Liver regeneration following partial hepatectomy and stimulation by hepatic stimulatory substance in cirrhotic and non-cirrhotic rats

The effects of hepatic stimulatory substance (HSS) on cirrhotic and non-cirrhotic rats were studied after 70% partial hepatectomy. Liver cirrhosis was produced by weekly intragastric infusion of chloroform for 12-16 weeks. The HSS was prepared by extraction from the livers of weanling mice. Rats in the experimental group were injected with 5 ml HSS after 70% partial hepatectomy, and those in the control group received normal saline. The results showed that the 3H-thymidine incorporation was higher in the HSS group 24 h after partial hepatectomy in both cirrhotic and non-cirrhotic rats, and persistently higher in the non-cirrhotic rats at 48 h. Total DNA was significantly higher in the HSS group of non-cirrhotic rats 24 and 48 h after partial hepatectomy. The restituted liver volume and weight was significantly higher in non-cirrhotic rats 48 h after partial hepatectomy, while there was no significant difference between the HSS and the control groups in the cirrhotic rats. The HSS induced significant effects on 3H-thymidine incorporation in the non-cirrhotic liver, resulting in increasing liver weight, volume and total DNA 48 h after partial hepatectomy. In cirrhotic rats, the 3H-thymidine incorporation was higher in the HSS group at 24 h after partial hepatectomy, though not showing any increase at 48 h, but the regeneration of liver weight, volume and total DNA at 48 h showed no difference between the HSS group and the control group.

Emphysematous gastritis secondary to acute gastric dilatation

Emphysematous gastritis is a life-threatening disease. Although rare in incidence, it has a fulminating course with a high mortality rate. A case of a 58 year old male with emphysematous gastritis is reported. Initially, he presented with acute gastric dilatation secondary to anorexia/bulimia-like behaviour. Later, emphysematous gastritis developed. The abdominal sonographic findings, which have not been previously described in the literature, showed intramural gas and gastric wall thickening. After receiving a total gastrectomy, he had a satisfactory outcome. The present report discusses the possible aetiologic relationship between acute gastric dilatation and emphysematous gastritis, and suggests abdominal sonography to be the first choice of diagnostic measure for patients and the intramural gas in the gastric wall. This is the first case of emphysematous gastritis diagnosed by abdominal sonography.

Polyethylene wear debris in modular acetabular prostheses

The longevity of total hip arthroplasty has brought forth the recognition of aseptic loosening of prosthetic components as the leading cause of implant failure. Modularity of implants, although a significant improvement in versatility, may increase debris formation, a recognized cause of implant failure. This study was designed to measure the relative motion, and to assess the polyethylene wear debris production at the interface between the metal acetabular shell and the back side of the polyethylene liner, in modular hip prostheses. Five models from 4 manufacturers with different locking mechanisms and acetabular shell surface treatments were tested under long-term simultaneous sinusoidal and static loading (10(7) cycles at 3 Hz with +/- 2.5 Nmeter and 220 N static load). Results showed that there were marked differences in the security of the acetabular shell and polyethylene liner locking mechanism, wear pattern, damage sites, and amount of polyethylene debris on the acetabular shell and polyethylene liner surfaces. The range of polyethylene liner motion observed among the 5 models during 1 cycle of testing varied from an average of 0.96 degrees to movement too small to be detected by the test machines. Image and scanning electron microscopy analysis showed different wear patterns and a wide range in the average polyethylene liner surface wear area (0.26 cm2-4.61 cm2). In general, a stable locking mechanism and a smooth acetabular shell surface are essential in minimizing polyethylene liner wear and polyethylene debris production.

A prospective study of fungal infection of gastric ulcers: clinical significance and correlation with medical treatment

A prospective study was performed to evaluate the prevalence of fungal infection in gastric ulceration and its effect on ulcer healing in 178 benign and 97 malignant gastric ulcers. Fungal infection was defined as presence of fungal hyphae or spores in the biopsy forceps specimen. For patients with benign gastric ulcers, sucralfate 1 g q.i.d. was prescribed and a second panendoscopy examination was carried out after 6 weeks to evaluate ulcer healing. Fungal colonization was found in 36 (20.2%) patients with benign gastric ulcers and 26 (26.8%) patients with gastric cancers (p > 0.2). The mean age of patients with benign gastric ulcer with fungal infection (group I) was 64.2 +/- 11.4 years, whereas the mean age of those without fungal infection (group II) was 56.2 +/- 13.1 years (p < 0.01). Follow-up panendoscopy after 6 weeks of sucralfate therapy revealed 6 of 24 patients (25%) in group I and 19 of 81 patients (23%) in group II with unsatisfactory healing (difference not significant). Comparison of confounding factors such as smoking, daily tea or coffee intake, underlying disease, ulcer location, and endoscopic appearance between these two groups revealed no significant differences. In conclusion, the presence of fungus in gastric ulcers is a secondary phenomenon and it does not affect ulcer healing.

The role of colonoscopy in screening persons with family history of colorectal cancer

First-degree relatives of colorectal cancer patients are at increased risk for developing colorectal neoplasms. In order to assess the potentiality of colonoscopy screening in this high-risk population, 213 asymptomatic family members (age range 30-69 years, mean 42.8 years) of those patients with colorectal cancer received colonoscopic examination at Chang-Gung Memorial Hospital from April 1992 to May 1994. Twenty-eight persons with 42 lesions (polyps or cancer) were identified, including 28 adenomas, nine hyperplastic polyps and five adenocarcinomas. The positive detection rate was 9.9% for adenoma and 2.3% for cancer. Colorectal neoplasms afflicted males more frequently than females (16.7 vs 5.7%, P < 0.05) and occurred less frequently in those < 40 years of age (5.5 vs 17.2%, P < 0.05). Forty-two per cent of the detected neoplastic lesions were beyond the reach of 60 cm flexible sigmoidoscopy and 36% of adenomas were < 0.5 cm in size and would be missed if patients were screened by air contrast barium enema. Cost analysis revealed that the charges of both screening colonoscopy and screening flexible sigmoidoscopy/air contrast barium enema were approximate. Colonoscopy also has a high acceptability and safety. It appears appropriate to use colonoscopy, rather than flexible sigmoidoscopy or air contrast barium enema, as an initial screening procedure for persons with a family history of colorectal cancer, especially those > 40 years of age.

