Accessory atrioventricular pathways and atrioventricular nodal reentrant tachycardia in teenagers. Electrophysiologic characteristics and radiofrequency catheter ablation

Accessory pathway-mediated tachyarrhythmias and AV nodal reentrant tachycardia represent a large portion of supraventricular tachycardia in younger patients. Reports comparing electrophysiologic characteristics and results of radiofrequency ablation between teenagers and adults from the same electrophysiology laboratory are rare, and these deserve further study. This study included 49 teenage patients (mean age 17 +/- 3 years, range from 10 to 20) and 1008 adult patients (mean age 50 +/- 13 years, range from 21 to 92) referred for electrophysiologic study and radiofrequency ablation for treatment of accessory pathway-mediated and AV nodal reentrant tachycardia. The results showed that: (1) mean duration of tachyarrhythmia was shorter in teenagers, but incidences of syncope, cardioversion for hemodynamic compromise and associated cardiovascular diseases were similar in both groups; (2) teenagers had a higher incidence of right-sided free wall accessory pathways (34.1% vs 14.9%, p = 0.048) and better conduction properties of accessory pathways and AV nodal pathways; (3) fast-slow and multiple forms of AV nodal reentrant tachycardia were significantly less frequent (p = 0.026) in teenagers, whereas atrial fibrillation with ventricular preexcitation was common in adults; (4) success rate, incidence of recurrent tachycardia, total procedure time, radiation exposure time and number of radiofrequency pulses for successful ablation did not differ significantly between teenagers and adults.

IN CONCLUSION

(1) different electrophysiologic characteristics were found between teenagers and adults; and (2) radiofrequency ablation was effective and safe in teenagers with paroxysmal supraventricular tachycardia.

Stable microbubble test for predicting the occurrence of respiratory distress syndrome

To predict the development of respiratory distress syndrome (RDS) in premature neonates who might benefit from early administration of surfactant, the clinical applicability of stable microbubble (SM) test was prospectively evaluated. Fifty-nine preterm neonates with the gestational ages of less than 37 weeks were studied. SM test was performed on gastric aspirates obtained within 30 minutes after birth. The number of microbubbles was correlated with later development of RDS. With a cut-off value of less than 10 microbubbles/mm2, the SM test showed a positive predictive value of 76.0% (19/25) and a negative predictive value of 97.1% (33/34), while sensitivity and specificity were 95.0% (19/20) and 84.6% (33/39), respectively. The overall accuracy was 88.1% (52/59). It was concluded that use of the SM test on gastric aspirates immediately after birth is a rapid, simple and reliable procedure for identifying those neonates with surfactant deficiency who may benefit from prophylactic surfactant therapy.

Effects of fluid retention on the measurement of body composition using bioelectric impedance

Body composition measurements using bioelectrical impedance analysis (BIA) were performed on 50 uremic patients immediately before and after hemodialysis (HD) therapy, on 10 uremic patients under continuous ambulatory peritoneal dialysis (CAPD) therapy before and after the fluid was drained out of the peritoneal cavity and on 3 cirrhotic patients before and after abdominal paracentesis. Thirty-two pairs of measurements were performed on the CAPD patients and 3 pairs on the cirrhotic patients. Significant increases in both resistance and reactance were noted after HD. However, resistance and reactance before and after peritoneal fluid had been drained were not significantly different. In HD, body fluid loss as estimated by BIA (LBIA) was higher than that from the body weight method (LBW). The relationship between the two is described by the equation LBW = 0.841LBIA + 0.588. The total body fat estimated before HD was significantly lower than after HD, and it was significantly higher when measured with peritoneal fluid retention than with fluid drained. Generalized edema caused an increase in resistance and reactance, while local peritoneal fluid retention did not cause any significant changes. When total body fluid is measured by the BIA method, it is often overestimated in the case of generalized edema and underestimated in case of peritoneal fluid retention. Therefore, total body fat is underestimated by BIA in generalized edema before HD and overestimated in peritoneal fluid retention.

Diffuse neonatal haemangiomatosis with intra-uterine haemorrhage and hydrops fetalis: a case report

A case of diffuse neonatal haemangiomatosis involving the skin, liver, lungs, adrenals, gums, diaphragm, skull, and testes is reported. Intra-uterine onset of bleeding led to bloody amniotic fluid, severe anaemia, congestive heart failure, and hydrops fetalis. Intractable coagulopathy and renal failure resulted in persistent bleeding, anuria, metabolic acidosis, and hyperkalaemia, leading to a fatal outcome.

Incidence, significance, and pharmacological responses of catheter-induced mechanical trauma in patients receiving radiofrequency ablation for supraventricular tachycardia

BACKGROUND

Catheter-induced mechanical trauma is unfavorable during electrophysiological study. However, its incidence, significance, and pharmacological responses in patients receiving radiofrequency ablation for supraventricular tachycardia have not been investigated.

METHODS AND RESULTS

A prospective study was performed in 666 consecutive patients with documented, symptomatic supraventricular tachycardia. All had been referred for electrophysiological study and radiofrequency ablation. Catheter-induced mechanical trauma was defined by either disappearance of or change in preexcitation pattern induced by the electrode catheters or noninducibility of tachycardia after the electrode catheter-induced termination of tachycardia, confirmed by electrophysiological study. Adenosine, isoproterenol, and atropine were serially administered 1 hour after the mechanical trauma to study pharmacological response. "Rescue" radiofrequency ablation was defined as delivery of radiofrequency energy just at the presumed ablation site immediately after the mechanical trauma. Of the 666 patients, 254 had atrioventricular (AV) nodal reentrant tachycardia, 367 patients had accessory pathways, 30 patients had atrial tachycardia, and 15 had atrial flutter. Catheter-induced mechanical trauma occurred in 17 patients (2.6%): 4 patients had AV nodal reentrant tachycardia, 9 had accessory pathways, and 4 had atrial tachycardia. Five patients had such episodes during the placement of electrode catheters and 12, during mapping and ablation procedures. Of the 4 patients with AV nodal reentrant tachycardia, 3 had mechanical trauma on the retrograde fast pathway and 1, on the antegrade slow pathway. In the 9 patients with accessory pathways, those pathways were located in the left free wall in 4 patients, right free wall in 1, right posteroseptum in 1, and right anteroseptum in 3. Atrial tachycardia was more easily traumatized than AV nodal reentrant tachycardia (P < .01) and than accessory pathways (P < .01). The clinical courses of mechanical trauma were variable: 1 patient had spontaneous recovery within 1 week, 5 patients had recurrence of tachycardia within 3 months, and the rest have been free of tachycardia from 3 to 35 months. The recurrence rate was higher in patients with mechanical trauma than in those without (33.3% versus 3.5%, P < .0001) despite rescue radiofrequency ablation given in 7 patients. Pharmacological agents were generally unable to revive the traumatized tissues, and recurrence was unpredictable.

