Concomitant human immunodeficiency virus infection and syphilitic meningitis

Syphilis has once again become a public health issue with the advent of human immunodeficiency virus (HIV) infection. We report a 28-year-old Chinese man with recently acquired HIV infection together with early neurosyphilis. His presentation of acute mononucleosis-like syndrome, lymphadenopathy, aseptic meningitis, positive central nervous syndrome and reactive Venereal Disease Research Laboratory test in his cerebrospinal fluid helped to reach the diagnosis. Paired serum Western blot tests for HIV infection performed 1 month apart revealed either a new appearance or an increasing intensity of bands for p17, p24, p31, gp41, p52, p55, p68, gp120 and gp160 suggesting recently acquired HIV infection. The lymphadenopathy disappeared spontaneously and the neurosyphilis responded well to 14 days of penicillin G therapy. The Western blot pattern, clinical course, laboratory data, and therapeutic response indicated that the acute retroviral syndrome and early central nervous system involvement caused by Treponema pallidum occurred concomitantly.

Etiology of lymphadenopathy in patients with AIDS in Taiwan

From 1986 to 1995, we retrospectively reviewed the records of 40 of 125 patients (32.0%) with acquired immunodeficiency syndrome (AIDS) who presented with extrainguinal lymphadenopathy. Most of the patients had an advanced stage of HIV infection with a mean CD4 lymphocyte count of 44/mm3. AIDS-defining opportunistic infections and malignancies were present in most patients and the neck region was the most common site of involvement. The etiology of lymphadenopathy was established in 26 patients. Tuberculous lymphadenitis was the most common cause, followed by lymphadenopathic Kaposi's sarcoma, benign reactive hyperplasia, cryptococcal lymphadenitis and disseminated Mycobacterium avium complex infection. Characteristic histopathologic findings were detected in 19 patients and 7 had presumptive tuberculous infections. The remaining 14 patients had no definitive etiology for their lymphadenopathy. As the causes are variable and the number of HIV/AIDS cases is increasing in Taiwan, more patients with lymphadenopathy, especially in the early stages of HIV infection will be encountered. Therefore, it is essential that diagnostic histopathologic and microbiologic studies be performed for appropriate and timely treatment.

Nosocomial candidemia in a university hospital in Taiwan

The incidence of nosocomial candidemia increased 27-fold over the past 13 years at National Taiwan University Hospital. In order to investigate its predisposing factors, clinical manifestations and prognostic determinants, a prospective observational study of nosocomial candidemia was undertaken at the hospital. From 1 May 1994 to 30 April 1995, 118 consecutive adult patients with 120 Candida spp blood isolates were analyzed. Clinical presentations included fever (100%) with a median duration of 3 days, diarrhea within 7 days of candidemia (27.9%) and macronodular skin emboli (7.6%). Laboratory studies showed worsening azotemia (35.6%), elevation of aminotransferase (28.3%), leukocytosis (27.1%) and thrombocytopenia (23.3%). Use of multiple antibiotics, retained vascular catheters and parenteral nutritional support were the three most common predisposing factors for candidemia. C. albicans was the most common isolate (50%), followed by C. tropicalis (20%), C. glabrata (14%), C. parapsilosis (9.2%). C. guilliermondii (2.5%), and C. Krusei (1.7%). C. tropicalis was more frequently the cause of candidemia in patients with leukemia and neutropenia, while C. glabrata was more commonly seen in patients receiving fluconazole prophylaxis. A severity scoring system adopted from prospective bacteremia studies proved to be highly predictive of mortality in candidemic patients. The overall case fatality rate was 70/118 (59.3%), and 51/70 (72.9%) were attributable to candidemia. In a multivariate analysis, the prognostic factors adversely influencing outcome were: higher severity scores, no removal of the catheter, persistent candidemia and lack of antifungal therapy.

Characterization of multiple metalloproteinases with fibrinogenolytic activity from the venom of Taiwan habu (Trimeresurus mucrosquamatus): protein microsequencing coupled with cDNA sequence analysis

