Osseous choristoma of oral cavity--report of two cases and review of the literature

Osseous choristoma of the oral cavity is an extremely rare lesion. Two cases of osseous choristomas of oral cavity, representing two different natures of such lesions are reported. One was situated on the dorsal surface of posterior tongue just anterior to the circumvallate papillae and the other on the right buccal mucosa just below the orifice of the Stensen's duct. To date, about 73 cases of oral osseous choristoma have been reported in the literature including the two present cases, of which, 61 and 8 cases occurred in the tongue and buccal mucosa, respectively. The clinical and microscopic characteristics, and their common sites of these peculiar lesions are presented. The origin and pathogenesis of the lesion are discussed and the literature on the subject is reviewed.

A retrospective study of oral and maxillofacial biopsy lesions in a pediatric population from southern Taiwan

This is a retrospective study of biopsied oral lesions (N = 534) in a pediatric population (0-15 years old) in southern Taiwan. In this study, we included 6% of the 9672 biopsies performed from 1985 through 1996. The lesions were divided into three groups according to patients' ages, 0-5 years old; 6-10 years old; and 11-15 years old The majority of the samples were from the oldest age group (273/518). With the exclusion of normal tissues (N = 26), 518 samples were classified into four categories: inflammatory lesions, cystic lesions, tumor or tumor-like lesions, and other lesions. The largest number of lesions occurred in the inflammatory lesion group (46%). The 12 most frequently occurring lesions contributed about 78% of all the biopsies in the three age groups (0-15 years old). Frequencies of the lesions of mucous extravasation phenomenon, dentigerous cyst, fibrous dysplasia, and odontonia in our three pediatric age groups showed a significant proportion in the biopsies of the same lesions in the group of patients of all ages. These information may be valuable for both epidemiology and teaching.

Harlequin ichthyosis: report of one case

Harlequin ichthyosis, or harlequin fetus, is a relatively rare, severe form of congenital ichthyosis. Although the clinical features have been well described, very little is known about the pathogenesis, clinical course, appropriate treatment and prognosis of harlequin ichthyosis because most of these babies with harlequin ichthyosis die within a few weeks of life. We herein report a case of harlequin ichthyosis, which we believe is the first such case in Taiwan.

Radiotherapy in the treatment of duodenal bleeding due to hepatocellular carcinoma invasion

Haemorrhage from an hepatocellular carcinoma (HCC) directly invading the gastrointestinal (GI) tract is uncommon. A 58-year-old man was admitted with upper gastrointestinal (UGI) bleeding and panendoscopy on examination revealed a large duodenal ulcerative bleeding mass. The mass was eventually diagnosed as HCC by pathological examination. The bleeding failed to respond to conventional management of haemostasis, but resolved with an external beam of radiotherapy with a total dose of 6000 cGy over a 5 week period. This unusual presentation of UGI bleeding, due to HCC invading the duodenum and treated by radiotherapy, has not been previously reported.

Thyroid dysfunction and nodular goiter in hemodialysis and peritoneal dialysis patients

OBJECTIVE

To investigate the prevalence of nodular goiter and thyroid dysfunction in uremic patients undergoing hemodialysis (HD) and peritoneal dialysis.

DESIGN

Cross-sectional study.

SETTING

Single dialysis unit and outpatient clinic.

PATIENTS

The study included 221 patients [143 HD and 78 continuous ambulatory peritoneal dialysis (CAPD) patients] along with 135 consecutively selected outpatients as controls.

MAIN OUTCOME MEASURES

Ultrasonography was used to detect patients' thyroid function and nodular goiter.

RESULTS

Nodular goiter was detected in 54.8% of the uremic patients and in 21.5% of the controls. Uremic patients had higher prevalence of thyroid dysfunction, which included reduced serum concentration of total T3, total T4, and free T4, and increased serum level of TSH. Hypothyroidism was also observed more frequently in uremic patients than in the control group (5.4% vs 0.7%, p < 0.05). Nodular goiter was more frequently found in females than in males (63.5% vs 48%, p < 0.05). Moreover, the prevalence of nodular goiter increased with age (p < 0.02) in uremic patients. Hemodialysis patients had a higher frequency of reduced total T3 level (46.9% vs 29.5%, p < 0.02). However, CAPD patients had lower T4 levels (6.23+/-1.82 microg/dL vs 7.15+/-1.99 microg/dL, p < 0.05).

