonography cannot be readily performed.

Fatigue model to characterize cement-metal interface in dynamic shear

This study evaluated the interface shear strength between vacuum mixed polymethyl-methacrylate and two types of surface enhancements under static and dynamic shear loading. Cobalt chrome coupons with grit blasted or light plasma sprayed surfaces were tested. For each test, two coupons were mounted in a stainless steel chamber such that they were bonded with a 2-mm cement mantle for each test. Pullout and dynamic fatigue tests were performed on an Instron machine. The mean static pullout strength of the grit blasted surfaces was 13.78 (+/- 2.73) MPa, whereas that of the light plasma sprayed surfaces was 18.46 (+/- 1.98) MPa. The rate of degradation of interface strength caused by fatigue was almost identical for both surface treatments. Qualitative analysis showed that the failed light plasma sprayed surface generated more metal and cement particles. These data suggest that light plasma sprayed surfaces sustain higher loads but have a potential for increased debris generation.

Prognostic study of gastric cancer without serosal invasion: reevaluation of the definition of early gastric cancer

BACKGROUND

Early gastric cancer, a term defined by Japanese researchers in the 1960s, is equivalent to pT1 tumor stage regardless of nodal status. Recently, there were suggestions to exclude node-positive pT1 gastric cancer from this entity and to consider node-negative pT2 gastric cancer as early gastric cancer.

STUDY DESIGN

A survival analysis was conducted of 294 patients who underwent resection for gastric cancers confined within the gastric wall (pT1, n = 164; pT2, n = 130) between 1986 and 1992.

RESULTS

The cumulative 5-year survival rate was 93.5% for pT1 patients and 67.9% for pT2 patients, with an overall survival of 82.5%. There was a significant difference in the 5-year survival rate between node-positive and node-negative pT1 patients (72.8% versus 95.6%; p = 0.0095). The 5-year survival rate of node-negative pT2 patients (80.4%) was significantly worse than that of node-negative pT1 patients (p = 0.011) but was not significantly better than that of node-positive pT1 patients (p = 0.4). If excellent prognosis is a prerequisite for the definition of early gastric cancer, then node-positive pT1 cancer and node-negative pT2 cancer should not be considered early gastric cancer.

CONCLUSIONS

In the 1990s, now that new imaging techniques such as endoscopic ultrasonography has been introduced, the preoperative staging of gastric cancer can be made more accurately than in the 1960s, when the term "early gastric cancer" was defined. Because the prognosis of early gastric cancers, if subcategorized by nodal status, is not homogeneously excellent, a reevaluation of the definition of early gastric cancer may be necessary.

Colorectal adenoma in patients with a history of breast cancer: a prospective study in Taiwan

The increased incidence of colorectal cancer in women with a history of breast cancer is well established. However, the relationship between the prevalence of adenomatous polyps and breast cancer is still controversial. We conducted a prospective study of the incidence of colorectal polyps in patients with a history of breast cancer in Taiwan. Eighty-nine patients (86 women and 3 men) received colonoscopy to test for precancerous lesions. Mean age was 49.4 +/- 10.4 years. Twelve polyps (9 adenomatous, 2 hyperplastic, 1 inflammatory) (13.5%) and one cancer (1.1%) were found. The mean age of patients with and without colorectal neoplasia was 56.3 +/- 9.4 and 48.2 +/- 10.2 years respectively, (p < 0.005); 10 out of 13 patients (77%) with colorectal neoplasia were over 50 (p < 0.1). Compared with a study of Chinese people in Hong Kong, our population had a lower incidence of colorectal adenomatous polyps, but breast cancer patients have a greater risk of developing colorectal cancer than the general population in Taiwan.

Factors affecting delection of bleeding lesions in the stomach by initial emergency endoscopy

BACKGROUND

Accurate endoscopic diagnosis of acute gastric bleeding can be problematic and missing diagnoses are not uncommon. However, the causes of diagnostic difficulty and the most common locations of bleeding resulting in missed diagnosis are not well known.

METHODS

To determine the causative factors of incomplete study, we analyzed the medical records and performed follow-up on 64 patients for whom initial emergency endoscopy had failed to identify the sites of acute gastric bleeding. The bleeding sites were confirmed by the findings of subsequent endoscopic examination or operation in these cases.