Three fibrinogenolytic proteases were isolated and purified from the venom of Taiwan habu (Trimeresurus mucrosquamatus) using anion-exchange and gel-filtration chromatographies followed by cation-exchange HPLC. Further characterization of these purified fractions with fibrinogenase activity indicated that they are single-chain proteases of approximately 24 kDa, possessing strong cleaving activity mainly on the A alpha and less on B beta and gamma chains of fibrinogen subunit chains. Enzyme activities were strongly inhibited by EDTA or 1,10-phenanthroline and not by phenylmethanesulfonyl fluoride, suggesting that these fibrinogenases belong to the family of metalloproteinases and not thrombin-like serine proteases. N-Terminal sequence analysis of these proteases failed to show any free amino-terminal residues, thus hampering the sequence determination by conventional sequencing strategy. Microsequencing on the electroblotted fragments of CNBr-treated proteases separated on SDS-PAGE was then used to determine the partial sequences. Sequence comparison of the determined partial sequences of these proteins with published sequences of the protein data bank revealed that they showed sequence homology with H2-protease. HR2a and protrigramin, which were all shown to belong to metalloproteinases present in various snake venoms. Polymerase chain reaction (PCR) was employed to amplify cDNAs constructed from the poly(A)+RNA of fresh venom glands of the same snake species to facilitate cloning and sequencing of these proteases. Sequencing several positive clones containing amplified cDNAs revealed the existence of one fibrinogenase in the Taiwan habu, which was contained within one complete cDNA encoding the preproproteinase precursor of hemorrhagic metalloproteinases.

Inhibition of protein kinase C by snake venom toxins: comparison of enzyme inhibition, lethality and hemolysis among different cardiotoxin isoforms

Cardiotoxins, neurotoxins and phospholipase A2 (PLA2) are three major classes of toxic components present in the Taiwan cobra, Naja naja atra of the Elapidae family. Cardiotoxins (or called cytotoxins), a group of major polypeptides of around 60 amino-acid residues present abundantly in the elapid family of snakes, comprise about 45-55% of the crude venom of Taiwan cobra. In contrast to another prominent group of structurally similar neurotoxins with well-established acetylcholine receptors and modes of action, cardiotoxins showed no defined cellular targets and very diverse pharmacological functions. A systematic structure/function comparison of these toxins was made by their relative inhibitory effects on protein kinase C (PKC) isolated from mouse brains. Lethality and hemolysis of various cardiotoxin isoforms were also compared in order to shed some insight on the biological targets and mechanisms of these surface-active amphiphilic polypeptides. A structure comparison of these cardiotoxins based on computer model-building revealed that some defined and subtle differences can be detected upon the superposition of these three-dimensional polypeptide chains, which may reflect the intrinsic differences in the hydrophobic peptide segments present on the surface loops of toxin molecules. The differences seem to correlate with different inhibitory activities exhibited by cardiotoxins in contrast to the lack of activity by cobrotoxin and PLA2 on PKC.

Cerebellar medulloblastomas: a comparison between adults and children

A retrospective analysis of 19 medulloblastomas in patients aged 2 to 24 years was conducted employing 14 children (<15 years old) and 5 adults. All patients received gross total excision of the tumour with postoperative craniospinal irradiation. The patients were then followed up for more than 5 years. To determine which factors influenced the prognosis of these two age groups, we analysed the differences of the proliferating cell nuclear antigen (PCNA), the degree of tumour invasion and the outcome between adult and childhood medulloblastomas. In summary, medulloblastomas in adults and children had similar cell proliferative activity and long term survival rates but the tumours with brain stem invasion, which commonly occurred in children, had an early recurrence rate and a poor prognosis. The prognosis of medulloblastoma may depend upon the degree of tumour invasion of the brain stem.

Trichosporon beigelii fungemia in patients with acute leukemia: report of three cases

Trichosporon beigelii fungemia with localized visceral involvement or dissemination is a life-threatening infection in patients with granulocytopenia. We report three cases of T. beigelii fungemia in patients with acute leukemia seen at the National Taiwan University Hospital. Two patients were in the granulocytopenic state after cytoreductive chemotherapy, while one was in complete remission. Fever persisted or recurred despite conventional antibiotic treatment when fungemia developed. Cutaneous trichosporonosis was noted in one patient, which was misdiagnosed as candidiasis. An indwelling catheter constituted the likely portal of entry in two patients. Therapeutic response to amphotericin B is generally not achieved in patients without recovery of neutrophil counts and in those with retained catheters.

Sequence comparison and computer modelling of cardiotoxins and cobrotoxin isolated from Taiwan cobra

Six cardiotoxins and one neurotoxin isolated and purified from the Taiwan cobra venom (Naja naja atra) possess distinct pharmacological and biochemical properties despite the existence of a grossly similar tertiary structure among these toxins, i. e., a core consisting of a series of short loops and four disulfide bridges. A systematic structure comparison of these major toxin isoforms was made by the secondary-structure predictions together with computer model-building based on the primary sequences and the established X-ray and NMR structures of one published cardiotoxin isoform and cobrotoxin. It is of interest to find that some defined and subtle differences can be detected upon the superposition of these three-dimensional polypeptide chains, which may reflect the intrinsic differences in the surface hydrophobicity of cardiotoxins and cobrotoxin as revealed by hydropathy profiles of these toxins in one of three major loops. The differences seem to correlate with different inhibitory activities exhibited by cardiotoxins in contrast to the lack of activity by cobrotoxin on protein kinase C (PKC).