Early gastric cancer--a clinicopathological study

From 1983 to 1991. 981 cases with gastric cancer underwent gastric resection in Chang Gung Memorial Hospital. Ninety-two cases (9.4%) had early gastric cancer with a mean age of 54.5 years. The most commonly present symptoms were epigastralgia and abdominal fullness (79.3%). Most lesions were located in the lower third of stomach (64.0%). Type IIc was the most common macroscopic type (31.5%). The tumor was confined to the mucosa layer in 40 (43.5%) cases; submucosa invasion was noted in the remaining 52 (56.5%) patients. Lymph node involvement was found in 5 (5.4%) cases. No statistical correlation between the depth of tumor invasion and the size of the tumor was noticed. Three patients died of tumor recurrence on the 11th, 13th and 36th months after operation. The Kaplan-Meier estimate for five year survival was 96.4% in these 92 cases. 96.6% in mucosa cancer and 95.6% in submucosa cancer. The risk factor for mortality was lymph node metastasis which had a positive correlation with the depth of tumor invasion. There were four (4.3%) cases of minute early gastric cancer. However, there was neither mortality nor lymph node metastasis in these four cases. Retrospectively, the review of original histological slides in 40 cases, the intestinal type of early gastric cancer had a higher association with intestinal metaplasia, had more frequency of submucosa invasion (70% vs 35%, p = 0.026), and were older in age (61 vs 50.4 years old) than the diffuse type. Although statistically insignificant, the intestinal type had the tendency to involve the lymph node.

Data analysis for dynamic contrast-enhanced MRI-based cerebral perfusion measurements: correcting for changing cortical CSF volumes

The time evolution of the histogram (number of pixels versus signal intensity) is used to calculate delta R2 parameters from dynamic contrast-enhanced magnetic resonance (MR) imaging of the brain. This method partially corrects for partial volume effects and is an improvement over the approach using the signal intensity as a function of time when confounding factors such as changing cortical cerebrospinal fluid volumes are involved. The maximum value for delta R2 is found to correlate with relative cerebral blood flow as assessed by xenon inhalation and can be used to discriminate between vascular dementia and healthy volunteers. With this method, the normal range for delta R2 values is found to be the same for both young (19-40 years old) and elderly (65-85 years old) healthy volunteers.

Mapping the domain(s) critical for the binding of human tumor necrosis factor-alpha to its two receptors

The extracellular domains of the two human tumor necrosis factor (TNF) receptors critical for binding TNF-alpha were examined by deletion mapping. The ligand binding capability of full-length and truncated recombinant soluble TNF receptors (TNFRs) was assessed by ligand blot analysis and their binding affinity determined by Scatchard analysis. The results showed that deletion of the fourth cysteine-rich domain of the p55 receptor (TNFR-1) did not alter ligand binding affinity significantly. Deletion of domains 3 and 4 of TNFR-1 resulted in no ligand binding, suggesting that domain 3, but not 4, of TNFR-1 binds directly to ligand. Deletion of domain 4 of TNFR-2 resulted in drastically reduced protein yield and 3-fold reduction in ligand binding affinity, while deletion of both domains 4 and 3 yielded no protein. Thus, the domain 4 of TNFR-2, but not that of TNFR-1, appears to be involved directly in binding TNF, although it is also possible that the domain 4 of TNFR-2 is involved in the correct folding of other domains. These results suggest that the modes of interaction between TNF-alpha and its dual receptors are different, providing opportunity to modulate each receptor specifically for research and therapeutic purposes.

[Clinical observation of Henoch-Schonlein purpura-focus on gastrointestinal manifestation and endoscopic findings]

During the 5.5-year period from January 1988 to June 1993, there were 40 cases of Henoch-Schonlein purpura diagnosed in Chang Gung Memorial Hospital, Taipei. The diagnosis criteria is defined as a typical skin rash, which pathologic examination shows leukocytoclastic vasculitis, accompanied by any two of these major manifestations of the disease, namely gastrointestinal, renal and joint involvement. Their medical records were reviewed with respect to the clinical symptoms, laboratory findings, roentogenologic findings, endoscopic findings, and morbidity. There are 21 women and 19 men with age raging from 10 to 63 years old (mean age 35.9 years old). The male to female ratio was 1:1.1 and about 80% of the patients were at the age of fifteen or older. There was no special season distribution in this series. The main clinical features were purpuric skin rashes, 40 cases (100%), followed by gastrointestinal symptoms, 25 cases (62.5%), renal involvement, 21 cases (52.5%) and joint involvement, 19 cases (47.5%). The major gastrointestinal symptoms were abdominal pain (25 case) and bleeding from gastrointestinal tract (10 cases), and minor symptoms included vomiting (7 cases), diarrhea (1 cases) and acute pancreatitis (2 cases). Gastrointestinal endoscopy was performed in 5 cases and all had hyperemic mucosa and scattered hemorrhagic purpura in the stomach and duodenum. The characteristic hemorrhagic erosive duodenitis were observed in 3 cases. These findings may alert the gastroenterologists to take into consideration of this disease earily and thus avoid unnecessary laparotomy and complications.

