Comparison of skeletal muscle microcirculation between clamp ischemia and microsurgical ischemia

We compared ischemia reperfusion injury-associated vasospasm and perfused capillary density (PCD) at the microcirculatory level between clamp ischemia and microsurgical ischemia in rat skeletal muscle. Rat cremaster muscle was prepared as an island flap, attached only with pudic-epigastric vessels branching from external iliac vessels. Two types of ischemia, with clamping only or with microvascular anastomosis, were applied at the external iliac vessels for 2 hours followed by 1-hour reperfusion before in vivo microscopic examination for hemodynamic changes. At the end of observation, small segments of the vessels at the clamping site and microsurgical anastomoses site were also harvested for histological examination. It was found that the first- and second-order arterioles had about 12-15% diameter reductions in both groups, whereas diameter reductions of the third-order arterioles were up to 37.8% in the microsurgical ischemia group, much greater than that in the clamp ischemia group (2.3%). There was also no significant difference in PCD reduction between the two groups, although the red blood cell velocity was much slower in the microsurgical ischemia group. Histological examination of the anastomosis site showed massive accumulation of polymorphonuclear neutrophils on the venous endothelium. These results suggested a different degree of endothelial damage and local leukocyte activation between microsurgical ischemia and clamp ischemia. Therefore, we conclude that clamp ischemia cannot replace microsurgical ischemia for studying microcirculatory changes in free tissue transfer.

Fibrillar amyloid-beta production, accumulation, and recycling in transgenic mice pancreatic acinar cells and macrophages

Amyloid-beta (A beta) production, accumulation, and recycling were examined by light and electron microscopy in the pancreas of transgenic mice (from 45 days to 22 months of age) that express the gene for the carboxy-terminal fragment of the human amyloid-beta protein precursor. Ultrastructural immunocytochemistry revealed four types of cells accumulating fibrillar A beta 1-40 in cytoplasmic vacuoles: acinar pancreatic cells, macrophages infiltrating stroma, epithelial cells of pancreatic ducts, and blood monocytes/macrophages in the lumen of pancreatic vessels. The ultrastructure of amyloid deposits suggests that each of these four types of cells produces fibrillar A beta. Three basic types of amyloid deposits were distinguished: primary vacuoles in different stages of amyloid aggregation and fibrillization, secondary vacuoles that are the product of fusion of primary vacuoles, and phagosome-like vacuoles with morphologically intact fibrillar amyloid and residues of ingested cells. Amyloid production in acinar pancreatic cells starts in mice younger than 45 days, progresses in 2- to 7-month-old mice, and plateaus in the second year of life. In macrophages, amyloid appears in 60-day-old mice, and the increase in the number of macrophages and the amount of amyloid in their cytoplasm correlates with age.

Pediatric intractable epilepsy: the role of presurgical evaluation and seizure outcome

Surgical experience with long-term follow-up is limited in childhood intractable epilepsy, compared with adult epilepsy. To assess the role of each presurgical evaluation modality and to identify prognostic factors for favorable seizure control after epilepsy surgery, 38 children with intractable epilepsy who underwent surgery were retrospectively reviewed. Among the available preoperative evaluation modalities, PET and neuropsychological testing showed the highest rates of positive results, whereas MRI was the most concordant with EEG findings. During a follow-up period of at least 12 months, 26 of the 38 patients showed favorable seizure control (Engel classifications I and II). The best seizure control was achieved in patients with a temporal resection and discrete lesion on magnetic resonance imaging. In spite of the invasive study, the less satisfactory results followed an extratemporal resection. We conclude that epilepsy surgery benefits children with intractable epilepsy and that the role of invasive study should be reestablished according to the area of resection and presence of discrete lesion on MRI.

[Chemical weed control of medicinal plant Bupleurum falcatum L]

OBJECTIVE

To select low-residue herbicide for cultivation of Bupleurum falcatum.

METHOD

Probing the effect of various kinds of herbicide on the budding, growth and yield of B. falcatum both in laboratory and in the fields.

