Hepatitis B infection and changes in interferon-alpha and -gamma production in patients with systemic lupus erythematosus in Taiwan

According to previous reports, the prevalence of hepatitis B virus (HBV) infection in patients with systemic lupus erythematosus (SLE) is varied. There has been no report on Taiwan, a hyperendemic area for HBV infection. Furthermore, impaired production of interferon (IFN) in peripheral blood mononuclear cells (PBMC) has been reported to be potentially pathogenic to both chronic HBV infection and SLE. However, the production of IFN in patients with both diseases coexisting is unknown. The aims of this study were to evaluate the prevalence of HBV infection in lupus patients in Taiwan and to measure the production of IFN in patients with both diseases coexisting. One hundred and seventy-three consecutive lupus patients and a control group of 692 age- and sex-matched healthy subjects were included for evaluation of the prevalence of HBsAg. Four groups of subjects (patients with SLE and HbsAg, SLE, chronic hepatitis B and normal controls) were selected for evaluation of the in vitro production of IFN-alpha and -gamma. Six (3.5%) of the 173 SLE patients were positive for HBsAg, which was significantly lower than that of controls (14.7%; P < 0.0001). Patients with coexistent SLE and chronic HBV infection had less lupus activity, including less proteinuria (P = 0.02) and a lower serum titre of anti-double stranded DNA antibodies (anti-dsDNA; P = 0.04), than HBsAg-negative lupus patients. The in vitro production of IFN-alpha in patients with chronic hepatitis B was significantly lower than in those patients with SLE or in the normal control group (P < 0.01). The yields of IFN-alpha and -gamma in patients with coexistent SLE and chronic HBV infection were significantly different from those patients with SLE alone (P < 0.05), but close to those of patients with chronic HBV infection. In conclusion, the prevalence of HBsAg carriers is significantly lower in lupus patients in Taiwan. Patients with coexistent SLE and chronic HBV infection had less lupus activity. Interferon-alpha and -gamma may play a role in the above phenomenon.

CT grading of blunt pancreatic injuries: prediction of ductal disruption and surgical correlation

PURPOSE

The purpose of our study was to devise a CT grading scheme for blunt pancreatic injuries (BPIs) and to apply it to predict the presence or absence of ductal disruption.

METHOD

We retrospectively reviewed CT scans of 22 patients with proven BPIs. We graded these injuries on CT (A, BI, BII, CI, and CII) based on the (a) presence or absence of pancreatic lacerations, (b) site of lacerations, and (c) depth of lacerations. CT grading was correlated with surgical findings for glandular and ductal injuries.

RESULTS

Main pancreatic ducts were intact in 2 patients with normal CT scans and in all grade A injuries (n = 10). Distal pancreatic ducts were disrupted in all grade B injuries (BI, n = 1; BII, n = 4). Of five grade C injuries, three CII injuries had disruption of proximal pancreatic duct, one CII injury had disruption of minor duct, and one CI injury had an intact ductal system.

CONCLUSION

CT grading of BPIs was useful in predicting ductal integrity or disruption. Ductal disruption was likely present if the pancreas appeared to have a transection or deep laceration on CT scans. It was accurate in grade A and B injuries. Overestimation could occur in grade CI and CII injuries.

Spontaneous rupture of left external iliac vein: case report and review of the literature

Iliac vein rupture is rare and primarily results from major trauma or occurs during pelvic surgery. Spontaneous nontraumatic rupture is even more unusual, with only 14 cases reported in the literature. We report an additional case, summarize all of the cases, and discuss the possible causes and treatment of iliac vein rupture and the role of anticoagulants in postoperative management.

[Pulmonary and paradoxical embolism after total knee replacement--a case report]

Pneumatic tourniquet and hone cement are often applied in orthopaedic surgery. In lower limb surgery, deep vein thrombosis may occur after release of tourniquet, causing embolism of lungs and vital organs. Paradoxical embolism may develop if the patients present extracardiac or intracardiac right to left shunt, such as atrial septum defect, etc. A 60-year-old female patient suffered from osteoarthritis of both knees was admitted for total knee replacement (TKR). Pneumatic tourniquet was inflated on the operated leg for the orthopaedic surgery which lasted for 2h. Dyspnea, sinus tachycardia and abdominal pain were noted after TKR. Blood gases analysis showed arterial hypoxemia and respiratory alkalosis. Chest X-ray revealed diffused bilateral pulmonary infiltration, pulmonary trunk engorgement, and decreased lung markings. Two days after TKR under the impression of peritonitis, she received exploratory laparotomy in which ischemic bowel and gall bladder were found. Pulmonary and paradoxical embolism were diagnosed, both of which were the well-known complications of TKR with tourniquet and bone cement application. The patient finally succumbed because of multiple organ failures.