Vibrio vulnificus infection--report of 8 cases and review of cases in Taiwan

Vibrio vulnificus infection, which is a rare and fatal disease, can be categorized clinically as either primary septicemia or wound infection. The clinical presentation of patients with primary septicemia can vary from fever alone to a more severe illness including high-grade bullous lesions, hypotension, and shock. Wound infection typically results from either injury to the skin in a marine environment or contact of a preexisting wound with sea water. We reported eight cases with Vibrio vulnificus infection in Chang gung Memorial Hospital and reviewed ten other cases previously reported with details in Taiwan. Fourteen patients presented with primary septicemia, and four with wound infection. Thirteen patients had alcoholism or chronic liver disease, two had peptic ulcer disease, one was steroids abuser, and one patient had thalassemia and chronic liver disease. Overall mortality was 55.6% (ten patients). Patients with hypotension within 48 hours of admission had higher mortality than normotensive patients (77% vs. 0%, P = 0.007). Patients with chronic liver disease or liver cirrhosis also had tendency to a higher mortality than not (64% vs. 25%, P = 0.274). Chronic liver diseases and liver cirrhosis are common disease in Taiwan. They take a high risk for Vibrio vulnificus infection. Clinician should keep in mind of this potentially fatal infection in these patients reporting a history of recent raw oyster consumption and presented with sepsis and characterized skin lesions. Prompt empirical antibiotics treatment and aggressive surgical treatment may be lifesaving for this acute and fatal disease.

Cortical CSF volume fluctuations by MRI in brain aging, dementia and hydrocephalus

Dynamic MR imaging has revealed dramatic fluctuations in the appearance of CSF in the cortical sulci and cortical subarachnoid spaces in aging individuals and patients with hydrocephalus, dementia and Down syndrome in contrast to young healthy volunteers. The changes have been interpreted as volume fluctuations that represent undamped CSF hydrodynamics and have implications with respect to the origin of CSF in the cortical regions and with respect to the similarity between aging and dementia and edematous states of the brain.

Partial purification of hydrogenase from Anabaena sp. CH3 with heat treatment

The methylviologen-dependent hydrogenase of Anabaena sp. CH3 is unstable at 4 degrees C and in air. All the purifying procedures were carried out at 25 degrees C and under argon atmosphere. The enzyme was partially purified by the following steps: heat treatment, DEAE-cellulose ion-exchange chromatography and gel filtration on TSK-Fractogel. Experimental results indicated that the heat-treatment procedure was beneficial for the separation of the enzyme from phycobiliproteins.

Myoepithelial carcinoma of the breast with distant metastasis and accompanied by adenomyoepitheliomas

A breast tumour in a 47-year-old female with axillary lymph node metastasis was interpreted as the rare malignant adenomyoepithelioma based on morphological and immunohistochemical studies. Multiple bone metastases developed and the patient died after 7 months. The malignant neoplasm consisted of cords and interlacing bundles of spindle cells with indistinct cell borders and clear cytoplasm. The cells stained positively for cytokeratin, S-100 protein, GFAP, and muscle-specific actin, and possessed basal lamina, pinocytic vesicles, tonofilaments, desmosomes, and intermediate filaments with dense bodies. In some areas, cells with microvillous projections enclosed small spaces. In the breast, foci of myoepithelioma with various morphological subtypes and infiltration coexisted, demonstrating the origin of the malignant tumour. The histogenesis of the myoepithelial tumours is discussed.

Cholangiography of icteric type hepatoma

OBJECTIVES

Icteric type hepatoma caused by floating tumor debris in the major bile duct was rare. Such cases were often incorrectly identified as biliary carcinoma or choledocholithiasis until pathological proof. The goal of this study was to analyze the cholangiograms of icteric type hepatomas, and to identify the characteristic cholangiographic features of this rare disease.

METHODS

A retrospective analysis of 20 cholangiographies of icteric type hepatomas during a 10-yr period was carried out.

RESULTS

There were 15 males and five females in this series. Seventeen (85%) patients were hepatitis B virus carriers, and liver cirrhosis was detected in 16 (80%) patients. Serum alpha-fetoprotein levels in 13 (65%) of the patients were over 400 ng/ml. The cholangiographic findings included: 1) intraductal filling defects resulting in partial or complete obstruction and ductal dilation in 14 cases (70%), 2) abrupt complete obstruction of the common hepatic duct with an irregular cut surface in three cases (15%), and 3) tumor encasement and stricture of the biliary system in three cases (15%). Management of these patients included hepatic resection, choledochotomies with T tube stenting, or PTCD. Most of them died within one-half year after diagnosis, but one patient in our series, who received hepatic resection, survived more than 70 months.

CONCLUSIONS

It is important to recognize this group of patients. Because with proper management, good palliation or cure is possible. The cholangiographic appearances, when taken alone, are not diagnostic of icteric type hepatomas. Once these cholangiograms are seen in patients with associated risks of developing a hepatoma, such as liver cirrhosis, chronic viral hepatitis, and elevated serum alpha-fetoprotein, however, an icteric type hepatoma should be suspected.

Effects of highly selective vagotomy and additional procedures on gastric emptying in patients with obstructing duodenal ulcer

A solid gastric emptying study was conducted on 46 patients more than 1 year after highly selective vagotomy (HSV) and additional procedures for obstructing duodenal ulcer and on 21 patients after HSV alone for uncomplicated duodenal ulcer. The additional procedures included dilatation (n = 14; HSV + D group), Holle pyloroplasty (n = 14; HSV + P group), and Jaboulay gastroduodenostomy (n = 18; HSV + GD group). The test meal consisted of two eggs labeled with 99mTc sulfur colloid, two slices of white bread toast, and 300 ml of orange juice (total 322 kcal). Gastric emptying curves and emptying parameters (t1/2, half emptying time; lag phase, TLAG; emptying rate, k; and beta value) were compared with those of 17 healthy volunteers, the normal control group. The patients after HSV alone had an almost normal gastric emptying. The HSV + D group showed a significant delay from minute 45 to the end of the emptying curve, corresponding to a longer t1/2 (p = 0.02), and a slower emptying rate (p = 0.029). The HSV + P group approached a nearly normal emptying curve, corresponding to an insignificant difference in emptying parameters. The HSV + GD group had significantly faster emptying from minute 15 to the end of the emptying curve, corresponding to a faster t1/2 (p = 0.0005), a shorter lag phase (p = 0.027), and a faster emptying rate (p = 0.021). Recurrent ulcerations were noted in one patient (4.8%) of the HSV alone group, five (35.7%) of the HSV + D group, one (7.1%) of the HSV + P group, and one (5.6%) of the HSV + GD group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute upper gastrointestinal bleeding in Chang Gung Memorial Hospital: comparison between 1980 and 1989]

