Management of small infected tibial defects with antibiotic-impregnated autogenic cancellous bone grafting

Between January of 1991 and December of 1993, 36 patients who had tibia fractures complicated by small infected tibia defects were treated at the authors' service. The group included 30 men and 6 women whose average age was 36.5 years (range, 18-72 years). The average follow-up period was 3.7 years. By using the Cierney-Mader staging classification of chronic osteomyelitis, 26 of 36 patients (72%) were stage 4A and 10 of 36 patients (28%) were stage 4B. Ten patients required muscle transfer. All patients were treated with a two-stage protocol. In the first stage, antibiotic-impregnated polymethylmethacrylate bead chains were used to obliterate the debrided osseous defect. In the second stage, the beads were removed, and the defects were reconstructed with antibiotic-impregnated autogenic cancellous bone graft. The time between the first and second stage was 2 to 8 weeks for patients without muscle transfer and 8 to 12 weeks for the patients with muscle transfer. The bone defects ranged from 2 to 4 cm. Wound healing and bony union were achieved in all patients. Only two patients had recurrent infections. The infection arrest rate was 94.4%. Minor pin tract infection of the external skeletal fixation was seen in two patients. Two patients developed skin rashes secondary to antibiotic therapy. Radiographs at an average follow-up of 3.7 years showed good consolidation and hypertrophy of grafted bones in all patients. After 3 to 5 years of follow-up, our results suggest that the use of impregnating antibiotics have no adverse effects on autogenic cancellous bone graft incorporation and may help to eliminate infection. This treatment protocol provided rapid recovery from osteomyelitis. The use of antibiotic-impregnated autogenic bone graft seems to be an effective and safe method for the management of small infected tibial defects.

Neurodevelopment of surviving infants at age two years, with a birthweight less than 2000 g and cared for in neonatal intensive care units (NICU)--results from a population based longitudinal study in Taiwan

All surviving infants from nine neonatal intensive care units (NICU) in a southern city and county of Taiwan were followed up and assessed at 2 y of age if they had a birthweight of less than 2000 g and were born between February 1, 1993 and January 31, 1994. The assessments included: neurological, growth and general health. A comparison group of normal birthweight and full-term infants without congenital anomalies, matched by birth month and sex to the NICU survivors was also studied with respect to the same outcome measures. A developmental delay (either a severe neurological deficit or Mental Development Index < 68 or Psychomotor Development Index < 68) was present in 21 (15.4%) of the cases, compared to 3 (2.5%) of the controls (P < 0.0004). Significant correlates of developmental outcome for the cases were birthweight, gestational age, and maternal education. The very low birthweight (VLBW) children (< 1500 g) in our study cohort had a comparatively higher incidence of severe neurological deficits (and cerebral palsy) than that reported by other similar studies in developed countries. The incidence of abnormal neurodevelopmental outcome remained high in the graduates of NICU at 2 y of age, compared to that in normal controls. The findings have important implications in future health policy making regarding postnatal management of the surviving infants of NICU in developing countries such as Taiwan.

Pregnancy in a previous cesarean section scar: case report

An ectopic pregnancy developing in a previous cesarean section scar is an extreme rarity among all ectopic pregnancies. Due to the difficulty of making an accurate diagnosis, this kind of ectopic pregnancy is the most dangerous and life-threatening type. A 30-year-old woman, who was gravida 4, para 3, was admitted to our emergency room with massive vaginal bleeding. She had undergone a cesarean section due to a breech birth 3 months prior to this admission. Ultrasound examination showed a pregnancy located in the low corpus uterus. The possibility of a spontaneous abortion in progress or a cervico-isthmic pregnancy were considered. Due to the massive vaginal bleeding and unstable vital signs of the patient, surgical intervention was decided upon to save the woman's life. We first performed dilatation and curettage. There was no gestational villi and severe vaginal bleeding was noted during this procedure. An emergent exploratory laparotomy was then performed, followed finally by a hysterectomy. Pathologic findings confirmed the diagnosis of a pregnancy in the previous cesarean section scar. Diagnosis, prevention, clinical evaluation and management of these conditions are discussed.

