Curcumin-containing diet inhibits diethylnitrosamine-induced murine hepatocarcinogenesis

Curcumin has been widely used as a spice and coloring agent in foods. Recently, curcumin was found to possess chemopreventive effects against skin cancer, forestomach cancer, colon cancer and oral cancer in mice. Clinical trials of curcumin for prevention of human cancers are currently ongoing. In this study, we examine the chemopreventive effect of curcumin on murine hepatocarcinogenesis. C3H/HeN mice were injected i.p. with N-diethylnitrosamine (DEN) at the age of 5 weeks. The curcumin group started eating 0.2% curcumin-containing diet 4 days before DEN injection until death. The mice were then serially killed at the scheduled times to examine the development of hepatocellular carcinoma (HCC) and changes in intermediate biological markers. At the age of 42 weeks, the curcumin group, as compared with the control group (DEN alone), had an 81% reduction in multiplicity (0.5 versus 2.57) and a 62% reduction in incidence (38 versus 100%) of development of HCC. A series of intermediate biological markers were examined by western blot. While hepatic tissues obtained from the DEN-treated mice showed a remarkable increase in the levels of p21(ras), PCNA and CDC2 proteins, eating a curcumin-containing diet reversed the levels to normal values. These results indicate that curcumin effectively inhibits DEN-induced hepatocarcinogenesis in the mouse. The underlying mechanisms of the phenomenon and the feasibility of using curcumin in the chemoprevention of human HCC should be further explored.

Evaluation of conjugated estrogen plus medroxyprogesterone acetate versus tibolone in early postmenopausal Chinese women

BACKGROUND

The safety and efficacy of tibolone (Livial) were compared with the traditional cyclic, sequential conjugated estrogens/medroxyprogesterone acetate (Premarin/Provera; PP) regimen for the treatment of climacteric symptoms, prevention of postmenopausal bone loss, endometrial stimulation and influence on lipid profile.

METHODS

Forty women, one to three years postmenopause, were randomly enrolled in one of two treatment groups, receiving either tibolone (2.5 mg) every day for six months or Premarin (0.625 mg) every day plus Provera (5 mg) from day 1 to day 12 every month for six months. The scores of climacteric complaints, using the Greene Climacteric Scales, and bleeding pattern were recorded at baseline and follow-up visits at months 1, 3 and 6. Bone resorption (deoxypyridinium) and formation (osteocalcin) markers were measured at baseline, three and six months. Lipid profiles, bone density of the lumbar spine and neck of the femur measured by dual energy X-ray absorptiometry were checked at baseline and six months.

RESULTS

Tibolone was as effective as PP in alleviating climacteric complaints. Both regimens were effective in slowing bone metabolism and preventing bone loss. After six months of treatment, bone density of the lumbar spine increased 2.174% in the tibolone group. The endometrium of patients remained atrophic (< 4 mm); only one woman reported vaginal spotting after three months of tibolone therapy. Significant decreases in triglyceride (31.48%) and high-density lipoprotein (29.25%) were also observed. In the PP group, bone density of the lumbar spine increased 1.405%; cyclic withdrawal bleeding occurred in every patient. A significant increase in triglyceride (38.76%) and a significant decrease in low-density lipoprotein (15.10%) were observed.

CONCLUSIONS

Tibolone proved to be effective and safe in the treatment of women with climacteric symptoms and postmenopausal bone loss. As a form of hormone replacement therapy without the need for withdrawal bleeding, tibolone has great appeal to postmenopausal women, and compliance is higher than reported with other forms of hormone replacement therapy.

Risk assessment of lung cancer and mesothelioma in people living near asbestos-related factories in Taiwan

Estimates from environmental risk assessments are criticized by professionals who indicate that inaccuracies occur in exposure assessment, model selection, and determination of the population at risk. In the current study, we tackled the aforementioned issues and estimated the risks of lung cancer and mesothelioma caused by airborne asbestos among individuals who lived near asbestos factories in Taiwan. We conducted 8-h full-period samplings upwind and downwind from each factory, and we used transmission-electronic microscopy (10,000x) and phase-contrast microscopy to determine asbestos concentrations in and around each factory. We estimated the numbers of residents who lived in concentric circles of 200-m, 400-m, and 600-m diameters around each factory. A dose-response model for asbestos-induced lung cancer was adopted from a summary of seven epidemiological studies. The asbestos-mesothelioma models were patterned after the first-exposure-effect models developed by Peto and Finkelstein. The data obtained from phase-contrast microscopy significantly overestimated the risk, compared with transmission-electronic microscopy. The estimates we calculated from adopting the arithmetic mean were approximately 2-fold higher than those we calculated with the geometric mean. There were relatively low concentrations of asbestos in the study areas, thus causing an absence of a significant difference in risk estimates between different models for mesothelioma. Among the more than 20,000 residents who lived near 41 asbestos factories in Taiwan, we found that the numbers of expected excess deaths from lung cancer and mesothelioma were 5 and less than 1, respectively. We concluded that in future risk assessments for ambient asbestos exposure, investigators should adopt transmission-electronic microscopy and the geometric mean estimate. Moreover, Taiwan should enhance asbestos-control programs to assure the safety of residents who live near asbestos factories.