CONCLUSIONS

Catheter-induced mechanical trauma was not common in patients receiving radiofrequency ablation for supraventricular tachycardia. Their clinical courses were variable, and pharmacological manipulation offered little assistance. More than half of the patients had long-term cures. However, the recurrence rate was, on the whole, significantly high despite rescue radiofrequency ablation. There is a need for great caution in the placement of electrode catheters in every patient during electrophysiological study and radiofrequency ablation.

Radiofrequency catheter ablation of sustained intraatrial reentrant tachycardia in a patient with mirror-image dextrocardia

INTRODUCTION

There has been limited experience with radiofrequency catheter ablation in patients with dextrocardia. This report describes a 37-year-old man who had secundum type atrial septal defect, mirror-image dextrocardia, and drug-refractory atrial tachycardia, in whom catheter-mediated radiofrequency energy successfully eliminated the tachycardia without complication.

METHODS AND RESULTS

On electrophysiologic study, the atrial tachycardia could be induced and terminated by atrial extrastimulation or rapid atrial pacing. Mixed resetting response pattern and manifest entrainment were also demonstrated. These findings suggested that the mechanism of atrial tachycardia might be related to reentry with an excitable gap. Because of the mirror-image dextrocardia, biplane fluoroscopy was adjusted to the right anterior oblique (RAO) 60 degrees and left anterior oblique (LAO) 30 degrees positions. Inducibility of the tachycardia was completely abolished after the sixth application of radiofrequency current (30 W). It was noted that the successful electrogram preceded the onset of P wave during atrial tachycardia by about 40 msec.

CONCLUSION

This report presents another case in which radiofrequency catheter ablation was used in a patient with dextrocardia. Atrial tachycardia in patients with congenital heart disease may be difficult to control pharmacologically; however, the use of radiofrequency catheter ablation could be recommended as an alternative to medication and surgery.

Sustained atrial tachycardia in adult patients. Electrophysiological characteristics, pharmacological response, possible mechanisms, and effects of radiofrequency ablation

BACKGROUND

Mechanisms and electropharmacological characteristics in adult patients with atrial tachycardia (AT) are not well described. We proposed that a combination of electropharmacological characteristics, recording of monophasic action potential, and effects of radiofrequency ablation could further determine the mechanisms and achieve a new classification in adults with various types of AT because they were important in regard to the correlation between mechanisms and pathophysiology, clinical syndrome, and responses to specific pharmacological or nonpharmacological therapies.

METHODS AND RESULTS

Thirty-six patients (11 female, 25 male; mean age, 57 +/- 13 years) with AT were referred for electropharmacological studies and radiofrequency ablation. Resetting response pattern, entrainment phenomenon, recording of monophasic action potential, serial drug test, response to Valsalva maneuver, endocardial mapping technique, and radiofrequency ablation were performed. Seven patients had automatic AT provocable with isoproterenol; neither initiation nor termination was related to programmed electrical stimulation. The other 29 patients had AT initiated or terminated by electrical stimulation and mechanisms related to triggered activity or reentry; nine of them needed isoproterenol to facilitate initiation of AT, associated with delayed afterdepolarization in monophasic action potential. All responded to adenosine (15 to 60 micrograms/kg) and Valsalva maneuver. Dipyridamole terminated AT and decreased the slope of afterdepolarization. Afterdepolarization was not found in the patients with automatic or reentrant AT. In 40 of 41 (98%), AT was ablated successfully, with late recurrence in 2 of 40 (5%) (follow-up, 18 +/- 4 months).

CONCLUSIONS

This study demonstrates the diverse mechanisms and electropharmacological characteristics of AT in adults. Furthermore, radiofrequency ablation of various types of AT could achieve high success and low recurrence rates.

Atrial pacing-induced reverse alternating Wenckebach periods. A common electrophysiologic phenomenon in patients with dual atrioventricular nodal pathways

Reverse alternating Wenckebach periods (RAWP) have rarely been described, and the significance of dual AV nodal pathways in atrial pacing-induced RAWP is unknown. Forty-five of 50 consecutive patients (M/F = 23/27, mean age 40 +/- 5 years) with common type AV nodal reentrant tachycardia had discontinuous antegrade conduction curves. Atrial pacing revealed that pattern A RAWP (23 patients) had the fourth paced beat conducted over the fast pathway, and pattern B (18 patients) over the slow pathway. Four patients had both pattern A and B RAWP during different pacing cycle lengths. All episodes of atrial pacing-induced RAWP emerged from (or started as) 3:2 AH block, which thereafter were followed by runs of 2:1 AH block. Comparisons between patterns A and B showed (1) maximal atrial pacing cycle length with RAWP was longer in pattern A; (2) A2H2-A1H1 and A4H4-A1H1 were significantly greater in pattern B; (3) A2H2-A4H4 and H2A4/A2H2 were significantly greater in pattern A. It is concluded that atrial pacing-induced RAWP is a common electrophysiologic phenomenon in patients with dual AV nodal pathways. Furthermore, intermittent slow pathway conduction associated with different AnHn and HnAn+2 parameters helped the interpretation of different conduction patterns.

Transcriptional activation by herpes simplex virus type 1 VP16 in vitro and its inhibition by oligopeptides

VP16 is a herpes simplex virus (HSV)-encoded transcriptional activator protein that is essential for efficient viral replication and as such may be a target for novel therapeutic agents directed against viral gene expression. We have reconstituted transcriptional activation by VP16 in an in vitro system that is dependent on DNA sequences from HSV immediate-early gene promoters and on protein-protein interactions between VP16 and Oct-1 that are required for VP16 activation in vivo. Activation increased synergistically with the number of TAATGARAT elements (the cis-acting element for VP16 activation in vivo) upstream of the core promoter, and mutations of this element that reduce Oct-1 or VP16 DNA binding reduced transactivation in vitro. A VP16 insertion mutant unable to interact with Oct-1 was inactive, but, surprisingly, a deletion mutant lacking the activation domain was approximately 65% as active as the full-length protein. The activation domains of Oct-1 were necessary for activation in reactions containing the VP16 deletion mutant, and they contributed significantly to activation by full-length VP16. Addition of a GA-rich element present in many HSV immediate-early gene enhancers synergistically stimulated VP16-activated transcription. Finally, oligopeptides that are derived from a region of VP16 thought to contact a cellular factor known as HCF (host cell factor) and that inhibit efficient VP16 binding to the TAATGARAT element also specifically inhibited VP16-activated, but not basal, transcription. Amino acid substitutions in one of these peptides identified three residues that are absolutely required for inhibition and presumably for interaction of VP16 with HCF.