Antibiotic therapy for Listeria monocytogenes bacteremia

Listeria monocytogenes has been recognized as an important pathogen in immunocompromised patients, but it has been rarely reported in Taiwan. We reviewed 13 cases of L. monocytogenes bacteremia at National Taiwan University Hospital over a 12-year period. All of the patients had underlying diseases. Fever was the most common presenting symptom, and neurologic signs were found in 6 patients. Most of the patients received penicillin G, ampicillin or piperacillin with an aminoglycoside. Corticosteroids were used in 9 of 13 patients. The overall mortality directly due to L. monocytogenes bacteremia was 31%. However, patients treated with cephalosporins or oxacillin had higher mortality than those treated with penicillin G, ampicillin or piperacillin (p = 0.05). Given the increasing number of immunosuppressed patients in Taiwan, it is likely that more cases will be encountered. Physicians in Taiwan should be aware of L. monocytogenes bacteremia and its treatment.

Characterization of one novel venom protease with beta-fibrinogenase activity from the Taiwan habu (Trimeresurus mucrosquamatus): purification and cDNA sequence analysis

Several fibrinogenolytic proteases were isolated from the venom of Taiwan habu, Trimeresurus mucrosquamatus, a snake species belonging to the Crotalidae family. One protease with strong fibrinogenolytic activity was further purified to homogeneity through multiple-step chromatographies including ion-exchange chromatography, gel permeation and reversed-phase HPLC. In vitro, the purified enzyme cleaved beta-chain of fibrinogen molecules efficiently and showed relatively lower activity on alpha-chain, with almost no activity on gamma-chain even after a long period of incubation. Further characterization indicated that it is a single-chain polypeptide with molecular weight of about 28,000. Its stability at high temperatures (> 90 degrees C) distinguished it from the previously reported venom fibrinogenases. N-Terminal sequence analysis revealed that it is similar to batroxobin and ancrod, which were shown to possess either fibrinogen-clotting or antithrombotic effect. Polymerase chain reaction (PCR) was employed to amplify cDNAs constructed from the poly(A)+RNA of fresh venom glands of the same snake species to facilitate the cloning and sequencing of this important fibrinogenase. Sequencing several positive clones corresponding to the coding sequence of the enzyme revealed the existence of a family of novel thrombin-like fibrinogenases in the Taiwan habu, which are heat-stable and may be useful as strong antithrombotic agents.

Plasmodium vivax infection in a renal transplant recipient: report of a case

A patient with end-stage renal disease who acquired Plasmodium vivax infection after renal transplantation is reported. This 24-year-old male, a native of Taiwan, had chronic renal failure due to nephrotic syndrome of unknown etiology and had been maintained on regular hemodialysis. He developed a fever 18 days after receiving a blood transfusion and a renal allograft transplant from unknown donors in India, while he was taking corticosteroids, azathioprine and cyclosporine. Ring forms, schizonts and trophozoits of P. vivax were found in the patient's peripheral blood. He achieved defervescence after a three-day treatment of chloroquine. Malaria should be considered in the differential diagnosis of fever in transplant recipients who have received organs or blood products from an area of endemic malaria.

Invasive pulmonary pseudallescheriasis with direct invasion of the thoracic spine in an immunocompetent patient

Most invasive pseudallescheriasis infections have occurred in immunocompromised patients. The case of an immunocompetent patient with invasive pulmonary pseudallescheriasis and subsequent contiguous extension to the ribs and spine is reported. Aspergillosis was mistakenly diagnosed on histopathologic examination of the debrided tissue. Culture of the debrided tissue yielded Pseudallescheria boydii.