RESULT AND CONCLUSION

Haloxyfop acts slightly on the growth of B. falcarum, but effectively kills weeds of many kinds. Butralin is a good herbicide for Gramineae.

Transoral protrusion of a peritoneal catheter: a case report and literature review

Transoral protrusion of a peritoneal catheter is rare. Only two cases have been reported in the English literature. We now report the case of a 5-year-old girl who presented with a catheter that had been inserted 4 years previously, protruding from her mouth. Signs of cerebrospinal fluid infection or peritonitis were absent. The peritoneal catheter was cut and externalized at the chest. The distal portion, which had perforated the stomach wall, was removed using endoscopic procedures. After 3 weeks of antibiotic treatment, a new shunt was inserted. Analysis of 50 cases of bowel perforation extracted from the English literature showed that among the suggested factors such as age, gender, nutritional state, history of abdominal surgery, and length and type of the catheter, age was the only predisposing factor. In the treatment of bowel perforation by a peritoneal catheter, suspected shunt infection should be managed properly and contamination be minimized during removal of the peritoneal catheter.

Association of the cytoplasmic membrane protein XpsN with the outer membrane protein XpsD in the type II protein secretion apparatus of Xanthomonas campestris pv. campestris

An xps gene cluster composed of 11 open reading frames is required for the type II protein secretion in Xanthomonas campestris pv. campestris. Immediately upstream of the xpsD gene, which encodes an outer membrane protein that serves as the secretion channel by forming multimers, there exists an open reading frame (previously designated ORF2) that could encode a protein of 261 amino acid residues. Its N-terminal hydrophobic region is a likely membrane-anchoring sequence. Antibody raised against this protein could detect in the wild-type strain of X. campestris pv. campestris a protein band with an apparent molecular mass of 36 kDa by Western blotting. Its aberrant slow migration in sodium dodecyl sulfate-polyacrylamide gels might be due to its high proline content. We designated this protein XpsN. By constructing a mutant strain with an in-frame deletion of the chromosomal xpsN gene, we demonstrated that it is required for the secretion of extracellular enzyme by X. campestris pv. campestris. Subcellular fractionation studies indicated that the XpsN protein was tightly associated with the membrane. Sucrose gradient sedimentation followed by immunoblot analysis revealed that it primarily appeared in the cytoplasmic membrane fractions. Immune precipitation experiments indicated that the XpsN protein was coprecipitated with the XpsD protein. In addition, the XpsN protein was co-eluted with the (His)(6)-tagged XpsD protein from the metal affinity chromatography column. All observations suggested that the XpsN protein forms a stable complex with the XpsD protein. In addition, immune precipitation analysis of the XpsN protein with various truncated XpsD proteins revealed that the C-terminal region of the XpsD protein between residues 650 and 759 was likely to be involved in complex formation between the two.

Surgical outcome of pediatric hydrocephalus treated by endoscopic III ventriculostomy: prognostic factors and interpretation of postoperative neuroimaging

In order to analyze the surgical outcome according to clinical characteristics and to evaluate the correlation between clinical improvement and neuroimaging changes, we retrospectively reviewed 32 children who had undergone endoscopic III ventriculostomy (ETV) from February 1994 to May 1998. There were 15 boys and 17 girls, with a mean age of 5.2 years (range: 1 month to 13 years). The etiology of the hydrocephalus was primary aqueductal stenosis in 18 patients, secondary aqueductal stenosis caused by tumors in 5, IV ventricle outlet obstruction in 5, and hydrocephalus associated with meningomyelocele in 4. The mean duration of follow-up was 19.4 months (range 1-50 months). Overall, surgical outcome was regarded as good in 21 of 29 patients. Surgical outcome was poor in patients younger than 1 year (P<0.05). Neuroimaging 1 month after ETV showed a decrease in ventricular size in 11 of the 16 patients with good surgical outcomes. Five showed minimal changes only. In patients with good outcomes, ventricular size tended to decrease as time passed. Resolution of periventricular edema, flow void in the III ventricle on T2-weighted axial images, and cine-MR imaging were sensitive indicators of good outcome. We suggest that ETV be considered as a primary treatment option in patients older than 1 year of age with noncommunicating hydrocephalus. In addition, time factors should be taken into consideration when surgical outcome is judged. Changes in ventricular size could not predict surgical outcome completely in themselves. Therefore, a comprehensive postoperative assessment should be made with the help of T2-weighted MRI and cine-MRI.