Accessory pathway and atrioventricular node reentrant tachycardia in elderly patients: clinical features, electrophysiologic characteristics and results of radiofrequency ablation

OBJECTIVES

This study was designed to evaluate the clinical features, electrophysiologic characteristics and results of radiofrequency ablation in elderly patients with accessory atrioventricular (AV) pathways or AV node reentrant tachycardia.

BACKGROUND

Radiofrequency ablation in elderly patients with paroxysmal supraventricular tachycardia has not been well described, and comparative study between elderly and younger patients is limited.

METHODS

Electrophysiologic studies and radiofrequency ablation were performed in 92 elderly patients (45 with an accessory pathway, 47 with AV node reentrant tachycardia).

RESULTS

The elderly patients had poorer electrophysiologic properties in accessory pathways and dual AV node pathways than those of younger patients. The success rate of radiofrequency ablation was similar in elderly and younger patients. However, elderly patients had more complications (14%) in left-sided accessory pathways.

CONCLUSIONS

Radiofrequency ablation in elderly patients with supraventricular tachycardia was effective. However, it must be performed cautiously in those patients with left-sided accessory pathways.

Clinical features and electrophysiologic characteristics of accessory atrioventricular pathways and atrioventricular nodal reentrant tachycardia: comparative study between young and elderly patients

Information focused on elderly patients with paroxysmal supraventricular tachycardia, and a comparative study between the elderly and younger patients was limited. The aim of this study was to investigate the clinical features and electrophysiologic characteristics in elderly patients (> or = 65 years of age) with accessory atrioventricular pathway-mediated tachyarrhythmia or atrioventricular nodal reentrant tachycardia. Electrophysiologic studies of 45 elderly patients with accessory pathway-mediated tachyarrhythmia and 47 elderly patients with atrioventricular nodal reentrant tachycardia were performed. When compared with younger patients, the elderly patients had a similar incidence of critical clinical manifestation, higher incidence of other cardiac disease or systemic disease, similar inducibility of tachycardia, greater baseline electrophysiologic parameters (sinus node, atrioventricular node, atrium and ventricle), and poorer properties of accessory pathways and dual atrioventricular nodal pathways. These results suggest that conduction properties of accessory pathways and dual atrioventricular nodal pathways were poorer in elderly patients, but similar critical manifestations and tachycardia events were found in elderly and younger patients.

Usefulness of serial follow-up electrophysiologic studies in predicting late outcome of radiofrequency ablation for accessory pathways and atrioventricular nodal reentrant tachycardia

A total of 408 patients received radiofrequency catheter ablation for paroxysmal supraventricular tachycardia, and 326 patients underwent serial follow-up electrophysiologic studies (early and late) after initially successful radiofrequency catheter ablation of accessory pathways (group 1, 186 patients with Wolff-Parkinson-White syndrome) and slow atrioventricular (AV) nodal pathways (group 2, 140 patients with AV nodal reentrant tachycardia). Among the patients in group 1, early (4 +/- 1 days) and late (129 +/- 14 days) studies found recurrent conduction through the accessory pathways in 12 and 16 patients, respectively. During a follow-up period of 21 +/- 7 months, recurrence of accessory pathway-mediated tachyarrhythmias was noted in six patients. Of these six patients, all had tachycardia inducible in the late study but not in the early study. Among the patients in group 2, four had recurrence of AV nodal reentrant tachycardia during a follow-up of 16 +/- 6 months. Of the four patients, one had tachycardia inducible in the early (4 +/- 1 days) study and three in the late (130 +/- 12 days) study. The results demonstrated that the early study was not as sensitive as the late follow-up electrophysiologic study in predicting late outcome of radiofrequency ablation, but both the early and late studies had a high total predictive accuracy (> 90%) in groups 1 and 2. Furthermore, only 4 of the 326 patients had initial evidence of recurrent tachycardia activated by programmed electrical stimuli during follow-up studies, suggesting that follow-up electrophysiologic studies in asymptomatic patients are not warranted.

Radiofrequency catheter ablation of sustained intra-atrial reentrant tachycardia in adult patients. Identification of electrophysiological characteristics and endocardial mapping techniques

BACKGROUND

Information about electrophysiological characteristics and radiofrequency ablation of intra-atrial reentrant tachycardia has not been reported before. We proposed that induction and termination of intra-atrial reentrant tachycardia by atrial extrastimuli or rapid atrial pacing and resetting the response pattern by atrial extrastimuli during intra-atrial reentrant tachycardia could ensure the mechanism of reentry and that the earliest site of endocardial activation and concealed entrainment pace mapping with the shortest stimulus-P wave interval could localize a critical area responsible for intra-atrial reentrant tachycardia and radiofrequency ablation.

METHODS AND RESULTS

Seven patients with refractory atrial tachycardia were referred for electrophysiological studies and radiofrequency ablation. Electrophysiological studies and endocardial mapping found (1) 10 atrial foci with atrial tachycardia cycle length of 406 +/- 41 ms; (2) atrial tachycardia had induction and termination by atrial extrastimuli (8 of 10) or rapid atrial pacing (10 of 10); (3) atrial tachycardia had increasing (6 of 10) or mixed (flat and increasing, 4 of 10) resetting response pattern, with resetting interval of 57 +/- 13 ms (14 +/- 4% of atrial tachycardia cycle length); (4) exit sites of atrial tachycardia in right atrial free wall (6 of 10), right atrial septum (3 of 10), and midposterior left atrium (1 of 10); and (5) earliest activation site had timing relative to P wave by -37 +/- 7 ms, and concealed entrainment pace mapping had shortest stimulus-P interval 23 +/- 3 ms. By the endocardial activation pace-mapping technique, radiofrequency energy (8 +/- 1 pulses, 31 +/- 3 W, 101 +/- 11 seconds) successfully eliminated the 10 atrial foci without recurrence (follow-up, 16 +/- 5 months).

CONCLUSIONS

Mechanism of intra-atrial reentrant tachycardia could be confirmed by the electrophysiological characteristics, and radiofrequency ablation energy delivered to a critical area in the atrial reentrant circuit is safe and effective for the treatment of intra-atrial reentrant tachycardia.

