Sexual precocity due to intracranial human chorionic gonadotropin-secreting tumor: report of a case

Human chorionic gonadotropin (HCG)-secreting tumors are one of the causes of isosexual precocity in boys. A seven-year-old boy had been noted to have an increased appetite, accelerated growth and the development of pubic hair in the previous three months. He had an elevated serum testosterone level (16.79 ng/mL). However, the response of luteinizing-hormone and follicle-stimulating-hormone to gonadotropin releasing hormone stimulation was suppressed. An intracranial tumor at the left thalamus was disclosed by a magnetic resonance image scan of the head, and an elevated HCG level (120 mIU/mL) was also noted. Sexual precocity due to an intracranial HCG-secreting tumor was diagnosed and a partial resection of the tumor followed by radiotherapy was carried out. His serum testosterone and HCG levels became undetectable, and the secondary sexual characteristics regressed after treatment.

Oncogenic Ras blocks cell cycle progression and inhibits p34cdc2 kinase in activated Xenopus egg extracts

The effect of purified, bacterially expressed human RasH proteins on embryonic cell cycle progression in activated Xenopus egg extracts was studied. Bacterially expressed human oncogenic RasH protein is able to block the progression of the Xenopus embryonic cell cycle into M-phase. In contrast, the corresponding normal human Ras protein is relatively ineffective when assayed in a like manner. The observed arresting activity can be blocked by the addition of Y13-259 anti-Ras monoclonal antibody but not by nonspecific IgG. Oncogenic Ras also induces unique morphological changes in the reconstituted nuclei; the nuclei appear to be enlarged, and the chromatin partially condenses into fiber-like structures. This induced arrest is associated with suppression of p34cdc2 kinase activity, indicating that the oncogenic Ras protein induces the arrest by inactivating p34cdc2. This inactivation by oncogenic Ras protein does not result from inhibition of the synthesis of cyclin B or of the binding of the newly synthesized cyclin B to the p34cdc2.

Beneficial effect of prednisolone withdrawal followed by human lymphoblastoid interferon on the treatment of chronic type B hepatitis in Asians: a randomized controlled trial

To evaluate the effect of interferon and the benefit of prednisolone pretreatment in Oriental patients with chronic active hepatitis B, 120 male Chinese patients were randomly allocated to receive: 1) group A: a 4-week course of prednisolone followed by 2 weeks of no treatment and then a 12-week course of human lymphoblastoid interferon, 4 to 6 MU/m2 intramuscularly; 2) group B: as group A, but with placebo given instead of prednisolone; 3) group C: an 18-week course of placebo. Clearance of serum hepatitis B virus-DNA and HBeAg (complete response) was achieved in 21% of group A, 5% of group B and none of group C at the end of therapy (A vs B: p = 0.054; A vs C: p < 0.01). When assessed 12 months after the end of therapy, the complete response rate was 46% in group A, 24% in group B and 25% in group C (p < 0.05). Those with baseline alanine transaminase < or = 200 U/l showed a better response to interferon following prednisolone withdrawal (48%) than with interferon therapy alone (20%, p = 0.056) and no treatment (9%, p < 0.01). Those with a baseline serum hepatitis B virus-DNA < or = 1000 pg/ml also showed a higher complete response rate when pretreated with prednisolone (59%) than when treated with interferon alone (29%, p = 0.084) or untreated (22%, p < 0.03). The strongest independent predictor of a response to treatment was prednisolone withdrawal (p < 0.05). None of the responders lost hepatitis B surface antigen.(ABSTRACT TRUNCATED AT 250 WORDS)

Solitary cerebellar metastasis from Ewing's sarcoma: case report and review of the literature

A rare case of Ewing's sarcoma metastatic to the cerebellum is presented. Neurosurgical intervention was required which played a significant role in the treatment of this patient. The incidence and treatment of central nervous system involvement from Ewing's sarcoma is reviewed and discussed.

