Glucocorticoid upregulates Na-K-ATPase alpha- and beta-mRNA via an indirect mechanism in proximal tubule cell primary cultures

Adrenalectomy leads to the decline in the levels of renal Na-K-adenosinetriphosphatase (Na-K-ATPase) alpha- and beta-subunit protein and mRNA. Both alpha- and beta-mRNA, however, return to the control level within 1 h after corticosterone administration. Whether or not glucocorticoid acts directly on a specific segment of nephron to upregulate Na-K-ATPase has not been determined. Studies were undertaken in an attempt to elucidate this problem. Using primary cultures of renal proximal tubules, we found that 24-h treatment with dexamethasone augmented Na-K-ATPase activity and induced coordinate increase of alpha- and beta-protein and mRNA abundance dependent on the doses in the range of 10(-8) to 10(-6) M. We further demonstrated that 24-h incubation of dexamethasone (10(-7) M) enhanced Na-K-ATPase activity by 58 +/- 14%, alpha- and beta-protein abundance by 70 +/- 18 and 51 +/- 10%, and alpha- and beta-mRNA levels by 87 +/- 12 and 62 +/- 11%, respectively. The time course studies revealed that significant increase of Na-K-ATPase activity and alpha and beta-protein abundance was reached within 4 hr of dexamethasone treatment. Pretreatment of cultured proximal tubule cells with cycloheximide (20 micrograms/ml) completely inhibited dexamethasone-induced increase of Na-K-ATPase alpha- and beta-mRNA. Our results indicate that dexamethasone upregulates Na-K-ATPase in proximal tubule cells via pretranslational mechanisms, which may be mediated by proteins.

Absence of infection in breast-fed infants born to hepatitis C virus-infected mothers

The role of breast-feeding in perinatal transmission of hepatitis C virus (HCV) was explored in 15 HCV-infected mothers and their infants. The 15 carrier mothers had anti-HCV titers ranging from 1:80 to 1:40,000 and also had HCV-ribonucleic acid with concentrations ranging from 10(4) to 2.5 x 10(8) copies/ml. Both anti-HCV antibody and HCV-ribonucleic acid were present in colostral samples in much lower levels, but none of the 11 breast-fed infants had evidence of HCV infection for up to 1 year of age. Thus breast-feeding seems safe for these infants.

A functional analysis of tumor suppressor activity for peripheral neuroepitheliomas by monochromosome transfer

The microcell hybridization technique provides a powerful method for the identification and characterization of tumor suppressor genes. By introducing chromosomes from a normal human cell into a tumor cell, several studies have presented functional evidence for the presence of tumor suppressor activity. In order to map the location(s) of functional tumor suppressor gene(s) for peripheral neuroepithelioma (PNET) cells, we have used the microcell hybridization technique to transfer three individual human chromosomes into three different PNET cell lines, A673, SK-N-MC and TC32. We could not isolate microcell hybrids from one of the cell lines as the transferred chromosome tended to fragment upon transfer. Introduction of chromosome 13 into the remaining two cell lines caused a marked inhibition of in vitro and in vivo growth. Chromosome 11 appeared to harbor a functional tumor suppressor gene while transfer of chromosome 17 caused a suppression of growth in culture, presumably due to the presence of the p53 tumor suppressor gene. Thus, each cell line showed a different response to the introduction of normal genetic information suggesting diverse genetic abnormalities among these tumors of similar histological or origin.

Is total abdominal hysterectomy with bilateral salpingo-oophorectomy adequate for new FIGO stage I endometrial carcinoma?

OBJECTIVE

The new FIGO staging for endometrial cancer cases complies with other forms of surgical staging and correlates better with clinical outcomes because it includes prognostic factors. This study was done to investigate whether total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH+BSO) is adequate for new FIGO Stage I endometrial carcinoma.

SUBJECTS

Sixty-five cases of endometrial carcinoma defined according to the new FIGO Stage Ia (n = 26), Ib (n = 24) and Ic (n = 15) were analysed. They all received TAH+BSO only and were followed up for at least two years.

METHODS

The histologic type, grade, depth of myometrial invasion, lympho-vascular tumour emboli and tumour size were analysed by t-test to correlate the risk factors for treatment failure.

RESULTS

There were no recurrences after TAH+BSO in Ia and Ib cases. However, recurrences occurred in five cases (33%) of Stage Ic with deep myometrial invasion, high histologic grade, large tumour size and tumour emboli.

CONCLUSIONS

TAH+BSO is inadequate in some Ic cases with a high histologic grade, deep myometrial invasion and tumour emboli. Thus, thorough pre-operative and intra-operative staging, adequate operation method and prompt post-operative adjuvant therapy are indispensable for successful treatment.

Concomitant renal cell carcinoma and metastatic epithelioid angiosarcoma with microangiopathy

Epithelioid angiosarcoma is an extremely rare clinical entity. Recognized only in recent years, epithelioid angiosarcoma mimicks epithelial tumors, both morphologically and immunohistochemically. It is very aggressive, assuming a rapid, metastatic and fatal course. This is a report of a case with an unequivocal diagnosis of epithelioid angiosarcoma and concomitant renal cell carcinoma. Reports of cancer with double origins of this combination, in patients without inherited von Hippel-Lindau disease, are extremely rare in the English literature. A review of the literature encompassing all cases of epithelioid angiosarcoma since 1983 is included.

A surgical technique of radioulnar osteoclasis to correct severe forearm rotation deformities

Twenty-six forearms in 23 patients with marked pronation or supination deformities were treated with osteoclasis. Etiologies included 12 radioulnar synostoses, five brachial plexus injuries, three hemiplegias, two hemimelias, and four other types of deformities. Drill-assisted osteotomy of both the radius and ulna was followed 10 days later by manipulation to the desired functional position. Dominant extremities were placed in 20 degrees pronation, and nondominant extremities in 20 degrees supination. Range of motion was not significantly changed, but the arc of motion occurred in a more functional hand position. Average correction for 15 pronation deformities was 81 degrees and 69 degrees for 11 supination deformities. Two nonunions healed after bone grafting and there were no instances of neuromuscular compromise. Functional improvement was obtained in 25 of 26 forearms.