Upper gastrointestinal (UGI) bleeding remains a great medical problem despite the improvement in both diagnostic and therapeutic management. We retrospectively analyzed 560 cases (male 429 cases, female 131 cases, mean age 45.8 +/- 23.1 years) of acute UGI bleeding within one year from January to December 1980, and 1872 cases (male 1395 cases, female 477 cases, mean age 48.7 +/- 27.5 years) within one year from January to December 1989, in order to define the changing pattern of etiology in the past 10 years. The major cause of bleeding was duodenal ulcer bleeding, which occurred at the age of 20-40 years. The incidence significantly decreased (57.8% in 1980 VS. 46.3% in 1989, P < 0.001). The second common cause was gastric ulcer (11.1% VS. 13.5%), which occurred mainly at the age of 50-70 years. The third was esophageal varices bleeding with a significantly increased incidence (6.6% VS. 11.4%, P < 0.001), which occurred mainly at the age of 40-60 years. The other less common causes included gastric cancer (5.9% VS. 5.8%), which occurred mainly at the age of 50-70 years, gastric erosion (5.2% VS. 6.1%), Mallory Weiss tear (2.1% VS. 3.1%), esophagitis (1.9% VS. 2.9%), Dieulafoy's ulcer (1.6% VS. 2.7%), vascular lesion (1.6% VS. 2.6%), and non-diagnostic cases (6.2% VS. 5.6%). The ratio of male to female for each etiology of UGI bleeding was about 3 to 1 in both 1980 and 1989.(ABSTRACT TRUNCATED AT 250 WORDS)

[Kimura's disease: a case report]

Kimura's disease is endemic in Orientals. The pathogenesis of Kimura's disease is currently unknown, and the methods of treatment are undefined. The patient was a 21-year-old male, suffering from neck mass left over the parotid region of which the mass gradually increased and which combined with lymphadenopathy and pruritus over both lower limbs more than two years. The patient was diagnosed with Kimura's disease by neck lymph node biopsy, then received simple excision of mass and oral prednisolone therapy. The symptoms of lymphadenopathy and pruritus were improved without recurrence of neck mass.

Eosinophilic gastroenteritis: 10 years experience

Eight patients (five men, three women), mean age 36.9 +/- 13.5 (17-60) yr, were diagnosed to have eosinophilic gastroenteritis. The condition was proved in five patients by biopsies through endoscope, and in three, by operation. All had hypereosinophilia (absolute eosinophil count of 1,337-21,787/cm3). According to Klein classification, two had mucosal disease, three had muscle layer disease, and three, subserosal disease. The most common symptoms were abdominal pain (100%), diarrhea (62.5%), vomiting (62.5%), and nausea (50%). Four patients (50%) had symptoms for more than 1 yr before diagnosis. Barium studies revealed mucosal edema and/or thickening of the small intestinal wall in three cases (including one case with ulceration), partial gastric outlet obstruction in one case, and narrowing of lumen of the terminal ileum in one case. Hypotonic duodenogram revealed double contour in one case. Ultrasound examination revealed thickening of the intestinal wall in two cases; computer tomography revealed thickening of the intestinal wall in one case. All patients were treated with steroid (40 mg/day for initial dose and relapse; 5-10 mg/day for maintenance). The symptoms subsided and the eosinophil counts returned to normal within 2 wk in seven patients and 1 month in one. Of six patients being followed up for 2-10 yr, one had remission, four needed small maintenance dose of steroid, and one suffered from relapse with intestinal perforation.

Double-blind comparison of omeprazole 20 mg OM and ranitidine 300 mg NOCTE in duodenal ulcer: a Taiwan multi-centre study

Two hundred and twenty-six patients with endoscopically confirmed duodenal ulcers > or = 5 mm in diameter entered a double-blind randomized trial comparing 20 mg omeprazole administered once daily in the morning with 300 mg ranitidine administered once daily at night. The patients were assessed endoscopically and symptomatically after 2 weeks, and those whose ulcers had healed terminated the study. Patients with unhealed ulcers continued treatment for a total of 4 weeks. Omeprazole produced significantly higher healing rates than ranitidine at both 2 weeks (57 vs 28%, P < 0.0001) and 4 weeks (93 vs 80%, P = 0.006). Similarly, significantly higher 'effective healing rates' (defined on the criteria established by the Japanese Society of Digestive Endoscopy) were observed with omeprazole compared with ranitidine at 2 and 4 weeks. After 2 weeks, there were significantly fewer reports of both day-time and night-time epigastric pain by omeprazole-treated patients compared with ranitidine-treated patients (22 vs 44%, P < 0.0001 for day-time pain; 24 vs 35%, P = 0.025 for night-time pain). Both drugs were well-tolerated and no major adverse effects were recorded during either treatment. In conclusion, 20 mg omeprazole administered once daily was superior to 300 mg ranitidine administered once daily for duodenal ulcer healing and symptom relief.

[Transcervical resection of endometrium and submucous myomas]

Transcervical resection of the endometrium and submucous myomas using an unmodified urologic resectoscope has recently been developed as a treatment for menorrhagia and/or infertility when conservative management proves unsatisfactory but the patient desires to preserve the fertility or wishes to avoid hysterectomy. Through June 1990, 7 patients were treated with this procedure including one for endometrial ablation and six for transcervical myomectomy alone. No significant complication was seen and the results were relatively satisfactory in an average 7 1/2 months follow up. This approach seems a safe, effective surgical procedure and represents an attractive alternative to hysterectomy or abdominal myomectomy.

