Diverse manifestations of oral methylene chloride poisoning: report of 6 cases

OBJECTIVE

Methylene chloride is a solvent used in domestic and industrial preparations, such as paint removers and degreasing agents. Although it is considered of low toxicity, acute toxic manifestations have been reported following inhalation of methylene chloride, mainly from working in an enclosed environment. Oral ingestion of methylene chloride, however, remains rare and its consequences are less clearly understood.

CASE REPORTS

The various clinical manifestations of 6 patients with oral ingestion of methylene chloride are reported. Central nervous system depression, tachypnea, and corrosive gastrointestinal injury were the most common presentations following ingestion. An elevated carboxyhemoglobin level was documented in only 2 patients (35% and 8.4% carboxyhemoglobin, respectively). Due to a frequent misleading history of "chloroform" ingestion and unawareness of probable carboxyhemoglobin production in these patients, carboxyhemoglobin was not routinely measured. Renal failure, hepatic failure, and acute pancreatitis occurred in the 2 most severe cases of methylene chloride ingestion.

CONCLUSIONS

Ingestion of methylene chloride can result in diverse manifestations, including a high carboxyhemoglobin level. Corrosive gastrointestinal injury is common in oral poisoning and needs further therapeutic consideration. A high index of suspicion and appropriate laboratory studies are needed in those patients who allegedly ingest "chloroform" but do not present the incriminating solvent to their treating physicians. The presence of an elevated carboxyhemoglobin level suggests the diagnosis of methylene chloride poisoning. Symptomatic and supportive measures remain the mainstay in the treatment of patients with oral methylene chloride poisoning.

Agricultural avermectins: an uncommon but potentially fatal cause of pesticide poisoning

STUDY OBJECTIVE

Avermectins have been used in the control of parasites and insects; however, human data concerning poisoning are lacking. This study investigated the clinical spectrum of avermectin poisoning.

METHODS

A retrospective study was conducted to evaluate patients with avermectin poisoning reported to a poison center from September 1993 through December 1997.

RESULTS

Eighteen patients with abamectin (Agri-Mek; 2% wt/wt abamectin) exposure and 1 with ivermectin (Ivomec; 1% wt/vol ivermectin) ingestion were identified. There were 14 male and 5 female patients, ranging in age from 15 to 83 years. Most patients were exposed as a result of attempted suicide (14). Oral ingestion (15) was the most common route of exposure. Four patients were asymptomatic, and 8 had minor symptoms after a mean ingestion of 23 mg/kg abamectin (4.2 to 67 mg/kg), or after dermal and inhalation contact. Seven patients manifested severe symptoms, such as coma (7), aspiration with respiratory failure (4), and hypotension (3), after a mean ingestion of 100.7 mg/kg avermectin (15.4 mg/kg for ivermectin and 114.9 mg/kg for abamectin). All 7 patients received intensive supportive care; 1 patient died 18 days later as a result of multiple organ failure.

CONCLUSION

Ingestion of a large dose of avermectin may be associated with life-threatening coma, hypotension, and subsequent aspiration.

Blocking of cell proliferation, cytokines production and genes expression following administration of Chinese herbs in the human mesangial cells

In the hope of identifying agents of therapeutic value in immuoglobulin A nephropathy (IgA-N), we tested crude methanol extracts of 15 Chinese herbs for their effect on human mesangial cell proliferation. The results indicated that 4 out of the 15 crude extracts inhibited human cells proliferation activated by IL-1beta and IL-6. The extracts and their median inhibitory concentrations were as follows (in microg/ml): Ludwiga octovalvis (MLS-052), 49.9 +/- 1.8; Rhus semialata (MLS-053), 31.2 +/- 1.6; Tabernaemontana divaricata (MLS-054), 50.0 +/- 2.1; Amepelopsis brevipedunculata (MLS-059), 42.9 +/- 1.1. These findings indicate that human mesangial cells were most sensitive to MLS-053 treatment. These herbs also decreased interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) production. Moreover, IL- 1beta mRNA expression was inhibited by Rhus semialata (R. semialata; MLS-053). It is unlikely that cytotoxicity was involved, because no cell deaths were observable. We hypothesize that the inhibitory mechanisms of these Chinese herbs may be related to the impairments of gene expression and production of cytokines in human mesangial cells. Plans are underway for the isolation of pure compounds from these Chinese herbs and the elucidation of their mechanisms of action.