CONCLUSION

Because of the high incidence of hypothyroidism and nodular goiter in uremic patients, screening of thyroid function and goiter detection with ultrasound should be considered in evaluation of end-stage renal disease patients.

Placenta previa percreta involving the left broad ligament and cervix. A case report

BACKGROUND

Placenta previa percreta with invasion of the broad ligament and uterine cervix is an extremely rare condition and carries high maternal and fetal morbidity and mortality.

CASE

A 39-year-old, multiparous woman with two previous cesarean sections presented in active labor at term with placenta previa percreta involving the left broad ligament and cervix. The patient was managed by antepartum diagnosis of placenta previa accreta, supracervical hysterectomy, and blood transfusion.

CONCLUSION

This case was managed consistent with the literature, and favorable maternal and fetal outcomes were achieved.

Toxic effects of Erycibe obtusifolia, a Chinese medicinal herb, in mice

Extract of stem of Erycibe obtusifolia (EO) at doses of 10, 20 and 30 mg/kg was experimentally tested through oral and intraperitoneal administration. Toxic effects of EO were assessed through functional changes of the liver and kidneys. Mice died immediately following the i.p. injection at the dose of 10 mg/kg. However, no death occurred after the oral administration at the dose of 10, 20 or 30 mg/kg under close observations for at least 2 weeks. Changes of several functional parameters in both the liver and kidney appeared simultaneously after the oral administration. Although the higher dose increased the levels of serum glutamate-oxalate-transaminase (sGOT), serum glutamate-pyruvate-transaminase (sGPT), and blood urea nitrogen (BUN), and decreased the levels of hematocrit at 6 h after the treatment, no distinct dose-dependent relationship existed between the administered doses and the changes in functional parameters observed.

A unified multimedia database system to support telemedicine

A unified approach to managing multimedia medical databases in a telemedicine system is proposed. In order to manage, search, and display patient information more efficiently, we define a patient information package (PIP) as a concise data set of a patient's medical information from each visit. By means of PIP's, both patient-oriented and problem-oriented query strategies, which are most frequently used in daily clinical practice and medical education, can be accommodated. We also provide a unified methodology for accessing various types of patient medical records as well as design two types of user interfaces, high-quality data display and web-based interface, for different medical service purposes. The PIP-based management of databases has been successfully implemented between the National Taiwan University (NTUH), Taipei, and the Chinshan health care center, Chinshan, Taiwan, for teleconsultation, telediagnosis, and tele-education.

Pancreaticobiliary diseases associated with anomalous pancreaticobiliary ductal union

BACKGROUND

Anomalous pancreaticobiliary ductal union (APBDU) is associated with different pancreaticobiliary diseases. The aim of this study is to clarify the frequency with which it occurs and its several subtypes in various pancreaticobiliary diseases.

METHODS

Radiograms of 1752 subjects who underwent endoscopic retrograde cholangiopancreatography were reviewed independently by two endoscopists. APBDU was diagnosed using recently accepted criteria and divided into B-P and P-B subtypes according to the insertion of biliary and pancreatic ducts.

RESULTS

Fifty-nine (8.7%) of 680 subjects with clearly visualized pancreaticobiliary radiograms had APBDU. APBDU was present in 93.8% of patients (15 of 16) with choledochal cyst, 62.5% (5 of 8) with gallbladder cancer, 33.3% (9 of 27) with common bile duct cancer, 50.0% (6 of 12) with gallbladder adenomyomatosis, 13.2% (7 of 53) with biliary pancreatitis, 3.4% (10 of 293) with cholelithiasis, 2.2% (2 of 89) with non-biliary pancreatitis, 2.1% (1 of 47) with hilar cholangiocarcinoma, 1.9% (1 of 54) with pancreatic cancer, and 10.2% (9 of 88) with other miscellaneous disorders. There were 25 patients (42.4%) with the B-P type and 34 patients (57.6%) with the P-B type of APBDU. Patients with choledochal cyst frequently had the B-P type, whereas gallbladder cancer, adenomyomatosis, or biliary pancreatitis frequently coexisted with the P-B type.