[The effects of ketamine, propofol and nitrous oxide on visual evoked potential during fentanyl anesthesia]

To evaluate the effects of ketamine, N2O, propofol on visual evoked potential (VEP) during fentanyl anesthesia, 14 patients undergoing transphenoid pituitary dissections were studied. Visual stimulation was done by using the goggles with red light diodes through closed eyelids and responses were recorded in one channel montage, Cz against Oz. The stimulus frequency was 1.9 flashes/sec. The VEPs were recorded from skin incision until the opening of the dura. For comparison, the preanesthesia to anesthesia values were determined. The ratio for N2 (N75) latency were 100.5 +/- 13.9% in ketamine group, 104 +/- 3.5% in N2O group, 100.5 +/- 4.2% in propofol group. The ratios for P2 (P100) latency were 97.45 +/- 5.7% in ketamine group, 101.9 +/- 3.5% in N2O group, 96.8 +/- 5.5% in propofol group. For N2P2 amplitude, the ratios were 36.3% +/- 31.4% in ketamine group, 138.5 +/- 58.0% in N2O group, 80.8 +/- 42.2% in propofol group. The percentage of inadequate recordings were 2.5 +/- 4.3% in ketamine group, 19.2 +/- 2.2% in N2O group and 20.6 +/- 16.0% in propofol group. The percentage of false positive results were 0 +/- 0% in ketamine group, 9.8 +/- 19.9% in N2O group, 12.7 +/- 13.2% in propofol group. Satisfactory anesthesia was achieved in all groups except for ketamine group which required additional medications for elevated blood pressure and intracranial pressure, and postoperative nausea and vomiting. It is concluded that there was great variability of VEP during anesthesia and surgery. Amplitude rather than latency changes were observed during anesthesia combined with fentanyl.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasonographic changes of early liver cirrhosis in chronic hepatitis B: a longitudinal study

Ultrasonography of prospectively followed chronic hepatitis B patients who developed liver cirrhosis were reevaluated in order to identify the ultrasonographic changes of early cirrhosis. Ultrasonographic features of 29 patients before and after cirrhosis were as follows: portal vein diameter--1.20 cm/1.29 cm (NS); cirrhosis score--5.69/7.52 (p < 0.01); spleen size index--21.99 cm2/25.84 cm2 (NS). The result suggests that ultrasonographic diagnosis of early cirrhosis is not easy on a single occasion; however, the score system method is helpful in longitudinal follow-up chronic hepatitis patients. A careful comparison of hepatic parenchymal and surface changes are mandatory.

Sex difference in chronic hepatitis B virus infection: studies of serum HBeAg and alanine aminotransferase levels in 10,431 asymptomatic Chinese HBsAg carriers

To study the difference between the sexes with regard to chronic hepatitis B virus infection, we surveyed levels of serum hepatitis B e antigen (HBeAg) and alanine aminotransferase (ALT) among 10,431 asymptomatic Chinese carriers of hepatitis B surface antigen (HBsAg) in Taiwan. There were 7,095 men and 3,336 women in this study; ages ranged from 15 to 70 years. HBeAg was detected in 19.6% of HBsAg carriers. The prevalence of HBeAg decreased significantly with increasing age. HBeAg was detected in 17.7% of men and 23.6% of women. After correction for the confounding effect of age, it was found that the prevalence of HBeAg was significantly higher among women than among men. The level of serum ALT was abnormal in 20.8% of HBsAg carriers. Abnormal ALT levels were significantly more frequent among HBsAg carriers who tested positive for HBeAg (39.7%) than among those who did not (16.2%; P < .001). Among the HBeAg-positive carriers, 43.2% of men and 34.2% of women had abnormal ALT levels, and men were 1.45 times more likely to have abnormal ALT levels than women (P < .001). Among the carriers who were negative for HBeAg, 20.6% of men and only 6.0% of women had abnormal ALT levels, and men were 3.98 times more likely to have abnormal ALT levels than women (P < .001). Overall, 24.6% of men and only 12.6% of women had abnormal ALT levels, and men were 2.33 times more likely to have abnormal ALT levels than were women (P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

The incidence of bladder cancer in the black foot disease endemic area in Taiwan

A high incidence of bladder cancer (23.53/100,000 population per annum from 1981-1985) was found in an endemic area of peripheral vascular disease known as black foot disease (BFD) on the southwest coast of Taiwan. The average incidence of bladder cancer in the whole of the Taiwan area was 2.29/100,000 during the same period. The incidence of female bladder cancer (21.10/100,000) in this area was also high. The ratio of male to female bladder cancer in the BFD endemic area and the neighbouring area was 1.24 and 1.09, lower than that in the whole Taiwan area (2.75) and elsewhere around the world. The high content of arsenic and the high concentration of a "fluorescent substance" in artesian well water in this area are the only 2 related factors identified so far. Determination of the actual carcinogen requires further investigation.