Cytotoxic hammerhead ribozymes

Small catalytic RNA molecules of the hammerhead ribozyme type were found to have cytotoxic effects unrelated to their intended activity. An expression library of ribozyme sequence variants was constructed in a recA-deficient strain of Escherichia coli such that individual library members differed in regions designed to form base pairs with human immunodeficiency virus-1 (HIV-1) tat mRNA. The parental ribozyme and many variants exhibited a bacteriostatic effect. One variant studied in detail was also bactericidal. When its expression was induced, ribozyme-dependent inhibition of bacterial growth was not observed in recA+ or recA+ lexA3 (Ind-) cells, suggesting that the recombination function of the RecA protein, not the absence of the SOS response, is sufficient to alleviate the cytotoxic effect. These data document the need for careful testing for toxic effects during intracellular studies of ribozyme action.

Moe1, a conserved protein in Schizosaccharomyces pombe, interacts with a Ras effector, Scd1, to affect proper spindle formation

In fission yeast, Scd1/Ral1 is a putative guanine nucleotide exchange factor for Cdc42sp and also acts as a Ras1 effector necessary for the regulation of cytoskeleton organization. In this study, we have characterized a protein, Moe1, that binds directly to Scd1. A moe1 null (Delta) mutant exhibits numerous phenotypes indicative of abnormal microtubule functioning, including an abnormality in the spindle. moe1Delta mutants are resistant to microtubule destabilizing agents; moreover, moe1Delta rescued the growth defects of tubulin mutants containing unstable microtubules. These results suggest that Moe1 induces instability in microtubules. Biochemical and subcellular localization studies suggest that Moe1 and Scd1 colocalize in the nucleus. Furthermore, loss of function in Scd1 or Ras1 also induced abnormality in the spindle and is synthetically lethal with moe1Delta producing cells that lack a detectable spindle. These data demonstrate that Moe1 is a component of the Ras1 pathway necessary for proper spindle formation in the nucleus. Human and nematode Moe1 both can substitute for yeast Moe1, indicating that the function of Moe1 in spindle formation has been conserved substantially during evolution.

Effects of alendronate on bone turnover markers in early postmenopausal women

BACKGROUND

Alendronate sodium (Fosamax, Merck, Sharp & Dohme, Whitehouse Station, NJ, USA) is an aminobisphosphonate that can inhibit osteoclast-mediated bone resorption activity to reduce bone turnover rate and improve progressive gains in bone mass.

METHODS

This was a randomized, double-blind, placebo-controlled study comparing the effects on bone turnover markers between daily treatment with alendronate sodium 10 mg and placebo. Forty early postmenopausal women completed three months of treatment. The bone turnover rate was determined by measuring the biochemical markers at baseline, week 6 and at the end of the three-month treatment period. All adverse events were recorded during each follow-up visit.

RESULTS

Patients receiving alendronate treatment had a significant decrease in urinary excretion of the bone resorption marker deoxypyridinoline (Dpd) as well as one of the bone formation markers, bone-specific alkaline phosphatase (AlkP-B). Patients receiving placebo tended to have increased urinary excretion of bone resorption and formation markers. At the end of three months, the mean percentage change of Dpd and AlkP-B from baseline in the group receiving 10 mg alendronate was 30.49% and 29.45% reduction, respectively. The placebo group had 2.39% and 1.52% increase, respectively. Overall, three biochemical markers (Dpd, AlkP-B and osteocalcin) differed significantly between the treatment and control groups after three months of treatment. The drug was well tolerated, without a significant increase in incidence of adverse effects such as gastrointestinal discomfort and esophageal irritation.

CONCLUSIONS

Bone turnover rate decreased quickly following drug administration. The incidence of adverse effects did not differ significantly between the alendronate and placebo groups. Alendronate is, therefore, recommended as an effective nonhormonal treatment for postmenopausal osteoporosis.

CT findings of adrenal glands in patients with tuberculous Addison's disease

The CT findings of adrenals in 18 cases of tuberculous Addison's disease are reported. All cases demonstrated bilateral adrenal involvement, 35 glands with active tuberculosis appeared enlarged and one with non-active tuberculosis showed an atrophic gland with calcification. Areas of non-enhancing necrosis in the enlarged adrenals were seen in 34 glands (17 cases), among them 19 glands showed peripheral rim enhancement. In the 35 enlarged adrenals 25 glands had preserved contours. Small calcification dots in the adrenals were seen in 7 glands with active tuberculosis (4 cases). The CT signs of active tuberculous adrenalitis associated with Addison's disease were enlarged glands associated with large necrotic areas, with or without dot-like calcification. When the contours of the adrenals were preserved, the diagnosis of infectious disease could be made with increased confidence. Tuberculous adrenalitis should not be excluded when the enlarged adrenal glands appear mass-liking. CT study of the morphological changes of adrenal glands on patients with Addison's disease might help to define the etiology of the disease and contribute to treatment planning.