CONCLUSION

APBDU is relatively common in patients undergoing endoscopic retrograde cholangiopancreatography at our center. There are a variety of pancreaticobiliary diseases that are associated with APBDU. Its role in these conditions is uncertain and needs to be further delineated.

Effect of forskolin on endothelin-induced phosphoinositide hydrolysis and calcium mobilization in cultured canine tracheal smooth muscle cells

1. The effects of increase in intracellular adenosine 3':5'-cyclic monophosphate (cAMP) on endothelin-1 (ET-1)-induced generation of inositol phosphates (IPs) and increase in intracellular Ca2+ ([Ca2+]i) were investigated in canine cultured tracheal smooth muscle cells (TSMCs). 2. Pretreatment of TSMCs with either cholera toxin (CTX; 10 microg ml(-1), 4 h), forskolin (10 microM, 30 min), or dibutyryl cAMP (1 mM, 30 min) inhibited ET-1-stimulated Ca2+ mobilization (by 23 +/- 5%, n = 8) and IPs accumulation (by 32 +/- 6%, n = 4). While after treatment with forskolin for 24 h, the cells retained the ability to respond to ET-1-induced Ca2+ mobilization to the same extent as the control group. 3. Forskolin (1-100 microM) inhibited the ET-1-induced increase in [Ca2+]i, but the lower concentrations had little effect on this response. The inhibitory effects of these agents produced both depression of the maximal response and a shift to the right of the concentration-response curve of ET-1 without changing the -logEC50 values. 4. The water-soluble forskolin analogue L-858051, 7-deacetyl-7beta-(gamma-N-methylpiperazino)-butyryl forskolin, significantly inhibited ET-1-stimulated IPs accumulation. In contrast, the addition of 1,9-dideoxy forskolin, an inactive analogue of forskolin, had little effect on stimulated responses. Moreover, SQ-22536, 9-(tetrahydro-2-furanyl)-9H-purin-6-amine, an inhibitor of adenylate cyclase, and both H-89, N-(2-aminoethyl)-5-isoquinolinesulfonamide, and HA-1004, N-(2-guanidinoethyl)-5-isoquinolinesulfonamide, inhibitors of cAMP-dependent protein kinase (PKA), attenuated the ability of forskolin to inhibit ET-1-induced IPs accumulation. These results suggest that activation of cAMP/PKA was involved in these inhibitory effects of forskolin. 5. The locus of this inhibition of forskolin treatment on AlF4(-)-stimulated IPs accumulation was investigated in canine TSMCs. The AlF4(-)-induced IPs accumulation was inhibited by forskolin, supporting that G protein(s) are directly activated by AlF4- and uncoupled to phospholipase C by forskolin treatment. 6. We conclude that cAMP elevating agents inhibit ET-1-stimulated generation of IPs and Ca2+ mobilization in canine cultured TSMCs. Since generation of IPs and increases in [Ca2+]i are very early events in the activation of ET-1 receptors, attenuation of these events by cAMP elevating agents might well contribute to the inhibitory effect of cAMP on tracheal smooth muscle function.

Surveys of HIV-1, HTLV-I, and other sexually transmitted diseases in female sex workers in Taipei City, Taiwan, from 1993 to 1996

Between 1993 and 1996 in Taipei, Taiwan, we studied the prevalences of HIV-1, HTLV-I, HSV-2, Chlamydia trachomatis, and syphilis infection in female commercial sex workers (CSW) and the pathogens' associated risk factors. Female CSW from nine massage parlors, two karaoke bars (KB), and 22 brothels in Taipei city participated in this study. Two of 557 (0.4%) KB CSWs from those who participated during the period from 1993 to 1994 had HIV-1 infection, whereas no KB CSWs in the periods 1994 to 1995 or 1995 to 1996 had HIV-1 infection. None of the 725 MP CSWs or 291 brothel CSWs who participated in the study between 1993 and 1996 had HIV-1 infection. In contrast, CSWs from brothels had elevated rates of both HTLV-I and active chlamydia infections compared with KB and MP CSWs (p < .05 and p < .005, respectively). KB CSWs showed an elevated rate of HSV-2 infection in the years 1993 and 1994 when compared with CSWs employed by brothels and MPs (p < .005). The prevalence rates of syphilis for CSWs from brothels dropped from 42.8% in the year 1993 to 1994 to 26.3% in the 1995 to 1996 period, whereas for KB and MP CSWs, the rates were < 6% in each of year studied.