Luteinizing hormone-releasing hormone gene expression in the bovine brain: anatomical localization and regulation by ovarian state

Experiments were conducted to identify neurons in the bovine brain that express the LHRH gene and to determine whether LHRH mRNA levels are influenced by the ovaries. Two groups of postpubertal heifers were utilized: heifers killed during the mid-luteal phase of the estrous cycle (LUTEAL, n = 5) and heifers killed 14-16 wk following ovariectomy (OVX, n = 5). In situ hybridization was performed through use of a 32P-end-labeled deoxyoligonucleotide (59 mer) complementary to the human LHRH mRNA sequence. LHRH-expressing neurons were identified in the diagonal band of Broca, the preoptic area, and the anterior hypothalamus in a manner consistent with immunocytochemical localization. Reduced silver grains, proportional to LHRH mRNA content, were quantified (in pixels, 45x objective) with an image analysis system. Expected serum hormone concentration differences between endocrine states were confirmed by radioimmunoassay for progesterone (LUTEAL > OVX, p < 0.01) and for LH (OVX > LUTEAL, p < 0.01). Compared to the OVX group, LUTEAL heifers had 34% fewer LHRH-expressing neurons (p < 0.05); on the average, these neurons possessed 28% fewer pixels/cell (p < 0.01), indicating fewer copies of LHRH mRNA per cell. When the numbers of pixels in all labeled cells were totalled, LUTEAL animals had 57% fewer pixels (p < 0.05) than did the OVX females--probably reflecting a decrease in LHRH synthetic capacity in the LUTEAL animals. Therefore, during the mid-luteal phase of the bovine estrous cycle, ovarian steroid (i.e., luteal progesterone) suppression of LHRH release (as reflected by serum LH) is coincident with decreased LHRH mRNA in the brain.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasound imaging aids infraclavicular brachial plexus block

Infraclavicular approach to the brachial plexus provides adequate anesthesia of the entire arm. Local anesthetics can be deposited over cords and branches of brachial plexus above the formation of musculocutaneous and axillary nerves. The approach can also easily block ulnar segment of medial cord and intercostobrachial nerve, which helps preventing tourniquet pain. However, distance to the plexus is deeper than the other approaches so that current blind method using anatomical landmarks requires anesthesiologists' delicate manipulation and experience. Through ultrasonography, the location of subclavian artery, as an anatomical landmark, can be easily identified. It is then very easy and safe to perform infraclavicular brachial plexus block. Our new method showed 89% (n = 9) successful rate. The time for the block was 4.2 +/- 1.5 min and there was an average of 3.2 +/- 0.6 needle penetrations. Thirty three percent (n = 3) had subclavian artery been punctured without formation of hematoma clinically. No patient had clinical postoperative pneumothorax.

Development of macrovascular diseases in NIDDM patients in northern Taiwan. A 4-yr follow-up study

OBJECTIVE

To assess the development of macrovascular diseases and explore major associative factors in NIDDM.

RESEARCH DESIGN AND METHODS

A total of 479 NIDDM patients > or = 40 yr of age were recruited from four community primary care health centers of northern Taiwan in July 1986 for a cohort study with a 4-yr follow-up. No patient required insulin therapy within 1 yr of diagnosis nor had a history of diabetic ketoacidosis. All were able to participate independently in the activities of daily living. BP and ECG were measured, and a structured questionnaire was asked of each patient. Venous blood after overnight fasting was collected every year to measure cholesterol, HDL cholesterol, plasma glucose, and HbA1c.

RESULTS

The duration of diabetes was associated with the development of stroke with a relative risk of 1.063 for every 1-yr increment (P = 0.07). As for HVDs, the significant risk factors were serum cholesterol and HbA1c. For every 1-mg/dl increase in mean total cholesterol level, the relative risk of developing HVD increased 1.016-fold (P = 0.04). For every 1% increase in HbA1c, the relative risk of developing HVD increased 1.170-fold (P = 0.01). With regard to leg VDs, sex and cigarette smoking were significant risk factors. Women diabetic subjects had a higher relative risk than men. Cigarette smoking was significantly associated with leg VD with a relative risk of 6.9 for smokers compared with nonsmokers. The most significant risk factor for LVD was the total cholesterol level. For every 1-mg/dl increase in mean serum cholesterol level, the relative risk of LVD increased 1.013-fold.

CONCLUSIONS

In the prevention of macrovascular diseases, effective intervention of the nondiabetic cardiovascular risk factors may be as important as or even more important than the good control of diabetes.

Prevalence and risk factors of diabetic retinopathy among noninsulin-dependent diabetic subjects

In a population-based study in Taiwan, 11,478 subjects aged 40 years or older were screened for diabetes in one urban and five rural areas. Among the 715 subjects proven to have diabetes, 527 subjects underwent ophthalmoscopy. Diabetic retinopathy was present in 184 of the 527 subjects (35.0%), including background diabetic retinopathy in 157 subjects (30.0%), preproliferative diabetic retinopathy in 15 subjects (2.8%), and proliferative diabetic retinopathy in 12 subjects (2.2%). Diabetic retinopathy was correlated with the duration of diabetes and age at onset of diabetes, type of diabetes treatment, higher serum creatinine levels, and lower serum cholesterol levels. Several other factors, including gender, age, residential area, family income, educational level, control and family history of diabetes, body mass index, physical activity, exercise, cigarette smoking, stroke, ischemic heart disease, leg vessel disease, hypertension, and proteinuria, had no significant association with retinopathy. By multiple logistic regression analysis, duration of diabetes was the most important risk factor related to retinopathy. Diabetic subjects treated with insulin had a higher risk of developing retinopathy than those treated with dietary control (relative risk, 1.57; .05 < P < .10). The univariate analysis disclosed that proliferative diabetic retinopathy was related to older age at examination, older age at onset of diabetes, type of diabetes treatment, and presence of leg vessel disease. Insulin-treated diabetic subjects also had a higher risk of proliferative diabetic retinopathy than patients in whom diabetes was controlled by diet, with a relative risk of 2.51 (.05 < P < .10) in the multiple logistic regression analysis.

Transfection of mouse cytotoxic T lymphocyte with an antisense granzyme A vector reduces lytic activity

Murine CTL have seven serine proteases, known as granzymes, in their lytic granules. Despite considerable effort, convincing evidence that these enzymes play an obligatory role in the lytic process has not been presented. To investigate the function of one of these proteases, granzyme A (GA), we utilized an antisense expression vector to lower the level of the enzyme in the cells. An expression vector containing antisense cDNA for GA and the gene for hygromycin B resistance was constructed and electroporated into the murine CTL line, AR1. Transfectants were selected based on resistance to hygromycin B, and a number of stable lines were developed. One of the antisense lines had greatly reduced levels of GA mRNA, when compared to the parental cells or to control lines transfected with the vector lacking the antisense DNA. The message levels for two other CTL granule proteins, granzyme B and perforin, were unaffected by the antisense vector. The amount of GA, as measured by enzymatic activity, was 3- to 10-fold lower in the transfectant. Most significantly, this line also consistently showed 50 to 70% lower ability to lyse nucleated target cells and to degrade their DNA. Furthermore, it exhibited 90 to 95% lower lytic activity to anti-CD3-coated SRBC. Conjugate formation with target cells, however, was normal. These data provide strong evidence that GA plays an important role in the cytolytic cycle, and that the quantity of enzyme is a limiting factor in these cytolytic cells.