Leiomyosarcoma of the broad ligament: a case report and literature review

Solitary tumors of the broad ligament are rare. The most frequent solid tumor of the broad ligament is leiomyoma. Leiomyosarcoma of the broad ligament (LBL) is an extremely rare malignant tumor. Nine cases of leiomyosarcoma of the broad ligament had been reported previously. A 59-year-old woman with LBL is reported. Treatment consisted of resection and total abdominal hysterectomy with bilateral salpingo-oophorectomy. No evidence of metastasis is noted after 12 months follow-up. We conclude that the management of LBL is excision of the leiomyosarcoma as completely as possible and postoperative adjuvant chemotherapy.

Proximal interphalangeal joint silicone replacement arthroplasty: clinical results using an anterior approach

Sixty-nine proximal interphalangeal joint silicone arthroplasties in 36 patients inserted through an anterior approach were reviewed. Average followup time was 3.4 years. The average extension deficit was slightly improved from 17 degrees to 8 degrees, but the total active motion (active flexion minus active extension) did not significantly increase (44 degrees to 46 degrees). Coronal plane deformities were not successfully corrected. Pain relief was obtained in 67 of 69 digits. There were 12 digits with complications, and five implants fractured. The anterior approach allows preservation of the central slip insertion and initiation of immediate active and passive joint motion. With proper indications, careful surgical technique, and a supervised therapy protocol, proximal interphalangeal joint silicone arthroplasty is a useful operation for pain relief and functional gain.

Fungal infection of ventriculoperitoneal shunts in children

Infection is still the most common complication of shunt procedures in children. However, fungal infection is still considered to be rare. We found that fungi accounted for 17% of shunt infections (8 of 48) in a retrospective study. All of the patients were premature babies and had received a ventriculoperitoneal shunt because of hydrocephalus. The clinical manifestations were subtle and insidious. The time of onset of infection ranged from 1 month to 1 year after the insertion of the shunt. Examination of the cerebrospinal fluid of infected patients showed mild pleocytosis with an elevated protein concentration. Candida species (including Candida albicans, Candida parapsilosis, and Candida tropicalis) or Torulopsis glabrata were isolated. In all but one case, shunts were removed and systemic therapy with amphotericin B was administered. Amphotericin B was given intrathecally to two patients, who did not respond to systemic therapy. Treatment with fluconazole failed for one patient. We suggest performing fungal cultures in cases of shunt infection, especially those involving premature infants. Extraventricular drainage, systemic therapy with amphotericin B, and insertion of a new shunt remain the principal components of the treatment regimen for fungal shunt infections in children.

Clinical significance of multiple hypothalamic-pituitary functions assessment in patients with Turner's syndrome

Hypothalamic-pituitary functions in 26 cases of Turner syndrome were assessed with a combined stimulation test. The results showed that the peak GH levels of 12 cases were less than 10 micrograms/L; 3 patients were demonstrated as having an even TSH response, while another one with a delayed TSH peak, and other 4 had high basal values and consistent exaggerated TSH responses to TRH; all patients showed increased basal and peak LH and FSH levels but 5, whose LH and FSH secretion patterns were similar to normal. 12 cases have been treated with individualized protocols and followed up for 12 months or more, of them the growth velocity all increased, especially those with hypothyroidism or with a BA less than 13. It is suggested that multiple functions of hypothalamic-pituitary axis in Turner patients be evaluated as early as possible, in order that proper treatment could be adopted and their growth and development improved.

Measurement of gap junctional communication by fluorescence activated cell sorting

Cell-to-cell communication via gap junctions has played a fundamental role in the orderly development of multicellular organisms. Current methods for measuring this function apply mostly to homotypic cell populations. The newly introduced Fluorescence Activated Cell Sorting (FACS) method, albeit with some limitations, is simple, reliable, and quantitative in measuring the dye transfer via gap junctions in both homotypic and heterotypic cell populations. In the homotypic setting, the result in dye transfer from the FACS method is comparable to the scrape-loading and microinjection methods. Using this FACS method, we observed a decline of cell-to-cell communication in transformed and cancer cells. We also observed a differential degree of communication between two heterotypic cell populations depending on the direction of dye transfer.

Spatial W-plasty full-thickness skin graft for neovaginal reconstruction

Although neovaginal reconstruction has achieved satisfactory results, there is still room for refinement and improvement. Despite its popularity, McIndoe's inlay split-thickness skin graft method still has several significant drawbacks. Here a new approach to neovaginal reconstruction by using a full-thickness skin graft displayed in the fashion of spatial W-plasty is described. Our idea combines the advantages of a full-thickness skin graft and Z-plasty principle in clinical practice. Four patients who had been reconstructed with this method had satisfactory results with minimal secondary contracture and unilateral linear groin scar. Three of them have married and enjoy sexual life without difficulties. The fourth patient has not married but shows no contracture in follow-up examinations. Since the result is encouraging, this method deserves wider clinical application.

Ultrasound diagnosis of rudimentary uterine horn pregnancy in fourteen weeks of gestation: a case report

Pregnancy in a rudimentary uterine horn is rare. Rupture tends to occur in the second trimester, and results in maternal morbility and mortality. Although the diagnosis prior to rupture is difficult, early detection is essential in avoiding a fatal outcome. An asymptomatic case of pregnancy in the rudimentary horn of a bicornuate uterus prior to rupture is presented. This report is to emphasize the important value of sonography for early detection of the prerupture of the rudimentary pregnancy.

Long term clinical and virologic outcome of primary hepatitis C virus infection in children: a prospective study

To investigate the long term natural course of primary hepatitis C virus infection in children from the beginning, we prospectively followed up 88 children at risk because of frequent blood transfusions or of hepatitis C virus infection from the mother. Ten of the 88 children contracted primary infection during follow-up. In the acute stage of infection acute hepatitis with elevation of aminotransferases and a positive IgM antibody was found in both children infected during open heart surgery, 3 of the 5 multiply transfused children with congenital hemolytic anemia and none of the 3 infants infected by their mothers. Four of the 10 children later lost hepatitis C virus RNA, whereas 6 had a chronic course. Three of the latter 6 children had abnormal aminotransferase activities in the chronic phase. Our study suggests that the very young age of primary infection and the underlying status of the host may affect the clinical course of hepatitis C virus infection in children.