Characteristics and risk factors of acetaminophen-induced hepatitis in Taiwan

BACKGROUND

Overdose of acetaminophen may cause hepatic injury and fatal fulminant hepatic failure. Acetaminophen is the most common form of drug-induced hepatic injury in Western countries. However, there is no formal report of this important issue in Taiwan. To assess the clinical characteristics and risk factors of acetaminophen-induced hepatitis in Taiwan, we conducted this study.

METHODS

A total of 71 patients who were intoxicated or overdosed with acetaminophen at Veterans General Hospital-Taipei between February, 1991 and June, 1997 were enrolled in this study. Acetaminophen-induced hepatitis was defined according to the Paris international consensus criteria.

RESULTS

Suicide attempt was the major cause (67/71) of acetaminophen overdose. Sixty-two of the patients were female. The mean patient age was 24.5 +/- 9.7 years (+/- standard deviation, SD). Nineteen of 71 patients had acetaminophen-induced hepatitis. The peak serum alanine aminotransferase, aspartate aminotransferase and total bilirubin concentrations were 4,181.0 +/- 931.4 IU/l (mean +/- SD), 4,148.0 +/- 1,147.5 IU/l and 2.6 +/- 0.4 mg/dl, respectively. The hepatitis group had higher ingested acetaminophen doses and serum peak acetaminophen levels than did those of the nonhepatitis group (24.9 g vs 12.9 g, p = 0.004; 132.0 mg/l vs 61.7 mg/l, p = 0.013). A higher percentage of alcohol consumption was also noted in the hepatitis group than in the nonhepatitis group (32% vs 12%, p = 0.05). After logistic regression for multivariate analysis, alcohol consumption was the most important risk factor for acetaminophen-induced hepatitis (odds ratio = 8.14, p = 0.018), followed by ingested acetaminophen dose (odds ratio = 1.21, p = 0.001). Most patients received acetylcysteine treatment in time. Two of the 19 patients with hepatitis died.

CONCLUSIONS

The majority of acetaminophen-induced hepatitis in Taiwan occurs in young females who attempt suicide. Alcohol consumption and the dose of acetaminophen ingested were the significant risk factors for acetaminophen-induced hepatitis. Alcohol should not be concomitantly used with acetaminophen. Early diagnosis and administration of the antidote are crucial to decrease mortality.

Concentrated cresol intoxication

Cresol, a commonly used disinfectant, may cause gastrointestinal corrosive injury, central nervous system and cardiovascular disturbances, and renal and hepatic injury following intoxication. We report a case of acute severe cresol poisoning after a suicide attempt with ingestion of a cresol-soap solution used as a toilet disinfectant. A 44-y-old male was found unconscious after ingesting 300 ml of 50% cresol-soap solution. Endotracheal intubation, gastric lavage and activated charcoal were given immediately which reversed his conscious. He had dermal burns, esophageal and gastric erosion, pneumonia, mixed metabolic acidosis and respiratory aklalosis, renal and liver function impairment, leucocytosis and dark urine. Acute renal failure and hemolysis developed, but he recovered after hemodialysis and intensive supportive care. Urine levels of p-cresol, m-cresol, o-cresol and phenol were respectively 2083, 2059, 125 and 68 mg/g creatinine at 7 h post-ingestion. Though the amount cresol claimed ingested by the patient (150 g) far exceeded the reported lethal dose (30-60 g), and multiple complications developed after massive ingestion, this patient recovered. The renal, pulmonary and hematological effects in this patient might have resulted from the direct toxicity of cresol and its metabolites.

Prolonged severe withdrawal symptoms after acute-on-chronic baclofen overdose

INTRODUCTION

Baclofen is frequently used to treat muscle spasticity due to spinal cord injury and multiple sclerosis. Baclofen overdose can lead to coma, respiratory depression, hyporeflexia, and flaccidity. An abrupt decrease in the dose of baclofen due to surgery or a rapid tapering program may result in severe baclofen withdrawal syndrome manifesting hallucinations, delirium, seizures, and high fever. Severe baclofen withdrawal syndrome secondary to intentional overdose, however, has not received mention.