Tumor promoting effect of N-nitroso-N-(2-hexanonyl)-3'-nitrotyramine (a nitrosated Maillard reaction product) in benzo(a)pyrene-initiated mouse skin carcinogenesis

N-nitroso-N-(2-hexanonyl)-3'-nitrotyramine (NO-HNTA) is a product generated in a model browning system in the presence of sodium nitrite. The chemical structure of this compound has been confirmed by UV, mass, nuclear magnetic resonance and infrared spectroscopy in our study. Twenty weeks, twice weekly, topical application of NO-HNTA at the concentration of 10, 50 and 250 mumol to mice previously initiated with benzo(a)pyrene (B[a]P) increased their tumor formation by 3.2-, 4.6- and 5.8-fold respectively. Application of the same amount of NO-HNTA not only caused significant induction of hyperplasia but also the activity of epidermal ornithine decarboxylase (ODC). Treatment of mouse skin with various amounts of NO-HNTA (10, 50 and 250 mumol) caused production of hydrogen peroxide by 1.38-, 1.95- and 3.26-fold respectively, and induction myeloperoxidase (MPO) by 24-, 63- and 102-fold. These results indicate that the formation of NO-HNTA or its derivatives derived from the reaction of tyrosine and glucose in the presence of sodium nitrite has the potential as a tumor promoter.

Promotional effect of N-nitroso-N-(3-keto-1,2-butanediol)-3'-nitrotyramine (a nitrosated Maillard reaction product) in mouse fibroblast cells

N-Nitroso-N-(3-keto-1,2-butanediol)-3'-nitrotyramine (NO-NTA) is a product of model browning system generated in the presence of sodium nitrite. The chemical structure of this compound has been confirmed by UV, mass and nuclear magnetic resonance, and infrared spectroscopy in our previous study. A two-stage transformation protocol was used to chemically transform the mouse embryo fibroblasts C3H10T1/2 cells. To initiate transformation, the cells were treated with benzo[a]pyrene (BaP) (0.1 mg/ml), and NO-NTA (0.01, 0.1 and 1 mg/ml) was employed subsequently to complete the transformation process. Malignant transformed foci were formed in BaP-initiated and NO-NTA promoted C3H10T1/2 cells after 8 wk. Cells treated with NO-NTA alone failed to induce transformation. However, cells initiated with BaP and promoted by cells initiated with BaP and promoted by NO-NTA demonstrated oncogenic properties. Cell lines transformed with NO-NTA-transformed colonies exhibited enhanced growth rate, anchorage independence and tumorigenicity in animals relative to parent cells. These results indicate that NO-NTA is a new tumour promoter and may induce tumour promotion by two-stage oncogenesis. Further studies on the mechanism of action of NO-NTA are now in progress.

Anesthesia for pediatric herniorrhaphy or hydrocelectomy: comparison of propofol/ketamine and thiopentone/halothane