Age-specific prevalence of hepatitis B surface and e antigenemia in pregnant women in Taiwan

To investigate the age-specific prevalence of hepatitis B surface and e antigens (HBsAg and HBeAg) in pregnant women, we studied all the parturients encountered in National Taiwan University Hospital between 1985 and 1990. Serum HBsAg and HBeAg were checked by radioimmunoassay. The prevalence rate of HBsAg in pregnant women was 13.2%, 12.7%, 11.4%, 11.7%, 12.9% and 14.2%, respectively for each year. The figures seemed stable. The positive rate of HBeAg in HBsAg-positive pregnant women was 32.8%, 39.9%, 42.6%, 30.8%, 32.0% and 31.7%, respectively during the past 6 years. We also analyzed the results in different age-grouped pregnant women. The positive rate of HBsAg was 12.8%, 13.1%, 11.6% and 11.5% respectively in 21-25 year-old, 26-30 year-old, 31-35 year-old and 36-40 year-old groups. The positive rate of HBeAg in HBsAg-positive pregnant women was 49.4%, 36.5%, 31.5% and 20.0% respectively in these 4 age groups, with a prevalence declining with the advanced age. We conclude that HBsAg-positive rate was 11-14% in the pregnant women who visited our hospital, and their HBeAg-positive rate was 31-43%. No decrease of HBsAg carriage or HBeAg prevalence was seen in the past 6 years.

Temporal profile of hepatitis C virus antibody and genome in infants born to mothers infected with hepatitis C virus but without human immunodeficiency virus coinfection

To investigate mother-to-infant transmission of hepatitis C virus, serial follow-up of anti-HCV and hepatitis C virus RNA was undertaken in 11 infants born to hepatitis C virus-infected mothers who had been screened from 11,688 pregnant women. None of the hepatitis C virus-infected mothers was infected by human immunodeficiency virus. Anti-HCV was checked by the second-generation enzyme immunoassay kit, and hepatitis C virus RNA was examined by reverse transcriptase-nested polymerase chain reaction. Hepatitis C virus RNA was found in more than two serum samples in two of these 11 infants; those two infants were regarded as hepatitis C virus-infected. One of the two had hepatitis C virus RNA at the age of 1, 3, and 6 months, but not later. The course of hepatitis C virus RNA and anti-HCV in this baby may reflect fluctuating viral replication in chronic infectious disease or viral clearance in acute infection. The other infant had hepatitis C virus RNA detectable at the age of 3 months and at 15, 18 and 24 months. In the other nine non-hepatitis C virus-infected infants, maternally acquired anti-HCV gradually disappeared by the age of 6 months. The liver function profile fell to the normal range in all the infants, including the two hepatitis C virus-infected infants. This may indicate the subclinical nature of hepatitis C virus infection in infancy. Seven fathers and four siblings of these 11 infants were checked for anti-HCV and liver function tests; none had evidence of hepatitis C virus infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Possible role of high-titer maternal viremia in perinatal transmission of hepatitis C virus

To study perinatal transmission of hepatitis C virus (HCV), 15 anti-HCV-positive carrier mothers without human immunodeficiency virus coinfection were recruited. At delivery, maternal blood was taken and anti-HCV titer was determined and HCV RNA measured in each serum sample by reverse transcription polymerase chain reaction (PCR). A competitive PCR was used in selected samples to quantitate HCV concentration. The 15 neonates were followed regularly for 1 year and their sera were also assayed for anti-HCV and for HCV RNA by reverse transcription PCR. All the mothers were positive for HCV RNA. Only one normal spontaneously delivered neonate of a mother with extremely high titer of anti-HCV (1:20,000) and HCV concentration (10(10) copies/mL) had both anti-HCV and HCV RNA in serum for up to 6 months of age. In contrast, none of the remaining 14 neonates born to mothers with low- to high-titer anti-HCV (1:4-1:1000) and moderate amounts of HCV RNA (10(5)-10(6) copies/mL) contracted HCV infection. The results imply that high-titer maternal viremia and normal spontaneous delivery may allow more HCV to infect the neonate intrapartum, therefore establishing perinatal transmission.

Hepatitis C virus infection in pregnant women: detection by different anti-HCV immunoassays and serum HCV-RNA

To assess the seroepidemiology of hepatitis C virus (HCV) infection in pregnant women and explore the correlation between different anti-HCV immunoassays, we investigated 2 independent groups in Taipei: 1,687 pregnant women without screening for serum alanine aminotransferase (ALT) (group A) and 260 pregnant women with elevated ALT activity (> 45 IU/l) screened from 15,978 cases (group B). In group A, 11 women (0.65%) were found to be anti-HCV-positive by first-generation tests and 21 (1.24%) by second-generation tests, while 7 (2.69%) and 15 (5.77%) of the group B subjects were positive, respectively. The results of the second-generation assays, based either on recombinant proteins or synthetic peptides, were identical. Among the 36 second-generation anti-HCV-positive cases, 18 (86%) of the 21 cases in group A and 13 (87%) of the 15 cases in group B contained serum HCV-RNA by RT-PCR. We conclude that the prevalence of anti-HCV in pregnant Taiwanese women is 1.24%, and the prevalence is 5.77% among those with an elevated ALT level. HCV-RNA is present in 86% of the cases positive for anti-HCV. The discrepancy between positive anti-HCV and negative HCV-RNA in some pregnant women suggests that anti-HCV positivity in such cases may merely represent a past HCV infection or a fluctuating viremia.

Studies of the synthesis, immunology, and cytotoxicity of a cyclic octapeptide corresponding to TNF-alpha-(59-66)

In an attempt to investigate possible binding domains of the tumor necrosis factors (TNF), we have previously synthesized a cyclic hexapeptide corresponding to murine TNF-(127-132) (cTNF-1). In this report, we describe the synthesis and biological activity of another cyclic octapeptide corresponding to human TNF-alpha-(59-66) (cTNF-2). The design of these cyclic peptides is based on their high sequence homology with corresponding fragments of human TNF-alpha or TNF-beta. Similar to cTNF-1, the cyclic octapeptide cTNF-2 displayed low in vitro cytotoxicity against human HeLa and HEP-2 cell lines. The cyclic peptides cTNF-2 and cTNF-1 were then tested for the induction of interleukin-1 (IL-1) production from human peripheral blood mononuclear cells and monocytes in vitro. At low concentrations, the IL-1 levels induced by these cyclic peptides were similar to that of recombinant TNF-alpha. However, the IL-1 production by cTNF-2 stimulation was dose-dependently increased and reached that of a lipopolysaccharide (LPS; 0.1 micrograms/mL) level. These findings suggest that the fragments corresponding to human TNF-alpha-(59-66) and murine TNF-(127-132) may represent certain binding domains of the tumor necrosis factors that elicit IL-1 production.