Antioxidant and hepatoprotective activity of punicalagin and punicalin on carbon tetrachloride-induced liver damage in rats

Punicalagin and punicalin, isolated from the leaves of Terminalia catappa L., are used to treat dermatitis and hepatitis. Both compounds have strong antioxidative activity. The antihepatotoxic activity of punicalagin and punicalin on carbon tetrachloride (CCl4)-induced toxicity in the rat liver was evaluated. Levels of serum glutamate-oxalate-transaminase and glutamate-pyruvate-trans-aminase were increased by administration of CCl4 and reduced by drug treatment. Histological changes around the liver central vein and oxidation damage induced by CCl4 also benefited from drug treatment. The results show that both punicalagin and punicalin have anti-hepatotoxic activity but that the larger dose of punicalin induced liver damage. Thus even if tannins have strong antioxidant activity at very small doses, treatment with a larger dose will induce cell damage.

Thoracoscopic T2-sympathetic block by clipping--a better and reversible operation for treatment of hyperhidrosis palmaris: experience with 326 cases

Although thoracoscopic sympathectomy or sympathicotomy is the best treatment for hyperhidrosis palmaris, a new approach of clipping only without transection of T2-sympathetic trunk is just as effective. Aside from the guaranteed cure of hyperhidrosis, this new method has fewer complications and has the advantage of recovery of the sympathetic tone in the hands if the procedure is reversed by the removal of the clips. Between March 18 and September 30 of 1996, 326 patients (190 female and 136 male with a mean age of 20.5 years) underwent thoracoscopic T2-sympathetic block by clipping to treat hyperhidrosis. Good results and few complications were noted during follow up six months to one year postoperatively. Five of the 326 patients, all female, had the operation reversed because of intolerable compensatory sweating. Three recovered from the compensatory sweating within two months and had less palmar sweating than before their sympathetic block; the fourth achieved relief of compensatory sweating after nine months, and the fifth reported no improvement.

The haemodynamic effect of thoracoscopic cardiac sympathectomy

A patient with angina pectoris who had been successfully treated by thoracoscopic cardiac sympathectomy was scheduled to have scalp debridement under general anaesthesia for a scald burn. There were haemodynamic changes during and after the operation including anaesthetic induction, endotracheal intubation, maintenance, and early recovery period. The sympathetic denervated heart showed little chronotropic response to anaesthetic and surgical stimulation. On the contrary, the parasympathetic response was predominant. An episode of severe bradycardia occurred during endotracheal suctioning prior to extubation. The haemodynamic response to cardiac sympathetic denervation corresponded to the efferent effect of beta-receptor blockade

Osteoma of the mandibular coronoid process. Report of a case

A case of osteoma of the coronoid process in a 51-year-old woman is presented. Surgical resection, followed by postoperative physiotherapy to stimulate normal function, is the treatment of choice for this lesion.

Integrated medical informatics with small group teaching in medical education

National Taiwan University College of Medicine (NTUCM) introduced small groups of teaching and basic-clinical integrated courses for medical students in 1992. By using computer network and multimedia techniques, this study tried to overcome barriers to learning in small group teaching. The Department of Medical Informatics of NTUCM established campus networking and computer classrooms and provided Internet and intranet network services including mail, netnews, bulletin board systems (BBS), world wide web (WWW), gopher, ftp and local file servers. To implement an interactive learning environment, the authors first tried mail lists, newsgroups and BBS. Next an integrated learning system prototype on the WWW was developed to provide functions including online syllabus, discussion boards simulated to BBS, online talk, interactive case studies, virtual classroom with video on demand (VOD) and Internet medical resources. The results showed that after the medical students completed the required course of medical informatics and had good network access using a network to communicate with each other became a daily practice. In the future, the system will extend to the tutoring of clinical practice and continuing medical education. The authors expect a national medical education network and more international cooperation and exchange.