Total intravenous anesthesia has recently become available for ambulatory surgery. It has the advantages of decreased air contamination from volatile anesthetics and decreased exposure of operating room personnel to volatile anesthetics. The purpose of this study was to compare the anesthetic properties of propofol/ketamine (total intravenous) anesthesia and thiopentone/halothane (intravenous and gaseous) anesthesia for herniorrhaphy or hydrocelectomy in children. Sixty children aged 2 to 7 years scheduled for herniorrhaphy or hydrocelectomy were allocated to two groups. The propofol/ketamine group (group 1) received a loading dose of intravenous propofol 3 mg/kg followed by propofol infusion 200 micrograms/kg/minute; additional bolus doses of propofol 1 mg/kg were given as needed or the infusion dose was increased or decreased by 33 micrograms/kg/minute as needed. Ketamine 1 mg/kg was administered intravenously 2 to 3 minutes before herniorrhaphy or hydrocelectomy to reinforce the analgesic and anesthetic effects of propofol. The thiopentone/halothane group (group 2) received intravenous thiopentone 6 mg/kg followed by halothane with 40% oxygen using a mask. Group 2 patients maintained spontaneous breathing with intermittent assistance and group 1 patients maintained spontaneous natural airway breathing during anesthesia. The scores on the postoperative assessment scale were higher in group 2 patients, indicating poorer anesthesia recovery characteristics, but the differences were not significant. Pain on injection was more frequent in group 1 (12/32) than in group 2 (2/28). The incidence of vomiting in group 2 (6/28) was significantly higher than in group 1 (0/32). We conclude that propofol/ketamine allows patients to maintain spontaneous natural airway breathing during anesthesia, and its analgesic and anesthetic effects are comparable to those of thiopentone/halothane. Propofol/ketamine is appropriate for pediatric herniorrhaphy and hydrocelectomy. It can be recommended for pediatric ambulatory surgery.

Injection pain with propofol: the effectiveness of thiopentone on induction

One hundred and twenty-seven children aged 3-6 years were allocated to four groups. All of them received venous cannulation on the dorsum of the hand. On induction, the group L1, L2 and L3 patients received propofol 3 mg/kg mixed with lignocaine 0.15 mg/kg, 0.3 mg/kg, 0.6 mg/kg, respectively. The group T patients received thiopentone 3 mg/kg, then propofol 1.5 mg/kg mixed with lignocaine 0.075 mg/kg. Pain on injection was categorized into two-assessment items (facial expression and limbs withdrawal). The facial expression category were subdivided into none, mild (knit of brows), moderate (grimace), and severe (crying). The withdrawal of limbs was categorized into none, mild (withdrawal of hand), moderate (withdrawal of fore-arm and arm), severe (withdrawal of arm and twisting of body). Patients were monitored using an electrocardiogram, pulse oximeter, autonomic noninvasive blood pressure measuring device and capnography. The patient characteristics did not differ significantly among the four groups. Pain on injection was significantly more frequent in the group L1 patients (81%) compared with the group T (27%) patients. Increasing lignocaine dose reduced the incidence of pain graded as "moderate" or "severe" though there was no significant difference. The incidences of excitatory effect on propofol injection were reduced with increasing lignocaine dose and prior administration of thiopentone but there were no obviously differences among groups. We concluded that thiopentone reduced injection pain on propofol and should be recommended.

Extraperitoneoscopic colposuspension using CO2 distension method

PURPOSE

To validate our experience in extraperitoneoscopic colposuspension for genuine stress incontinence.

MATERIALS AND METHODS

Between March 1995 and July 1996, 48 women who had genuine stress incontinence underwent extraperitoneoscopic colposuspension in our institute. After standard laparascopic surgery preparation, a 10 mm puncture site was made midline just in the cm above the pubic hair line, and the extraperitoneal space was developed with the higher pressure of insufflating CO2. A pair of sutures was inserted at the level of the midurethral and unrethrovesical junction with Cooper's ligament.

RESULTS

All of these patients underwent the same procedures. The average blood loss was less than 50 ml, with a range from 10 to 200 ml. The operative time was from 20 to 90 min, with a mean time of 32 min. There was one bladder injury, 2 cases of voiding difficulties and 2 of detrussor instability in our series and the overall complication rate was 10.4%. So far, 45 of the 48 patients are satisfied with the surgery.

CONCLUSIONS

Laparoscopic Burch colposuspension is a practicable surgical procedure for managing stress incontinence. Extraperitoneal space was created easily with the higher pressure of insufflating CO2. An extraperitoneoscopic approach can reduce the necessity of laparscopic suturing. Moreover, it avoids violating the peritonel cavity and reduces the potential risk of postoperative adhesion formation and the discomfort resulting from pneumoperitonium. Thus, extraperitoneal colposuspension affords an alternative to laparoscopic or abdominal retropubic colposuspension in well-selected patients.