CASE REPORT

A 42-year-old male receiving chronic baclofen therapy, 20 mg/d, attempted suicide by ingesting at least 800 mg of baclofen. He was found in coma 2 hours postingestion with depressed respirations, areflexia, hypotonia, bradycardia, and hypotension. Treatment with intravenous fluids, atropine, dopamine, and hemodialysis was associated with restoration of consciousness within 2 days but disorientation, hallucinations, fever, delirium, hypotension, bradycardia, and coma developed during the following week. Baclofen withdrawal syndrome was not diagnosed until hospital day 9, when reinstitution of baclofen rapidly stabilized his condition. Oral overdosage of baclofen causes severe neurological and cardiovascular manifestations due to its GABA and dominant cholinergic effects. Severe baclofen withdrawal syndrome is manifest by neuropsychiatric manifestations and hemodynamic instability. Caution should be exercised after a baclofen overdose in patients receiving chronic baclofen therapy.

Chinese herbs as modulators of human mesangial cell proliferation: preliminary studies

In the hope of identifying agents of therapeutic value in immunoglobulin A nephropathy (IgA-N), we tested crude methanol extracts of 15 Chinese herbs for their effect on human mesangial cel proliferation in vitro. The results indicated that 7 out of the 15 crude extracts inhibited human mesangial cell proliferation activated by interleukin-1beta and interleukin-6. The extracts and their median inhibitory concentrations were as follows (in microg/ml): Selaginella tamariscina (MLS-032), 56.0 +/- 2.0; Ixeris chinensis (MLS-033), 62.7 +/- 1.7; Polygonum hypoleucum Ohwi (MLS-034), 25.0 +/- 1.5; Scutellaris rivularis (MLS-036), 39.6 +/- 1.1; Condonacanthus paucifiorus (MLS-042),63.6 +/- 2.6; Xanthium strumarium (MLS-043), 42.8 +/- 1.3; Daemonoropus margaritae (MLS-044), 56.1 +/- 1.9. These findings indicate that human mesangial cells were most sensitive to MLS-034 treatment. These herbs also decreased interleukin-1beta and tumor necrosis factor-alpha production. Moreover, TNF-alpha mRNA expression was inhibited by MLS-034. It is unlikely that cytotoxicity was involved, because no cell deaths were observable. We hypothesize that the inhibitory mechanisms of these Chinese herbs may be related to the impairments of gene expression and production of cytokines in human mesangial cells. Plans are underway for the isolation of pure compounds from these Chinese herbs and the elucidation of their mechanisms of action.

Characterization of the antiplatelet effects of (2S)-5-methoxy-6-methylflavan-7-ol from Draconis Resina

(2S)-5-methoxy-6-methylflavan-7-ol (MMF) was purified from Draconis Resina and its in vitro effects on various aspects of platelet reactivity were examined. Results indicated that MMF dose dependently inhibited aggregation of washed rabbit platelets induced by collagen, arachidonic acid, ADP, U46619 or platelet-activating factor (PAF), with IC50) values of 17.2, 49.8, 179.8, 109.6, and 189.2 microM, respectively. Concomitantly, MMF also dose dependently suppressed ATP release by platelets activated by these stimulants. The increase in intracellular free calcium ([Ca2+]i), elicited by these activating agents, was inhibited by MMF as reflected by fura-2 fluorescence measurements. However, MMF had no effects on the cyclic AMP level of platelets. In addition, MMF inhibited the arachidonic acid-induced thromboxane B2 and prostaglandin D2 formation in intact platelet suspensions or homogenized platelet lysates. This study provided evidence that MMF is an antiplatelet agent whose activity is likely related to cyclooxygenase inhibition and suppression of [Ca2+]i increase.