Dissolution difference between acidic and neutral media of acetaminophen tablets containing a super disintegrant and a soluble excipient. II

The disintegration and dissolution of acetaminophen tablets containing sucrose and Ac-Di-Sol/Primojel was significantly different between acidic and neutral media. The purpose of this study was to investigate the mechanism of this phenomenon and to propose a way of reducing the dissolution difference between the two media. Tablets of different combinations of active ingredient, sucrose, and Ac-Di-Sol/Primojel were prepared and their dissolution in various media was evaluated. The dissolution differences were found to be largely related to the hydrophobicity of the active ingredient and pH difference of the two media. This difference was even more evident under the condition where acetaminophen, sucrose, and Primojel were combined. The dissolution difference was therefore attributed to the depressed function of Primojel in the acidic medium, the stronger binding of sucrose, the hydrophobicity of the active ingredient and pH difference of the two media. Increasing the concentration of Primojel or incorporating the surfactant in the tablet can thus greatly decrease the dissolution difference between acidic and neutral media.

Long-term results of percutaneous balloon mitral valvuloplasty for mitral stenosis: a follow-up study to 11 years in 202 patients

We studied the first 202 patients with rheumatic mitral stenosis (MS) who underwent percutaneous balloon mitral valvuloplasty (PBMV) with the Inoue balloon catheter for a follow-up (FU) period of 5-11 years. Pre- and post-PBMV and at FU, the mean left atrial pressure was 21.3+/-7.4, 10.2+/-5.6, and 11.2+/-4.1 mm Hg; mean diastolic mitral gradient was 18.4+/-7.3, 2.9+/-3.2, and 5.1+/-4.3 mm Hg; and mitral valve area was 1.0+/-0.3, 2.1+/-0.6, and 1.7+/-0.5 cm2. Functional status improved from New York Heart Association (NYHA) class IV in 3, class III in 119, and class II in 80 pre-PBMV to class I in 163, class II in 37, and class III in 2 post-PBMV, and was class I in 146, class II in 39, and class III in 17 patients at FU. In the 17 patients with NYHA class III at FU, mitral restenosis was the culprit; 4 underwent repeat PBMV, 12 had mitral valve replacement for severe mitral calcification and subvalvular fusion, and 1 refused further intervention. Thus PBMV using the Inoue balloon catheter is an effective method of relieving MS with excellent long-term results in patients without severe mitral calcification and subvalvular fusion.

Fatal acute pulmonary oedema after inhalation of fumes from polytetrafluoroethylene (PTFE)

The cases of three patients with acute pulmonary oedema caused by inhalation of fumes from heated polytetrafluoroethylene (PTFE) in a plastic factory are described. One patient died from profound hypoxaemia and shock shortly after admission, and the other two patients survived after medical treatment. This is the first report of fatal pulmonary oedema in a worker exposed to PTFE heated in a plastic extruding operation. From this observation, it appears that inhalation exposure to pyrolytic products from polytetrafluoroethylene can cause fatal respiratory complications. Special precautions are warranted in this kind of operation to prevent workers from being exposed to these substances.

Occlusion of congenital ventricular septal defects by the buttoned device. "Buttoned device" Clinical Trials International Register

OBJECTIVES

To study the feasibility of congenital ventricular septal defect occlusion by the buttoned device and to establish guidelines for its safe and effective application.

DESIGN

A descriptive study of all patients with a congenital ventricular septal defect undergoing transcatheter occlusion with the buttoned device, from March 1994 to May 1995. These patients were otherwise candidates for elective surgery at their institutions because they had persistence of a significant shunt (Qp:Qs = 1.5-2.1:1, median = 1.7), with left ventricular enlargement and/or symptoms, although their systolic pulmonary artery pressure was invariably normal (20-28 mm Hg, median = 25). The angiographic diameter of the defect ranged from 2.5 to 14 mm (median 6 mm).

SETTING

A multi-institutional study.

PATIENTS

Out of 25 cases attempted, 18 children and adults aged 4-35 years had devices implanted. Fifteen of these patients had membranous ventricular septal defects and three had muscular defects. All patients with a membranous ventricular septal defect had an associated aneurysm of the membranous septum.