A 77-year-old man with right anterior knee pain. Intraosseous gout of the patella

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on the first two pages. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

[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)

Five-year experience of human immunodeficiency virus type 1 national screening program implemented at Veterans General Hospital-Taipei

From July 1986 through June 1990, 33,199 sera from various risk groups were collected in Veterans General Hospital-Taipei for detection of antibody against human immunodeficiency virus, type 1 (HIV-1). Sixty-five samples were proved positive by Western blot analysis. Among individual high risk groups, hemophiliacs had the highest positive rate of 20/60 (29.41%), followed by homosexual/bisexual males (41/1,264, 3.24%). The overall positive rate was 65/33,199 (0.19%). Ten cases were recognized as acquired immunodeficiency syndrome (AIDS), 1 case had AIDS-related complex (ARC) and 4 case had other apparently symptomatic infections. Among these 15 cases, 7 expired, 1 lost of follow-up and 7 surviving cases are being treated with zidovudine (AZT). Most of symptomatic HIV-1 antibody positive cases had abnormal T4/T8 ratio of 0.39 +/- 0.54 as compared with the asymptomatic HIV-1 carriers at a ratio of 0.81 +/- 0.69. The opportunistic infections included Pneumocystis carinii pneumonia (PCP) in 6 case, disseminated cytomegalovirus infection in 6 cases, herpes zoster virus infection in 3 case, candidiasis in 4 cases, syphilis in 3 cases, pulmonary tuberculosis in 2 cases, and others with cryptococcosis, salmonellosis, Mycobacterium avium-intracellulare infection, gonorrhea, Staphylococcus aureus endocarditis and bacterial sepsis, etc. The natural history of HIV-1 infection to AIDS involved acute and persistent multiple infections. Although prevalence of HIV-1 infection was low in Taiwan, nationwide surveillance of HIV-1 infection in various risk groups is still needed.

Vulvar neoplasia associated with other primary malignancies

It is recognized that a significant number of patients with vulvar neoplasia have had previous, concurrent, or subsequent genital tract neoplasia. This has resulted in speculation that there may be a common etiology and, in particular, of the possibility of an infection element. Among 59 cases of vulvar cancer diagnosed at the National Taiwan University Hospital from 1976 to 1991, there were seven cases (12%) associated with other primary malignancies. Carcinoma of the cervix was the most frequent other primary cancer (6/7, 86%). The possible role of human papilloma virus infection in genital neoplasia is discussed.

Hepatitis B virus in the colostra of HBeAg-positive carrier mothers

To investigate the amount of hepatitis B virus (HBV) in colostra of hepatitis B e antigen (HBeAg)-positive carrier mothers and the relationship of HBV amount between colostrum and maternal blood, 50 HBeAg-positive carrier mothers were recruited and studied for hepatitis B surface antigen (HBsAg) titer, HBeAg titer, and HBV-DNA concentration in their sera and colostra. According to the presence or absence of seral HBV-DNA determined by dot hybridization, these 50 HBeAg-positive carrier mothers could be divided into two groups: group 1 (n = 28, HBV-DNA < 0.04 ng/ml), and group 2 (n = 22, HBV-DNA > or = 0.04 ng/ml). The colostral HBsAg and HBeAg titers were both significantly higher in group 2 than in group 1. In addition, both colostral HBsAg and HBeAg titers had positive correlation with each corresponding maternal blood. Although the colostral HBV-DNA was undetectable by dot hybridization, all were positive by polymerase chain reaction with Southern blot hybridization. Because HBV-DNA can be detected in all HBeAg-positive carrier mother's milk, it reinforces the necessity of hepatitis B vaccination for the neonates born to these carrier mothers, particularly in countries with a high carrier rate.

"Salvage" procedures in the treatment of Kienböck's disease. Proximal row carpectomy and total wrist arthrodesis

In symptomatic stage III Kienböck's disease, proximal row carpectomy may be considered not only as a secondary "salvage," but also a primary reconstructive procedure. The need for concomitant radial styloidectomy is assessed intraoperatively after removal of the proximal row. Distraction resection arthroplasty is an alternative for patients with full-thickness cartilage loss on the capitate head or in the lunate fossa surpassing 3 mm in diameter. For patients with generalized carpal arthrosis (stage IV Kienböck's disease) or unsuccessful previous reconstructive surgeries, total wrist arthrodesis is the most reliable procedure for pain relief. PRC is an acceptable alternative to TWA for stage IV disease if the patient is willing to risk having some residual pain to preserve wrist motion. Transection of the articular branch of the posterior interosseous nerve may be a useful adjunct to these procedures.

Comparison of three different immunoassays and PCR for the detection of hepatitis C virus infection in pregnant women in Taiwan

To compare different hepatitis C virus (HCV) immunoassays and HCV-RNA in pregnant women, we investigated two independent groups: 1,687 cases without screening for serum alanine aminotransferase (ALT) (group A) and 333 cases with elevated ALT (> 45 IU/l) (group B), after screening 21,459 pregnant women. In group A, 11 (0.65%) and 21 (1.24%) were anti-HCV-positive by first- and second-generation tests, respectively, while in group B 8 (2.40%) and 19 (5.71%) were positive, respectively. The results revealed by second-generation assays based on either recombinant protein or synthetic peptides were identical, as were the anti-HCV titers in group B. Among 40 second-generation anti-HCV-positive cases, 18 (86%) of 21 in group A and 17 (89%) of the 19 in group B contained serum HCV-RNA by RT-PCR. Thus the prevalence of anti-HCV in Taiwanese pregnant women is 1.24% versus 5.71% in those with elevated ALT level.