RESULTS

Excessive blood covering the examination field was the most frequent cause of incomplete endoscopic study (60/64). Underlying gastric lesions which were later identified as sources of gastric bleeding included: 30 gastric ulcers, 9 gastric varices, 6 acute gastric mucosal lesions, 3 Dieulafoy's lesions, 3 portal hypertensive gastropathies, 2 gastric tumors, 1 Mallory-Weiss tear and 2 unidentified bleeding sites. Eight patients refused further evaluation. The locations of the bleeding sites included: 1 esophagocardiac junction, 8 cardia, 5 fundus, 21 body, 9 antrum, 7 stoma, 3 diffuse pattern. The 42-day mortality rate of these patients was 20%. Of these patients, decompensated liver cirrhosis (8/13) and hepatic failure (7/13) were the most common underlying diseases.

CONCLUSION

Inadequate preparation was the most frequently procedural problem associated with missed diagnosis. Lesions located in the body of the stomach were most likely to go undiagnosed. Gastric ulcers were the most common type of unidentified bleeding ulcer site. Hepatic failure was the most common cause of death. The high mortality rate of these patients appeared to be related to underlying diseases rather than to the nature of the lesions responsible for gastric bleeding.

Predictive pulmonary function of school children in an area of low air pollution in Taiwan

The objective of this study was to determine the effect of different parameters on a predictive model of pulmonary function for elementary school children in an area of low air pollution in Taiwan. Healthy children aged 7 to 12 years from three elementary schools in low-air-pollution areas (Da-Chen, Mai-Liau and Tai-Si) participated in the study. A total of 836 children (423 boys and 413 girls) were included in the study. During summer vacation, each child underwent a physical examination including a screening spirometry. A questionnaire regarding respiratory symptoms and indoor air pollutants was also completed by the children's parents. Air monitoring showed that the levels of outdoor pollutants were relatively low. Multiple linear regression analysis was performed with FVC (forced vital capacity) and FEV1 (forced expiratory volume in 1 sec) as dependent variables. Gender, age, height, weight, technician and indoor air pollution parameters were the independent variables. The results showed that gender,height, weight and technician were the most significant variables for predicting FVC and FEV1. The various indoor air pollution parameters seemed to have no influence on the pulmonary function of children, except that mildew in bedrooms mildly decreased FEV1. Regression analysis showed that all the pulmonary function parameters measured had a positive correlation with height, whereas weight correlated only with certain parameters. Because both indoor and outdoor air pollution was relatively low, we suggest that this model could be used as a basic predictive model of pulmonary function for elementary school children in Taiwan.

Ménétrier's disease: a new variant with duodenal involvement

Ménétrier's disease is a rare cause of hypertrophic gastropathy, usually confined to gastric body and fundus, which is characterized by giant rugae, hypoalbuminemia, and foveolar hyperplasia. The etiology of this disease is still unknown. We report a case of a 74-yr-old man who had dyspepsia, hypoalbuminemia, weight loss, and diffuse polypoid, nodular lesions affecting the whole stomach and proximal duodenum on gastroscopy and barium meal study. The histology of gastric and duodenal mucosal lesions fulfilled the diagnosis of Ménétrier's disease, that was not described to involve duodenum in the literature. The disease resolved clinically, endoscopically, and pathologically after therapy with famotidine for 3 months. We speculated that extensive pyloric metaplasia and then foveolar hyperplasia of duodenum in this patient might be a variant of Ménétrier's disease with favorable clinical course.

Eccrine syringofibroadenoma surrounding a squamous cell carcinoma: a case report

A 91-year-old man presented with a 9.0 x 7.0 cm exophytic mass on the dorsum of the right foot, surrounded by a scaling hyperkeratotic plaque-like lesion that had been present for many years. He had similar long-standing hyperkeratotic plaque-like lesions on both legs. Histopathologic examination of the exophytic mass revealed a well-differentiated squamous cell carcinoma surrounded by an eccrine syringofibroadenoma (ESFA). Histochemistry, immunohistochemistry and electron microscopy support this diagnosis. To our knowledge, this is the only reported case of ESFA being intimately associated with a malignant neoplasm.