Acute viral hepatitis in the elderly

Seventy-six cases of acute viral hepatitis in the elderly (65 years old or older) were reviewed. Their clinical symptoms, biochemical pictures and clinical courses were compared with patients less than 40 years old (young) and those 40-64 years old (middle-aged). There were 51 men and 25 women with the mean age of 69 years (range 65 to 78 years). The most common etiology of acute viral hepatitis in the elderly is acute non-A, non-B hepatitis (48.7%), followed by acute hepatitis in HBsAg carrier (44.7%) and acute type B hepatitis (7.9%). Acute hepatitis in HBsAg carrier is the most common etiology in the young and middle-aged patients. Gastric flu, deep or tea colored urine and fatigue-weakness are the common clinical presentations. In conventional liver function tests, serum levels of GPT and albumin tended to be lower in the elderly patients. Overall, 25% of acute viral hepatitis in the elderly were complicated with fulminant hepatic failure or subacute hepatic failure and 18.4% died. The prevalence of fulminant or subacute hepatic failure and the mortality in the elderly were significantly higher than those in the younger patients.

Therapy for supratentorial malignant astrocytomas: survival and possible prognostic factors

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

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

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

Effects of prednisolone pretreatment in interferon alfa therapy for patients with chronic non-A, non-B (C) hepatitis

The effect of corticosteroid pretreatment on interferon alfa treatment of chronic non-A, non-B or C hepatitis was evaluated in an open, randomized, controlled study. Normalization of the serum alanine aminotransferase level, which suggested complete response, was recorded in 14 (56%) of 25 patients at the end of a 6-month treatment with 3 million units of interferon alfa three times weekly alone. Prednisolone withdrawal followed by the same interferon alfa treatment resulted in complete response in 14 (61%) of another 23 patients. Both of these rates are significantly higher than the spontaneous ALT normalization rate of 9% observed in 2 of 22 patients during the same period (p < 0.01). ALT normalized within 2 months of interferon therapy in most (89%) of the complete responders. Of the patients pretreated with prednisolone, 43% showed a "rebound" following prednisolone withdrawal and 89% of the patients with "rebound" responded to subsequent interferon therapy. The cumulative probability of sustained remission in patients with and without prednisolone pretreatment in a 24-month period of follow-up after the end of therapy was 79% and 30%, respectively (p < 0.05). Clinical relapse mostly (85%) occurred within 3 months after the end of therapy. No obvious factor could be identified as a predictor of response or relapse. The results of this study suggest that prednisolone withdrawal tends to enhance the durability of the beneficial effects of interferon alfa therapy in patients with chronic non-A, non-B or C hepatitis.

Solitary cerebellar metastases: analysis of 11 cases

Solitary cerebellar metastatic tumors are rarely reported in the literature. We reviewed 240 posterior fossa tumors treated in the past eight years. There were 11 cases of solitary metastases in the cerebellum. The primary tumor was lung cancer in five cases and breast carcinoma in two cases; the remaining three cases had colon cancer, nasopharyngeal carcinoma (NPC) and Ewing's sarcoma, respectively. All patients underwent craniectomy and gross total excision of the tumor. Seven patients survived less than one year, two cases died in the second year, and one case of NPC survived for more than two years. The only survival is a case of Ewing's sarcoma who underwent surgery 14 months ago. The symptoms and signs of all patients improved satisfactorily after surgery. Four patients received postoperative irradiation to the posterior fossa and two cases of lung cancer had a thoracotomy for the primary lung lesion; however, the survival period was not prolonged. We suggest that a cancer patient or a patient in the fifth to seventh decades of life presenting headache, gait disturbance and vomiting should promptly undergo a computed tomography (CT) scan of the head. In selected cases, surgical intervention for solitary metastatic tumors in the tiny posterior fossa may be the best initial treatment. Adjuvant therapies should then be added according to the type of tumor.

Interpleural administration of bupivacaine for postoperative analgesia after thoracotomy in patients with patent ductus arteriosus

Interpleural analgesia for postoperative pain with bupivacaine 0.25%, 0.375% and 0.5% at dosage of 1.5 mg/kg was evaluated in three randomized groups (A, B and C) of 22 children having triple ligation for patent ductus arteriosus (PDA). Complete pain relief was obtained within 30 min irrespective of the concentration of bupivacaine. The duration of pain relief significantly varied with the concentrations of the drug used, respectively 5.02 +/- 0.4 h, 6.88 +/- 0.7 h and 8.24 +/- 1.08 h (mean +/- SD) for 0.25%, 0.375% and 0.5% bupivacaine (p less than 0.05). No side effects were observed and no other supplemented narcotics were given. We concluded that 0.5% bupivacaine at the dose of 1.5 mg/kg was effective in postoperative pain relief after thoracotomy in patients undergoing PDA ligation surgery.