Factors that influence the operative mortality after blunt hepatic injuries

OBJECTIVE

To analyse causes of death and possible factors that influenced the operative mortality in patients with blunt hepatic injuries.

DESIGN

Retrospective case study.

SETTING

Medical center, Taiwan.

PATIENTS

109 adult patients with blunt hepatic injuries were treated surgically over the four year period from September 1987 to August 1991.

MAIN OUTCOME MEASURE

Mortality.

RESULTS

36 patients (33%) had hepatorrhaphy or no repair, complex repairs were done for 73 patients (67%) and the overall mortality was 22% (24/109). Of those deaths, however, 4 were not liver-related, giving us a liver-related mortality of 19% (20/105). Fourteen of the liver-related deaths occurred within 24 hours of injury of hemorrhagic shock or coagulopathy. Six occurred after 24 hours of sepsis and multiple system organ failure. Multivariate analysis showed that higher initial aspartate aminotransferase (AST) and Injury Severity Score as well as increasing operative blood loss resulted in a worsening prognosis.

CONCLUSION

The initial AST activity and Injury Severity Score as well as the total operative blood loss were the significant factors that influenced the operative mortality after blunt hepatic injuries in our study. Prompt, expeditious, and appropriate surgical management to control operative loss is the only way for the surgeon to reduce the mortality of blunt hepatic injuries.

[Role of locus coeruleus in analgesia caused by stimulation of supraoptic nucleus]

The effects of stimulation of supraoptic nucleus (SON) on the changes of oxytocin (OT), arginine vasopressin (AVP), norepinephrine (NE) and serotonin (5-HT) in the perfusate of locus coeruleus (LC) and changes of pain threshild (PT) were studied by methods of microinjection, radioimmunoassay (RIA) and high pressure liquid chromatography (HPLC) technique. The results showed that the OT contents at 30, 60 and 90 min after stimulation, that of AVP at 30 min and 5-HT at 60 min were increased significantly, while the NE contents at 30 and 60 min were decreased markedly. Injection of V1 antagonist into LC did not affect the analgesic effect caused by administration of L-glutamic acid (L-Glu) into SON, which, however, could be partially inhibited by V2 antagonist or even reversed by OT antagonist. The above results suggested that the analgesic effect due to stimulation of SON is caused by increase of 5-HT and decreases of NE in the LC though the action of OT released by SON on OT and V2 receptor in LC.

Surgical management of juxtahepatic venous injuries in blunt hepatic trauma

The purpose of this analysis was to understand better the problems faced in the management of blunt juxtahepatic venous injuries and to try and simplify the controversies regarding the optimal surgical approach to these injuries. Charts of 92 blunt liver trauma patients treated between July 1, 1991 to June 30, 1993 were reviewed. Nineteen patients with blunt juxtahepatic venous injuries were identified. The isolated left hepatic vein injury group (five patients) were all treated using a nonshunting approach with no mortalities. Half of the isolated right hepatic vein injury group (ten patients) received an atriocaval shunt, and the other half did not. These two different approaches each produced one survivor, with a combined mortality rate of 80% (eight of ten patients). One of the combined injuries group (four patients) received a total hepatectomy followed by liver transplantation. Another received a shunt. The other two were treated without shunting, but all of them expired. The overall mortality rate was 63.2% (12 of 19 patients), with nine patients dying intraoperatively or immediately postoperatively from exsanguination. The other three died 10, 25, and 30 days postoperatively because of sepsis. Juxtahepatic venous injury should be suspected after failure of the Pringle maneuver to stop bleeding and the different venous injuries differentiated by palpation of the adjacent hepatic parenchymal injuries. If an isolated left hepatic vein injury is found and the liver parenchymal injury is limited to segments II, III, or IV, then a nonshunting approach will achieve the optimal outcome.

Clinical manifestations of hepatic arteritis in systemic lupus erythematosus

Hepatic arteritis is a rare complication in systemic lupus erythematosus (SLE). Information about its clinical manifestations is still very limited. Elevated serum r-glutamyl transpeptidase and alkaline phosphatase levels, but without elevated bilirubin and transaminase levels, were found in the present report to be the clinical presentation of hepatic arteritis. This clinical picture originally suggested a disease of the biliary tree. Hepatic arteritis must be included in the differential diagnosis of biliary tract disorders in SLE.