Transfection of mouse cytotoxic T lymphocyte with an antisense granzyme A vector reduces lytic activity

Murine CTL have seven serine proteases, known as granzymes, in their lytic granules. Despite considerable effort, convincing evidence that these enzymes play an obligatory role in the lytic process has not been presented. To investigate the function of one of these proteases, granzyme A (GA), we utilized an antisense expression vector to lower the level of the enzyme in the cells. An expression vector containing antisense cDNA for GA and the gene for hygromycin B resistance was constructed and electroporated into the murine CTL line, AR1. Transfectants were selected based on resistance to hygromycin B, and a number of stable lines were developed. One of the antisense lines had greatly reduced levels of GA mRNA, when compared to the parental cells or to control lines transfected with the vector lacking the antisense DNA. The message levels for two other CTL granule proteins, granzyme B and perforin, were unaffected by the antisense vector. The amount of GA, as measured by enzymatic activity, was 3- to 10-fold lower in the transfectant. Most significantly, this line also consistently showed 50 to 70% lower ability to lyse nucleated target cells and to degrade their DNA. Furthermore, it exhibited 90 to 95% lower lytic activity to anti-CD3-coated SRBC. Conjugate formation with target cells, however, was normal. These data provide strong evidence that GA plays an important role in the cytolytic cycle, and that the quantity of enzyme is a limiting factor in these cytolytic cells.

Relationships between age, sex, anthropometry and bioelectrical impedance

To establish the relationships between age, sex, anthropometric measurements and bioelectrical impedance, 446 healthy subjects (242 men and 204 women), aged 17 to 88 years, were enrolled in our study. Anthropometric parameters included body weight, height, body mass index (BMI), skinfold thickness of the triceps (TSF), and arm muscle circumference (AMC). Using the BIA-106, RJL System, the bioelectrical resistance, bioelectrical reactance and phase angle were measured. Correlation analysis revealed a significant correlation between gender, anthropometry and bioelectrical resistance. A significant correlation between age, anthropometry and reactance was also noted. Both male and female subjects in the fourth quartile of the age distribution showed significantly lower reactance and phase angle. The quartile study of the body mass index revealed corresponding changes in weight, BMI, TSF, AMC and resistance in quartiles, but not reactance. In conclusion, in addition to anthropometry, gender has an effect on bioelectrical resistance, and age has an effect on reactance.

FOS expression in gonadotropin-releasing hormone neurons: enhancement by steroid treatment and mating

Expression of the protooncoprotein FOS is now widely believed to be a marker for neuronal activation. In female rats, a steroid-induced LH surge is accompanied by an increase in FOS-positive GnRH neurons, especially in the region of the organum vasculosum of the lamina terminalis. The present study, conducted in mice, has examined the effects of both steroid hormone treatment and sexual behavior on the expression of FOS in GnRH neurons and their distribution in the central nervous system. Thirty-three ovariectomized mice, each bearing a sc priming capsule of 17 beta-estradiol, were divided into five groups, four of which were treated sequentially with estradiol benzoate (1 microgram) and progesterone (500 micrograms). In females maintained on 17 beta-estradiol only and killed between 1400-1530 h, only 1.3 +/- 0.7% of GnRH neurons contained FOS, while treatment with estradiol benzoate/progesterone increased FOS expression significantly to 31.7 +/- 8.5% in the same time period. In animals killed at 1530-1700 h, FOS expression declined in the absence of a male (13.8 +/- 2.2%) or when the male present in the cage displayed some sexual behavior but did not ejaculate (13.0 +/- 8.6%). Interestingly, the expression of FOS was maintained at a high level (42.3 +/- 11.4%) into the late afternoon in females paired with a reproductively successful (ejaculating) male. There was a positive correlation (r2 = 0.65; P < 0.01) between the level of LH and the number of FOS-positive GnRH neurons. Hence, the expression of FOS in GnRH neurons was enhanced by both a steroid regimen leading to a LH surge and an intense level of mating behavior. Mapping of the GnRH neurons indicates that in animals with the highest level of FOS expression, FOS-positive GnRH neurons were not confined to the region of the organum vasculosum of the lamina terminalis, but were found more widely distributed along the entire rostro-caudal axis of these cells.

[Parathyroid storm: report of two cases]

Parathyroid storm in patients with primary hyperparathyroidism has previously been described as hyperparathyroid crisis, parathyroid intoxication or acute hyperparathyroidism. Whatever the nomenclature, all emphasize the severity and urgency of this disease entity. Although fewer than 200 cases have been described since the first report by Dawson in 1932, it is generally agreed that parathyroid storm is more prevalent than commonly appreciated. The symptoms and signs of the syndrome are not only due to the hypercalcemia, but also to the toxic effects of the parathyroid hormone (PTH). Its wide, but nonspecific clinical presentations make it easily confused with other cardiovascular or renal diseases. The mortality rate in untreated cases of parathyroid storm is essentially 100%. With combined medical-surgical treatment, it is still reported to be as high as 40%. Two patients with parathyroid storm were encountered at our institute recently, they both presented with severe hypercalcemia, consciousness disturbance and acute renal failure. The serum level of the intact form of PTH (iPTH) in both patients was greater than 1,000 pg/mL. Case 1, a 63-year-old female, presented with hypercalcemic crisis. Initially, good responsiveness to a saline infusion, steroids and furosemide administration was noted. Unfortunately, she became comatous after fine-needle aspiration of the parathyroid tumor. The recurrent storm was refractory to medical therapy, but was treated successfully by surgical removal of the single adenoma. This is a rare reported case regarding a hyperparathyroid storm after fine-needle aspiration of a parathyroid adenoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital short bowel syndrome: report of a case treated with home central parenteral nutrition

Congenital short bowel is a rare anomaly. Among the 21 cases reviewed in the literature, only four (19%) survived beyond infancy. We present a female infant with short small bowel, malrotation and floating colon, who was successfully treated with home central parenteral nutrition. Improved long-term survival in this group of patients is expected with prolonged parenteral nutritional support.