The helix-loop-helix proteins (salivary-specific cAMP response element-binding proteins) can modulate cAMP-inducible RP4 gene expression in salivary cells

Salivary-specific and cAMP-inducible expression of the rat proline-rich protein gene RP4 is dependent on a 28-base pair sequence of a salivary-specific cAMP response element (SCRE) (Lin, H. H., and Ann, D. K. (1992) Gene Expression 2, 365-377). To unravel its trans-acting factor(s), we used double-stranded oligoprobes corresponding to the SCRE to screen a randomly primed lambda gt11 cDNA expression library made from RNA of rat salivary cells. In this report, we describe the cDNA cloning of these helix-loop-helix SCRE-binding proteins (SCBPs) and demonstrate that there are at least three isoforms in salivary cells, namely SCBP alpha, SCBP beta, and SCBP gamma. RNA polymerase chain reaction and sequence analyses further confirmed the existence of these three different SCBP isoforms, which code for putative proteins of 707, 706, and 682 amino acids, respectively. Expression of the cloned SCBP cDNAs in salivary cells stimulates the expression of a cotransfected reporter construct containing multicopies of the SCRE cloned upstream of the thymidine kinase promoter and the chloramphenicol acetyltransferase structural gene. This stimulation is much more pronounced in transfections in which SCBP alpha and SCBP beta are cotransfected than when they are transfected individually. Furthermore, when low concentrations of SCBP alpha and SCBP beta are cotransfected with the SCRE reporter gene, coexpression of the catalytic subunit of protein kinase A is required to efficiently activate the expression of the reporter gene. These results strongly suggest that the observed stimulation of the SCRE is achieved through the coordinated expression of the SCBP alpha, SCBP beta, and protein kinase A activities, perhaps via a direct association of the two SCBPs and their phosphorylation by protein kinase A. We conclude that the isolated SCBP alpha and SCBP beta cDNAs encode transcription activators that participate in the control of the inducible RP4 gene expression in salivary cells.

Macaque salivary proline-rich protein: structure, evolution, and expression

Proline-rich proteins are a family of proteins that exhibit unique features including an unusual high proline content and salivary-specificity. As a major constituent in the salivary secretion of higher primates, proline-rich proteins may have biological roles in oral lubrication and protection. In this article, the genomic structure and regulation by cAMP of one of the macaque salivary proline-rich protein genes, MnP4, is reviewed. The evolution of this multigene family of proteins is also discussed.

Clinical study of 381 postmenopausal bleeding patients

In order to evaluate the etiology, incidence of malignancy, clinical risk factors and the interval between menopause and the onset of abnormal vaginal bleeding in postmenopausal women, 381 cases with a complete medical history and available histologic findings were enrolled in this study at the National Taiwan University Hospital from 1989 to 1991. The results showed that 212 (55.6%) of these women had normal histologic findings and 83 (21.9%) had benign pathologic findings, whereas 14 (3.6%) had cervical intraepithelial neoplasia (CIN), 42 (11%) had endometrial hyperplasia, 19 (5%) had cervical cancer and 11 (2.9%) had endometrial cancer. Twenty-nine (7.6%) of the cases suffered from either CIN III or cervical cancer; this number was twice as high as those with endometrial atypical hyperplasia and endometrial cancer (n = 13, 3.4%). In addition, various risk factors, especially obesity, were found to be significantly correlated with malignancy. Fractional curettage should be performed for postmenopausal bleeding patients to ensure accurate diagnosis and correct management.

High incidence of hepatitis C virus infection in hemodialysis patients in Taiwan

A longitudinal follow up of 202 hemodialytic patients were conducted to evaluate the incidence of hepatitis C virus (HCV) infection in this high-risk group. A total of 113 patients were found to be seronegative for anti-HCV at the start of this study period. During the average follow-up period of 39 months, 51 patients developed anti-HCV later (group I), while the remaining 62 patients (group II) were seronegative throughout the study period. The results showed that the incidence of HCV seropositivity is 14.6% per year. Longer periods of hemodialysis and younger age of the patient, but not reuse of dialyzer or sex, were correlated with a higher positive rate of anti-HCV. Clinical hepatitis episodes occurred more frequently in group I (56.9%), while persistently normal alanine aminotransferase (ALT) was observed more often in group II (54.8%). There was no significant changes in hepatitis B surface antigen (HBsAg). A total of 41 patients developed hepatitis among the 59 patients who received transfusions, but there was no significant difference between the two groups. We conclude that HCV infection is the main cause of hepatitis in hemodialysis. The longer the patient underwent hemodialysis, the higher the anti-HCV positive rate became, which did not seem to be related to transfusions. Once infected, there is a low disappearance rate of anti-HCV. The exact route of transmission awaits further investigation.

Isoproterenol/tannin-dependent R15 expression in transgenic mice is mediated by an upstream parotid control region

Transgenic mice were used to locate the cis-acting DNA elements that are essential for tissue-specific and inducible expression of the rat proline-rich protein gene, R15. Chimeric genes with up to 10 kb of R15 5'-flanking region fused to chloramphenicol acetyltransferase (CAT) or polyomaviral large T-antigen (PyLT) reporter genes were tested. Our results demonstrate that (1) the isoproterenol/tannin-inducible, parotid-specific transgene expression requires an upstream cis-regulatory domain, namely the parotid control region, which extends from -6 to -1.7 kb of the R15 gene; (2) this parotid control region functions with a heterologous promoter and is indispensable for achieving a reproducible chromosomal position-independent transgene expression; (3) deletion of the R15 5'-flanking region up to -1.7 kb results in a pleiotropic effect on the transgene expression, which includes ectopic (nonsalivary) reporter expression and lack of inducibility by either the beta-agonist isoproterenol or dietary tannin stimulation; (4) when the -10 to -6 kb region from the R15 gene is deleted in the construct, the inducible expression in the parotid glands of the transgenic mice decreases by over 30-fold, but position-independent and tissue-specific transgene expression is retained. Moreover, the mechanism of induction by either catecholamine isoproterenol or dietary tannin appears to be through a beta 1-adrenergic receptor-mediated pathway for both normal (non-transgenic) and transgenic animals.

Clinical evaluation of fleroxacin in the treatment of bone and joint infections

The objective of this open label, non-comparative study was to evaluate the efficacy and safety of fleroxacin 400mg administered orally once daily to patients with acute osteomyelitis and/or acute septic arthritis. Nineteen patients (10 males and 9 females) were evaluable for the analysis of clinical efficacy and safety. Of these, 7 (36.8%) had osteomyelitis and 12 (63.2%) had septic arthritis. Bacteriological cures were reported in 6 of 7 patients (85.7%) with osteomyelitis and in 8 of 11 patients (72.7%) with septic arthritis. The median duration of treatment for the clinical cures in osteomyelitis and septic arthritis were 29.5 days and 46 days respectively. The eradication rate for the most common pathogens, Salmonella enteritidis and Staphylococcus aureus were 77.7% and 80.0%, respectively. The clinical response was cure in 4 of 7 patients (57.1%) evaluable for osteomyelitis, and in 9 of 12 patients (75.0%) evaluable for septic arthritis at the three-month follow-up after treatment. Adverse reactions were minimal. It is concluded that fleroxacin appears to be an effective and safe in the treatment of acute osteomyelitis and acute septic arthritis.