Isolation of multiple isoforms of alpha-fibrinogenase from the Western diamondback rattlesnake, Crotalus atrox: N-terminal sequence homology with ancrod, an antithrombotic agent from Malayan viper

Three fibrinogenolytic proteases from the rattlesnake (Crotalus atrox) venom were isolated and purified from multiple-step chromatographies including ion-exchange chromatography, gel permeation and reversed-phase HPLC. The fractions were shown to be homogeneous as judged by SDS-gel electrophoresis. In vitro, they also showed a high and specific proteolytic activity against alpha-chains of fibrinogen molecules. Further characterization of these purified fractions with fibrinogenase activity indicated that they are all single-chain proteins with similar molecular weights of about 33,000-35,000. Their stability at high temperatures was examined and the cleavage specificity of various proteases was studied using oxidized insulin B-chains as substrates. The reactivity toward fibrinogen molecules in the presence of varied protease inhibitors including EDTA, beta-mercaptoethanol, soybean trypsin inhibitor, aprotinin and phenylmethanesulfonyl fluoride was also investigated in order to classify these proteases based on their reaction mechanisms. Amino acid analysis indicates that these purified venom toxins possess closely-similar compositions with regard to most amino acids including cysteine, methionine and tyrosine. N-Terminal sequence analysis of these proteases revealed that they are similar to ancrod, an antithrombotic agent isolated from the Malayan pit viper. This study points to the existence of a family of novel ancrod-like fibrinogenases in crotalid rattlesnakes, which may be useful as effective venom-based anticoagulants.

Craniofacial hyperhidrosis treated with video endoscopic sympathectomy

Craniofacial hyperhidrosis as well as palmar hyperhidrosis is an abnormal state of local excessive sweating of unclear etiology. The hyperhidrosis may be isolated in the craniofacial region or associated with palmar hyperhidrosis. The patient's face is so wet with sweat that their daily activities are often seriously disturbed. To the best of our knowledge, there has been no satisfactory medical therapy, nor any effective surgical treatment reported in the literature. In 1991, we started to treat a patient with such distress using endoscopic ablation of the sympathetic T2 segment, because we mastered the technique after treating a large series of palmar hyperhidrosis patients. Furthermore, we were impressed by concomitant reduction of craniofacial sweating after T2-3 sympathectomy resulting from the relatively different domination of sympathetic supply between the eye and face. It appears possible to relieve excessive sweating of the head and face, without producing ptosis or miosis by ablation of the T2 segment. During the past 2 years, 7 patients with severe craniofacial hyperhidrosis have been successfully treated with the method and all obtained a satisfactory result. No complete Horner's syndrome has been produced except in one patient, who showed a mild and transient left eye ptosis, in whom coagulation of the sympathetic trunk higher than the T2 segment was performed. Intraoperative monitoring of forehead skin perfusion and observation of the change of pupillary size is emphasized during the lesion making. The longest postoperative follow-up was 2 years, with a mean follow-up of 12.4 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Sequence analysis and expression of phospholipase A2 from Taiwan cobra

Polymerase chain reaction (PCR) was employed to amplify cDNAs constructed from the poly(A)+RNA of venom glands in Taiwan cobras to facilitate the cloning and sequencing of phospholipase A2 (PLA2) gene. The PCR product was then subcloned into pUC18 vector and transformed in E. coli strain JM109. Plasmids purified from the positive clones were prepared for nucleotide sequencing by dideoxynucleotide chain-termination method. Sequencing several clones containing about 0.5 kb DNA inserts constructed a complete and unambiguous full-length reading frame of 468 base pairs covering a precursor for phospholipase A2 with a deduced mature protein sequence of 119 amino acids and a 27 amino-acid segment of signal peptide. The sequenced major PLA2 with pI 4.991 shows a high degree of sequence homology to those PLA2 of the same or closely-related genus. The deduced protein sequence allows us to correct and resolve some discrepancy between the sequences determined by conventional protein sequencing (Toxicon, 19, 141(1981)) and X-ray crystallography (Science, 250, 1560(1990)). Expression of PLA2 in E. coli vector generated a polypeptide which can cross-react with the antiserum against the native and purified PLA2 from the same cobra venom albeit with a much lower activity.

Sequence characterization of cardiotoxins from Taiwan cobra: isolation of a new isoform

Cardiotoxins (or called cytotoxins) are a group of very basic polypeptides present in some snake venoms, which are especially abundant in Formosan cobras. Several cardiotoxins with distinct pharmacological and biochemical properties were isolated and purified from the Taiwan cobra venom (Naja naja atra) by employing sequentially preparative-scale cation-exchange chromatography on TSK CM-650 coupled with the improved separation of toxin components on reversed-phase HPLC based on their hydrophobicity. The complete sequences of six cardiotoxin analogues, including one novel isoform never reported previously in this venom, were determined by N-terminal Edman degradation with the automatic pulsed-liquid phase sequencer and comparison of amino-acid compositions of purified toxin components. This novel cardiotoxin, a basic polypeptide of pI 10.13, comprises about 5% of total crude venom. It consists of 60 amino-acid residues with four disulfide bonds and shares about 80-92% sequence identity with several cytotoxins isolated from varied sources of different snakes. A systematic structure comparison of six major cardiotoxin isoforms was made by the secondary-structure predictions and hydropathy profiles based on their primary sequences. It is of interest to find that some subtle differences among these natural cardiotoxin analogues may lie in the intrinsic differences of the surface hydrophobicity of these isotoxins.