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.

Effects of anticoagulants and storage of blood samples on efficacy of the polymerase chain reaction assay for hepatitis C virus

Blood samples from 11 patients with posttransfusion hepatitis C virus infection were collected. Each sample was divided into three fractions to obtain sera, sodium-citrated plasma, and heparinized plasma and then tested for HCV RNA by a nested polymerase chain reaction (PCR). Of them, eight sodium-citrated plasma samples, seven serum samples, and no heparinized plasma samples were PCR positive. Eight PCR-positive sodium-citrated plasma samples were exposed to different physical conditions and semiquantified for HCV RNA after serial dilutions. Samples stored at -70 degrees C showed the best preservation of HCV RNA, and storage at the other conditions resulted in only minimal loss of the PCR signal. Therefore, serum or sodium-citrated plasma specimens are satisfactory for detecting HCV RNA by PCR, but heparinized blood specimens are not.

Acute hepatitis C virus superinfection followed by spontaneous HBeAg seroconversion and HBsAg elimination

Acute hepatitis C virus superinfection followed by spontaneous hepatitis B e antigen seroconversion and hepatitis B surface antigen clearance in a patient with chronic type B hepatitis is described. The observations suggests that HCV may exert a suppressive effect on hepatitis B virus.

Prednisolone withdrawal followed by recombinant alfa-interferon in chronic non-A, non-B hepatitis: interim results of a randomized controlled trial

To determine the effect of a recombinant alpha interferon 2b (Intron-A) and possible benefit of prednisolone pretreatment in chronic non-A, non-B hepatitis, 75 Chinese patients with clinico-histologically proven chronic hepatitis were randomly allocated to one of the following regimens: (A) 3 million units of Intron-A trice weekly for 6 months; (B) dose titration according to ALT-AST values; (C) prednisolone withdrawal followed by regimen A; (D) control group: no treatment for 6 months but followed by alternating treatment with 3 million units of Intron-A trice weekly for 2 weeks followed by 2 weeks no treatment for 6 months. Up to September 30, 1990, 67 patients have been followed for a minimum of 2 months. At the end of the second month, complete response (normal ALT) was achieved in 71% of group A, 50% of group B, 50% of group C and 0% of group D. At the end of the 6th month, the complete response rate was 62%, 47% and 64% respectively in groups A, B and C. The response rates in groups A and C were significantly better than the 7% in the control group. Complete response usually (91%) occurred within 2 months after the first dose of interferon. Relapse occurred in 40% of the complete responders, usually within 2 months of the last dose. The cumulative relapse rate was significantly lower in responders of group C (11% vs 43% in group A and 86% in group B during a period of 6 months). Only mild adverse effects were reported though two patients withdrew because of intolerable fatigue.(ABSTRACT TRUNCATED AT 250 WORDS)

Recombinant immunoblot assay for hepatitis C antibody in patients with posttransfusion non-A, non-B hepatitis

In a prospective study of 287 patients who received blood transfusion, 26 who were found positive for hepatitis C antibody (anti-HCV) by an enzyme-linked immunosorbent assay (ELISA) were studied by a recombinant immunoblot assay (RIBA). Nineteen of the 26 patients had posttransfusion non-A, non-B (NANB) hepatitis. Sixteen (84.2%) of the 19 patients with hepatitis had positive results by RIBA, 2 had indeterminate results, and 1 was negative. By contrast, five of the 7 recipients without hepatitis were negative, 1 indeterminate, and 1 positive by RIBA. Those with negative RIBA results had significantly lower optical density (OD) readings by ELISA than those with positive RIBA tests. Therefore, patients without hepatitis or lower OD value have a higher false-positive rate in anti-HCV ELISA than did those with a high OD value or with evidence of hepatitis.