[Naloxone suppresses ischemic arrhythmias via potentiating baroreflex]

AIM

To study the relationship between the anti-arrhythmia action of naloxone (Nal) and its effect on baroreflex sensitivity (BRS).

METHODS

Acute myocardial infarction was produced by ligating coronary artery in Sprague-Dawley rats. Ventricular extrasystole (VE), tachycardia (VT), and fibrillation (VF) were recorded on ECG. The slopes of linear regression (b) from systolic blood pressure and cardiac cycle after intravenous injection (i.v.) of phenylephrine 2 micrograms was taken as the BRS. The area of infarct was estimated after TTC staining.

RESULTS

Nal 0.5 mg i.v., intracisternal injection (i.c.) of Nal 0.1 mg, and i.c. beta-endorphin (beta-End) antiserum 10 microL suppressed the ischemic arrhythmias, arrhythmia score was 1.8 +/- 1.1 (Nal i.v.) vs 3.8 +/- 2.1 (Saline i.v.); 1.7 +/- 1.5 (Nal i.c.) vs 4.0 +/- 2.6 (Artificial CSF i.c.) and 1.7 +/- 1.6 (beta-End antiserum i.c.) vs 4.1 +/- 2.0 (Serum i.c.) (P < 0.05) and potentiated the BRS, BRS was 4.2 +/- 1.8 (Nal i.v.) vs 2.9 +/- 0.8 (saline i.v.); 4.5 +/- 1.7 (Nal i.c.) vs 2.8 +/- 0.7 (Artificial CSF i.c.) and 4.4 +/- 1.1 (beta-End antiserum i.c.) vs 3.0 +/- 0.9 (Serum i.c.) (P < 0.05). BRS showed negative relations to the arrhythmia scores with r of -0.69 for i.v Nal, -0.72 for i.c. Nal, and -0.67 for i.c. beta-End antiserum (P < 0.05).

CONCLUSION

Nal suppressed ischemic arrhythmias via antagonization of beta-endorphin and potentiation of BRS.

[Effect of anti-opioid peptide sera on oxytocin-induced enhancement of electroacupuncture analgesia]

The effects of intracerebroventricular injection of Anti-opioid peptide sera on oxytocin-induced enhancement of electroacupuncture (EA) analgesia were observed in this study. It was found that injection of anti-beta-endorphin serum (AEPS) alone could attenuate EA analgesia in rats. Injection of AEPS prior to intraventricular injection of oxytocin could not block the enhancement of EA analgesia by oxytocin. The antidynorphin A1-13 serum (ADYNS) alone could also reduce the EA analgesia, whereas injection of ADYNS prior to injection of oxytocin could potentiate the enhancement of EA analgesia by oxytocin. However, neither the anti-methionine enkephalin serum nor the anti-leucine enkephalin exerted any effect on the enhancement of EA analgesia by oxytocin. The above results showed that the dynorphin attenuate oxytocin-induced enhancement of EA analgesia, but Beta-endorphin and enkephalin do not affect this role of oxytocin. These data suggest the enhancement of EA analgesia by oxytocin is not dependent upon the endogenous pioid peptides in brain.

[Effects of stimulation and cauterization of hypothalamic paraventricular nucleus on acupuncture analgesia]

The role of hypothalamic paraventricular nucleus (PVH) in acupuncture analgesia was investigated by local brain stimulation and cauterization. The results showed that electrical or L-glutamate sodium stimulation of PVH could enhance the effect of analgesia of Zusanli acupuncture, both in a dose dependent manner. Electrical cauterization of PVH decreased the effect of acupuncture analgesia, while removal of pituitary had no effect on the enhancing effect by L-glutamate sodium injection.

HYPOTHALAMIC PARAVENTRICULAR NUCLEUS PLAYS A ROLE IN ACUPUNCTURE ANALGESIA THROUGH THE CENTRAL NERVOUS SYSTEM IN THE RAT

This work investigates the effect of hypothalamic paraventricular nucleus (PVN) on acupuncture analgesia in the rat. Electrical stimulation of PVN or injection of L-glutamate sodium into PVN could enhance the analgesic effect induced by acupuncture Zusanli (St. 36) while the electrical cauterization of PVN is decreased; Removal of the pituitary could not influence the effect of enhancing acupuncture analgesia induced by the injection of L-glutamate sodium into PVN. These results suggest that PVN might play an important role in acupuncture analgesia through central nervous system.