Characterization of three fibrinogenolytic proteases isolated from the venom of Taiwan habu (Trimeresurus mucrosquamatus)

Snake venoms, particularly those belonging to Crotalidae and Viperidae families, are known to possess fibrinogenolytic proteases which strongly affect the blood coagulation system. Three fibrinogenolytic enzymes, named as TM-1, TM-2 and TM-3, were purified from the venom of Taiwan habu using anion-exchange and gel-filtration chromatographies followed by cation-exchange HPLC. These enzyme fractions were shown to be homogeneous as judged by SDS-gel electrophoresis. Further characterization of these purified fractions with fibrinogenase activity indicated that they are single-chain proteases possessing basic isoelectric points and molecular masses of approximately 27 kDa. These enzymes cleaved alpha-chain of fibrinogen first and then beta-chain, with relatively low activity on gamma-chain. Fibrinogenolytic activities of these enzymes were not significantly affected at extreme pH values, activity loss occurred only at temperatures higher than 65 degrees C. Enzyme activities were strongly inhibited by some metal chelators such as EDTA or 1,10-phenanthroline, suggesting that these fibrinogenases belong to metalloproteases. The closely similar amino-acid compositions coupled with identical cleaved products of similar molecular masses observed on the autolysis of TM-1 and TM-2 suggest that these two proteases are similar in primary structures and probably mutually related.

Neurobehavioral manifestations following closed head injury

This study was designed to examine neurobehavioral sequelae following closed head injuries. It adapted the Neurobehavioral Rating Scale (NRS) which was designed by Harvey S. Levin in 1987. The scale has been proven to be valid and reliable in previous Western studies and was translated by the authors into Mandarin with the consent of its designer. A total of 335 cases of closed head injury in eight major hospitals in Taipei were studied. The main findings obtained from this preliminary study were: 1) the correlation coefficients between raters ranged from 0.749 to 0.956, manifesting satisfactory reliability; 2) seven factors were obtained through factorial analysis of NRS, explaining 65.5% of the variance; and 3) significant differences in neurobehavioral change were found in patients with various degrees of severity and various types of head injuries. The results demonstrate that NRS is applicable to Chinese patients. Possible modification as well as elaboration of this scale is suggested.

[Follow-up study on screening positives of hypertension and diabetes--results of follow-up by the Yang-Ming Crusade in 1990]

This study was to follow-up the screening positives of hypertension and diabetes screened in 1989 by the Yang-Ming Crusade. The purposes were to understand the control situation of hypertensive and diabetic positives, to understand the continuing situation of diagnosis and treatment by local health center, and to understand the medical attitude and behavior of the screening positives. A total of 768 positives were screened in 1989 and 462 (60.2%) were interviewed. Among them, 44.4% were male and 55.6% were female; 27.7% were aged 50-59 and 28.4% were aged 60-69; 337 positives were hypertensive, 97 were diabetic and 28 had both conditions. The results of follow-up in 1990 showed that, 34.2% of 462 interviewees had gone to the local health center for testing, 37.7% had regular treatment and 19.7% (91 persons) had become normal. The leading methods of treatment were western doctor (35%), local health center (27.2%) and pharmacies (18.7%). Most patients pursued a regular treatment. The reasons not to have a regular treatment were that it was unnecessary because of lack of symptoms (37.2%), lack of time (18.1%), and that it was unnecessary because of cure (3.5%). The results showed that patients lacked knowledge of chronic diseases. Health education is important to let patients have proper information about regular treatment. Logistic regression analysis showed that two factors, "age" and "geographic area", were significantly related to submitting to testing in the local health center. The results of logistic regression also indicated that three factors, "whether having submitting to testing in the local health center or not", "age", and "geographic area", were significantly related to regular treatment.