Detection of two Zn-finger proteins of Xenopus laevis, TFIIIA, and p43, by probing western blots of ovary cytosol with 65Zn2+, 63Ni2+, or 109Cd2+

Two Zn-finger proteins, TFIIIA (a constituent of 7S RNP particles) and p43 (a constituent of 42S RNP particles), were detected in ovary extracts of juvenile Xenopus laevis females by in vitro binding of radiolabeled divalent metals. Proteins fractionated by SDS-PAGE (sodium dodecylsulfate-polyacrylamide gel electrophoresis) were transferred by Western blotting onto nitrocellulose membranes, probed with 65Zn2+, 63Ni2+, or 109Cd2+, and visualized by autoradiography. Detection limits for TFIIIA were approx 0.07 micrograms/well by 109Cd(2+)-probing, 0.13 micrograms/well by 65Zn(2+)-probing, and 0.26 mu/well by 63Ni(2+)-probing. Protein p43 was more clearly visualized by probing with 63Ni2+ than with 65Zn2+ or 109Cd2+. After purified TFIIIA was cleaved with cyanogen bromide, 65Zn2+, 109Cd2+, and 63Ni2+ distinctly labeled the 22 kDa middle fragment; 65Zn2+ and 109Cd2+ also labeled the 11 kDa N-terminal fragment, but did not label the 13 kDa C-terminal fragment. These results are consistent with the notion that the radioligands were bound to finger-loop domains of TFIIIA, which occur in the middle and N-terminal fragments. Based on the abilities of nonradioactive metal ions to compete with 65Zn2+ for binding to TFIIIA on Western blots, the relative affinities of the metals for TFIIIA were ranked as follows: Zn2+ = Cu2+ greater than or equal to Hg2+ greater than Cd2+ greater than Co2+ greater than or equal to Ni2+. Even at a 1000-fold molar excess, Mn2+ did not compete with 65Zn2+ for binding to TFIIIA. Probing Western blots with the radiolabeled metal ions greatly facilitates the detection, isolation, and quantitation of TFIIIA and p43.

Hepatocyte expression of HBcAg and serum HBeAg in hepatitis B: comparison of polyclonal and monoclonal antibodies during a trial of interferon

The distribution and quantitative expression of HBcAg in relation to serum HBeAg and liver histology before and after a trial of interferon in 50 patients with chronic type B hepatitis were evaluated using polyclonal and monoclonal antibodies. In general, both antisera showed a similar pattern in terms of the distribution of HBcAg, with predominant localisation of HBcAg in the cytoplasm in HBeAg positive patients with chronic active hepatitis. Semiquantitative analysis showed, however, that there was a higher degree of cytoplasmic expression of HBcAg with polyclonal than with monoclonal anti-HBc. Some of the HBeAg positive patients with only a focal expression of HBcAg in the cytoplasm by polyclonal anti-HBc showed no expression of HBcAg with monoclonal anti-HBc. The expression of HBcAg with polyclonal anti-HBc correlated better with the histological features of chronic active hepatitis or the persistence of serum HBeAg on follow up, suggesting that it did not result from non-specific or false positive staining. All of the HBeAg negative patients with minimal histological changes or inactive cirrhosis were HBcAg negative with both antisera. In conclusion, though both polyclonal and monoclonal antibodies produced a quite similar distribution of HBcAg in patients with chronic type B hepatitis, polyclonal antibody seemed to be more sensitive in detecting HBcAg in the cytoplasm than did monoclonal anti-HBc, and the expression of HBcAg with polyclonal anti-HBc correlated better with the clinical and histological outcome.

Thoracic spondylosis: experience of 4 cases

Thoracic spondylosis is relatively uncommon compared to cervical or lumbar spondylosis. It may cause spinal canal stenosis and result in radiculopathy, neurogenic claudication, and most commonly, myelopathy. We present our experience in the management of 4 cases with symptomatic thoracic spondylosis. The lower thoracic spine was involved in all 4 cases. The pathological changes are almost the same as in cervical or lumbar spondylosis except that ossification of ligamenta flava is more common in thoracic spondylosis. The ossified ligamenta flava may adhere tightly to the dura mater, and therefore increase the difficulty of operation. The results of decompressive laminectomy for thoracic spondylosis were acceptable.

Rectal ketamine versus intranasal ketamine as premedicant in children

The effects of ketamine administered per nasus (PN) or per rectum (PR) as pre-anesthetic medication for day surgery was studied in 70 ASA class I children with age ranging from 6 months to 6 years. Before study they were divided into 3 groups. Group A (n = 25) received no premedicant, while group B (n = 25) and group C (n = 20) received ketamine 6 mg/kg PR and 3 mg/kg PN as premedicant respectively. It was demonstrated that patients in group B and group C accepted the facemask during induction of anesthesia more willingly and peacefully than those in group A. In group B and group C there was accompaniment of analgesic effect seen postoperatively. The incidence of adverse reactions (nausea, vomiting, laryngospasm, salivation, respiratory depression) was low following the use of PR or PN ketamine although the children in these two groups emerged more belatedly from anesthesia and stayed in the post-anesthetic recovery room (PARR) for a longer time than in group A.