Hepatitis B virus infection among aboriginal children in eastern Taiwan

Hepatitis B virus (HBV) infection is endemic in Taiwan, with 15-20% of the adult population carrying the surface antigen (HBsAg). Hualien in Eastern Taiwan is relatively isolated from other parts of the island by the Central Mountains. The status of HBV infection among mountain aborigines in Hualien has not been studied on a large scale before. A survey of serum HBsAg and its antibody (anti-HBs) was conducted in 1989. A total of 3,287 children from 27 primary schools in three mountainous counties of Hualien were tested. The carrier rate (HBsAg positive) for the whole group was 31.9%, and the infection rate (HBsAg and/or anti-HBs positive) was 80.7%. Both the carrier rate and infection rate of 1,618 boys were significantly higher than those of 1,669 girls (35.7% vs 28.3% and 83.0% vs 79.3%, respectively, p < 0.001). The carrier rates of children in the first to sixth grades were 29.4%, 35.0%, 31.5%, 30.8%, 33.3% and 32.0%, and the infection rates were 74.9%, 79.0%, 80.1%, 82.6%, 83.3% and 84.1%, respectively. The infection rate increased significantly with age (p < 0.05). The results show that HBV infection is a serious problem among the children of mountain aborigines in Hualien, with nearly one-third of them carrying HBsAg. Aggressive vaccination, as well as public health education programs, are greatly needed.

Correlation between ELISA and recombinant immunoblot assay in serum samples positive for anti-HCV

To determine the false-positivity of antibody to hepatitis C virus (HCV) (anti-C100-3), the correlation between ELISA optical density (OD), anti-HCV titer and recombinant immunoblot assay (RIBA) in 87 anti-HCV-positive sera was analyzed. The results showed that > 90% of the serum samples with an anti-HCV OD > 2.0 or with titers > 10 x were RIBA reactive. These findings are applicable in daily clinical practice.

Cellular immune response to HBcAg in mother-to-infant transmission of hepatitis B virus

Cellular immunity to HBcAg was studied in hepatitis B virus carrier children and neonates born to hepatitis B virus carrier mothers. A significant proliferative response of peripheral blood mononuclear cells to HBcAg was found in 5 of 10 children with elevated ALT levels but in none of the nine HBeAg-positive children with normal ALT levels. HBeAg but not HBsAg was detected in cord blood of 9 of 10 neonates born to HBeAg-positive carrier mothers, suggesting exposure of these neonates to HBeAg in utero. However, cord mononuclear cells from neonates born to HBeAg-positive carrier mothers did not show a significant change in the proportion of suppressor and helper T-cell subsets or proliferative response to HBcAg. Nor did they produce interleukin-2 receptor after being cocultured with HBcAg. The unresponsiveness of peripheral-blood mononuclear cells or cord mononuclear cells to HBcAg was not reversed by CD8+ cell depletion. Although cord blood mononuclear cells from neonates born to carrier mothers positive for antibody to HBeAg also did not respond to HBcAg, we encountered an infant, born to a carrier mother positive for antibody to HBeAg, who contracted acute hepatitis B at 2.5 mo of age. The baby's peripheral-blood mononuclear cells showed a significant proliferative response to HBcAg. These results support the view that transplacental maternal HBeAg probably induces a specific unresponsiveness of helper T cells to HBcAg and HBeAg in the neonates born to HBeAg-positive carrier mothers. This specific helper T cell tolerance could be maintained throughout the early replicative phase of carrier state but might break someday with the appearance of raised ALT level.

Treatment and outcome of unexplained recurrent spontaneous abortions in subclinical autoimmune disorders

Patients with a history of three or more fetal losses before a gestational age of 20 weeks were examined. Only patients with normal chromosomal, hormonal and anatomic findings were included in this study. These patients were tested for the antinuclear antibody, the C3 and C4 levels, anti-ENA [Ro(SSA), La(SSB), SM, RNP, scl-70], anti-single-stranded DNA and anti-double-stranded DNA, lupus anticoagulant, anticardiolipin and antiphosphotidylserine. All of these patients were free of any symptoms, except for the repeated abortions. The results showed that 10 out of 213 (4.7%) patients with unexplained recurrent spontaneous abortions had abnormal serologic tests, and 28% of the abortions (nine out of 32 abortions) occurred during the second trimester. With treatment of low-dose aspirin alone, or in combination with prednisolone, two out of 11 pregnancies in these 10 patients resulted in repeated abortions (18%), which was significantly lower than their previous abortion rate where 32 out of 33 pregnancies resulted in abortions (97%). Four babies (three term and one premature) were delivered without any abnormalities and the other five pregnancies are beyond the 28th week of gestation and are progressing smoothly. This study revealed that subclinical autoimmune disorders may play a role in recurrent spontaneous abortions and adequate treatment can improve the pregnancy outcome.

The prognostic factors of severe amebic liver abscess: a retrospective study of 125 cases

One hundred twenty-five cases of amebic liver abscess were diagnosed at Chang Gung Memorial Hospital in Taiwan from January 1981 to December 1989. An analysis of possible prognostic factors for severe amebic liver abscess was done retrospectively. The majority of the patients came from the southern part of Taiwan. Severe amebic liver abscess was defined as the rupture of an abscess that was resistant to 72 hr of medical treatment, or complicated by secondary bacterial infection. The results showed significant differences between patients with severe liver abscess and those with more moderate forms of amebic liver abscess in indices such as jaundice, hemoglobin and serum bilirubin levels, and dyspnea, as well as in pulmonary changes (right diaphragm elevation, right pleural effusion) seen on chest radiographs. Those patients with diabetes mellitus also had greater evidence of severe liver abscess. Moderate cases that were treated with amebicides showed excellent responses (no mortality). Severe cases required, in addition to amebicide therapy, either percutaneous or surgical drainage of pus, especially in those patients with ruptured abscesses. Those patients with abscesses that ruptured into the thoracic cavity were treated by either thoracostomy or needle aspiration, and all were cured. Three patients died of abscess rupture into the abdominal cavity, associated with secondary bacterial infection. The overall mortality rate was 2.4%. These symptoms and signs of severe liver abscess are indicators of the need for intensive treatment such as aspiration or surgical drainage.