INTERVENTIONS

The buttoned device was introduced either directly or, in the last 12 cases, over a wire bridging the femoral artery and the femoral or jugular vein; the devices were delivered through 7-9 French (F) long sheaths. A membranous defect was regarded as suitable for device closure if the distance from the centre of the defect to the insertion of the right coronary aortic valve leaflet was more than 50% of the size of the required device. The device was guided by echocardiography and fluoroscopy. All muscular defects were corrected through the right jugular vein and all membranous ones through the femoral vein.

RESULTS

All 18 patients underwent initial successful implantation of the device. In thirteen patients the shunts were completely occluded and in the remaining five there were trivial residual shunts. In two patients with membranous ventricular septal defects a change from the original position was noticed at two weeks; mild aortic regurgitation developed in one and the murmur recurred in the other; the devices had to be removed surgically. One patient developed transient third degree atrioventricular block during implantation; no tricuspid regurgitation was observed.

CONCLUSION

Clinical occlusion of congenital ventricular septal defects was achieved in 16 out of the 18 attempted cases (13 full occlusions). Membranous ventricular septal defect occlusion can be effective and safe if patients and device sizes are carefully selected.

Mite-induced allergic airway inflammation in guinea pigs

BACKGROUND

Mites are the most common aeroallergen in human allergic asthma. However, no animal model of mite-induced allergic airway inflammation has been reported before. In this study, an animal model of mite-induced allergic airway inflammation in guinea pigs was developed.

METHODS

Firstly, we found that two intraperitoneal injections of 100 micrograms crude mite extract (CME), but not multiple aerosol inhalations of 10 mg/ml CME, can cause sensitization in guinea pigs. The sensitization to mites was confirmed by the measurement of serum antimite antibody titer and the detection of anaphylactic bronchoconstriction after intravenous injection of CME solution. Then, single or multiple aerosol challenges with different concentrations (8, 4 or 1 mg/ml) of CME in these sensitized animals were performed. The total white cell and differential counts in the bronchoalveolar lavage (BAL) fluids were studied at different time intervals after challenge in different animals, and tracheal pathology was performed to detect the allergic airway inflammation. For comparison with the study in animals treated with CME, a BAL study in animals treated with ovalbumin was also performed.

RESULTS

The inhalation challenge of CME aerosol in sensitized animals caused prolonged eosinophilia in BAL fluid which persisted for at least 7 days after single challenge. Neither inhalation challenge at higher concentrations of CME aerosol nor repeated inhalation challenges increased the degree of eosinophilia in BAL fluid compared to a single challenge. Using the same procedures, we also found that the mite model caused more eosinophilia in BAL fluid than did ovalbumin.

CONCLUSION

This is the first report of an animal model of mite-induced allergic airway inflammation in guinea pigs which can provide us with a useful model to study airway inflammation of mite-induced asthma in humans.

Role of KATP channels on modulating diaphragmatic microvascular flow during hemorrhagic hypotension

The effects of glibenclamide (GLB), a specific blocker of ATP-sensitive potassium (KATP) channels, and tetraethylammonium (TEA) on modulating the regulation of diaphragmatic microcirculation were assessed in anesthetized mechanically ventilated rats. With bicarbonate-buffered Ringer solution continuously suffusing the left hemidiaphragm, microcirculatory blood flow was recorded by laser-Doppler flowmetry (QLDF). Hemorrhagic hypotension (HH) was induced via bleeding into a pressure reservoir. Five sets of experiments were performed. In set 1 (n = 6), the vasodilator effect of diazoxide (3 x 10(-4) M) was abolished after a 30-min suffusion with GLB, whereas the vasodilator effect of sodium nitroprusside (3 x 10(-6) M) remained the same. In set 2 (vehicle + HH; n = 23), a stepwise reduction in systemic arterial blood pressure (ABP) induced two distinct patterns of microvascular responses. Regulation of QLDF could be observed in pattern A animals in a range of ABP from 113 to 52 mmHg, whereas QLDF in pattern B animals rose progressively with declining ABP. In set 3 (GLB + HH; n = 17), baseline values of QLDF were not significantly affected after a 30-min suffusion of GLB (10(-5) M). During HH, two microvascular patterns similar to those in set 2 were observed. GLB significantly potentiated the reduction in QLDF in pattern A animals. In contrast, GLB had no effect on QLDF in pattern B animals. In set 4 (TEA + HH; n = 17), similar microvascular responses, compared with the vehicle group, were observed during HH after a 30-min suffusion of TEA (2 x 10(-3) M). In set 5 (n = 5), baseline values of QLDF were not significantly altered during sham hypotension. We conclude that 1) KATP channels are functional but not active in the resting diaphragmatic microcirculation and 2) KATP channels can modulate regulation of the microcirculation in the resting diaphragm during HH.