Herpes esophagitis: a cause of upper gastrointestinal bleeding in an immunocompetent patient

Herpes esophagitis presents as dysphagia and odynophagia in the majority of cases. Rarely has hematemesis been reported. We report a case of herpes esophagitis presenting with hematemesis in an immunocompetent patient. This 67-year-old man suffered from herpes esophagitis, proven by a panendoscopic examination, with characteristic histological findings. He presented with hematemesis and passage of tarry stools, but was otherwise healthy with normal humoral, cell-mediated immunity and was negative for human immunodeficiency virus antibody. Only supportive treatment was given. He has been well for the past nine months since the initial diagnosis.

Age related alterations in the response of the pial arterioles to adenosine in the rat

To evaluate the effects of aging on vasoreactivity of pial arterioles to adenosine and barium chloride, an hydraulically intact cranial window preparation was developed in the rat. The microvasculature of anesthetized 3- and 24-month-old Fischer-344 rats was studied during superfusion with artificial cerebrospinal fluid with and without test agents and results determined by videomicroscopy techniques. In both cohorts, the response of pial arterioles to adenosine was both dose and vessel size dependent: arteriolar dilation increased with increasing concentrations of adenosine and at any given concentration the percent increase in diameter was greater in the smaller vessels. During adenosine superfusion the absolute changes and percent increase in vessel caliber were greater in the young rats. Arteriolar vasoconstriction due to barium chloride was vessel size dependent but there were no significant differences in response between young and aged rats. The results indicated an attenuated cerebrovascular response in aged rats to adenosine, but not to barium chloride. This may be due to a difference in the mode of action in these two compounds. Venules did not respond to adenosine at any concentration.

Endoscopic balloon dilation of esophageal strictures following surgical anastomoses, endoscopic variceal sclerotherapy, and corrosive ingestion

Between 1987 and 1991, endoscopic balloon dilation was performed for esophageal strictures which developed after operation in 28 cases, after sclerotherapy in 9 cases, and after corrosive injury in 8 cases, for a total of 45 cases. The locations of stricture were upper third in 20 cases, mid-third in 2 cases, and lower third in 23 cases. The stricture appeared clinically 1 to 3 months after esophageal injury. Endoscopic follow-up interval was 1 week. A total of 136 dilations were done in these 45 patients with an average of 2.6 times/case (range, 1 to 8). The result of dilation was good in 9 cases, improved in 18 cases, slightly improved in 15 cases, with only 3 cases having no response. The follow-up period was 2 years on average (range, 0.5 to 4 years). The data suggest that endoscopic balloon dilation is a safe, effective, and easy method for the management of esophageal stricture caused by surgical anastomosis, sclerotherapy, and corrosive injury.

Retrograde jejunogastric intussusception caused by a jejunal polyp

A 70-year-old male presented with epigastric pain, vomiting and upper gastrointestinal bleeding 11 years after a subtotal gastrectomy. Retrograde jejunogastric intussusception was diagnosed by endoscopy and barium meal study and finally confirmed by laparotomy. After reduction of the intussusception, a small polyp was found at 20 cm distal to the anastoma, which served as the leading point of intussusception. The pathophysiology and clinical manifestations of this disease were reviewed.

Gastric adenocarcinoma simulating benign gastric ulcer

The pathologic features and prognosis of patient in whom gastric cancer simulates at endoscopy as a benign gastric ulcer has been poorly characterized. We performed a retrospective study with particular reference to the long term prognosis on 191 patients treated for gastric adenocarcinoma over the period 1980-1986. In 176 of these 191 patients (92.2%), the endoscopic findings suggested cancers, while in the remaining 15 patients (7.8%), the endoscopic appearance suggested benign ulcer. Comparing gastric cancers masquerading as benign gastric ulcers with those appeared malignant endoscopically, the former had higher resectability rate (100% vs 77.3%), higher incidence of early gastric cancer (73.3% vs 6.25%), less poorly differentiated carcinoma (33.3% vs 65.4%), less lymph node metastasis (13% vs 69.5%) and a higher five-year survival rate (86.6% vs 24.8%) (p less than 0.05 in all). Our study indicated that gastric adenocarcinomas simulated benign gastric ulcers at endoscopy are mostly early gastric cancers that carry a much better prognosis.

A prospective randomized controlled trial of sandostatin and vasopressin in the management of acute bleeding esophageal varices

To study the hemostatic effect of Sandostatin, a long-acting analogue of somatostatin, in acute variceal bleeding, a prospective randomized controlled trial comparing it with Vasopressin was conducted in 41 cirrhotic patients with esophageal variceal bleeding. Initial hemostasis was achieved within 6 hours in 75% of patients treated with Sandostatin and in 61.9% treated with Vasopressin. Recurrent bleed developed in 20% of patients in Sandostatin group and 46.2% in Vasopressin group following initial hemostasis. Complete control of bleeding for 24 hours was attained in 60% of the Sandostatin group and in 33.3% of the Vasopressin group. There was no statistically significant difference in both the rate of initial hemostasis and complete bleeding control. Hospital mortality was also similar in both groups. However, transfusion requirements were less (P less than 0.05) and side effects tended to be milder in patients treated with Sandostatin. In conclusion, Sandostatin is at least as effective as Vasopressin in the treatment of acute variceal bleeding, and carries less severe complications than Vasopressin does.

[Pseudomembranous colitis: a clinical analysis and review of literatures]

Clostridium difficile has been well known to be a pathogen of pseudomembranous colitis. It is characterized by the formation of elevated plaques and pseudomembranes which result in varying degree of diarrhea. This series analysed 20 cases of pseudomembranous colitis diagnosed at Chang Gung Memorial Hospital between January 1985 and December 1989. The male to female ratio was 1:3. Their ages ranged between 13 and 81 years, with a mean of 53.7 years. Sixteen of our patients claimed to have taken antibiotics for upper respiratory tract infection, pneumonia, cellulitis or acute pelvic inflammatory disease within six weeks before onset of symptoms. The antibiotics were mainly in the penicillin group and cephalosporin group. Clinical presentations included diarrhea of varying degree, fever, and abdominal pain. The diagnosis was made by the typical colonic mucosal changes under sigmoidoscopic or colonoscopic examination and pathological findings. The lesions were prominent in the rectum and sigmoid colon. Eleven cases were treated with vancomycin. Of these, one failed and died, and two recurred. The two recurrences were again treated with the same dose of vancomycin and with complete remission. Three of our patients responded to metronidazole. The other six cases with milder symptoms were successfully controlled by using cholestyramine (2 cases) or by supportive treatment (4 cases).