A possible dual mechanism involved in the inhibitory influence of suckling on luteinizing hormone release in the ovariectomized rat

A study was conducted to further understand involvement of the endogenous opioid peptides in suckling-induced inhibition of LH release in ovariectomized rats. The first experiment was designed to determine the effect of an opioid antagonist, naloxone (NAL, 1.0 mg. kg-1h-1), on the increase in peripheral LH concentration 18 h after pup removal and on the decrease in LH concentration 18 h after pup return. Infusion of NAL during the 18 h after pup removal or during the 18 h after pup return neither accentuated nor attenuated serum LH concentrations. The second experiment was designed to determine the effect of NAL on peripheral LH concentrations in continuously suckled rats. Serum LH increased (p less than 0.10 and p less than 0.005, respectively) in response to 18 and 36 h of NAL infusion. The third experiment was designed to determine the effect of pup removal during NAL infusion on serum LH. Peripheral LH concentrations were not different in the rats treated with 36 h of NAL infusion whether they were suckled for the duration of the infusion or nonsuckled for the last 18 h of infusion. These results suggest that suckling may inhibit LH release through two mechanisms. The first may be an opioid-independent or enhanced opioid tone mechanism important for the initiation of the inhibitory effect of suckling on LH release, while the second may be an opioid-dependent mechanism important for the sustained inhibitory effect of suckling on LH release.

Mini-dose intrathecal morphine for post-cesarean section analgesia

Dose-response relationship of mini-dose intrathecal morphine (0.025-0.125 mg) for analgesia after Cesarean section was studied. Sixty-three patients were randomly divided into six groups by the following intrathecal morphine injection: group 1 (0 mg), group 2 (0.025 mg), group 3 (0.05 mg), group 4 (0.075 mg), group 5 (0.1 mg), and group 6 (0.125 mg). The selected dose of morphine mixed with 2 ml 0.5% hyperbaric bupivacaine (10 mg) was administered intrathecally to induce spinal anesthesia. The mean analgesia duration in each group was 3.6 +/- 2.0, 10.6 +/- 7.1, 17.3 +/- 13.8, 25.6 +/- 7.5, 33.9 +/- 10.1, and 39.5 +/- 11.9 h respectively (mean +/- SD). In morphine groups, duration of analgesia was significantly longer (p less than 0.05) than control group (0 mg), and the first 24 h pain scores were also lower (p less than 0.01). Furthermore, a significant linear dose-response relationship between analgesic duration and the dose of intrathecal morphine was revealed (y = 3.28 + 295.5x, r2 = 0.64, p less than 0.05). Among morphine groups, analgesic quality was significantly better in patients in groups 4-6 than those in group 2 and 3 (p less than 0.05), so as in the proportion of effective analgesia in the first 24 h (p less than 0.01). Neonatal condition was not adversely affected by such mini-dose of intrathecal morphine. The most common maternal adverse effect observed was pruritus, and its incidence was significantly greater in groups 3-6 than in the control group (p less than 0.05). However, no significant difference was observed among all morphine groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Bioelectrical impedance analysis of nutritional status in uremic patients on regular hemodialysis

The body composition of uremic patients on regular hemodialysis (HD) therapy was studied using the bioelectrical impedance analysis (BIA) technique. The accuracy of BIA in estimating fluid loss during HD was also studied. Thirty-five uremic patients (28 men and 7 women), regularly treated by hemodialysis (HD), were enrolled. The uremic patients had lower serum albumin levels and a marginally lower arm muscle circumference (AMC; p = 0.06) than 107 age- and sex-matched normal control subjects (86 men and 21 women). Before HD, the uremic patients presented with a similar percentage of body fat (BF), fat-free mass (FFM) and total body water (TBW) as normal controls, but they possessed a lower percentage of TBW and FFM, and a higher percentage of BF after HD. When BIA was applied to estimate the fluid loss during HD, overestimation usually occurred. A good correlation between the body fluid loss estimated by the BIA method (BIAL) and that estimated by the body weighing method (BWL) was noted. An equation of BWL = 0.452 BIAL + 0.844 (n = 35, R = 0.85, SEE = 0.58, p less than 0.0001) was derived following linear regression analysis. The weight of BF estimated by BIA before and after HD demonstrated a good correlation (n = 35, R = 0.98, p less than 0.0001). In conclusion, uremic patients on regular HD therapy seem to have decreased serum albumin levels and decreased AMC in anthropometry. After HD, they possess a lower percentage of FFM and TBW than normal controls. The results suggest that accelerated protein catabolism is a common problem in uremic patients on regular HD therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

A priming effect of naloxone on in vitro LHRH release from the hypothalamus of mid-luteal ewes

The possible involvement of endogenous opioid peptides (EOPs) in LHRH release from hypothalami of ewes during the breeding season was investigated using an in vitro perifusion system. Hypothalami were procured in December from ovariectomized (OVX; 62-65 days before the experiment; n = 6) and mid-luteal (ML; n = 7) Western White-Face ewes. Hypothalami were mid-sagitally sectioned into halves containing the preoptic area, mediobasal hypothalamus, and infundibulum (median eminence). The left half (treated) received two 30-min challenges (beginning at 130 and 250 min, respectively, after onset of perifusion) of 500 microM naloxone (NAL) followed by a 30-min 60-mM potassium (K) challenge (at 370 min after onset of perifusion). The right half served as the control, receiving only K at the same time as the treated tissue. Both NAL challenges elicited (p less than 0.05) LHRH release from tissues of both ML and OVX ewes. Release of LHRH by hypothalami from ML, but not from OVX, ewes was greater (p less than 0.01) after the second than after the first NAL challenge. These results are consistent with the view that an inhibitory opioid influence exists on LHRH release from ovine hypothalami. The release of LHRH in response to NAL was dependent on the ovarian status in vivo since the priming effect of NAL on subsequent NAL-induced LHRH release occurred only from the hypothalami of ML ewes. We suggest from these results that EOPs may modulate LHRH release from ovine hypothalami in an ovarian steroid-dependent and independent manner.

Clover-leaf nucleus of atypical lymphocytes in CMV-mononucleosis syndrome: report of one case

Atypical lymphocytes with clover leaf nucleus are a frequent finding in adult type T-cell leukemia, and are occasionally seen in an overnight blood sample. This type of cell has apparently never previously been reported in cytomegaloviral infection. The case of a thirty-seven-day-old female infant presented with cytomegalovirus induced mononucleosis syndrome; her blood smear revealed atypical lymphocytes with clover leaf nucleus.