Successful treatment by percutaneous balloon angioplasty of Budd-Chiari syndrome caused by membranous obstruction of inferior vena cava: 8-year follow-up study

OBJECTIVES

This study sought to report the long-term result (up to 8 years) of percutaneous transluminal balloon angioplasty (PTBA) for Budd-Chiari syndrome (BCS) caused by membranous obstruction of the inferior vena cava (MOVC).

BACKGROUND

We previously reported on this nonoperative form of therapy in a smaller series of patients and found the short-term results to be excellent.

METHODS

We studied the long-term results of PTBA in the treatment of BCS caused by MOVC in 42 patients who underwent PTBA with the Inoue balloon catheter between June 1988 and February 1996. There were 28 men and 14 women with a mean age of 35.6 years (range 16 to 56). MOVC was incomplete in 27 patients and complete in 15. PTBA was successful in 38 patients (91%). The longest follow-up period was 8 years.

RESULTS

All 38 patients who successfully underwent PTBA showed marked symptomatic improvement. Immediately after PTBA, the diameter of the inferior vena cava at the MOVC increased from 1.7 +/- 2 to 19.9 +/- 3.5 mm (p < 0.0001), the caval pressure below the MOVC decreased from 23.6 +/- 8.5 to 12.0 +/- 6.5 mm Hg (p < 0.0001), and the enlarged liver size decreased from 6.5 +/- 1.5 to 2.0 +/- 1.5 cm below the right costal margin at the midclavicular line (p < 0.0001). Over a follow-up period of up to 8 years (7 to 8 years in 4 patients, 5 to 7 years in 12, 3 to 5 years in 11, 2 to 3 years in 6 and < 2 years in 9), MOVC returned in only 1 patient. This patient, our first, required a second PTBA 3 years later and a third 4.25 years after the second PTBA, in combination with stent placement for recurrence of stenosis.

CONCLUSIONS

PTBA with the Inoue balloon catheter is an effective, safe and long-lasting alternative to surgical treatment of patients with BCS due to MOVC.

Increased IL-5 and IL-10 transcription in bronchial cells after Sauropus androgynus ingestion

An outbreak of rapidly progressive obstructive lung disease in Taiwan was noted in some patients regularly ingesting the vegetable Sauropus androgynus because of its perceived weight reducing properties. Bronchoalveolar lavage (BAL) prior to administration of medication was performed in two women who had regularly ingested this vegetable and had developed obstructive ventilatory defects. Both patients showed a significant increase in neutrophils and, to a lesser extent, of eosinophils in the lavage fluid as compared to two unrelated controls. Interleukin (IL)-1 beta, IL-2, IL-5, IL-10, interferon (IFN)-gamma and tumor necrosis factor (TNF)-alpha in cells recovered from BAL fluid were analyzed by reverse transcription-polymerase chain reaction (RT-PCR). Augmented expression of the IL-10 gene was detected in only two patients who had regularly ingested S. androgynus. Our results suggest that altered cytokine expression and infiltration of eosinophils and neutrophils may be involved in the pathology of obstructive lung disease caused by regular ingestion of S. androgynus.

Isoniazid-induced fever

A rare case of isoniazid (INH)-induced fever is described. A 27-year-old woman diagnosed with miliary tuberculosis (TB) began to receive combined anti-TB treatment including INH, ethambutol, rifampicin and pyrazinamide on the second day of hospitalization. A spiked fever developed in the afternoon of the seventh hospital day. There was no evidence of a hypersensitivity reaction. All examinations including liver function tests, routine biochemistry tests, serum titer of antinuclear antibody and rheumatoid factor were within normal limits. The blood leukocyte count was also within normal range and no evidence of infection at other sites was found. Following the discontinuance of anti-TB agents, the patient's body temperature gradually returned to normal. When the patient was rechallenged with INH, the high fever recurred. The fever subsided again after the discontinuance of INH, and her recovery followed a smooth course thereafter, on combination therapy with rifampicin, ethambutol and pyrazinamide. This experience demonstrates the potential of INH to cause an isolated fever without other manifestations, which may be misdiagnosed as an infectious process. Though it is very rare, INH-induced fever must be considered when fever develops during anti-TB treatment.

The efficacy and safety of a 19 nor-steroid in the treatment of endometriosis

BACKGROUND

An oral synthetic 19 norsteroid (gestrinone) characterized by antigonadotropic activity and antioestrogenic properties provides its use in the treatment of oestrogen depending pathologic conditions. The purpose of this open study is to evaluate the efficacy and tolerance of gestrinone in the treatment of endometriosis.

METHODS

Twenty premenopausal women with laparoscopically confirmed endometriosis received 2.5 mg gestrinone two times per week for six months. Laparoscopy was performed before treatment, and clinical responses were determined by second laparoscopy after six months. Serum CA-125 level, plasma lipid and bone density measurements during and after therapy were compared with baseline.