Characterization of the statin-like S1 and rat elongation factor 1 alpha as two distinctly expressed messages in rat

Previously, we reported a rat S1 protein that is antigenically related to statin, a nonproliferating cell-specific marker; however, it shares high homology with the known human elongation factor-1 alpha (EF-1 alpha). To differentiate S1 from rat EF-1 alpha and to study their respective regulation for expression, a rat EF-1 alpha cDNA clone was isolated and characterized. The nucleotide and deduced amino acid sequences of this partial rat EF-1 alpha cDNA are compared with that of human and mouse as well as with rat S1. Both their messages were detected in rat brain by EF-1 alpha- or S1-specific probes. However, the mRNA encoding EF-1 alpha is more abundant than that encoding S1. S1 and EF-1 alpha expression were investigated in the parotid and submandibular glands of untreated rats and those treated with isoproterenol, a proliferation-inducing catecholamine. Quantitative solution hybridization demonstrated a dramatic reduction (approximately 68%) in the S1 mRNA following isoproterenol injection in proliferation-responsive parotid glands and a mild reduction (approximately 20%) of S1 steady-state messages in the proliferation-refractile submandibular glands. A slight increase or no changes of EF-1 alpha levels in both parotid and submandibular glands following isoproterenol treatment are also observed. Therefore, the EF-1 alpha and S1 genes are different genes, both expressed and regulated in vivo, but in differential quantitative and qualitative patterns.

A common precursor for a putative hemorrhagic protein and rhodostomin, a platelet aggregation inhibitor of the venom of Calloselasma rhodostoma: molecular cloning and sequence analysis

Rhodostomin is a platelet aggregation inhibitor secreted by the venom gland of Calloselasma rhodostoma. We report here the isolation of a 1.67-kilobase (kb) lambda gt11 cDNA clone using degenerate oligonucleotide probe based on a partial amino acid sequence of rhodostomin. The amino acid sequence deduced from an open reading frame of the cDNA indicates that (i) the 68-amino acid sequence of rhodostomin is located at the carboxyl terminus of the precursor polypeptide and (ii) a peroxisomal targeting sequence (ser.his.ala.) exists between the stop codon and the rhodostomin sequence of the precursor. Since the amino-terminal segment of the deduced sequence shows a high degree of identity with hemorrhagic proteins, which are zinc-metalloproteinases, found in the venom of some crotalid and viperid snakes, our results also predict the existence of at least one such hemorrhagic protein in the venom of Calloselasma rhodostoma. The derivation of a platelet aggregation inhibitor and a hemorrhagic protein from the same precursor protein is consistent with the fact that these proteins may be synergistic in function.

Low prevalence of hepatitis C virus and infrequent perinatal or spouse infections in pregnant women in Taiwan

To assess the prevalence of hepatitis C virus (HCV) infection in the pregnant women in Taiwan, we investigated two groups of pregnant women, 944 women without serum alanine aminotransferase (ALT) screening (group A) and 197 women with abnormal ALT (greater than 45 IU/L) (group B). They were checked for anti-HCV (anti-C100-3) with HCV EIA kit (Abbott Lab., North Chicago, IL). The results showed that 21 (2.2%) in group A and 5 (2.5%) in group B were anti-HCV-positive. However, 15 out of 21 in group A had an optical density (O.D.) of anti-HCV less than 1.0, were negative by recombinant immunoblot assay (RIBA), and were regarded as false-positive. Nine infants delivered by those 11 cases were negative for anti-HCV at 6 months of age, while none of the 8 husbands were anti-HCV-positive. It is concluded that the prevalence of anti-HCV in pregnant women in Taiwan is low (6/944, 0.63%), even in the cases with abnormal ALT (5/197, 2.5%). There was no serologic evidence for perinatal transmission or spouse infection.

Isoproterenol downregulation of statin-related gene expression in the rat parotid gland

Statin, a 57 kilodalton (kDa) nuclear protein, is characteristically found in nonproliferating cells in culture as well as nondividing cells of a wide range of highly differentiated tissues. Moreover, cells in culture that are statin positive lose this statin expression when re-entering the cell-cycle traverse. In this work, statin expression was investigated in the parotid gland of untreated rats and those treated with isoproterenol (IPR), a proliferation-inducing catecholamine. Indirect immunofluorescence microscopy revealed specific nuclear staining with anti-statin monoclonal antibody (S-44) in the acinar and ducts cells of the untreated rats but significantly reduced in those induced with isoproterenol. To characterize the protein recognized by S-44, protein extracts from both tissues were immunoblotted and incubated with S-44. The antibody reacted specifically with a 48 kDa protein in the extract of the parotid glands from untreated rats while no reaction was detected in that of the proliferation-induced ones. These observations along with the result that a statin-like (S1) transcript is downregulated by isoproterenol in the parotid glands further support the notion that the disappearance of statin-related expression is associated with the IPR-induced proliferation in the rat parotid glands. The discrepancy between the apparent molecular mass of the protein identified by S-44 in nonproliferating parotid cells and that of statin originally found in fibroblasts, suggests that either a modified form of statin may be present in the parotid gland, or this 48 kDa protein may be a member of the nonproliferative statin-like family.

Sequence and expression of the MnP4 gene encoding basic proline-rich protein in macaque salivary glands

We report here the macaque MnP4 cDNA and genomic sequences which encode a basic proline-rich protein (PRP), which is synthesized in macaque parotid gland and submandibular gland. The locations of intron positions and the prototype of the tandem 20-amino-acid repeat motif with the sequence, PPPPGKPQGPPQQGGNKPQG, in MnP4, were compared to those in related genes encoding PRP and glutamic/glutamine-rich proteins (GRP) in humans and rodents. Exceedingly high homology of the first exon and 40-bp region immediately upstream of exon I is observed with other PRP genes of all species studied. In order to identify the regulatory elements involved in control of MnP4 gene expression, a rat submandibular gland-derived cell line (RSMT-A5) was transfected with MnP4-cat constructs that contained the promoter and 5'-flanking regions of the macaque MnP4 gene fused to the bacterial cat gene. Deletion analysis revealed that putative positive and negative regulatory elements reside between nucleotides (nt) -107 and +5, and nt -586 and -108, respectively. As part of this study, the promoter of the macaque MnP4 gene appears to be salivary gland specific. This salivary gland-specific gene expression attests to the complexity of transcriptional regulation in eukaryotes.