Therapy for supratentorial malignant astrocytomas: survival and possible prognostic factors

Maximum feasible resection of the tumor followed by 50 Gy whole brain irradiation was the routine management for patients with malignant glioma in this series. To determine treatment results and possible prognostic factors, a retrospective analysis was done of 116 patients with pathologically proven supratentorial malignant astrocytomas (71 glioblastoma multiforme and 45 anaplastic astrocytoma) from January 1981 to December 1990. The mean age of the patients at the time of diagnosis was 46 years for glioblastoma multiforme and 37 years for anaplastic astrocytoma. In 86% of the patients, their condition improved or was constant after surgery; in 14% of the patients, the conditions worsened. The median survival time was 10 months for patients with glioblastoma multiforme and 22 months for those with anaplastic astrocytoma. Cox regression analysis showed that the duration of symptoms, extent of resection, irradiation and tumor histology were significantly related to the survival time. However, gross total resection did not improve the survival time relative to a subtotal resection, although both were shown to be better than a partial resection or biopsy.

Prognostic factors of intraspinal neurilemmoma and meningioma with severe preoperative motor deficits

A total of 20 cases of intraspinal benign tumors (13 neurilemmomas and seven meningiomas) with severe motor deficits operated on from 1978 to 1991 were reviewed. Motor deficits were graded according to the classification of Cooper and Ebstein. Grade IV represented slight movement of the lower extremities, but no ability to walk or stand; grade V was complete paralysis. There were 16 patients classified as grade IV and four classified as grade V. All patients underwent total excision of the tumor and postoperative physical therapy. After various periods of follow-up, 13 patients could walk independently, five could walk with assistance, one could stand, and one was still restricted to a wheelchair. For the 13 patients who could walk independently, 11 were able to stand within one month after surgery. In contrast, of the seven patients who could not walk independently, only two managed to stand within one month of surgery. Statistically, age, duration of paraplegia and tumor location all had a significant influence on the recovery of motor function. Being able to stand within one month of surgery was predictive of a good recovery.

Biochemical characterization of crystallins from pigeon lenses: structural and sequence analysis of pigeon delta-crystallin

Crystallins from pigeon eye lenses were isolated and purified by gel-permeation chromatography and characterized by gel electrophoresis, amino-acid composition and sequence analysis. Alpha- and beta-crystallins could be obtained in relatively pure forms by single-step size-exclusion chromatography whereas an extra step of ion-exchange chromatography was needed for the separation of delta-crystallin from the beta-crystallin fraction. In contrast to most characterized vertebrate species, a large amount of glycogen is eluted as a high molecular form in the first peak of the gel filtration column. Pigeon delta-crystallin, similar to duck and reptilian delta-crystallins, exists as a tetrameric structure of about 200 kDa in the native form and is composed of one major subunit of 50 kDa with heterogeneous isoelectric points spreading in a range of 4.7 to 6.8. In contrast to those obtained from duck, goose and caiman, delta-crystallin isolated from the pigeon lens possessed very little argininosuccinate lyase activity. However, pigeon delta-crystallin can still cross-react with the antibody against enzymically active duck delta-crystallin as revealed by the sensitive immunoblotting technique. It was also shown that the delta-crystallin content of the total pigeon soluble proteins decreased with the age of the animal. Structural analysis of purified delta-crystallin fraction was made with respect to its amino-acid composition and protein primary sequence. N-terminal sequence analysis indicated the presence of blocked amino-termini in all crystallin fractions of pigeon lenses. Therefore, a sequence analysis of PCR (polymerase chain reaction) amplified delta-crystallin cDNA was employed to deduce the protein sequence of this crystallin. Structural comparison of delta-crystallin sequences from pigeon, chicken and duck lenses casts some doubts on the recent claim that His-89-->Gln mutation in the chicken delta-crystallin may account for the loss of argininosuccinate lyase activity in this avian species, as compared to high enzymic activity in the duck crystallin (Barbosa et al. (1991) J. Biol. Chem. 266, 5286-5290).

[Epidemiologic study of head injuries in Taipei City, Taiwan]