RESULTS

The mean endometriosis score, defined by the revised American Fertility Society scoring system, decreased from 20.16 to 4.68 (p < 0.01). The mean serum level of CA-125 also declined from 44.04 U/ml to 18.64 U/ml (p < 0.01). Metabolic studies showed a significant decrease of cholesterol in high-density lipoprotein (p < 0.05), a moderate increase in low-density lipoprotein (p > 0.05), and a slight increase in both triglyceride and total cholesterol levels (p > 0.05). Bone density in this study also showed no significant difference in either spine or femur neck for a duration of six months treatment. Hot flush occurred in less frequency in gestrinonetreated group than in gonadotropin releasing hormone agonist (GnRHa-treated group), where the side effects of weight gain and acne were less often than in the danazol group well.

CONCLUSIONS

Gestrinone 2.5 mg given twice a week for six months provides an effective and safe treatment for those women suffering from endometriosis.

Percutaneous balloon valvuloplasty for pulmonic stenosis in adolescents and adults

BACKGROUND

Percutaneous balloon valvuloplasty has been the accepted first-line treatment for congenital pulmonic stenosis in children. Its efficacy in adolescents and adults is less well defined.

METHODS

Between December 1985 and July 1995 we performed percutaneous pulmonic valvuloplasty with a single Inoue balloon catheter in 53 adolescent or adult patients 13 to 55 years of age (mean [+/- SD], 26 +/- 11). Follow-up studies were performed 0.2 to 9.8 years after the procedure (mean, 6.9 +/- 3.1) by Doppler echocardiography (in all the patients) and by cardiac catheterization and angiography (in nine patients).

RESULTS

After balloon valvuloplasty, the systolic pressure gradient across the pulmonic valve decreased from 91 +/- 46 mm Hg to 38 +/- 32 mm Hg (P < 0.001), and the diameter of the pulmonic-valve orifice increased from 8.9 +/- 3.6 mm to 17.4 +/- 4.6 mm (P < 0.001). In the nine patients catheterized at follow-up, the systolic gradient decreased from 107 +/- 48 mm Hg before valvuloplasty to 50 +/- 29 mm Hg after valvuloplasty and to 30 +/- 16 mm Hg at follow-up (P < 0.001 for the comparison of the gradient before and after valvuloplasty; P < 0.001 for the comparison before valvuloplasty and at follow-up; and P < 0.05 for the comparison after valvuloplasty and at follow-up). In the same nine patients, the diameter of the pulmonic valve, as measured by right ventricular angiography, increased from 8.3 +/- 1.4 mm before valvuloplasty to 17.2 +/- 2.0 mm after valvuloplasty (P < 0.001) and to 18.4 +/- 1.4 mm at follow-up (P = 0.08). Incompetence of the pulmonic valve was noted in 7 of the 53 patients (13 percent) after balloon valvuloplasty, but it had disappeared at follow-up in all of them.

CONCLUSIONS

Patients with congenital pulmonic stenosis who present in late adolescence or adult life can be treated with percutaneous balloon valvuloplasty with excellent short-term and long-term results that are similar to those in young children.

DNA gyrase and topoisomerase IV on the bacterial chromosome: quinolone-induced DNA cleavage

DNA gyrase, the bacterial enzyme that supercoils DNA, is trapped on chromosomal DNA by the 4-quinolone compounds, as drug-gyrase complexes that contain DNA breaks. Examination of chromosomal DNA extracted from Escherichia coli indicated that bacteriostatic concentrations of oxolinic acid trap gyrase and block DNA synthesis without releasing broken DNA from gyrase-DNA complexes. Release, detected as free rotation of DNA in the presence of an intercalating dye, occurred only at high, bactericidal oxolinic acid concentrations. Release of DNA breaks and cell death were both blocked by chloramphenicol, an inhibitor of protein synthesis, suggesting that synthesis of additional protein activity is required to free the DNA ends. Ciprofloxacin, a more potent quinolone, released DNA breaks and killed cells even in the presence of chloramphenicol. It is proposed that this second, chloramphenicol-insensitive mode for release of DNA breaks and cell killing arises from dissociation of gyrase subunits. Ciprofloxacin also killed a gyrase (gyrA) mutant resistant to the prototype of quinolone, nalidixic acid, and created complexes on DNA detected by DNA fragmentation. This lethal effect of ciprofloxacin was eliminated by additional mutations mapping in parC, one of the two genes encoding topoisomerase IV. Thus, the fluoroquinolone compounds have two intracellular targets. In the absence of the gyrA mutation, the parC (CipR) allele did not by itself confer resistance to ciprofloxacin, indicating that gyrase is the major quinolone target in E. coli. These findings provide a molecular explanation for quinolone action in bacteria and a new way to study topoisomerase IV-chromosome interactions.