Major hemorrhage in a patient with multiple submucous leiomyomata during the treatment of long-acting gonadotropin-releasing hormone agonist

Gonadotropin releasing hormone agonist (GnRH-agonist) therapy has been useful as an adjunct before myomectomy or hysterectomy for uterine myoma but the concealed risk is often overlooked. We report an extremely rare clinical presentation of a patient with multiple submucosal myomata during the treatment of long-acting gonadotropin-releasing hormone agonist (GnRH-agonist) in a 23-year-old, virgin woman. This patient exhibited heavy menstruation and severe anemia for half of a year. Ultrasound demonstrated multiple submucous myomata and intramural myomata. She received a conservative medical treatment by GnRH-agonist. The patient showed marked suppression of serum estradiol concentrations throughout treatment (< 20 pg/ml since first dose injection). The volume of the uterus decreased 21% and the total volume of the uterine myomata decreased 27% at the end of the second dose injection. However, a sudden onset of major hemorrhage occurred at the 65th day without "add-back" hormonal replacement therapy after initial therapy of GnRH-agonist. Hypovolemic shock followed soon and immediately resuscitation was performed. After resuscitation, the patient was treated with hysteroscopic myomectomy, followed by 30 ml balloon Foley catheter placement for compressing the intrauterine rough surface and hormonal replacement therapy. When uterus returned to the normal size at the end of the first week, intrauterine device was positioned and maintained for three months. The patient married four months later and got pregnant soon. Now she has a pregnancy of 22 gestational weeks. The phenomenon suggests presence of concealed and potential risk of GnRH-agonist for managing a patient with multiple submucous myomata, even though GnRH-agonist is a well-documented transient treatment for uterine myomata not only by its effect on tumor shrinkage and decreasing blood loss during the myomectomy but also by providing a time for hematological recovery. This unexpected and unwanted clinical presentation should be alerted.

Outcomes of medical treatment of neurocysticercosis: a study of 65 cases in Cheju Island, Korea

BACKGROUND

Although cysticidal drugs hasten the death and disappearance of the parasite, the long-term prognosis of NCC is still not satisfactory.

METHODS

In this study, 65 patients with active neurocysticercosis (NCC) treated with praziquantel or albendazole were retrospectively reviewed to evaluate radiological and clinical outcome. According to worm location, patients were divided into two groups: parenchymal (n = 42) and extraparenchymal NCC (n = 23). The average duration of follow-up was 23 months.

RESULTS

In terms of cysticidal effectiveness (73% vs. 50%), seizure control (60% vs. 43%) and symptomatic improvement of non-seizure patients (64% vs. 44%), the outcome of treatment was better in the parenchymal NCC than in the extraparenchymal. Repeated cysticidal treatment was needed in 26% of parenchymal and 39% of extraparenchymal NCC. After treatment, 38% of parenchymal NCC complained of seizure and 35% suffered from headache. Likewise, 27% and 36% of extraparenchymal NCC complained of seizure and headache, respectively. During the follow-up, 7 of 30 patients without initial seizure developed new seizures after medical treatment.

CONCLUSION

Despite the development of cysticidal drugs, a considerable number of patients suffer from late neurologic sequelae such as seizure and headache. Therefore continuous attention should be given to the patients after cysticidal treatment. Prevention by health education is emphasized.