Relation between body composition, anthropometry, and glucose tolerance

Based upon the results of a 75 g oral glucose tolerance test, 305 subjects (157 men and 148 women), who were admitted to the National Cheng Kung University Hospital for health check-up, were divided into diabetic (n = 47, 25 men and 22 women), impaired glucose tolerance (IGT) (n = 53, 27 men and 26 women) and normal (n = 205, 105 men an 100 women) groups. All diabetics were of non-insulin-dependent diabetics. Body composition and anthropometries including body mass index (BMI), thickness of triceps skinfold (TSF), arm muscle circumference (AMC), and blood pressure were compared among these three groups. Body composition (percentage of fat, lean mass and total body water) was significantly correlated to BMI, TSF, AMC, blood pressure, blood glucose, hemoglobin Alc (HbAlc) and cholesterol. BMI was significantly correlated to blood pressure, blood glucose, HbAlc, triglyceride and serum glutamic pyruvic transaminase (SGPT) levels. TSF and AMC were not correlated to blood pressure, blood glucose, HbAlc or blood lipids. However, in defining adiposity, TSF seems more sensitive than BMI. The data of the IGT group did not show a significant difference from those of the normal group except for a higher systolic pressure and a 2-hour plasma glucose level after a 75 g oral glucose loading. The diabetic group showed significantly higher BMI, systolic pressure, triglyceride, and SGPT levels than both the IGT and normal groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of lower concentrations of lidocaine to suppress bucking before extubation during recovery of general anesthesia

Thirty females, aged 25-50 years old, scheduled for abdominal total hysterectomy were randomly divided to two groups. For patients in group I, 2 mL 1% lidocaine solution was injected through the catheter on the tube to desensitize the trachea while surgeon started to close the peritoneum. In group II, 2 mL 2% lidocaine was used. The peak cuff pressures generated in the awakening group I patients were 49.0 +/- 2.5 cmH2 O (mean +/- SD) which shows greater than that in group II (27.9 +/- 7.2 cmH2 O), p less than 0.01. Bucking before awakening was also evaluated clinically. One hundred % (15/15) in group I patients bucked compared with 13.3% (2/15) in group II patients (p less than 0.01). Gag reflex was preserved in all patients and none suffered from aspiration postoperatively. Intratracheal administration of two mL 2% lidocaine through the catheter of modified endotracheal tube showed significant effect for suppressing bucking during recovery of general anesthesia.

A comparison of diabetic control status between urban and rural diabetic patients in Taiwan

Between 1985 and 1987, in two urban and five rural areas in Taiwan, a total of 16,636 subjects aged 40 or over were screened for diabetes mellitus according to the WHO criteria. Four hundred and fifty-two previously diagnosed patients and 274 newly diagnosed patients were found. All were non-insulin-dependent diabetics. The blood glucose control status was compared between the urban and rural previously diagnosed diabetics. Those living in the rural areas were found to have better control with a higher percentage under regular treatment. Stepwise multiple regression failed to discover a significant correlation between control status and any of the following factors: sex, age, body mass index (BMI), diabetic duration, treatment regularity, exercise, occupation, education, family income and the presence of hypertension or large vessel diseases. About 30% of the patients in rural areas and 40% in urban areas were poorly controlled. This indicates that our diabetic control program should be strengthened.

Suppression of hemodynamic change before extubation--lidocaine through modified endotracheal tube

Twenty females, aged 31 to 49 years, scheduled for abdominal total hysterectomy were randomly divided into two groups in this study. An epidural catheter was placed at T11-12 before general anesthesia. All patients receive the combination of epidural anesthesia and general anesthesia for the operation and relief of pain postoperatively. The modified endotracheal tube we used is shown in Fig. 1. For patients in group I (Lidocaine group), 2 mL 4% lidocaine solution was injected through the catheter to desensitize the tracheal mucosa around the cuff after the surgeon had removed the uterus. In group II (Control group), no special management was made. All patients were not extubated until they were considered to be awake. Systolic blood pressure at three and one minute before extubation and pulse rate recorded at one minute before extubation showed in patients of group I were statistically smoother than those recorded in group II (p less than 0.01). All patients had gag reflex just after awake extubation.

A comparison of newly and previously diagnosed diabetics in Taiwan

Between 1985 and 1986, during a population survey of diabetes in 1 urban and 5 rural areas of Taiwan, a total of 11,478 adults aged 40 or older were screened. Capillary whole blood glucose was determined with a glucometer (Ames Co.) The diabetic criteria followed the WHO designations. From this survey, a comparison of 225 newly diagnosed and 383 previously diagnosed diabetics was conducted. Multiple regression analysis revealed a highly significant correlation for all diabetics with regard to age, body mass index, family history and hypertension, but no specific correlation to habitat. Mean fasting glucose levels in previously and newly diagnosed diabetics were 172 and 158 (males 158 vs 147 and females 184 vs 165) mg/dl, respectively, which suggest that treatment is apparently inadequate in this population. The prevalent rate (%) of retinopathy for previously and newly diagnosed diabetics was 45.2 and 28.3 (males 42.8 vs 33.3 and females 47.5 vs 24.8), respectively. The prevalence is as common as those reported in western countries. In conclusion, previously diagnosed diabetics had higher fasting glucose concentrations and prevalent rates of retinopathy than newly diagnosed diabetics, and these findings were particularly prominent in females.

The application of pulse oximeter for supraclavicular brachial block

The subclavian artery is the most important landmark of the supraclavicular brachial block. However, it is difficult to locate the artery by palpation in the patients with poor landmark. The present study was aimed to compare two localizing methods of the subclavian artery by a pulse oximeter or by palpation. One hundred patients were divided into three groups. Group A (Slim Group): 6 patients, Group B (Normal Weight Group): 75 and Group C (Obese Group): 19. All patients received both methods to locate the subclavian artery. The first method was by palpating the pulsation of the subclavian artery. The second was by observing the wave depression of the pulse oximeter while pressing supraclavicular area. It was found that the detection rate of the first method was 83.3% in Group A, 52.0% in Group B, 26.3% in Group C and 49.0% in overall patients. However, the detection rate of the second method was 100% in each group. It shows a significant difference between the two methods in Group B, Group C and all patients (P less than 0.001), but no difference in Group A (P = 0.68). There were 13 patients among the 100 patients undergoing surgery of the upper extremity. Seven of them whose pulsation was not clearly palpated but could be located exactly by pulse oximeter. Supraclavicular brachial block was still completed successfully in these 13 patients. No pneumothorax was found. Utilizing pulse oximeter in supraclavicular block provides a high detection rate of the pulsation of the subclavian artery and improves the reliability of the block, especially in the patients with poor landmark.