Occlusion of large atrial septal defects with a centering buttoned device: early clinical experience

A feasibility clinical study was conducted for the transcatheter occlusion of large ostium secundum atrial septal defects with the centering buttoned device. The centering buttoned device is a modification of the regular buttoned device in which a centering counter-occluder is sutured at the central 40% portion of the occluder. During centering it is stretched, forming a parachute-shaped structure and pulling the occluder over the center of the defect. During buttoning, the counter-occluder forms a double figure eight, opposing the right atrial side of the atrial septum. Occlusion was performed in 12 patients aged 6 to 56 years. All had been rejected for transcatheter occlusion by the regular buttoned device, because of either their defect size or the lack of adequate septal rim. The defect size varied between 23 and 31 mm, and the device size varied between 45 and 60 mm. Nine had immediate effective occlusions of their defects and three residual shunts. One patient with unbuttoning had hemolysis at 2 weeks and underwent surgery. Early results of the transcatheter occlusion of large atrial septal defects are promising, and larger clinical trials are justified.

Percutaneous balloon mitral valvuloplasty by the Inoue technique: a multicenter study of 4832 patients in China

Between November 1985 and January 1994, 4832 patients with rheumatic mitral stenosis from 120 medical centers in China underwent PBMV by the Inoue technic. There were 1440 men and 3392 women with a mean age of 36.8 +/- 12.3 years. The procedure success rate was 99.30%. Major complications included death in 0.12%, > or = 3+/4+ mitral regurgitation in 1.41%, cardiac tamponade in 0.81%, and thromboembolism in 0.48%. After PBMV, the mean left atrial pressure decreased from 26.2 +/- 7.6 mm Hg to 11.4 +/- 6.1 mm Hg (p < 0.001); mean mitral diastolic gradient decreased from 18.3 +/- 5.1 mm Hg to 5.4 +/- 3.1 mm Hg (p < 0.001); pulmonary artery systolic pressure decreased from 51.2 +/- 14.8 mm Hg to 33.9 +/- 8.8 mm Hg (p < 0.001); cardiac output increased from 3.8 +/- 1.3 L/min to 4.8 +/- 1.2 L/min (p < 0.001); and mitral valve area expanded from 1.1 +/- 0.3 cm2 to 2.1 +/- 0.2 cm2 (p < 0.001). Functional status was NYHA class IV in 5.6%, class III in 38.8%, class II in 55.5%, and class I in 0.1% of patients before PBMV and improved to class I in 75.8%, class II in 23%, and class III in 1.2% after PBMV. The rate of restenosis was 5.2% over a follow-up period of 32.2 +/- 14.2 months in the entire group and 4.6% over a follow-up period of 5.1 +/- 1.0 years in Guangdong Cardiovascular Institute, where PBMV was begun in China.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of prostaglandins and nitric oxide on basal blood flow and acetylcholine-induced vasodilation in rat diaphragmatic microcirculation

To assess the effect of prostaglandins and endothelium-derived relaxing factor (EDRF) on diaphragmatic microcirculation under basal conditions and after acetylcholine (ACh) stimulation, we studied a diaphragmatic preparation in anesthetized rats. With bicarbonate-buffered Ringer's solution suffusing the abdominal surface of the left costal diaphragm, laser-Doppler flowmetry was used to record microvascular blood flow (QLDF). Microvascular conductance (CLDF) was derived from QLDF by dividing by the systemic blood pressure. Drugs were applied to the surface of the diaphragm. Four series of experiments were performed. In Series 1 (n = 9), ACh (3 x 10(-5)-10(-3) mol/L) elicited a concentration-dependent increase in QLDF and CLDF. In Series 2 (n = 11), ACh-induced QLDF and CLDF changes were significantly attenuated after 30 minutes suffusion of indomethacin (10(-5) mol/L), although baseline QLDF and CLDF were little affected. In Series 3 (n = 7), following suffusion of N omega-nitro-L-arginine methyl ester (L-NAME) (10(-4) mol/L) for 30 minutes, there was no change in baseline QLDF and CLDF. The ACh-induced QLDF change was abolished, while there was still a slight increase in CLDF (172 +/- 26%) at high concentrations of ACh (10(-3) mol/L). In Series 4 (n = 5), co-administration of indomethacin (10(-5) mol/L) and L-NAME (10(-4) mol/L) for 30 minutes did not completely prevent the increase in CLDF (143 +/- 13%) induced by high concentrations of ACh (10(-3) mol/L). The data suggest low basal activities of both vasodilatory prostaglandins and EDRF in diaphragmatic microvascular beds of the anesthetized rat, while both mediators independently modulate microvascular responses to ACh.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hemolytic disease of the newborn caused by maternal anti-Di(a): a case report in Taiwan]