Hypertrophic osteoarthropathy in nasopharyngeal carcinoma patients: two cases report

Hypertrophic osteoarthropathy (HOA) is a rheumatic disorder characterized by digital clubbing, bone pain, and arthralgia. HOA can be idiopathic or secondary to a variety of pulmonary, cardiogenic, or malignant disorders. We present 2 male patients, aged 46 and 42, with advanced nasopharyngeal carcinoma (NPC) who developed HOA 1-4 years after radiotherapy. Differential diagnosis between HOA and coexisting bone metastasis must be made with caution. We found bone scintigraphy to be the most sensitive tool to distinguish between these 2 disease. Intense symmetrical uptake of radioisotope along the cortex of long bones, so-called parallel tract sign, is typical. Plain radiographs demonstrating prominent periosteal reaction were also effective for this. The rheumatic manifestation of HOA was paraneoplastic and related to pulmonary metastasis. The clinical manifestation of the 2 patients suggested that pulmonary metastasis should be suspected in NPC patients when HOA appears.

A dynamic local bump system for producing synchrotron radiation with an alternating elliptical polarization

To facilitate high-sensitivity soft X-ray magnetic circular dichroism experiments, a dynamic local bump system has been developed at the SRRC storage ring. This system was devised to vary dynamically the vertical slope of the electron beam in a bending magnet, producing, in the electron orbit plane, soft X-rays with an alternating elliptical polarization. The local bump was created by using two pairs of vertical correctors located on each side of the bending magnet. The bump strength coefficient was obtained both from calculated estimation and from measured beam-response matrices. Control electronics for proper bump strength settings were designed to incorporate the existing orbit-corrector function. A corresponding graphic user interface was implemented so that the bump amplitude could be easily adjusted. The performance of this system is presented. Disturbance on the stored electron beam orbit was observed while flipping the corrector polarity during EPBM (elliptical polarization from bending magnets) operation. A local feedback loop, developed to eliminate such disturbance on other beamlines, is also described.

Inhibitory effect of Hibiscus protocatechuic acid on tumor promotion in mouse skin

Hibiscus protocatechuic acid (PCA), a phenolic acid isolated from Hibiscus sabdariffa L., was evaluated for its ability to inhibit the 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced promotion in skin tumors of female CD-1 mice. Topical application of PCA (5, 10 or 20 micromol) 5 min prior to TPA (15 nmol) treatment twice weekly for 20 weeks to mice which were initiated with benzo[a]pyrene (B[a]P) inhibited the incidence of tumors in mice to 81.3, 62.5 and 56.3%, respectively, while all mice in the TPA-treated group developed tumors. The average number of tumors in mice pretreated with PCA was 2-4 and that of mice treated only with TPA was 6.6. The protection effects of PCA were also presented by its significant suppression on the TPA-induced hyperplasia in the skin and edema of mouse ears by 65 and 73% at doses of 10 and 20 micromol, respectively. When it was applied to the dorsal surface of CD-1 mice before TPA application, PCA (5, 10 or 20 micromol) inhibited the induction of epidermal ornithine decarboxylase (ODC) activity by 5 nmol TPA and myeloperoxidase (MPO) activity by 6.5 nmol TPA. The same doses of PCA also reduced the formation of hydrogen peroxide in the mouse skin to an inhibition of 61, 84 and 89%, respectively, when compared with that of the TPA-treated group. These results indicate that PCA possesses potential as a cancer chemopreventive agent against tumor promotion.

Minimal access surgery in children: the use of laparoscopy for management of pediatric ovarian teratoma: a case report

This article presents a case of left ovarian teratoma in a young child. Prompt diagnosis was made using real-time ultrasound, computed tomography (CT) and laparoscopy. The latter was used for performing tumor enucleation. We recommend that laparoscopy precede laparotomy and be done more routinely in the young patient.