Spurious hyperchloremia and decreased anion gap in a patient with dextromethorphan bromide

Although cold syrup containing dextromethorpan bromide is widely administered, the bromism due to cold syrup has not been reported. We report a patient who had negative anion gap with hyperchloremia and conscious loss because of daily intake of cold complex syrup (containing dextromethorphan bromide 0.4 mg/ml, acetaminophen 8.33 mg/ml) for headache for 4-5 years. The bromide content in cold complex syrup resulted in serum levels of bromide that interfered with the automated analyzers for chloride content. When conscious change is due to bromism, hemodialysis instead of forced hydration and diuresis should be performed immediately. Therefore, patients with a markedly negative anion gap with hyperchloremia should be considered as having halide intoxication.

Mechanism of action of arginine vasopressin on acute ischemic brain edema

The purpose of this experiment is to study the role of arginine vasopressin (AVP) in acute cerebral ischemic edema in Mongolian gerbils. The results show that intracerebroventricular injection (ICV) of AVP exacerbates acute ischemic brain edema, while ICV of AVP antiserum significantly decreases the ischemic brain edema. Nimodipine (calcium antagonist) cannot block this role of AVP in brain edema. In addition, the cortical Na(+)-K+ ATPase activity is significantly decreased, while the cAMP content of ischemic cortex and hypothalamus and the cGMP content of the hypothalamus are markedly increased after AVP ICV. These suggest that AVP may play an important role in the pathophysiologic process of ischemic brain edema by inhibiting the Na(+)-K+ ATPase activity of the cerebral cell membrane and the AVP receptors mediated by cAMP and cGMP.

Comparison of selective arginine vasopressin V1 and V2 receptor antagonists on burn shock in the rat

STUDY OBJECTIVE

Two selective V1 and V2 receptor antagonists of arginine vasopressin, d(CH2)5Tyr(Me)AVP and d(CH2)5[D-Ile2, Ile4, Ala9-NH2]AVP, were given intravenously in burn shocked rats to investigate the respective effects of V1 and V2 receptor blockade on the haemodynamic variables in burn shock.

DESIGN

Computer assisted on line real time measurements of mean arterial blood pressure, diastolic blood pressure, left ventricular systolic pressure, dP/dtmax, and heart rate were used to study the effects of the receptor antagonists during burn shock. In addition, the radioactive microsphere method was used to measure the changes of cardiac output and regional blood flows to heart, kidney, and liver in response to the antagonists during burn shock. Third degree burns extending over 30% of body surface area were made by dipping the rat's shaved back into water at 100 degrees C for 20 s.

EXPERIMENTAL MATERIAL

Male Sprague-Dawley rats (250-300 g) were used in groups of 6-9 per experiment.

MEASUREMENTS AND MAIN RESULTS

Mean and diastolic arterial blood pressures, left ventricular systolic pressure, dP/dtmax and heart rate were measured for 8 h after burns. Cardiac output and regional blood flow were measured at 3 h and 8 h postburn. Results showed that blockade of V1 receptor lowered mean and diastolic arterial blood pressures throughout the 8 h period, and raised left ventricular systolic pressure and dP/dtmax only during the early phase of shock. Cardiac output and blood flows to heart, kidney, and liver were increased by the V1 antagonist at 3 h but not at 8 h postburn. The V2 receptor antagonist increased mean and diastolic arterial blood pressures, left ventricular systolic pressure, and dP/dtmax both during the early and during the late phases of burn shock. It also improved cardiac output and blood flows to the heart, kidney, and liver during the early and late phases of burn shock. However, heart rate was not affected by V1 and V2 receptor antagonists.

CONCLUSIONS

The V2 like receptor may be the dominating receptor mediating vasopressin's inhibitory effect on the heart. V1 receptor mediated coronary vasoconstriction contributes to the myocardial depression possibly only at the compensatory phase of shock. In addition V1 receptor mediated vasoconstriction is important in maintaining blood pressure during burn shock.

Effect of peripheral injection of arginine vasopressin and its receptor antagonist on burn shock in the rat

To investigate the effect of arginine vasopressin (AVP) in the peripheral circulation on burn shock in the rat, AVP and its nonselective V1/V2 receptor antagonist d(CH2)5Tyr (Et)VAVP were administered intravenously in burn shocked rats. Cardiovascular parameters were recorded including left ventricular systolic pressure (LVSP), +/- dP/dt max, total area of the cardiac force loop (Lo), mean arterial blood pressure (MAP), heart rate (HR) and electrocardiogram (ECG). Our results showed that AVP failed to increase MAP in burned rats whereas it elicited a greater fall in LVSP, +/- dP/dt max and Lo and MAP than seen in control burned rats and hastened the onset of the decompensatory phase of burn shock resulting in the early death of burn shocked animals. The receptor antagonist d(CH2)5Tyr(Et)VAVP elevated LVSP, +/- dp/dt max and Lo for the eight hour observation period, and allowed MAP to recover from the initial profound fall following burn injury. Furthermore, it prolonged the survival time of the burned rats. AVP treated rats also displayed earlier abnormal changes such as elevation of S-T segment, inversion of T wave and ventricular fibrillation in ECG. The onset of these changes was much delayed in antagonist treated rats.