The first case of hemolytic disease of the newborn (HDN) possibly caused by anti-Di(a) in a Chinese infant in Taiwan is reported. The mother had two pregnancies before but no history of blood transfusion. Her first male infant was normal, but her second full-term male one developed mild jaundice soon after birth, and the total bilirubin level was 12.1 mg/dL, 18.3 mg/dL, 23.6 mg/dL at 24 hours, 48 hours, and 72 hours of age, respectively. Total bilirubin was 9.1 mg/dL on the eighth day after receiving phototherapy and compatible blood exchange transfusion. The infant recovered uneventfully. The immunohematological study revealed that the mother was group AB, Rh (D)+; Di(a - b+), the father was group O, Rh (D)+; Di(a + b+), the infant boy and his 2-year-old brother were group B, Rh(D)+; Di(a + b+). The direct antiglobulin test (DAT) on the infant red cells was positive (4+ with polyspecific AHG; 4+ with anti-IgG). The maternal serum and infant's eluate from red blood cells showed negative reactions in routine antibody detection tests, but they contained alloantibody reacting against the Di(a+) cells by the manual polybrene test (MP) and indirect antiglobulin test (IAT) in AHG phase. The anti-Di(a) titers in the mother's serum was MP 1:256 and AHG 1:256, and in the infant's eluate was MP 1:128 and AHC 1:64 against Di(a + b+) cells. Based on the above results we conclude that the jaundice in this newborn baby was caused by maternal anti-Di(a) which was most likely induced by previous pregnancy. In conclusion, Diego blood group is a system of high value in anthropology because it accounts for the Mongoloid origin of American Indians, Japanese and Chinese. Anti-Di(a) may cause HDN, as in our case of HDN due to maternal anti-Di(a) in a Chinese infant. But in Europe and America, where practically all people are Di(a - b+) phenotypes, the system seems of no interest in parental studies as well as in blood transfusions. Owing to the Di(a) antigen is of higher incidence in Chinese population, we suggest that the Diego system should be involved in routine compatibility testing or antibody identification problems in parental studies and in blood transfusions in Taiwan.

Diaphragmatic microcirculation measured by laser-Doppler flowmetry in the rat

The applicability of laser-Doppler flowmetry (LDF) in measuring regional blood flow of the diaphragm (Qdi) was evaluated in anesthetized and mechanically ventilated rats. Specifically, we assessed the issues of the degree of tissue perfusion, spatial variations of Qdi signals, and the correlation between these signals and total Qdi. Qdi was detected from an area 1 mm in diameter and 0.5 mm in depth. With Ringer solution continuously suffusing the abdominal surface of the left hemidiaphragm, drugs were applied to the surface of the diaphragm at 1/100 of the flow rate of the suffusing fluid. In 13 rats, resting Qdi and the response of Qdi to a single concentration of adenosine (10(-4) M) remained unchanged over a 2-h period. Increasing adenosine concentrations (10(-9) to 10(-3) M) in eight rats elicited a progressive rise in Qdi. In six rats, the variability of Qdi in a given rat was assessed over five different sites at 2-mm intervals in a line on the diaphragm. A wide range of variability in Qdi was noticed among different sites. The depth of tissue penetration of LDF was little affected when a piece of freshly diaphragm was interposed between the probe and the perfused diaphragm, suggesting that LDF signals arise from complete penetration of the perfused diaphragm. Finally, significant linear relationships between mean Qdi and total Qdi were observed in all animals; however, the slopes of these relationships varied significantly between animals. In conclusion, LDF provides a stable and continuous method for monitoring regional microvascular diaphragmatic perfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Rapidly fatal outcome of bacteremic Klebsiella pneumoniae pneumonia in alcoholics

Twenty-eight alcoholic patients with community-acquired pneumonia who were admitted to a referral medical center during a 3-year period were reviewed. All were men and with few exceptions were heavy smokers. The overall mortality was 64.3%. The most dramatic group was that of 11 patients (39.3%) with bacteremic Klebsiella pneumoniae pneumonia (BKPP), which had high mortality rate (100%), short onset of illness before hospital admission (42.6 +/- 8.2 h, mean +/- SD), and short survival time after the admission (24.6 +/- 7.9 h). All these 11 patients needed intensive care unit (ICU) management and ventilatory support. ARterial blood gas values showed marked hypoxemia and metabolic acidosis in most of these 11 patients, and presence of shock at arrival in the hospital was noted in 8 patients. Acute renal failure and disseminated intravascular coagulation developed in six patients. Chest radiographs showed pleural effusion and radiographic spread in nearly 50% of patients. Combination chemotherapy consisting of one aminoglycoside and one second- or third-generation cephalosporin was initiated in all patients. The rapidly fatal outcome of these 11 patients with BKPP despite management with adequate antibiotics and intensive care indicated the fulminant nature of this disease. High virulence of the microorganism, altered immune response, and increased susceptibility to infection may all have contributed to the fulminancy in this group of patients. The disease continues to present many difficulties in management.