Fetal congenital malformations. Biophysical profile evaluation

OBJECTIVE

To study the association between various fetal congenital malformations and the biophysical profile (BPP), we tested the following hypotheses: (1) a specific organ system malformation is associated with the absence of one or more BPP parameters, and (2) four BPP parameters are not affected by the advancement of fetal maturation.

STUDY DESIGN

From 1985 to 1995, 316 fetuses with congenital malformations and 351 controls were identified in a high-risk population undergoing ultrasound examinations of anatomic structures and biophysical profile evaluations. For investigation of the influence of fetal maturity on biophysical profile evaluations, both the malformed fetuses and the controls were stratified into two gestational-age groups, 26-34 weeks and > 34 completed weeks. Four parameters of the BPP, including (1) fetal breathing, (2) gross fetal movements, (3) fetal muscle tone, and (4) quantitative amniotic fluid volume, were divided into low (0-6) and high (8) total score subgroups. Tests of significance were done using chi 2 analysis, Student's t test or Fisher's exact test, as appropriate. Level of significance was set at P < .05.

RESULTS

When comparing malformed fetuses to controls, the malformed group had a statistically significantly higher percentage of low BPP scores due to absent fluid, tone or breathing. Fetuses with a musculoskeletal anomaly were statistically significantly more likely to lose points for fetal movement (P < .02); fetuses with a genitourinary system anomaly lost points for fluid (P < .001), tone (P < .005) and breathing (P < .005); fetuses with a central nervous system anomaly lost points for tone (P < .02) and breathing (P < .001); and fetuses with a thoracic anomaly lost points for breathing (P < .002). There was no statistically significant difference in BPP scores between fetuses at 26-34 weeks' gestational age and fetuses > 34 completed weeks' gestational age.

CONCLUSION

The two hypotheses were confirmed by the study results.

Raffinee, a free radical scavenger, in the treatment of subacute stage brain and spinal cord lesions: a case report

This report presents the effects of the natural antioxidant formulation "Raffinee" in treatment of a case with subacute cerebellar hemorrhage and a case with subacute incomplete cervical cord injury. Four days after onset of cerebellar hemorrhage, the regimen started and ameliorated severe headache and dizziness within 3 days. Forty-five days after incomplete spinal cord injury with marked edema of cervical cord, the regimen started. Excellent motor and sensory function recovery were obtained within one month with remission of cord edema. The dosage of "Raffinee" is equivalent to 2,280,000 units of superoxide radical scavenging activity and 47,000 units of hydroxyl radical scavenging activity. Based on the secondary injury theory, superoxide and hydroxyl radical scavengers may have a valuable use in subacute central nervous system (CNS) lesions. Further larger scale of randomized, placebo-controlled, double-blind clinical trials are indicated to verify the effect of "Raffinee" on subacute CNS lesions.

Palatal pleomorphic adenoma in a child with osteoid formation: report of case

This paper reports a case of palatal pleomorphic adenoma in a Chinese child. The rare histologic feature of osteoid tissues is also presented.

Pancreas divisum coexistent with gallbladder carcinoma--report of a Chinese patient

The coexistence of pancreas divisum and gallbladder carcinoma is uncommon and, to the best of our knowledge, has never been reported in English literatures. We have encountered a 62-year-old patient with symptom of intermittent right upper quadrant abdominal pain. Abdominal ultrasonography and computed tomography showed a gallbladder tumor. Endoscopic retrograde cholangiopancreatography revealed existence of complete pancreas divisum but no anomalous union of pancreaticobiliary duct. He underwent cholecystectomy and histologic analysis revealed tubulovillous adenoma with focal malignant change in the gallbladder.

Enhancing management of cancer pain: contribution of the internal working model

The purpose of this article is to organize the current knowledge regarding patient-related factors that can have an impact on cancer pain management by using the construct of the internal working model: a theoretical framework for integrating current knowledge and interpreting and predicting factors related to the management of cancer pain. These factors include patients' beliefs and misconceptions about cancer pain and pain treatment, meanings that patients ascribe to their pain, their expectations about pain relief, and communication between patients and clinicians about pain control. The construct of the internal working model predicts and explains factors related to pain control and provides implications for practice. It has potential utility in enhancing the quality of cancer pain management.