Successful resection of a teratoma of the third ventricle in a 3-year-old boy

Few cases of teratoma in the third ventricle have been reported in detail. We describe a 3-year-old Chinese boy presenting with increased intracranial pressure, headache, and vomiting. Preoperative computed tomography and magnetic resonance imaging demonstrated a teratoma in the third ventricle. Complete excision of the tumor was achieved through the interhemispheric transcallosal approach. The patient did well and was without neurologic deficits postoperatively. Although the majority of tumors located in the third ventricle are malignant and can penetrate the brain tissues that constitute the wall of the third ventricle, mature teratomas are an exception and total removal may be possible.

Postoperative analgesia by intra-articular neostigmine in patients undergoing knee arthroscopy

BACKGROUND

Recently, the spinal administration of neostigmine was shown to produce a dose-dependent analgesia. However, this analgesia is limited by adverse effects. The purpose of this study was to examine the analgesic action of peripheral muscarinic receptors by administering intra-articular neostigmine after operation in patients undergoing knee arthroscopy.

METHODS

Sixty patients (classified as American Society of Anesthesiologists status I or II) having arthroscopic meniscus repair during general anesthesia were randomized to receive, in a double-blind manner, after operation 125, 250, or 500 microg intra-articular neostigmine; 2 mg intra-articular morphine; or as control groups intra-articular saline or 500 microg neostigmine given subcutaneously (s.c.). Visual analog pain scores (VAS), duration of analgesia as defined by first demand for patient-controlled analgesia by morphine, and subsequent 48-h consumption of morphine were evaluated.

RESULTS

Intra-articular (500 microg) neostigmine resulted in significant VAS reduction 1 h after injection compared with patients given intra-articular saline and with those given intra-articular morphine. Analgesia lasted longer after 500 microg intra-articular neostigmine (350 +/- 126 min) compared with intra-articular morphine (196 +/- 138 min; P < 0.05) or with the control groups (intra-articular saline, 51 +/- 11 min; s.c. neostigmine, 46 +/- 8 min; P < 0.05). The need for supplementary analgesia was significantly higher in control groups than for patients given intra-articular morphine or 500 microg intra-articular neostigmine. No significant analgesic effects were observed for the two lower doses of intra-articular neostigmine. Among all study groups, no adverse effects were observed.

CONCLUSIONS

Intra-articular injection of the acetylcholinesterase inhibitor neostigmine produced a moderate but significant analgesic effect. Several mechanisms such as the hyperpolarization of neurons, reduction in the release of pronociceptive neurotransmitters, or activation of the nitric oxide-cyclic guanosine monophosphate pathway might mediate this peripheral cholinergic antinociception by elevating endogenous acetylcholine.

Impact of the extent of parametrial involvement in patients with carcinoma of the uterine cervix

PURPOSE

A scoring system is proposed to measure the extent of parametrial involvement and predict treatment outcome in patients with carcinoma of the uterine cervix.

METHODS AND MATERIALS

244 patients with FIGO Stage IIB (n = 146) or IIIB (n = 98) carcinoma of the uterine cervix were treated by radical radiotherapy from October 1987 to June 1992. Impact of the extent of parametrial involvement on outcome was studied. All patients were scored by the newly introduced scoring system described as follows: score 1, tumor extending <1/2 the distance to the pelvic side wall; score 2, tumor extending >1/2 the distance to the pelvic side wall but not to pelvic side wall; score 3, tumor extending to the pelvic side wall. The score in each patient was defined as the sum of the scores of both the left and right parametrial tumor extent.