A tumor cell growth inhibitor from Polygonum hypoleucum Ohwi

Polygonum hypoleucum Ohwi (P. hypoleucum Ohwi) has been used as a Chinese medicine for a long time. In the present study, four anthraquinones, emodin, emodin 1-O-beta-D-glucoside (49A), physcion (62A), and physcion 1-O-beta-D-glucoside (50A) were identified from P. hypoleucum Ohwi and their inhibitory effects on various tumor cells proliferation were investigated. On a percentage basis, emodin had the highest suppressing activity on the various tumor cells proliferation. At 10 microg/ml, the percentage inhibition on K562 cells proliferation for emodin, 49A, 62A, and 50A were 97+/-3.4%, 18+7.3%, 24+/-3.6%, and 31+/-8.9%, respectively. However, inhibitory activities of 10 microg/ml of emodin, 49A, 62A, or 50A on Raji cells proliferation were 98+/-5.0%, 25+/-5.0%, 22+/-3.2%, and 28+/-4.3%, respectively. It was also found that the both C1 and C3 positions of emodin were important for antitumor action. The IC50s of emodin, 49A, 62A, and 50A on various tumor cells were also calculated. The IC50 of emodin on K562 cells was significantly lower than on Raji, HeLa, Calu-1, Wish, and Vero cells (1.5+/-0.2 vs. 2.8+/-0.4 microg/ml, P < 0.01 ;1.5+/-0.2 vs. 8.4+/-1.6 microg/ml; 1.5+/-0.2 vs. 8.9+/-1.0 microg/ml; 1.5+/-0.2 vs. 8.7+/-0.5 microg/ml; 1.5/-0.2 vs. 3.5+/-0.12 microg/ml; P < 0.001). The results indicated that K562 and Raji cells were more sensitive to emodin treatment. Cell viability test indicated that inhibitory effect of emodin on various tumor cell lines was not through direct cytotoxicity. It suggested P. hypoleucum Ohwi included a tumor cell growth inhibitor.

In vitro characterization of cocaine binding sites in human hair

In vitro studies were performed to characterize [3H]cocaine binding to dark and light ethnic hair types. In vitro binding to hair was selective, was reversible and increased linearly with increasing hair concentration. Scatchard analyses revealed high-affinity (6-112 nM) and low-affinity (906-4433 nM) binding in hair. Competition studies demonstrated that the potencies of 3beta-(4-bromophenyl)tropane-2beta-carboxylic acid methyl ester, and 5-(4-chlorophenyl)-2,5-dihydro-3H-imidazol[2,1-alpha]isoindole-5-ol and 2beta-carbomethoxy-3beta-(4-fluorophenyl)tropane were similar to or less than that of (-)-cocaine. The potency of (-)-cocaine was 10-fold greater than that of (+)-cocaine at inhibiting radioligand specific binding to hair. Multivariate analysis indicated that significantly greater nonspecific and specific radioligand binding occurred in dark hair than in light hair. Multivariate analysis also demonstrated a significant ethnicity x sex effect on specific and nonspecific binding to hair. Greater radioligand binding occurred in male Africoid hair than in female Africoid hair and in all Caucasoid hair types. Melanin was considered the most likely binding site for cocaine in hair. Typically, the concentration of melanin is much greater in dark than in light hair. Scatchard analysis indicated that dark hair had a 5- to 43-fold greater binding capacity than light hair. Differences in radioligand binding between hair types appeared to be due to differences in the density of binding sites formed by melanin in hair.

Glutathione S-transferase-rhodostomin fusion protein inhibits platelet aggregation and induces platelet shape change