Respiratory and irritant health effects of a population living in a petrochemical-polluted area in Taiwan

Reported herewith are the results from an ongoing study of outdoor air pollution and the health of persons living in the communities in close proximity to petrochemical industrial complexes. To determine if there is an excess of adverse health outcomes in the population exposed to petrochemical industrial emissions, a health survey was undertaken in 1996 in this area and in one reference area which has no local industrial emissions. The subjects were 436 adults (30-64 years of age) living in the Sanwei area (exposed area) and 488 in Taicei (reference area). For several indicators of respiratory health, including cough, wheezing, and chronic bronchitis, the prevalence rates were not significantly different between the study and the control populations. Acute irritative symptoms (eye irritation, nausea, throat irritation, and chemical odor perception) were significantly more common in the exposed area, particularly perception of chemical odors (84.6% vs 2.1%). It is concluded that exposure to petrochemical air emissions may be associated with increased rates of acute irritative symptoms. Future studies are needed to identify the potential role of petrochemical industrial emissions (particularly volatile organic compounds) in the genesis of acute irritative symptoms in a nearby petrochemical industrial area.

[Endoscopic diagnosis and clinical experience of colonic tuberculosis]

From February 1979 to May 1994, 18 cases of colonic tuberculosis were detected by colonscopy at Chang Gung Momorial Hospital, Linkou Medical Center. There were 10 males and 8 females, with mean age of 43.6. In ten, the diagnosis was confirmed histologically or bacteriologically in colonic biopsy material and post-operated lymph nodes. The remaining 8 patients was suspected on colonoscopy, and had good response to antituberculous therapy. The major symptoms were abdominal pain (83%), diarrhea (67%), and body weight loss (61%). Average duration from symptoms to diagnosis was 4.1 months. Chest X-ray revealed active pulmonary tuberculosis in 14 of 18 patients (78%), 4 of 14 patients were military type. The colonic tuberculosis involved in ileocecal area in 6, ileocecum and contiguous colonic regions in 7, segmental colonic involvement in 4, and pancolitis in 1 patient. Multiple ulceration and ulcerohypertrophic lesions were the major colonoscopic findings. Typical caseating granuloma were found in 5 cases (36%) from colonoscopic biopsy, the other 5 from surgical resected specimens. Antituberculous therapy produced remarkable symptomatic improvement in all patients except 2 cases complicated with intestinal obstruction necessitating laparotomy. Colonoscopy with biopsy is a useful diagnostic tool in early diagnosis and avoiding unnecessary laparotomy in colonic tuberculosis.

Primary signet ring cell carcinoma of colorectum: an age- and sex-matched controlled study

OBJECTIVE

To evaluate the differences of clinicopathological features between colorectal signet ring cell carcinoma and ordinary adenocarcinoma.

METHODS

The clinicopathological data of 28 cases with primary colorectal signet ring cell carcinoma was reviewed and compared with the data from 56 age- and sex-matched patients with ordinary adenocarcinoma.

RESULTS

Fifteen cases (53.5%) with primary signet ring cell carcinoma were younger than 40 yr of age. Compared with 985 ordinary adenocarcinoma cases, signet ring cell carcinoma is present in excess in younger patients (p < 0.005). Further comparison with 56 age- and sex-matched ordinary adenocarcinomas showed that signet ring cell carcinomas could affect any sites of colon, presented as scirrhous appearance more frequently, had a higher percentage of stage III or IV tumors (78.6 vs 48.2%, 14.3 vs 7.2%, p < 0.005), had a higher rate of peritoneal seeding (35.7 vs 12.5%, p < 0.005) but a lower rate of liver metastasis (14.3 vs 32.1%, p < 0.005), and had a lower curative resection rate (64.2 vs 80.4%, p < 0.005) and a higher local or distant metastasis rate (61.1 vs 17.8%, p < 0.05). Survival with signet ring cell carcinoma is lower than that of ordinary adenocarcinoma. "Stage-on-diagnosis" and "presence of subsequent distant metastasis" were the major factors influencing survival of signet ring cell carcinoma patients.

CONCLUSION

The delay in diagnosis reduces the chance of curative resection, increases the possibility of local or distant metastasis postoperatively, and, thus, shortens the survival chances. To improve outcome, recognition of the factors responsible for this delay should be stressed so that this tumor may be found at a stage when cure is possible.