RESULTS

There were 53, 47, 61, 34, 25, and 24 patients in score 1, 2, 3, 4, 5, and 6, respectively. All 244 patients were subdivided into three groups described as follows: score 1 and 2, group I; score 3 and 4, group II; score 5 and 6, group III. In univariate analysis, lower score groups had better overall survival rate (OS), disease-free survival rate (DFS), local control rate (LC), and distant metastasis-free rate (DMF) than higher score groups including groups I vs. II, II vs. III, or I vs. III. The differences were all statistically significant except for the difference of the DMF in group I vs. II. In multivariate analysis, score (range 1-6) was also statistically significant in OS (p < 0.0001), DFS (p = 0.0015), LC (p = 0.0032), and DMF (p = 0.0141).

CONCLUSIONS

The data suggested that the new scoring system defined by pelvic examination is a convenient, simple, and reliable method of measuring the degree of parametrial extension and predicting the outcome of patients with parametrial disease.

Tuberculous arthritis of the elbow

Twenty-three patients with tuberculous arthritis of the elbow were treated and followed up for 3 to 8 years. The diagnosis was established by finding mycobacterium tuberculosis in the aspirate or in a surgical specimen in 18, and by histology in 5. A long history of symptoms and extensive involvement of bone and joint are associated with poor results. Early diagnosis and adequate treatment can be followed by good functional results. Postoperative continuous passive motion is valuable in improving the range of movement in elbows with extensive osteoarticular tuberculosis.

Radioactivity concentrations of 137Cs and 40K in basidiomycetes collected in Taiwan

Radioactivity concentrations of 137Cs and 40K in 64 mushroom samples belonging to 16 species of basidiomycetes collected at various locations in Taiwan have been measured in 1994. All of the samples were mushrooms cultivated indoors. The concentrations of 137Cs in many samples were below the limit of detection (< 1.0 Bq kg-1 dry weight), and 134Cs was not detected in any of the samples. The radioactivity concentration ranges of 137Cs and 40K in basidiomycetes were < 1.0-7.3 Bq kg-1 dry weight and < 50-1230 Bq kg-1 dry weight, respectively. The transfer factors of F. velutipes, G. lucidum and L. edodes from sawdust (growing substrate) to mushroom were approximately 10, 10.2, < 3.8 for 137Cs, and 7.2, 1.6, 1.8 for 40K, respectively. The effective dose equivalent due to the dietary intake of radiocesium through mushrooms for the Taiwanese people was estimated to be only 4.4 x 10(-10) Sv y-1.

The correlation of acute toxicity and late rectal injury in radiotherapy for cervical carcinoma: evidence suggestive of consequential late effect (CQLE)

PURPOSE

To correlate the acute toxicity during pelvic irradiation and the development of late rectal injury following radiation therapy for cervical carcinoma.

METHODS AND MATERIALS

Two hundred and twenty patients treated with curative-intent radiation therapy between November 1987 and January 1992 were analyzed. Patients were treated initially with external beam irradiation, 40-44 Gy/20-22 fractions to whole pelvis, followed by high dose rate intracavitary brachytherapy, 7.2 Gy to point A for 3 fractions. Severity of diarrhea during radiation therapy was scored according to six criteria: fecal characteristics, frequency, onset, prescription of antidiarrheal agents, body weight loss during irradiation, and extramedical care needed. Patients were categorized as group ND (no obvious diarrhea), group MD (moderate diarrhea), and group SD (severe diarrhea) for sum score 0-1, 2-5, and > or = 6, respectively. The rate of radiation proctitis was expressed, analyzed, and compared with actuarial proctitis-free rate and prevalence.

RESULTS

1) According to the score, 76 (35%), 89 (40%), and 55 (25%) patients were categorized as group ND, group MD, and group SD, respectively. Distribution of patients and treatment characteristics among the three groups appeared similar. Patients treated with a larger field size, > or = 16.5 cm2, tended to have increased severity of diarrhea. 2) Overall, 103 patients (47%, 103 of 220) developed radiation proctitis. Twenty-one patients were in group ND (28%, 21 of 76), 43 in group MD (48%, 43 of 89), and 39 in group SD (71%, 39 of 55). 3) The five-year actuarial proctitis-free rate was 72, 52, and 29% for group ND, MD, and SD, respectively (p < 0.005). 4) Taking time evolution and recoverability into account, the effect of diarrhea on the prevalence of radiation proctitis remained statistically significant at the first through the fourth year after irradiation. 5) Severity of radiation proctitis and severity of diarrhea were not correlated (Spearman's rank correlation coefficient r(s) = 0.229, p = 0.098). 6) Cox's multivariate analysis revealed that severity of diarrhea was the only factor that significantly correlated with the development of radiation proctitis.