Rhodostomin (RHO) from Agkistrodon rhodostoma venom, consisting of 68 amino acids with an arginine-glycine-aspartic acid (RGD) sequence and 12 cysteine residues, is a potent inhibitor of platelet aggregation. We previously demonstrated that cell culture plates coated with the bacterially produced fusion protein of glutathione S-transferase-RHO [GST-RHO(RGD)] can facilitate human hepatoma cell attachment via intergrin interaction within 15 min. In this study, we further characterized the effect of RHO fusion protein on platelet cells by creating two other related fusion proteins, GST-RHO(RGE) and GST-(PS)RHO. The former was a single amino acid-substituted mutant, in which the aspartic acid residue of RGD was replaced by glutamic acid, and the latter was an insertion mutant, in which a pentapeptide of protein kinase A phosphorylation site was inserted between GST and RHO. These two mutant proteins together with a wild-type of GST-RHO(RGD) and native form of RHO were used to study effects on the inhibition of ADP-induced platelet aggregation. Results indicated that GST-RHO(RGD) inhibited platelet aggregation as potently as the native RHO, while the two other mutants were inactive. Furthermore, when unactivated platelet cells attached on the GST-RHO(RGD)-coated plate, they became a flattened pancake shape. From the results of facilitation of cell attachment on fusion protein-coated plates, we concluded that: (1) the GST-RHO(RGD) fusion protein is equally functional in inhibition of platelet aggregation and facilitation of cell attachment, which is through the interaction of RGD and integrins on the cell membrane; (2) the GST-RHO(RGE) mutant protein is unable to bind with integrins and results in loss of function; (3) the insertion mutant of GST-(PS)RHO may disrupt a proper conformation of RHO and also results in loss of function; (4) the bacterially produced fusion protein GST-RHO(RGD) can be properly used as an antithrombotic agent and an extracellular matrix.

Antiplatelet flavonoids from seeds of Psoralea corylifolia

The MeOH extract of the seeds of Psoralea corylifolia L. was found to inhibit the aggregation of rabbit platelets induced by arachidonic acid, collagen, and platelet activating factor. Bioassay-directed fractionation led to the isolation of three flavonoids, isobavachalcone (1), neobavaiso-flavone (2), and bavachin (3). Compounds 1 and 2 inhibited platelet aggregation.

[The investigation of the immunomodulatory effect of san-hwang-sei-sin-tang]

San-Hwang-Sei-Sin-Tang is a famous ancient Kampo. In order to investigate the immunomodulatory effect of this Kampo, we can stimulate lymphocytes with PHA to study the lymphocyte transformation and IL-2 production as indicators of effect. In this study, we found that the extract of San-Hwang-Sei-Sin-Tang at the concentration of 0.1 mg/ml and 1 mg/ml could effectively inhibit the index of lymphocyte transformation. San-Hwang-Sei-Sin-Tang at the concentration of 0.01 mg/ml, 0.1 mg/ml and 1 mg/ml also have the tendency of inhibition of IL-2 production. In the future, San-Hwang-Sei-Sin-Tang may be developed as an effective immunosuppressant.

Cordyceps sinensis as an immunomodulatory agent

Effects of various fractions of methanol extracts from fruiting bodies of Cordyceps sinensis on the lymphoproliferative response, natural killer (NK) cell activity, and phytohemagglutinin (PHA) stimulated interleukin-2 (IL-2) and tumor necrosis factor-alpha (TNF-alpha) production on human mononuclear cells (HMNC) were studied. Two of the 15 column fractions (CS-36-39 and CS-48-51) significantly inhibited the blastogenesis response (IC50 = 71.0 +/- 3.0 and 21.7 +/- 2.0 micrograms/ml, respectively), NK cell activity (IC50 = 25.0 +/- 2.5 and 12.9 +/- 5.8 micrograms/ml, respectively) and IL-2 production of HMNC stimulated by PHA (IC50 = 9.6 +/- 2.3 and 5.5 +/- 1.6 micrograms/ml, respectively). TNF-alpha production in HMNC cultures was also blocked by CS-36-39 and CS-48-51 (IC50 = 2.7 +/- 1.0 and 12.5 +/- 3.8 micrograms/ml, respectively). These results indicated that neither CS-36-39 nor CS-48-51 was cytotoxic on HMNC, and that immunosuppressive ingredients are contained in Cordyceps sinensis.

HLA-DPB1 polymorphism in patients with rheumatoid arthritis in Taiwan

OBJECTIVE

To investigate the role of HLA-DP alleles in the pathogenesis of rheumatoid arthritis (RA).

METHODS

HLA-DPB1 alleles were studied in 144 patients with RA and 144 healthy controls using the polymerase chain reaction/sequence specific oligonucleotide probe method.

RESULTS

HLA-DPB1*0510 was the the most common allele in patients with RA and healthy controls in Taiwan. There was no significant difference in frequencies of HLA-DPB1 alleles between patients and controls. The HLA-DPB1 alleles were not associated with seropositivity for rheumatoid factor, extraarticular involvement, or bone erosion in patients. There was also no significant difference in frequencies of HLA-DPB1 alleles among DR4-positive and DR4-negative patients and controls.