Blood glucose measurement by multiple attenuated total reflection and infrared absorption spectroscopy

The difficulty of measuring physiological concentrations of glucose in blood by conventional infrared absorption spectroscopy is due to the intrinsic high background absorption of water. This limitation can be largely overcome by the use of a CO2 laser as an infrared source in combination with a multiple attenuated total reflection (ATR) technique. To demonstrate the applicability of this technique, we compared in vitro measurements of glucose in blood obtained from an experimental infrared laser spectrometer with independent measurements made by a standard YSI 23A laboratory glucose analyzer. The capability of continuous measurement of blood glucose concentration is of primary importance in the future development of a glucose sensor for diabetic patients.

[The role of central oxytocin in electroacupuncture analgesia]

The effects of intraventricular injection (ICV) of oxytocin (OT) and antioxytocin serum (AOTS) on the pain threshold and electroacupuncture (EA) analgesia in rats were investigated in this study. The potassium iontophoresis induced tailflick was used to measure the pain threshold. An increase of 20-38% in the pain threshold was observed within 80 min after OT injection (50 ng), while the OT administration (50 ng) in combination with EA produced a dramatic increase of 139-234% in the pain threshold, which was much higher than that in the saline-EA group (P less than 0.05 or 0.01). The OT effect was dose-related in the range between 25-100 ng. Although ICV of AOTS did not change the pain threshold, the EA analgesia became weakened significantly. After injection of AOTS, EA only produced an increase of 47-61% in the pain threshold, while following ICV injection of normal rabbit serum instead of AOTS the EA could cause a rise of 104-123% in the pain threshold. There was a significantly statistical difference between the above two groups (P less than 0.05-0.01). The data indicate that ICV of OT not only elevates the pain threshold, but also enhances the EA effect, and that AOTS attenuates the EA analgesia. These results suggest that endogenous oxytocin in the central nervous system may play a role in the electroacupuncture analgesia.

Possible involvement of beta-endorphin in the deteriorating effect of arginine vasopressin on burn shock in rats

The effect of intracerebroventricular injections of arginine vasopressin (AVP) on burn shock in the rat and its possible mechanism were explored in this study. AVP was administered intraventricularly at 30 min intervals (50 ng) in the burned rats. The arterial pressure and electrocardiogram (ECG) were recorded with a multipurpose polygraph before and after burn. Compared with the control, the MAP of the rats in the AVP group was elevated at the initial stage and fell dramatically at the late stage of burn shock with a higher mortality. The ECG of the rats in the AVP group also displayed earlier changes such as elevation of S-T segment, inversion of T wave, and ventricular fibrillation. These findings suggest an unfavorable role of AVP in burn shock. The plasma, hypothalamic, and anterior and posterior pituitary levels of beta-endorphin 3 hr after burn were measured by radioimmunoassay. The increased level of beta-endorphin in the plasma after AVP treatment indicates the possible involvement of beta-endorphin in the deteriorating effect of AVP on burn shock.

Beta-endorphin-like immunoreactivity in CSF of patients with acute head injury. A clinical report of 36 cases

beta-endorphin-like immunoreactivity (beta-ELI) was measured in the cerebrospinal fluid (CSF) of 36 patients with acute head injury and 12 controls. The mean values of beta-ELI in CSF of controls and patients with moderate and severe acute head injury were 51.9 +/- 5.6 pg/ml, 110.5 pg/ml, and 173.8 +/- 20.1 pg/ml respectively, with significant difference between them (p less than 0.05). The results showed that beta-ELI increased in CSF of acute head injury patients.

Carbon dioxide laser based multiple ATR technique for measuring glucose in aqueous solutions

Conventional IR transmission methods are not suitable to measure accurately the concentration of biological molecules in aqueous solutions since the dominant water component has a high intrinsic absorption band over a wide range of the IR spectrum. This limitation can be largely overcome by the use of a laser as a light source. This paper describes the design of an experimental IR spectrometer based on a CO(2) laser and an ATR technique. To demonstrate the applicability of this laser spectrometer in medical diagnosis, we compared quantitative measurements of D-glucose solutions obtained from the IR spectrometer with measurements made by a standard laboratory glucose analyzer.