Supratentorial primitive neuroectodermal tumor in children: clinical features, treatment outcome and prognostic factors

To investigate clinical features, treatment outcome and prognostic factors of pediatric supratentorial primitive neuroectodermal tumors(ST-PNETs), 28 ST-PNET cases were retrospectively analyzed. The prognostic importance of age, sex, size of tumor, M stage, extent of surgical resection, histological features, immunohistochemical labelling indices (Ki-67, p53), and apoptotic index were assessed. The mean age at diagnosis was 6.8 years, and the male-to-female ratio was 18:10. The presenting symptoms in 22 cases were increased intracranial pressure and focal neurological deficits. Gross total resection was achieved in 17 cases, near-total (>90%) resection in 3, and subtotal in 7; biopsy was performed in 1 case. The mean duration of follow-up was 37 months. For 25 patients who completed planned adjuvant therapy, the 3-year survival rate was 73%. Univariate analysis showed that the presence of tumor necrosis (P=0.002) and extent of resection (P=0.04) correlated with survival. Patients with a high Ki-67 labelling index (>10%) tended to have shorter survival (P=0.095). In multivariate analysis, tumor necrosis showed statistical significance(P=0.03).

Neurenteric cyst: its various presentations

Neurenteric (NE) cyst is an uncommon developmental lesion lined with epithelium of endodermal origin. To investigate the clinical manifestation and response to surgery, we retrospectively analyzed eight cases of NE cyst that has been confirmed by surgery. Four were in children. The duration of follow-up ranged from 2 to 105 (mean 38) months. One cyst was in the ventral portion of the posterior cranial fossa and the other seven were on the spinal cord. The chief complaints were motor weakness (5), pain (2), and voiding difficulty (1). In one child and three adults, the duration of symptoms was more than 3 years. Children tended to show rapid progression and excellent recovery after surgery. Although total removal of cyst was possible only in two cases, there was no recurrence. The presentation of an NE cyst may be insidious. Clinical suspicion is important for an early diagnosis and better outcome. Because of the benign course after subtotal excision, too-aggressive removal of the lesion should be avoided.

Reconstruction of ankle and heel defects by a modified wide-base reverse sural flap

BACKGROUND

Flap reconstruction around the ankle and heel is a technically demanding procedure. Some patients have contraindications for microsurgery, however, limiting the options for local tissue transfer. In this study, we describe our experience with a new flap technique for ankle and heel coverage.

METHODS

We designed a modified wide-base reverse sural flap and applied it to 20 patients with lower leg trauma from 1994 to 1997. All patients sustained Gustilo type IIIb,c open fractures with soft-tissue defects around the ankle and heel. Six cases had chronic osteomyelitis. Most of our patients had contraindications for microsurgery such as old age, poor medical condition, or heavy smoker status. The average age was 69.5 years old, and the average follow-up time was 18.5 months.

RESULTS

All 20 patients underwent successful modified reverse sural flap reconstruction. There were no deep infections, no soft-tissue necrosis, or pressure ulcers. The nonunion rate was 5%. The average time for flap elevation and rotation was 29.3 minutes. No blood transfusion was required. An unsightly scar was the major complaint (60%) from our patients. Seventeen cases (85%) achieved good functional outcomes.

CONCLUSION

This report demonstrates that our design of this modified wide-base reverse sural flap is suitable for flap reconstruction around the ankle and heel; especially for patients who have difficulty in receiving microsurgery. The surgical procedure is simple, and the results are satisfactory.

Treatment of intracranial nongerminomatous malignant germ cell tumor in children: the role of each treatment modality

To investigate the role of surgical tumor resection, radiotherapy and chemotherapy, the outcome of treatment in 17 children with nongerminomatous malignant germ cell tumor (NG-MGCT) was reviewed. The median follow-up period was 38 months after diagnosis, and the overall 3-year survival rate was 75%. Eleven patients who underwent craniospinal radiation (CSRT) did not receive chemotherapy. In 4 of them more than 90% of the tumor was removed, and they were free of disease at 16, 30, 93 and 111 months after surgery. Among the other 7, who did not undergo tumor resection (n=5) or had considerable residual tumor (n=2), 2 were disease-free at 73 and 88 months after diagnosis, and 5 died of recurrences. Of 6 patients who received cisplatin and etoposide chemotherapy in addition to CSRT, none showed intracranial recurrence, regardless of the extent of removal. The authors believe that multimodal treatment is the preferred choice and that chemotherapy plays an important role, especially when a significant amount of tumor remains after surgery. CSRT plays a major role at least in some patients. If chemotherapy is not feasible, radical removal plus CSRT seems to be an alternative.