CONCLUSION

There was no significant difference in the prevalences of HLA-DPB1 alleles between Taiwanese patients with RA and healthy controls. HLA-DPB1 alleles were not related to the clinical manifestations of patients with RA in Taiwan.

HLA-DRB1 genotyping in patients with rheumatoid arthritis in Taiwan

OBJECTIVE

To investigate the relation of HLA-DR alleles to the development of rheumatoid arthritis (RA) and the correlations between HLA-DR alleles and clinical manifestations of patients with RA in Taiwan.

METHODS

The HLA-DRB1 alleles were studied in 144 patients with RA and 154 healthy controls using polymerase chain reaction/sequence specific oligonucleotide probe methods. The subtypes of HLA-DR4 were detected by cloning sequencing.

RESULTS

The prevalence of HLA-DR4 was significantly higher in patients with RA (46.53%) than in healthy controls (25.97%). HLA-DRB1*0405 was more common in patients than in controls (83.58 vs 50%), while the prevalence of DRB1*0403 in patients (4.48%) was significantly lower than in controls (27.5%). There was no significant difference in frequencies of HLA-DR alleles between DRB1*0405 negative patients and DRB1*0.05 negative controls. We also noted a positive correlation in patients between HLA-DR4 and bone erosion, but not HLA-DR4 and age of onset, seropositivity, or extraarticular involvement. There was no significant difference in seropositivity, extraarticular involvement, and bone erosion between homozygous and heterozygous DR4 patients.

CONCLUSION

HLA-DRB1*0405 is related to the development of RA in Taiwan, while DRB1*0403 was a negative risk factor. HLA-DR4 was associated with bone erosion in patients.

Aspirin inhibits collagen-induced platelet serotonin release, as measured by microbore high-performance liquid chromatography with electrochemical detection

A sensitive microbore high-performance liquid chromatographic method with electrochemical detection has been developed for the measurement of small quantities of serotonin (5-hydroxytryptamine; 5-HT) and its metabolite 5-hydroxyindoleacetic acid (5-HIAA) in rabbit platelets. The limit of detection of 5-HT is 0.1 ng/ml. To evaluate the 5-HT release from platelet suspension, the aggregating agent collagen was added at concentrations of 10, 30 and 100 micrograms/ml and the 5-HT concentrations rose from the base level (11.80 +/- 0.42 ng/ml) to 123.97 +/- 11.02, 361.96 +/- 17.90 and 470.45 +/- 35.46 ng/ml, respectively. Further results demonstrated that aspirin inhibits collagen-induced 5-HT release from platelet suspension significantly.

An outbreak of tetrodotoxin poisoning following gastropod mollusc consumption

Tetrodotoxin, a violent neurotoxin, is present in puffer fish and may occur in a variety of marine animals. Outbreaks of human tetrodotoxin poisoning, following consumption of marine organisms other than puffer fish, has been rare. We here report an outbreak of tetrodotoxin poisoning following ingestion of gastropod molluscs and its clinical features are discussed. A 71-year-old woman was admitted with hypertension and other neurological symptoms developing after ingestion of some molluscs. A further 16 cases were also found to have typical symptoms of tetrodotoxication after mollusc consumption. Clinical features in these 17 cases were similar to those conventionally found in tetrodotoxin poisoning, except that there was hypertension in eight cases (47%). All except one case had mild poisoning and recovered well. The molluscs consumed comprised two different species: Nassarius castus and Nassarius conoidalis, both of which were shown to contain various amounts of tetrodotoxin. It is concluded that tetrodotoxin poisoning following mollusc consumption is a possibility. Hypertension, as an unusual feature in tetrodotoxication, is frequent in this outbreak, and should be looked for in future cases. The explanation of hypertension in tetrodotoxication may come either from an exaggerated response to sympathetic stimuli, or due to various responses of the vasomotor centre to a small dose of tetrodotoxin. Further studies are required to answer this question.