Inhibitors of farnesyl protein transferase. 4-Amido, 4-carbamoyl, and 4-carboxamido derivatives of 1-(8-chloro-6,11-dihydro-5H-benzo[5,6]- cyclohepta[1,2-b]pyridin-11-yl)piperazine and 1-(3-bromo-8-chloro-6,11- dihydro-5H-benzo[5,6]cyclohepta[1,2-b]pyridin-11-yl)piperazine

The synthesis of a variety of novel 4-amido, 4-carbamoyl and 4-carboxamido derivatives of 1-(8-chloro-6,11-dihydro-5H-benzo[5,6]cyclohepta[1,2-b]pyridin-11-yl) piperazine to explore the SAR of this series of FPT inhibitors is described. This resulted in the synthesis of the 4- and 3-pyridylacetyl analogues 45a and 50a, respectively, both of which were orally active but were found to be rapidly metabolized in vivo. Identification of the principal metabolites led to the synthesis of a variety of new compounds that would be less readily metabolized, the most interesting of which were the 3- and 4-pyridylacetyl N-oxides 80a and 83a. Novel replacements for the pyridylacetyl moiety were also sought, and this resulted in the discovery of the 4-N-methyl and 4-N-carboxamidopiperidinylacetyl derivatives 135a and 160a, respectively. All of these derivatives exhibited greatly improved pharmacokinetics. The synthesis of the corresponding 3-bromo analogues resulted in the discovery of the 4-pyridylacetyl N-oxides 83b (+/-) and 85b [11S(-)] and the 4-carboxamidopiperidinylacetamido derivative 160b (+/-), all of which exhibited potent FPT inhibition in vitro. All three showed excellent oral bioavailability in vivo in nude mice and cynomolgus monkeys and exhibited excellent antitumor efficacy against a series of tumor cell lines when dosed orally in nude mice.

Substance use disorders among inpatients with bipolar disorder and major depressive disorder in a general hospital

The prevalence and type of substance abuse and dependence were determined for 49 patients with mood disorders on a general hospital psychiatric unit. A standardized diagnostic interview was conducted with a high value of inter-rater reliability. This study found that 18.4% of mood disorder inpatients met the diagnostic criteria for psychoactive substance use disorders by DSM-III-R. Sedatives-hypnotics-anxiolytics was the most common substance use disorder (10.2%), followed by alcohol (6.1%). Patients with major depression had a higher rate of comorbidity with substance use disorders than did the bipolar disorder patients (p = 0.011). The prevalence of sedatives-hypnotics-anxiolytics use disorder among major depression patients was 35.7%, which was higher than that among bipolar disorder patients (0%). Male patients had a significantly higher percentage of substance use disorders than did female patients (p = 0.054). Seventy-seven percent of the patients with a dual diagnosis of mood and substance use disorder were not diagnosed as having substance use disorders by psychiatrists in charge.

Defining the anatomy of the Rangifer tarandus sex chromosomes

A comprehensive cytogenetic characterization of the unusally large reindeer (Rangifer tarandus) sex chromosomes is presented for the purpose of studying the evolution of these atypical gonosomes. Sex chromosome idiograms were constructed from G-banded and C-banded chromosomes to illustrate the relative amounts and locations of euchromatin and heterochromatin. Hybridization with a Mazama gouazoubira X whole-chromosome paint revealed that essentially all reindeer X-linked euchromatin and most reindeer Y-linked euchromatin is conserved interspecifically. Subsequently, painting probes were generated from flow-sorted reindeer X chromosomes, flow-sorted reindeer Y chromosomes, and from microdissections of specific gonosomal regions to establish specific segment-to-segment homologies between these gonosomes. In particular, one microdissection-generated paint demonstrated that certain constituent repetitive DNAs, found in C-band region Xq31, were also present in essentially all heterochromatin blocks of the Y chromosome. Microdissection-generated paints from other X-linked heterochromatin blocks revealed the presence of DNA sequences that lacked homologous sequences on the Y chromosomes and were more specific for their region of origin. These characteristics of the reindeer sex chromosomes are consistent with the notion that mammalian sex chromosomes were derived from homologous progenitor chromosome pairs and provide insights into the evolution of these atypical mammalian gonosomes.