Change of gastric liquid emptying after highly selective vagotomy and pyloric dilatation for patients with obstructing duodenal ulcer

Gastric liquid emptying was studied in duodenal ulcer patients with and without stenosis before highly selective vagotomy (HSV) and 1 week, 3 months, and 1 year after. The test meal consisted of 1 mCi of 99m Technetium-diethylene penta-acetic acid (DTPA) in 500 ml of isotonic saline. The patients were divided into 2 groups: group 1 (16 cases) without clinical stenosis, who underwent HSV alone, served as control; group 2 (14 cases) with mild to moderate stenosis, who underwent HSV and transgastric dilatation to 20 mm in diameter. Before HSV, the stenotic group showed a significantly slower liquid emptying than the nonstenotic. Most of the stenotic group could resume a normal diet quickly after operation, but they still had prolonged liquid emptying. At 3 months, the emptying curve of the stenotic patients had approached that of the preoperative controls without a significant difference, while the nonstenotic patients showed an accelerated initial emptying. Although there was a significant improvement with the appearance of accelerated initial emptying at 1 year, the stenotic group still demonstrated slightly slower emptying than the nonstenotic group. A temporary state of preexistent gastric atony due to chronic outlet obstruction may explain the delayed emptying in the early postoperative period; however, minor residual resistance in the fibrotic, scarred tissue was postulated to be persistent despite dilatation, and responsible for the slower emptying of the stenotic than the nonstenotic group at 1 year.

Demonstration of uniform capillary basal lamina thickness by computer technology

Blood capillaries are assumed to be circular cylinders composed of an inner layer of endothelial cells surrounded by an acellular uniformly thick basal lamina. The capillary basal lamina is the structural and functional interface between the capillary endothelial cells and the adjacent extracellular matrix, important in growth and control mechanisms of the endothelial cell. Capillaries examined in electron micrographs are cut randomly and a projected image of a capillary other than perpendicular to its long axis will produce artifactual thickening of the assumed uniformly thick basal lamina. We have developed an interactive computer program to determine the thickness of the capillary basal lamina that corrects the thickness resulting from the sectioning artifact. We have applied this methodology to demonstrate that the basal lamina of the pancreatic capillaries of the rat are uniformly thick.

Testicular scintigraphic findings two to three months after torsion. Correlation with sonography and histopathology

A patient with a nontender testicular mass had sonographic abnormalities compatible with but not entirely typical of a chronic torsion. His scintigraphic studies, done on the same day as ultrasonography and 1 month later, revealed only findings consistent with a very mild subsiding scrotal inflammatory process. On surgical exploration and pathologic examination, it was found that he had an organizing infarct of the testicle secondary to torsion. The clinical history, diagnostic studies, and microscopic slides of the surgical specimen were reviewed. It appeared that tissue granulation and lipogranulomatous changes in the epididymis, known histologic sequelae to the unusually prolonged testicular torsion of 2-3 months, produced scintigraphic findings different from those which have been described for a late or an atrophic torsion.

Upper gastrointestinal bleeding in dengue fever

Twenty-six virologically and serologically confirmed Dengue patients with signs of upper gastrointestinal tract bleeding (13.1%) were studied during the 1987 outbreak in southern Taiwan. Within a 1-yr period from 1987 to 1988 in Kaohsiung Chang Gung Memorial Hospital, there were 198 patients with Dengue fever confirmed. Viral isolation and serological studies indicated that type I Dengue was the cause. There was no evidence of sequential secondary infection among them. The 26 patients were evaluated gastroduodenoscopically. Most of the Dengue patients who developed upper gastrointestinal bleeding had gastric ulcers or duodenal ulcers; superficial and hemorrhagic gastritis are the other relevant endoscopic findings. Thirteen patients (50%) had a past history of peptic ulcer symptoms, whereas the other 13 did not. Dengue infection is a precipitating factor in inducing peptic ulcer bleeding because of hemostatic derangements. Supportive therapy and blood transfusions alone were adequate treatment, except for one patient who required surgery due to massive bleeding of a duodenal ulcer. No mortality was observed in this study.

The spectrum of acute intestinal vascular failure: a collective review of 43 cases in Taiwan

High mortality rates associated with mesenteric ischaemia are a tremendous challenge. We reviewed 43 patients admitted to Chang Gung Memorial Hospital between 1981 and 1988. A total of 24 patients (55.8%) had thrombosis or embolus of the superior mesenteric artery, five patients (11.6%) had superior mesenteric vein thrombosis, and 14 patients (32.6%) had non-occlusive infarction. Patients with mechanical obstructions (volvulus, intussusception, tumour compression, aortic dissection) causing mesenteric ischaemia were excluded. The initial symptoms were not specific before signs of peritonitis presented. The tetrad of leucocytosis (88.4%), metabolic acidosis (88.6%), hyperamylasaemia (46.9%) and elevated phosphate (33.3%) was noted to be significant. There was a high association with previous cardiovascular diseases (78.2%). The plain abdominal X-ray, which was the most frequently used investigative tool, showed suggestive but non-specific findings. A total of 38 patients (88.4%) were operated upon. In six patients (14%) the exploratory laparotomy was open and closed because the bowel gangrene was too extensive. The total mortality rate was 55.8%. To improve prognosis, clinical awareness of the problem should be raised and the use of mesenteric angiography should be encouraged in an attempt to obtain an early diagnosis.