CONCLUSION

Patients with increased acute toxicity and diarrhea during radiation therapy of cervical carcinoma significantly increased the risk of late rectal injury. This result suggested that early excessive damage of acute-responding component of rectal wall may play an important role in the initiation of late rectal injury. Radiation proctitis can be accounted, in part, as a consequential late effect.

The prognostic factors of lung cancer patients with brain metastases treated with radiotherapy

PURPOSE

To analyze the prognostic factors of lung cancer with brain metastases (BM) and evaluate the role of cranial irradiation on survival.

METHODS AND MATERIALS

From 1987 to 1994, 159 lung cancer patients with CT scan documented BM were reviewed. All of them underwent cranial irradiation (median radiation dose: 30 Gy). Chemotherapy and surgery of BM were performed in 21 and 10 cases, respectively.

RESULTS

Overall median survival was 3.5 months and one year survival rate was 10.69%. Univariate analysis showed that the significant factors were performance status, age, total radiation dose to brain, BM as the first metastasis, neurosurgery, symptoms of urine/stool incontinence, and synchronous BM. Multivariate analysis indicated that (1) performance status (p = 0.0002), (2) total radiation dose (p = 0.0032), (3) BM as the first metastasis (p = 0.0449), (4) neurosurgery (p = 0.0233), (5) symptoms of urine/stool incontinence (p = 0.0002), and (6) the presence of a midline shift on cranial CT scans (p = 0.0063) were significant prognostic factors.

CONCLUSION

The prognosis of BM in lung cancer patients is extremely poor. Radiotherapy appears as an effective means of palliation with 75% overall symptomatic response rate. Higher radiation dose (> or = 30 Gy) and neurosurgery are associated with longer survival. Good performance status, BM as the first metastasis, absence of sphincter dysfunction, and midline shift on CT scans are favorable prognostic predictors. The role of midline shift is very interesting and needs to be explored further.

Pituitary adenomas in the old-aged

From 1986 to 1996, 187 patients with pituitary adenoma were diagnosed and received surgery at Kaohsiung Medical College Hospital. Of which, 29 patients older than 60 years were retrospectively studied. Their initial clinical symptoms, pathological findings, immunoperoxidase staining, electronic microscopic findings and hormone levels were retrospectively recorded. We found that the old patients more often suffered from the neurological deficit such as headache and visual problems rather than endocrine of the tumors cells are compared, and fewer cells and nuclei are found in the older group than that in the younger group. The secretary granules in functioning tumors especially prolactinomas in old-aged patients are larger than those in the young patients. The tumor cells in the old-aged patients have fewer subcellular organelles and secretary granules but have large secretary granules. It is concluded that: (1) transsphenoidal surgery is feasible and safe in this age group; (2) plurihormonal tumors occur more frequently in old-age than young patients; (3) clinically endocrine-inactive pituitary adenomas occur more often in old-aged; (4) pituitary adenomas in old-aged cause neurological deficit more frequently than endocrine disturbance.