Hepatitis C virus infection in patients with chronic liver diseases in an endemic area for hepatitis B virus infection

Taiwan is an endemic area for hepatitis B virus (HBV) infection, which is responsible for up to 80% of chronic liver diseases there. In contrast to an HBV carrier rate of 15-20% in the general population, only 1% of its population are seropositive for anti-HCV. To evaluate the role of HCV infection in chronic liver diseases in Taiwan, serum anti-HCV was studied using an enzyme immunoassay in 123 "healthy" administration staff of the hospital, 724 hepatitis B surface antigen (HBsAg)-positive and 157 HBsAg-negative patients with chronic liver disease. The prevalence of anti-HCV was 0.8% in the hospital staff, 24.3% in HBsAg-positive and 80.9% in HBsAg-negative patients with chronic liver diseases. Anti-HCV was positive in 10 (9.6%) of 104 HBsAg-positive and 31 (77.5%) of 40 HBsAg-negative patients with inactive chronic hepatitis; 94 (27.2%) of 346 HBsAg-positive and 53 (85.5%) of 62 HBsAg-negative patients with active chronic hepatitis; 49 (26.1%) of 181 HBsAg-positive and 33 (86.8%) of 38 HBsAg-negative patients with cirrhosis; 23 (26.7%) pf 86 HBsAg-positive and 10 (58.8%) of 17 HBsAg-negative patients with hepatocellular carcinoma. In HCV infected HBsAg-positive patients, the optical density was usually lower, and anti-HCV became negative in 27% on follow-up. HCV infection tends to occur more frequently in older, HBeAg-negative and anti-HD-positive patients with chronic HBV infection. It is concluded that HCV not only is the major agent for non-B chronic liver diseases but also plays a significant role in HBsAg-positive chronic liver diseases in Taiwan.

Isolation and characterization of the rat chromosomal gene for a polypeptide (pS1) antigenically related to statin

Increasing evidence shows the existence of nonproliferation-specific gene(s) whose expression is mostly present in growth-arrested cells. One member of this gene family has been identified by previous work as a nuclear protein of 57,000 Da, termed statin. Logical extensions of statin research are to identify the genomic and cDNA clones encoding for statin and to study the regulation of statin gene expression. During the search for the statin gene, we have identified a cDNA clone and a genomic clone named S1 and S10, respectively, by screening a rat brain lambda gt11 expression library with the statin antibody and subsequently using S1 cDNA as a probe to screen a rat genomic cosmid library. Here, we report the cloning and sequencing of the S1 cDNA and S10 genomic clones. Primary sequence analyses indicate that the derived amino acid sequence of S1 shares high homology (greater than 92.6%) with human elongation factor 1 alpha (EF-1 alpha), whereas the 5'- and 3'-untranslated regions are less than 20% homologous. Despite the unusually high degree of similarity between S1 and human EF-1 alpha at the amino acid sequence level, their protein products are different and immunologically distinct. The in vitro transcription and translation product of S1 (pS1), a 49,000-Da polypeptide, reacts only with the monoclonal antibody against statin; this antibody exhibits no antigenic reaction to the EF-1 alpha protein. Northern blot analysis shows that the S1 message is most abundant in G0 phase of 3T3 mouse fibroblasts, but becomes significantly reduced in G1 and S phase cells. EF-1 alpha messages do not show such dramatic changes during cell cycle phase transition. These findings suggest that the expression of the identified S1 cDNA clone is specific for nonproliferating cells and that the in vitro translation product of the S1 cDNA is recognized by the statin antibody. Genomic Southern blots indicate that S1 cDNA is encoded by a single copy gene in the rat genome and is a unique member of the EF-1 alpha/S1 supermultigene family. DNA sequence analysis demonstrates that the rat S1 transcription unit is 12 kilobase pairs in length and contains seven introns. The organization of exons is virtually identical between S1 and human EF-1 alpha. In contrast, neither a TATA box nor a CAAT box is located in the proximal 5'-flanking regions from positions -1 to -1359 of the S1 gene, where we could expect to find the regulatory region containing the elements controlling gene expression; no evident sequence homology to the human EF-1 alpha gene is detected in this region.(ABSTRACT TRUNCATED AT 400 WORDS)

Early predictor of the efficacy of immunoprophylaxis against perinatal hepatitis B transmission: analysis of prophylaxis failure

To research early predictors of the efficacy of the ongoing mass immunoprophylaxis against perinatal hepatitis B virus (HBV) transmission in Taiwan and to analyse the possible causes of immunoprophylaxis failure, 52 hepatitis Be antigen (HBeAg)-positive carrier mothers were recruited for the study. Maternal blood samples were taken at the first and third trimesters and delivery. Umbilical blood was collected and venous blood samples were taken at 4, 7, 11 and 14 months of age. Serum hepatitis B surface antigen (HBsAg) and antibody titres, HBeAg titre and HBV-DNA concentration were analysed. All the umbilical cord blood samples were negative for HBsAg. Among the 52 vaccinated infants, four were poor responders (anti-HBs less than 10 mIU ml-1 before vaccine booster). Another five infants became HBsAg-positive by 4 months of age and remained carriers. All these five carrier mothers were HBV-DNA-positive and three of them had risk factors related to maternal-fetal haemorrhage during pregnancy or delivery. The remaining 43 infants showed protective anti-HBs level (greater than 10 mIU ml-1) by 4 months of age. Three mothers out of these 43 cases also had the same haemorrhage risk factors during pregnancy or delivery, but were HBV-DNA-negative. Therefore, the anti-HBs level at 4 months is a predictor of the success of immunoprophylaxis. It may be helpful to distinguish HBV-DNA-positive carrier mothers among HBeAg-positive ones, to avoid inducing more maternal-fetal haemorrhage in such cases during pregnancy or delivery. Otherwise, additional hepatitis B immune globulin may be indicated in such cases to raise the successful prevention rate.

[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).