Duodenal ulcer hemorrhage with and without dyspepsia

To clarify the clinical significance of dyspepsia in patients with bleeding duodenal ulcer, we studied 298 patients prospectively. Ages of patients ranged from 16 to 81 yr (mean 45.9). There were 244 (82%) dyspeptic and 54 (18%) nondyspeptic patients. In the dyspeptic group, significantly more patients were taking nonsteroidal anti-inflammatory drugs. In the nondyspeptic group, there was a higher percentage of patients with duodenal bulb deformity (p less than 0.005), which deformity was related to previous peptic ulcer disease. The age, sex, past history of dyspepsia or bleeding, consumption of alcohol and cigarettes, and the hospital course of the two groups of patients did not differ significantly. Our results show that the clinical course of duodenal ulcer hemorrhage is not significantly different in patients with or without dyspepsia, and indicate that bleeding and dyspepsia probably are two independent presentations in the natural course of the disease. The significance of the correlation between dyspepsia and duodenal bulb deformity is discussed.

Smoking behaviour, knowledge and opinion of medical students

On the basis of a questionnaire on smoking behaviour, knowledge and attitudes administered to medical students in the University of Malaya in July 1987, the prevalence of smoking was found to be low (10%) among medical students. Smokers and non-smokers were equally well informed about common smoking complications. Most students, irrespective of smoking status, felt that they would as future doctors, often advise sick smokers against smoking. In contrast, less than half would do so for healthy smokers who do not themselves raise the question of smoking. The students' personal smoking behaviour also influenced their view of their professional role. Appropriate values, attitudes and a preventive approach towards smoking need to be further developed in the medical students' thinking and behaviour.

[The treatment of esophagojejunal anastomotic stricture after total gastrectomy]

From December 1983 through December 1988, 200 cases of total gastrectomy were performed in Chang Gung Memorial Hospital. The esophagojejunostomy was performed with EEA staplers in 196 cases, and with hand suture in 4 cases. Twelve cases developed anastomotic stricture after the operation. All of these 12 anastomoses were done with EEA 28 mm staplers. Four of the 12 patients received no further treatment either because the symptoms were mild or because of development of carcinomatosis. Six patients received endoscopic YAG laser treatment, only 2 had good results. Four Patients received balloon dilatation, 2 of them had good results, 4 patients received surgical intervention after failure of the balloon dilatation or YAG laser treatment. Of the 4 patients who underwent surgery, the thoracoabdominal approach was used in 3, and a thoracotomy in 1. Three patients received side to side esophagojejunostomy to bypass the stricture site. In the remaining patient, stricture was excised and a new end to end anastomosis was done with hand sutures. All of these 4 patients had good results after the operation. There are many possible mechanisms of the development of anastomotic stricture. Anastomotic leakage, technical error, lack of mucosa-to-mucosa apposition, size of the EEA stapler and tissue ischemia all have been regarded as the possible causes of anastomotic stricture. Once the esophagojejunal anastomosis stricture occurs, treatment should be done to relieve dysphagia. From the results of our patients, endoscopic YAG laser is not a satisfactory treatment for anastomotic stricture.(ABSTRACT TRUNCATED AT 250 WORDS)

Normal inhibition of DNA synthesis following gamma-irradiation of radiosensitive cell lines from patients with Down's syndrome and Alzheimer's disease

Inhibition of DNA synthesis was studied in gamma-irradiated lymphoblastoid cells from patients with Alzheimer's disease and Down's syndrome. A normal biphasic pattern of inhibition was observed over a dose range of 0-4 krad of gamma-rays in all of the cell lines. 3 out of 4 Down's and all the Alzheimer's cell lines were shown to be hypersensitive to ionizing radiation based on induced chromosomal aberrations. Increased G2 phase delay, comparable to that occurring in ataxia-telangiectasia cells, was observed for some of the cell lines, after exposure to gamma-rays. Contrary to other data in the literature these results demonstrate that radioresistant DNA synthesis is not an intrinsic feature of all disorders characterized by radiosensitivity.

Physiological factors determining hydrogenase activity in nitrogen-fixing heterocystous cyanobacteria

Four species of nitrogen-fixing heterocystous cyanobacteria were compared with respect to induction of hydrogenase activity. Two of the strains contained phycoerythrin and built up high levels of carbohydrate storage material when grown in batch culture under nitrogen-fixing conditions and continuous illumination. These strains did not exhibit hydrogenase activity. Lack of activity in the phycoerythrin-containing species was determined by cell-free assays measuring both hydrogen-evolving and hydrogen-uptake activities. Apparently, expression of hydrogenase is negatively correlated with the carbohydrate pool present and concurrent respiration. Furthermore, there is an apparent relationship between the presence of phycoerythrin, carbohydrate accumulation, and the absence of hydrogenase activity.

[A clinical analysis of esophageal achalasia]

Thirty-one cases of esophageal achalasia were admitted to Chang Gung Memorial Hospital between 1981 and 1986. Eighteen male patients and 13 female patients, aged from 12 to 84 years old with an average of 39 years old, were included in this series. Their chief complaints were dysphagia (83.9%), postprandial vomiting (12.9%), and food regurgitation (3.2%). The symptoms are present for an average of 2.8 years (mostly between 0.5 and 2 years) before the diagnosis is made. The clinical signs and symptoms included dysphagia, postprandial vomiting, loss of body weight, food regurgitation, abdominal fullness, cough, chest pain, belching, and choking. The tentative diagnoses at admission were achalasia, esophageal stricture R/O achalasia, achalasia R/O esophageal cancer, and esophageal cancer. Laboratory examinations showed 90.3% with absence of the gastric air shadow in chest P-A view X-ray film. Typical birds-beat deformity in barium-meal esophagogram was seen in 100%, and during esophagoscopic examination, 25% (6/24) were without abnormal findings, 66.7% (16/24) had liquid and food stasis, 8.3% (2/24) had esophagitis. Manometry of esophagus was performed in 5 cases, all had positive abnormal patterns detected, such as aperistalsis of esophageal body and incomplete relaxation of lower esophageal sphincter, but only 60% showed hypertensive lower esophageal sphincter. In these 31 cases, 3 cases refused any treatment, 9 cases received medical therapy including drug therapy(9) and pneumatic esophageal dilatation(8), and 19 cases received surgical operations. Better swallowing improvement was obtained in the surgically treated group than in the medically treated patients during follow up period.