This study was designed to examine the descriptive epidemiology of head injuries in an urban population in the Taiwan area, Taipei City, during the period from July 1, 1987 to June 30, 1988. Clinical records reviewed included emergency room (ER) charts, inpatient charts of 19 major hospitals, death registration forms and medical examiners' reports in this city. A formulated definition was used to identify patients with head injuries. A total of 4,692 cases were collected, which included 4,319 hospital inpatients and 373 non-hospital deaths. The average incidence rate for head injury was 180/100,000 per year, 246/100,000 for males and 111/100,000 for females. The highest incidence rate was observed in the elderly group followed by the age group of 20-29 years. Sixty eight percent of the head injuries were caused by traffic accidents, 59.7 percent of which were involved in motorcycle rides. This rate was higher than those in any western reports. Among the 10-39 age group, the head injuries caused by traffic accidents were mainly due to motorcycle accidents. However, most of the children and the elderly who were injured were either pedestrians or bicycle riders. The average mortality rate was 23/100,000 per year, 34/100,000 for males and 12/100,000 for females. Initially the Glasgow Coma Scale was used in assessing the severity of head injuries. Seventy-two percent of the cases were considered mild, and 28 percent moderate to severe in degree, including 609 deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Characterization of a protease with alpha- and beta-fibrinogenase activity from the Western diamondback rattlesnake, Crotalus atrox

A metalloprotease from the rattlesnake Crotalus atrox venom was isolated and purified from multiple-step chromatographies including anion-exchange chromatography, gel permeation and reversed-phase HPLC. The fraction was shown to be homogeneous as judged by SDS-gel electrophoresis. It also showed a high proteolytic activity against alpha- and beta-chains of fibrinogen molecules. Further characterization of the purified fraction with fibrinogenase activity indicated that it is a single-chain protease with a molecular mass of about 24 kDa and an acidic isoelectric point. It is relatively heat stable up to about 65 degrees C, inhibited by EDTA, beta-mercaptoethanol, but not by phenylmethanesulfonyl fluoride, N alpha-p-tosyl-L-phenylalanine chloromethyl ketone and N alpha-p-tosyl-L-lysine chloromethyl ketone, soybean trypsin inhibitor and aprotinin. Amino acid analysis showed that the enzyme possesses an amino acid composition very similar to some metalloproteases characterized before from the closely related rattlesnake venoms. N-Terminal sequence analysis of the enzyme corroborated some similarity between this enzyme and the reported sequences of these enzymes characterized from the Crotalidae snake family. This study indicated the presence of a novel fibrinogenase (termed Catroxase) with N-terminal sequence different from the metalloprotease with hemorrhagic activity isolated from the same Western diamondback rattlesnake.

Spontaneous spinal epidural hematoma: report of seven cases

From July 1984 to June 1990, seven cases of spontaneous spinal epidural hematoma (SSEH) were studied. The common clinical pictures in these cases were rather typical with an apoplectic onset of severe spinal pain followed in hours (median: four hours) by signs of progressive spinal cord compression. All cases underwent myelography and computed tomographic (CT)-myelographic studies which showed in all cases a block by a posterior extradural lesion in the spinal column; however, the correct diagnosis of SSEH was made preoperatively in only three cases. The neurologic deficits prior to surgery were complete or nearly complete paraplegia in five cases and a high grade of paraparesis in the other two. The median interval of paralysis or paresis before surgery was 28 hours. The final outcome was evaluated by the grade of functional recovery, and the following were found to be the favorable factors: 1) incomplete preoperative neurologic deficits; 2) a slow course of clinical progression, especially a long duration of pain before the onset of paralysis; 3) no delay in surgery; 4) involvement of short spinal segments; and 5) lumbosacral lesions. Particular emphasis is made on early diagnosis and prompt surgery for a favorable outcome.

Isolation of a crotalase-like protease with alpha-fibrinogenase activity from the western diamondback rattlesnake, Crotalus atrox

Venom toxins were isolated from rattlesnake (Crotalus atrox) venom by cation-exchange chromatography. Seven major fractions could be obtained by single-step ion-exchange chromatography with two fractions showing essentially apparent homogeneity by SDS-gel electrophoresis. All fractions showed various extents of specific proteolytic activity against alpha- or beta-chains of fibrinogen molecules. Further characterization of one of the purified fractions with alpha-fribrinogenase activity indicated that it is a single-chain thrombin-like protease with a molecular mass of about 30 kDa. It is relatively heat stable, inhibited by phenylmethanesulfonyl fluoride, N alpha-p-tosyl-L-phenylalanine chloromethyl ketone and N alpha-p-tosyl-L-lysine chloromethyl ketone but not by soybean trypsin inhibitor and beta-mercaptoethanol. Amino acid analysis showed that the enzyme possesses an amino acid composition very similar to thrombin and crotalase characterized before from the closely related snake venoms. N-Terminal sequence analysis of the enzyme corroborated the close similarity between this enzyme and those sequences of crotalase and kallikrein-like enzymes characterized from the same Crotalidae snake family. This study is in contrast to the previous reports which indicated a lack of thrombin- and crotalase-like enzyme in the venom of Western diamondback rattlesnake.