Prospective, randomized trial of hypertonic glucose water and sodium tetradecyl sulfate for gastric variceal bleeding in patients with advanced liver cirrhosis

BACKGROUND AND STUDY AIMS

Information about the appropriate endoscopic treatment of gastric variceal bleeding is sparse. We therefore designed a prospective and randomized study to evaluate and compare efficacy and complication rates of two agents, hypertonic glucose water (50% GW) and sodium tetradecyl sulfate (STS), in treating acute gastric variceal bleeding after esophageal varix eradication.

PATIENTS AND METHODS

Of 51 patients with advanced cirrhosis of the liver (Child's C), with acute gastric variceal bleeding initially evaluated, 25 patients were randomized to receive 1.5% STS and 26 to receive 50% glucose water. Treatment was aimed at achieving initial and permanent hemostasis by variceal eradication.

RESULTS

Control of acute gastric variceal bleeding was achieved in 80% of the STS group and 92% of the GW group. The rebleeding rate in the STS group was 70%, while in the GW group it was 30% (P < 0.05). Overall, obliteration was achieved in only 32% of the STS group and 81% of the GW group during admission (P < 0.05). There was a trend toward a higher gastric ulcer rate in the STS group compared with the GW group (92% vs. 30%; P < 0.05). The rebleeding control rate and permanent hemostasis rate in the GW group (70%, 54%) were also significantly higher than in the STS group (21%, 12%; P < 0.05; P < 0.05). The hospital mortality for the STS group was 50%, and for the GW group 30%.

CONCLUSION

Treatment with hypertonic glucose water in gastric vericeal bleeding was superior to treatment with STS in controlling bleeding and in achieving vericeal obliteration, less rebleeding, and a lower complication rate. The results of this study suggest that hypertonic glucose water is a clinically effective, easily available, and safe sclerosing agent.

Detection of Helicobacter pylori by polymerase chain reaction assay using gastric biopsy specimens taken for CLOtest

The concordance rate between a rapid urease test (CLOtest) and polymerase chain reaction (PCR) assay for the detection of Helicobacter pylori in gastric biopsy samples was investigated. To avoid the bias produced by patchy distribution of the organism in the stomach, the samples used for these two tests were not obtained from two different sites of the antrum. Instead, the PCR assay was performed with the the same biopsy sample that was taken for the CLOtest. Among 82 biopsy samples included for this study, 56 were positive and 26 were negative by CLOtest. Of the 56 CLOtest-positive samples, 52 (93%) were also positive by PCR assay, and of the 26 CLOtest-negative samples, 20 (78%) were negative by PCR assay. The total concordance rate of these two tests was 87.6%. Of the 4 cases with CLOtest-positive and PCR-negative results, 3 had been treated with long-term H2 blockers. Of the 6 patients with CLOtest-negative and PCR-positive results, 4 suffered from recurrent or poorly healing duodenal ulcers. Interestingly, a significantly lower density of the PCR products was observed during electrophoresis analysis for all the 6 cases, presumably due to a small number of H. pylori in these samples. These results indicated that PCR might be used as a complementary assay for CLOtest. False negative results by CLOtest might occur when only a small amount of H. pylori was present in the samples, which could be detected by subsequent PCR assays using the same biopsy specimens. The clinical significance of such CLOtest-negative and PCR-positive cases requires further study.

Prevalence of ocular disorders among 6- and 7-year-olds in Santa Monica, California

BACKGROUND

Undetected ocular disorders can cause serious problems in a child's mental and social development.

METHODS

To investigate relationships between ocular disease, gender and ethnicity in children, vision screening examination data was analyzed from the UCLA Mobile Eye Clinic (MEC), collected from 1985 to 1990 on first graders (69.9 percent 6- and 30.1 percent 7-year-olds) in Santa Monica, California.