A new approach to suppress bucking before extubation--lidocaine through modified endotracheal tube

The conventional endotracheal tube was modified with an epidural catheter adhered on the concave aspect of it. The opening of the catheter is at the proximal margin of the cuff. Local anesthetic can be injected into the trachea, then desensitize the tracheal mucosa nearby the cuff. Thirty-four female gynecological patients underwent abdominal total hysterectomy were studied and divided into three groups. In group 1, anesthesia was maintained without special management. In groups 2 and 3, 2 mL gentian violet stained 4% lidocaine solution was administered intratracheally by two different methods 60-120 minutes before the conclusion of the surgery. The peak cuff pressures generated by the awakening patients were 53.8 +/- 2.2 cm H2O (mean +/- SE) in group 1, 47.3 +/- 2.5 cmH2O (Group 2) and 36.4 +/- 1.6 cmH2O Group 3) respectively. Bucking before awakening was also evaluated clinically and showed 100%, 73% and 0% in each group. Intratracheal administration of lidocaine in dose of 2 mL 4% showed significant effect for the suppression of bucking during the recovery of general anesthesia in group 2 and 3 compared with the group 1. Lidocaine administered through the catheter of modified endotracheal tube also resulted in less increase in the peak cuff pressure and even no clinically observed bucking than direct administered through the endotracheal tube. Gag reflex was preserved in all patients and none had suffered from aspiration postoperatively.

Estimation of the length of nasopharyngeal airway in Chinese adults

Nasopharyngeal airway should be placed to reach the tongue base without contact with the epiglottis. The correct length of the nasopharyngeal airway in Chinese adults was estimated in seventy-three surgical patients under general anesthesia (30 males and 43 females, aged 18-82 yr). Measurements were performed with a soft, uncuffed, ID 6.0 mm endotracheal tube (Portex) introduced through the nasopharyngeal passage. The proper tip placement of the tube was evaluated under direct laryngoscopy. The Nostril-epiglottis distance (N-E distance) is 15.31 +/- 1.09 cm (mean +/- SD) for all cases, 16.03 +/- 1.04 cm for male cases and 14.97 +/- 0.95 cm for female cases. There are correlation between the N-E distance and the height (p less than 0.001, r = 0.41), and between the N-E distance and the N-A distance (The distance from nose tip to mandibular angle) (p less than 0.004, r = 0.324). Linear regression analysis relating the N-E distance to the height and the N-E distance to the N-A distance were also statistically significant (p less than 0.001 and p less than 0.01, respectively).

The effect of health education for diabetics in the community

Diabetic care in the community has become a public health issue. To assess the effect of a community diabetes care program (CDCP) on knowledge acquisition and its impact on metabolic control, a 2-year study including 260 non-insulin-dependent diabetics from two different districts in Taipei city was conducted. The experimental group consisted of 140 cases. The remaining 120 cases served as controls. Preintervention knowledge scores were significantly correlated with the formal education level and the duration of diabetes [Diabetic knowledge score = 50.06 + 0.82 (duration of education in years) + 0.23 (duration of diabetes in years), p less than 0.001]. A large increase in the knowledge scores for experimental patients was noted 1 year after intervention. A significant difference in diabetic knowledge still existed between the control and experimental groups 2 years after intervention. HbAlc levels (mean +/- SD) for the experimental patients decreased from a baseline of 7.47 +/- 1.87% to 7.23 +/- 1.68% and 6.88 +/- 1.30% 1 year and 2 years after intervention, respectively. However, no significant decrease was found in the control group (7.20 +/- 2.00% at baseline and 6.98 +/- 1.96%, and 7.14 +/- 2.25% at 1 year and 2 years after intervention, respectively). Reduction in body weight was found in the experimental group. In order of baseline, 1 year and 2 years after intervention, the results were 63.6 +/- 9.6, 62.6 +/- 9.3 and 62.5 +/- 9.2 kg, respectively. There was no remarkable change in body weight in the control group during the 2-year observation period. In conclusion, an integrated approach to CDCP provides a cost-effective method for management of diabetes in the community.

Erythrocyte deformability in diabetes mellitus

Erythrocyte filterability was measured on 34 diabetic patients and 43 normal subjects. Filterability index (FI) was expressed as FI = 10 x ratio of flow rate of suspension to buffer. Mean FI (mean +/- SE) of diabetics was significantly lower than that of the control group (3.47 +/- 0.09 vs 4.03 +/- 0.07, p less than 0.0001). Values of blood urea nitrogen, triglycerides, fasting and postprandial plasma glucose, HbAlc, white blood cell counts (WBC), and mean corpuscular hemoglobin concentration (MCHC) were higher in diabetics. However, mean corpuscular volume (MCV) of diabetics was lower than that of the control group (90.1 +/- 0.6 vs 93.4 +/- 0.6 fl, p less than 0.001), and MCV was positively correlated with FI in both groups. Blood urea nitrogen, triglycerides, fasting and postprandial plasma glucose, HbAlc, MCHC, WBC were correlated inversely with FI. Multiple linear regression analysis revealed FI = -0.00266 (fasting plasma glucose) -0.00164 (triglyceride) -0.00041 (blood urea nitrogen) +5.07 (n = 77, R = 0.61, p less than 0.05). Diabetic patients with cardiovascular complications had lower FI and MCV values; however they had higher triglyceride values than those without cardiovascular complications. In summary, RBC filterability of diabetic patients was lower than that of normal subjects. The defect could be due to myriads of metabolic derangement.

Identification of an enhancer-like element in the 5' flanking region of the rat apolipoprotein A-I gene

In order to study the expression of the apolipoprotein (apo) A-I gene, we have isolated and characterized the structural gene encoding rat apo A-I. The 5' flanking sequence of the apo A-I gene was placed upstream of the coding sequence of the bacterial chloramphenicol acetyl transferase (CAT) gene, such that the expression of CAT activity in cultured cells is under the control of the promoter and regulatory sequences of the rat apo A-I gene. By transient transfection, nucleotide deletion and substitution methods, it was demonstrated that the nucleotide sequences between -464 and -148 upstream from the start of transcription of the rat apo A-I gene are required for the expression of this gene in Hep G2 cells and that these sequences function with an enhancer-like activity.

[Long-term results of an operation alone and postoperative adjuvant chemotherapy in advanced gastric cancer--report of 265 patients]

During the period from June 1973 to December 1978, 338 patients with advanced gastric cancer were treated in our hospital. By retrospective grouping, 142 out of 265 patients with tumor resected received postoperative adjuvant chemotherapy (MMC + 5FU + Ara-C), 123 operated alone were taken for comparison. These two groups were similar in: age, sex, location of tumor, mode of resection, histological type, clinical stage and follow-up rate. The results indicated that the 1, 3 and 5 year survival rates of the combined group were much higher than those of the operation only group. Further analysis showed that the supplementary chemotherapy was particularly valid in stages III and IV. In stage III patients, the 5 year survival rate was increased by 27.8%. In stage IV patients, the 3 and 5 year survival rates of the combined group were 16.3% and 9.8% but none survived over 3 years in the operation only group. The authors believe that postoperative adjuvant chemotherapy plays an important role in controlling the micrometastatic and residual cancer foci.