[An epidemiological study of head injury in Hualien County, Taiwan]

An epidemiological study of head injuries in Hualien County, Taiwan, was undertaken from July 1, 1987 to June 30, 1988. Clinical records, including emergency room (ER) charts, inpatient charts from the four major hospitals and coroner or medical examiner reports in this county, were reviewed. A formulated definition was used in identifying patients with head injury. A total of 1,183 cases were identified. They included 975 hospital inpatients and 208 nonhospital deaths. The age-adjusted incidence rate for head injuries was 333/100,000 for all, 450/100,000 for males and 194/100,000 for females, with a male-to-female ratio of 2.32. The cumulative incidence rate from 0 to 69 years of age was 27.6% for males and 13.7% for females. The highest incidence rate was observed in the elderly group, whereas in other published reports the highest occurrence has been noted in the young adult group. An extraordinary 82% of the head injuries were associated with traffic accidents, 71% of which directly involved motorcycle riders. The age-adjusted mortality rate was 89/100,000 per year, 127/100,000 for males and 44/100,000 for females. The cumulative mortality rate was 8.7% for males and 3.2% for females. These are the highest rates ever reported. Sixty percent of the 1,183 patients had a moderate to severe injury or were dead. In the remaining 40%, the injury was considered mild. The elderly group presented with the highest percentage of moderate to severe degrees of injury, as well as mortality. Among traffic accident victims, those from motorcycle accidents and pedestrians had the highest percentage of severe head injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

1H and 2H NMR studies of water in work-free wheat flour doughs

Proton and deuterium NMR relaxation methods were used to characterize water compartmentalization and hydration in work-free wheat flour doughs. Transverse (spin-spin) relaxation measurements define three motionally unique water compartments in the work-free dough preparations. The apparent occupancy fraction and relative mobility of each water domain are found to be functions of moisture content, temperature, and flour type. Additionally, the number of relaxation-resolved water compartments and their characteristic relaxation rate constants are found to depend critically on both moisture content and the interpulse-delay employed for the multi-pulse relaxation experiments. Under controlled experimental conditions, dynamics between the three water compartments can be observed to be consistent with the onset of flour hydration. The most notable observation during the initial period of hydration is a loss of "free" or "loosely bound" water to environments characterized by less mobility. Freezing studies show that hard wheat doughs have slightly less amorphous, non-freezable water than do soft wheat flour doughs prepared under similar conditions.

[T-cell subpopulation of bronchoalveolar lavage fluid in patients of sarcoidosis and hypersensitivity pneumonitis--2 cases report]

Diffuse interstitial lung diseases include more than 100 varieties. Even for a chest specialist differential diagnosis is difficult; accurate diagnosis without transbronchial lung biopsy or open lung biopsy was particularly hard. Bronchoalveolar Lavage (BAL) is a new diagnostic procedure which is relatively safe and repeatable. It takes about 30 minutes more, during the usual bronchoscopic examination, to obtain fluid and cells from the lower respiratory tract. These specimens aid differential diagnosis and an understanding of pathogenesis in the early stage of diffuse interstitial lung disease. Two cases are reported. One was sarcoidosis, as proved by mediastinoscopic lymph node biopsy; the other one was hypersensitivity pneumonitis by clinical impression. Both patients received bronchoscopic examination with bronchoalveolar lavage. The bronchoalveolar lavage fluid showed an increase in total cell count, lymphocyte count and lymphocyte percentage. In sarcoidosis, the main T-lymphocyte subpopulation was helper T-lymphocytes while, in hypersensitivity pneumonitis, the main T-lymphocyte subpopulation was suppressor T-lymphocytes. We concluded that, if the patients of diffuse interstitial lung diseases had increased lymphocyte count and percentage in bronchoalveolar Lavage fluid, examination of the lymphocyte subpopulation would help differential diagnosis.

[A case report of uterine carcinosarcoma with alpha-fetoprotein (AFP) production]

A case of carcinosarcoma, mixture of endometrial stromal sarcoma and adenocarcinoma, of the uterus with alpha-fetoprotein (AFP) production in a 69-year-old woman was reported. By the results of serum AFP levels (preoperative: 2,950.0 ng/ml, post-operative and chemotherapy: 2.1 ng/ml) and immunohistochemical localization of AFP, the AFP was thought to be produced from this tumor. Immunoreactive AFP was found in the carcinomatous components and no AFP was present in the sarcomatous components at all. It seems from this that immunohistochemical study supports the composition theory of mixed mullerian sarcoma of the uterus.