RESULTS

The sample consisted of 1,469 individuals, of whom 48.1 percent were female and 51.9 percent were male. Ethnicity data was available from 1988 to 1990 on 834 individuals, of whom 46.9 percent were Hispanic, 27.9 percent were White. 11.5 percent were Black, 4.4 percent were Asian, and 9.2 percent were of other races. Significantly more females than males had refractive errors, specifically hyperopia and astigmatism, and uncorrected visual acuity of 20/50 or worse in at least one eye. There were no significant associations of ethnicity or sex with any other disease category. The overall prevalences of other diseases were less than 4 percent. Of the 6- and 7-year-olds studied in Santa Monica, California, 18.5 percent had refractive errors.

CONCLUSIONS

Screening for ocular disorders at an early age allows for detection of problems, especially refractive errors, that might affect school performance if uncorrected.

Klippel-Trenaunay-Weber syndrome with hemimegalencephaly: report of one case

A full-term female neonate presented with facial port-wine stain, cutaneous telangiectasia, left facial hemihypertrophy, and left hemimegalencephaly at birth and subsequently developed hypertrophic change of left limb. She fit the diagnostic criteria of Klippel-Trenaunay-Weber syndrome. However, it was an unusual variant of this syndrome because the patient had left facial hemihypertrophy, left hemimegalencephaly and ipsilateral ventriculomegaly. Although patients with hemimegalencephaly are commonly thought to be associated with neurological defects, such as developmental delay, mental retardation and intractable seizure, she had normal neurological development and no seizure was detectable until two years of age.

Gastrointestinal bleeding after hepatic transcatheter arterial embolization in patients with hepatocellular carcinoma

BACKGROUND

Transcatheter arterial embolization is a popular palliative treatment for patients with hepatocellular carcinoma, but the incidence of post-treatment gastrointestinal bleeding is not well-defined.

METHODS

We retrospectively analyzed 206 patients with hepatocellular carcinoma who received transcatheter arterial embolization and compared them with 193 patients with hepatocellular carcinoma who underwent angiography along.

RESULTS

Twenty-three episodes (8.5%) of gastrointestinal bleeding occurred within 3 months of hepatic transcatheter arterial embolization following 269 procedures involving 206 patients with hepatocellular carcinoma. Eight episodes (3.0%) of esophageal variceal bleeding and 15 episodes (5.5%) of nonvariceal bleeding were found. The sites of the nonvariceal bleeding episodes were the stomach (n = 7), duodenum (n = 5), and colon (n = 3). When compared with other sources, bleeding from esophageal varices took place earlier, required intensive treatment, and led to a higher mortality. Among another 193 patients with hepatocellular carcinoma who received angiography only, 6 patients developed gastrointestinal bleeding within 3 months (3.1%), and all bled from esophageal varices.

CONCLUSIONS

This study suggests that esophageal variceal bleeding may occur after both angiography and transcatheter arterial embolization. Nonvariceal bleeding episodes, which were usually milder than episodes of variceal bleeding, may be related to the embolization procedure itself.

Clinicopathological study of colorectal mucinous carcinoma in Taiwan: a multivariate analysis

The clinicopathological significance of colorectal mucinous carcinoma is controversial, although some authors feel mucinous carcinoma has a worse prognosis than that of non-mucinous carcinoma. To clarify the significance of this type of carcinoma in Taiwan, a retrospective review of patients with colorectal carcinoma treated at Chang Gung Memorial Hospital between 1984 and 1988 was undertaken. During this period, 53 mucinous carcinomas and 401 non-mucinous carcinomas fulfilling the inclusion criteria were analysed. Mucinous carcinomas were more common in patients 39 years of age or under (P < 0.005). Most mucinous carcinomas were located in the rectum/rectosigmoid, followed by the right colon; however, the right colon had a higher relative incidence (38 vs 8%, respectively; P < 0.005). Mucinous carcinomas presented at a significantly more advanced stage (23 vs 8%, respectively, stage D disease; P < 0.005) and had a markedly lower curative resection rate (68 vs 84%, respectively; P < 0.05). Following curative resection, mucinous carcinomas tended to have an increased incidence of subsequent distant metastasis (27.8 vs 18.8%, respectively; P < 0.005). The overall survival rate of patients with mucinous carcinoma was worse than that of non-mucinous carcinoma (P < 0.005). Multivariate analysis showed that clinically important predictive factors were stage of disease on diagnosis and subsequent distant metastasis. The mucinous histological type itself was not an independent prognostic factor in colorectal cancer.