Severe rhabdomyolysis mimicking transverse myelitis in a heroin addict

Heroin addiction is known to cause various medical and neurological complications. We report here a case of rhabdomyolysis following heroin abuse, in which a neurological lesion mimicking transverse myelitis was also noted. A 29-year-old man was found comatose in a kneeling position one day after a heroin overdose. On admission, he was awake, yet with total paralysis of his lower legs. Physical examination revealed marked swelling and tenderness of the four limbs, especially the lower extremities. Deep tendon reflexes and positional sense were absent in both legs; however, pin-prick sense was preserved. Transverse myelitis or spinal cord vasculitis was the initial working diagnosis. Laboratory tests disclosed significantly elevated creatinine kinase of 146289 U/L. Though suffering transient acute renal failure, his neurological abnormalities gradually improved over four weeks and a left foot drop was the only residual lesion at discharge. Rhabdomyolysis, a well defined complication following heroin use, may also cause concomitant neurological symptoms, for which careful differential diagnosis is warranted. With the increasing number of heroin addicts in Taiwan, more cases with rhabdomyolysis-induced neurological symptoms may be observed in the future.

Malignant pheochromocytoma associated with Jaccoud's-type arthropathy, Raynaud's phenomenon, positive antinuclear antibody and rheumatoid factor

We describe a patient with malignant pheochromocytoma who developed Jaccoud's-type arthropathy and Raynaud's phenomenon as initial manifestations of malignant pheochromocytoma. Serologic findings included positive antinuclear antibody (ANA) and rheumatoid factor (RF) was also found in this patient. To our knowledge, this is the first time Jaccoud's-type arthropathy with positive ANA and RF has been reported as rheumatic manifestations of pheochromocytoma.

Rheumatoid factor in hepatitis B virus surface antigen positive patients

Rheumatoid factor (RF) is often found in the sera of patients with nonrheumatic diseases in comparison with normal individuals. We collected 95 healthy HBs antigen positive adults and 98 healthy HBs antigen negative adults. RF was present in 14.74% (14/95) of the HBs antigen positive group while it was present in 3.06% (3/98) of the HBs antigen negative group (p < 0.05). RF was positive in 15.38% (2/13) of the HBe antigen positive patients whereas it was positive in 14.63% (12/82) of the HBe antigen negative patients (p > 0.05). RF was found positive in 16.90% (12/71) of the anti-HBe antibody positive group while it was positive in 8.33% (2/24) of the anti-HBe antibody negative group (p > 0.05). We conclude that the positive rate of RF in HBs antigen positive patients is significantly higher than in that of HBs antigen negative patients. The incidence of RF positivity of the HBe antigen positive group is not higher than that of the HBe antigen negative group. The positive rate of RF in anti-HBe antibody positive group has a tendency to be higher than in that of their negative counterparts though there was no significant difference between them.

Growth inhibitors against tumor cells in Cordyceps sinensis other than cordycepin and polysaccharides

Cordyceps sinensis is a parasitic fungus that has been used as a Chinese medicine for a long time. In the present study, inhibitory effects of crude methanolic extracts of C. sinensis fruiting bodies on various tumor cell lines were demonstrated. The crude methanolic extracts were fractionated into 15 fractions by silica gel column chromatography. Two of the 15 fractions (CS-36-39 and CS-48-51) significantly inhibited the growth of K562, Vero, Wish, Calu-1, and Raji tumor cell lines. The inhibitory activities were not due to the polysaccharides, which have been removed in the extracting process. The polarities of these two fractions indicated that they were different from that of cordycepin. Therefore, it is suggested that tumor cell growth inhibitors, other than cordycepin and polysaccharides, are contained in C. sinensis.

Prevalence of familial systemic lupus erythematosus in Taiwan

A survey of familial occurrence of systemic lupus erythematosus (SLE) was conducted among 728 first-degree relatives of 102 SLE patients. All of the patients were from the rheumatology ward or outpatient clinic of Kaohsiung Medical College. Ten familial members (9.80%) in the 102 patients with SLE suffered from the same disease. Among them, one (20%) was from the 5 male patient families and 9 (9.28%) were from the 97 female patient families. The overall prevalence of SLE in first-degree relatives of SLE patients was 1.37% (10/728).