A simple method of predicting hormonal outcome in children with intracranial germinoma

Even a small intracranial germinoma (GE) frequently provokes pituitary hypofunction. We evaluated the relationships between preoperative hormonal status and hormonal outcome and between size of suprasellar mass and hormonal outcome in 22 children with intracranial pure GE to determine whether or not these can reflect the degree of hypothalamo-pituitary axis destruction. Preoperative hormonal status was graded from I to IV according to the serum prolactin level (s-PRL) and thyroid function (TF). The hormonal outcome was estimated by the type and the number of hormonal replacement medications taken on the basis of the triple load test and endocrinological examinations at the time of the last follow-up (median period: 43 months). Fifteen of the 22 patients had suprasellar lesions. All 13 patients who had diabetes insipidus (DI) at presentation needed desmopressin acetate (DDAVP) during the follow-up period. The correlation between increment of preoperative grade and the increment in the number of hormones to be replaced was statistically significant (P<0.05). This preoperative grading was a more reliable predictor than the size of suprasellar tumor. In conclusion, preoperative grading by s-PRL and TF test is useful for the prediction of posttreatment hormonal replacement in children with intracranial pure GE.

Congenital glioblastoma diagnosed by fetal sonography

Congenital brain tumors are very rare, and 2-9% of them are accounted for by glioblastomas. We encountered a case of congenital glioblastoma detected at the 39th week of gestation by fetal sonography, which revealed a large echogenic mass in the left temporo-parietal area of the fetal brain with significant midline shift and dilatation of the contralateral lateral ventricle. A detailed sonogram obtained 7 h later showed that the mass had increased in size, and this suggested an expanding hematoma. An emergency cesarean section was performed. Postnatal MRI demonstrated an enhancing mass with a large hematoma. Biopsy revealed a malignant brain tumor. Further management was refused and the boy died 6 days after birth. The postmortem pathological diagnosis was glioblastoma. When fetal sonography demonstrates an echogenic mass, a congenital brain tumor should be considered. The mode of delivery should be determined by the nature of the mass and the condition of the fetus.

Stroke complicating pregnancy and the puerperium

BACKGROUND

The role of nonobstetric factors, such as stroke, in maternal mortality has become of increasing importance because maternal deaths resulting directly from obstetric causes are decreasing. Strokes contribute to high mortality and morbidity, and are severe complications during pregnancy and puerperium. The objective of this study was to investigate the maternal outcome of patients with complications of stroke during pregnancy and puerperium. The causes, incidence and essential management of stroke are also reviewed.

METHODS

During the 10-year period from January, 1986, to January, 1996, women who suffered from stroke during pregnancy, or up to six weeks postpartum, and were discharged from our hospital were identified. Stroke was defined as the abrupt onset of a focal neurologic syndrome that consisted of hemorrhagic and ischemic central nervous system events. All were assessed using computerized tomography or magnetic resonance imaging. Neurologists reviewed each case from the medical records.

RESULTS

Thirteen women who had had a stroke during pregnancy or puerperium were identified. Nine of these women had intracerebral hemorrhage and four had ischemic strokes. During this 10-year period, approximately 85,321 women gave birth at the Mackay Memorial Hospital, and the incidence of stroke was approximately 1 in 6,500 pregnancies. Among the nine cases of hemorrhagic strokes, three women had preeclampsia and one had gestational diabetes mellitus. Mortality from strokes was 38%, and 63% of survivors had residual neurologic deficits; 46% of the strokes occurred during the puerperium.

CONCLUSIONS

Stroke during pregnancy and puerperium causes high mortality and morbidity. Early diagnosis and adequate treatment cannot be overemphasized, as prompt and proper management is beneficial for outcome. The same meticulous care provided during the antepartum and intrapartum periods should be continued into the puerperium.