Aggressive fibromatosis of the tongue: MR demonstration

A case of aggressive fibromatosis of the tongue is described in a 9-year-old boy. Magnetic resonance was used in the initial evaluation and revealed a well defined mass in the anterior third of the tongue which was mildly hypointense on a T1-weighted image and minimally hyperintense on a T2-weighted image. Magnetic resonance was useful in indicating the benign nature of the tumor, in defining its extent, and for follow-up after local surgical resection.

The prevalence of endemic goitre in the Keningau Division of Sabah

Four areas of differing remoteness were studied to determine the prevalence of goitre in the Keningau Division of Sabah. These areas were Keningau town, the Biah Resettlement Scheme, the Dalit subdistrict and the Pagalunggan subdistrict. The predominant ethnic group in these areas is the Murut. The overall endemicity of goitre for the study population was 76.5% for females aged 15 years and above. There was a significant correlation between the incidence of goitre and the remoteness of an area. The Dalit subdistrict has the highest incidence of goitre (82.6%) followed by the Pagalunggan subdistrict (77.8%), the majority of these goitre cases being classified as grade 2 (visible goitres). These were the two most remote areas in the study. In contrast, Keningau town, the least remote area has the lowest incidence of goitre (62.5%) with most of the goitres being relatively small. With regards to salt usage in the Dalit subdistrict, only 3.0% used iodised salt; 28.0% used fine salt; 3.6% used coarse salt and 65.5% used both fine and coarse salt. In the Pagalunggan subdistrict, all females used uniodised salt with 17.6% using fine salt, 20% using coarse salt and the remainder using both fine and coarse salt. As yet, there is no legislation for the iodisation of salt in Sabah. It is clear that all types of salt need to be iodised and adequately distributed to deprived areas, particularly inland areas.

Cell separation in the buffy coat

One of the most rapid methods to determine cell counts in whole blood is by way of layer thickness measurements of the buffy coat. The purpose of this study was to determine the separation and purity of blood cells in the different layers of the buffy coat. Blood samples were centrifuged at 10,000 g in microhematocrit tubes with an inserted float to expand the buffy coat region. Whole blood from normal laboratory individuals separates by density into four regions: platelets, a layer of lymphocyte and monocytes, granulocytes and erythrocytes. A thin band of highly swollen red cells was discovered between the buffy coat layers of many normal volunteers and patients. Stereological analysis of electron micrographs showed that mixing of formed elements within the layers is less than 2% with the exception of some erythrocytes, which can make up a higher volume fraction in the lymphocyte/monocyte and granulocyte layers. The red cell column contains about 95.7% erythrocytes and is depleted of platelets and leukocytes. In approximately 5% of hospital blood samples, the granulocyte-erythrocyte interface was feathered and undetectable, and a significantly higher volume fraction of red cells was found among the granulocytes. Cell mass density determinations indicate that the erythrocytes in these abnormal granulocyte layers have a lowered mass density, overlapping with that of the granulocytes.

Different implications of stigmata of recent hemorrhage in gastric and duodenal ulcers

A prospective study was conducted to evaluate the prognostic value of stigmata of recent hemorrhage in patients with bleeding peptic ulcer. Of 193 patients suffering from peptic ulcer bleeding identified by emergency gastrointestinoscopy, 52 patients were found to have bleeding gastric ulcer (spurt 5, active oozing 9, fresh clot 11, black clot 17, protruding vessel 4, and clear base without stigmata 6); the other 141 had bleeding duodenal ulcer (spurt 5, active oozing 26, fresh clot 43, black clot 23, protruding vessel 15, and clear base without stigmata 31). Patient with continuous bleeding or rebleeding was grouped as unstable bleeders. The rate of unstable bleeders was 39.1% (continuous bleeding 23.9% and rebleeding 15.2%) in patients with gastric ulcer, compared to 9.0% (4.5% and 4.5%) in duodenal ulcer (P less than 0.001). The unstable bleeder rate of ulcers with spurt, active oozing, clot, and protruding vessel was 80%, 44%, 35.7%, and 0%, respectively, in patients with bleeding gastric ulcer; and 33.3%, 19.2%, 6%, and 0%, respectively, in patients with bleeding duodenal ulcer. The data suggest that the stigmata of recent hemorrhage, excluding protruding vessel, has prognostic significance in bleeding gastric ulcer but less in bleeding duodenal ulcer.

Longhouse dwelling, social contact and the prevalence of leprosy and tuberculosis among native tribes of Sarawak

In Sarawak, some tribes stay in communal longhouses whilst others live in villages of single dwellings. The present study looks into the question of whether there is an association between the prevalence of leprosy and tuberculosis with the quantum of social contact that occurs in these two types of settlement patterns. It was found that the prevalence of leprosy and tuberculosis is significantly higher among longhouse dwellers compared with single house dwellers. It was also noted that social groups tended to be larger and to persist for much longer among longhouse dwellers than among those in single dwellings. This lends support to the evidence that social contact in longhouses is more extensive and contributes towards a higher prevalence of leprosy and tuberculosis.

Mercaptoethanol protects glutathione depleted cells

Buthionine sulfoximine depleted the glutathione (GSH) level of mouse lymphoma L1210A cells in culture to 6% of control and killed the cells within 48 hours in medium supplemented with fetal calf serum or bovine serum albumin. Mercaptoethanol or alpha-thioglycerol but not GSH or cysteine added to the medium protected the cells from the effect of GSH depletion. Horse serum was also protective, and this effect was removed by dialysis over 65 hours and could not be restored by adding GSH. Mercaptoethanol alone had a protective action in the dialyzed sera. The results suggest that mercaptoethanol may act independently and perform the functions of GSH.