Cerebrospinal fluid shunt infection in children: efficiency of management protocol, rate of persistent shunt colonization, and significance of 'off-antibiotics' trial

To evaluate the efficiency of our management protocol, 33 pediatric cases of bacteria-infected cerebrospinal fluid shunt were reviewed. The causative organism was staphylococcus in 23 patients. In 23 patients, shunt infection was managed according to the protocol. The complexity of the shunt system did not prolong hospitalization. Unchanged but externalized tubings showed persistent colonization despite adequate antibiotics in 10 of 21 patients. Staphylococcal infection was oxacillin-resistant in 7 of 19. The efficiency of an 'off-antibiotics' trial was minimal. Further modification of the protocol is expected to enhance efficiency of the management.

High-grade endometrial stromal sarcoma in a 10-year-old girl: case report

Endometrial stromal sarcomas occur primarily in perimenopausal women and are quite uncommon in children. We report a case of high-grade endometrial stromal sarcoma in a 10-year-old girl, who initially experienced lower abdominal pain on voiding. After a series of examinations, surgical treatment was performed, including an extended total hysterectomy with bilateral salpingo-oophorectomy, bilateral pelvic lymph node sampling, and partial omentectomy. Adjuvant radiotherapy and hormonal therapy followed, however, the abdominal tumor recurred 9 months later. Invasion of the right lobe of the liver with compression of the inferior vena cava and pleural effusion was noted. The patient then received prolonged oral etoposide therapy. The treatment stabilized the tumor size and relieved her symptoms for 4 months. She finally succumbed to the disease as a result of distant metastasis.

Studies on quinazolines and 1,2,4-benzothiadiazine 1,1-dioxides. 8.1, 2 synthesis and pharmacological evaluation of tricyclic fused quinazolines and 1,2,4-benzothiadiazine 1,1-dioxides as potential alpha1-adrenoceptor antagonists

A series of 2-substituted methyl 2,3-dihydroimidazo[1, 2-c]quinazolin-5(6H)-ones (4), 3-substituted methyl 2, 3-dihydroimidazo[1,2-c]quinazolin-5(6H)-ones (5), 3-substituted methyl 2,3-dihydro-5H-thiazolo[2,3-b]quinazolin-5-ones (15a,b), 3-substituted methyl 2,3-dihydroimidazo[2,1-b]quinazolin-5(1H)-ones (16a,b), 3-substituted methyl 2,3-dihydro-1H-imidazo[1,2-b][1,2, 4]benzothiadiazine 5,5-dioxides (33a,b), 2-substituted methyl imidazo[1,2-c]quinazolin-5(6H)-ones (42-45a,b), 3-substituted methyl imidazo[1,2-c]quinazolin-5(6H)-ones (50-53a,b), 3-substituted methyl 5H-thiazolo[2,3-b]quinazolin-5-ones (55-56a,b), and 3-substituted methyl 5-(methylthio)-2,3-dihydroimidazo[1,2-c]quinazoline (57) were synthesized as compound 1conformational rigid congeners for pharmacological evaluation as potential alpha1-adrenoceptor antagonists. Compounds 4, 5, 33a,b, 44a,b, 45a,b, 52a,b, 53a,b, and 57 were found to possess high affinity for the alpha1-adrenoceptor. Compounds 5 and 57 were the most highly selective and potent alpha1 antagonists with Ki = 0.21 +/- 0.02 and 0.90 +/- 0.08 nM, respectively. The S-enantiomers of these two compounds (Ki = 0.13 +/- 0.01 nM for (S)-(-)-5; Ki = 1.0 +/- 0.2 nM for (S)-(+)-57) were 144-200-fold more potent than the R-enantiomers (Ki = 26 +/- 8 nM for (R)-(+)-5; Ki = 144 +/- 23 nM for (R)-(-)-57). Compound 4 showed 8-fold higher affinity to alpha1A-AR better than alpha1B-AR. These compounds possessed weak to no activity against the 5-HT1A receptor.

Cytokinetic pattern in the thoracic spinal cord of chick embryos (incubation day 5-13) using PCNA staining and TUNEL method

For the cytokinetic studies using spinal cords of chick embryos, chronological patterns of cell proliferation and programmed cell death (apoptosis) should be known. Information in the early stages of chick embryos is available while data on later stages are seldom available. To investigate the chronological patterns of cell proliferation and apoptosis in the thoracic spinal cord of normal chick embryos on incubation day 5, 6, 8, 10 and 13 (Hamburger and Hamilton stage 26-40), proliferating cell nuclear antigen (PCNA) staining and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) method were used. Cell proliferation was active at the germinal layer on days 5 and 6. It markedly declined on day 8 and became negligible on day 13. TUNEL-positive cells were mainly found in the germinal layer, the ventrolateral part of the mantle layer and the dorsal root ganglion. Compared to PCNA-positive cells, TUNEL-positive cells were sparse, especially after day 10, when only a few positive cells were scattered. These results will be used as a control data for the studies such as an experimental research for neural tube defects.

Control of intraoperative bleeding with hydrostatic pressure during endoscopic surgery

Though intracranial endoscopic surgery has several advantages, poor visibility caused by bleeding from the operative field is one of its limitations. In two cases involving endoscopic III ventriculostomy the authors encountered moderate bleeding, and this was controlled with 'water column tamponade.' Following the application of hydrostatic pressure of 40-50 cmH2O for less than 2 min, the bleeding temporarily stopped and the operative field became clear. Several applications of this tamponade made it possible to complete the procedures. Although the pressure applied by the water column was not high enough to disturb the cerebrovascular autoregulation, blood pressure rose significantly during application of the water column tamponade. This method was valuable for the completion of procedures when bleeding was not at high pressure from large arteries. Careful monitoring of the blood pressure is mandatory, and adjustment of the pressure applied will make the procedure safer.

[An epidemiological study of the adolescent nonfatal unintentional injuries in Taiwan]

In Taiwan, the unintentional injury is the major cause of morbidity, mortality, and school absenteeism among adolescents. This problem has been ignored in past years, so this investigation was undertaken to alert public, school, and parental attention and concern, to establish the baseline data for adolescent unintentional injuries, and to provide information and guidance for adolescent injury prevention and control programs. Two thousand-three hundred and seventeen students were randomly sampled from 1,115 junior high, senior high, and vocational schools in Taiwan during the 1994-1995 academic year through a multi-stage stratified cluster random sampling with probabilities proportional to sizes. The data were collected via the self-reported adolescent unintentional injury records, and analyzed with frequency distribution, Pearson's Chi-square statistics, and product-moment correlation coefficient. It was found that an overall injury rate (per season) was 56.37% (1292/2292). The rates were higher for boys than girls, for junior high students than senior high or vocational students, for those being near-sighted, for those having a history of previous injuries, and for younger students. Abrasions, sprains, bumps, cuts, and falls were the five most common injuries among adolescents, and mostly appeared in upper and lower extremities. Most injuries took place in athletic fields, classrooms, campus, stairways and corridors at school, mainly due to self, others of carelessness, and sports.

Cell kinetics of surgically induced spinal open neural tube defect in chick embryos

In an attempt to understand cell kinetics of open neural tube defects (ONTDs) in the embryonic stages, chronological changes of cell proliferation and cell death patterns in the surgically induced spinal ONTDs of chick embryos were investigated using proliferating cell nuclear antigen (PCNA) staining and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL) method. ONTDs were induced at Hamburger and Hamilton stages 17-19. Compared with the control group, the surgery group showed a lower PCNA labeling index for 5 days after surgery and demonstrated more TUNEL-positive cells at 6 h, 3 and 5 days after surgery. Decreased cell proliferation and enhanced apoptosis were seen in the ventral as well as in the dorsal spinal cord. These results partly explain the functional deficits of ONTDs.