Potential effect of sodium nitrite on the expression of nuclear proto-oncogenes during 2-acetyl aminofluorene-induced hepatocarcinogenesis in rats

2-acetyl aminofluorene (AAF) reacts in acidic conditions with nitrous fume yielding N-nitroso-AAF (N-NO-AAF), as previously described, that exerts more toxic and mutagenic effects than its parental compound. In this study, the effect of sodium nitrite (NaNO2) on the tumorigenicity of AAF in rats fed with AAF and NaNO2 was observed. Wistar rats were divided into five groups: group I served as control; group II were treated with NaNO2 (0.3%); group III was given 0.02% AAF alone; groups IV and V received both AAF and NaNO2 (0.2 and 0.3% respectively) in their diet for 12 weeks. At the end of the experiment, all rats in groups III, IV and V developed early stage phenomena of hepatocellular carcinoma, including hepatomegaly with variable-sized foci and neoplastic nodules. Severe damage was observed in the rats treated with AAF and NaNO2. Feeding of AAF (0.02%) for 3 months elevated the levels of c-Fos, c-Jun and c-Myc proteins in the rat livers. The AAF-induced c-Jun, c-Fos and c-Myc expressions were significantly magnified (P < 0.001) by NaNO2. These data confirmed that the strengthening of AAF-induced hepatocarcinogenesis by NaNO2 should be associated with its enhancing effect on the AAF-induced increases in the expressions of c-Jun, c-Fos and c-Myc.

Two tandemly repeated telomere-associated sequences in Nicotiana plumbaginifolia

Two tandemly repeated telomere-associated sequences, NP3R and NP4R, have been isolated from Nicotiana plumbaginifolia. The length of a repeating unit for NP3R and NP4R is 165 and 180 nucleotides respectively. The abundance of NP3R, NP4R and telomeric repeats is, respectively, 8.4 x 10(4), 6 x 10(3) and 1.5 x 10(6) copies per haploid genome of N. plumbaginifolia. Fluorescence in situ hybridization revealed that NP3R is located at the ends and/or in interstitial regions of all 10 chromosomes and NP4R on the terminal regions of three chromosomes in the haploid genome of N. plumbaginifolia. Sequence homology search revealed that not only are NP3R and NP4R homologous to HRS60 and GRS, respectively, two tandem repeats isolated from N. tabacum, but that NP3R and NP4R are also related to each other, suggesting that they originated from a common ancestral sequence. The role of these repeated sequences in chromosome healing is discussed based on the observation that two to three copies of a telomere-similar sequence were present in each repeating unit of NP3R and NP4R.

Protective effects of dried flower extracts of Hibiscus sabdariffa L. against oxidative stress in rat primary hepatocytes

Dried flower extracts of Hibiscus sabdariffa L., a local soft drink material and medical herb, was found to possess antioxidant activity in the present study. In the preliminary studies, antioxidant potential of three fractions of the ethanol crude extract (HS-C: chloroform-soluble fraction; HS-E: ethyl acetate soluble fraction; HS-R: residual fraction) obtained from the dried flowers of Hibiscus sabdariffa L. were evaluated by their capacity of quenching 1,1 -diphenyl-2-picrylhydrazyl (DPPH) free radical and inhibiting xanthine oxidase (XO) activity. HS-E showed the greatest capacity of scavenging free radical (EC50=0.017mg/ml), and HS-C showed the strongest inhibitory effect on XO activity (EC5o=0.742 mg/ml). Furthermore, antioxidant bioactivities of these crude extracts were investigated using a model of tert-butyl hydroperoxide (t-BHP)-induced oxidative damage in rat primary hepatocytes. All fractions were found to inhibit significantly the unscheduled DNA synthesis (UDS) induced by t-BHP at a concentration of 0.20 mg/ml. HS-C and HS-E also decreased the leakage of lactate dehydrogenase (LDH) and the formation of malondialdehyde (MDA) induced by t-BHP (1.5 mM) considerably at a concentration of 0.10 and 0.20 mg/ml in the rat primary hepatocyte cultures. These results indicated that the dried flower extracts (HS-C and HS-E) of H. sabdariffa L. protect rat hepatocytes from t-BHP-induced cytotoxicity and genotoxicity by different mechanisms.

An alternative method for evaluating lipoprotein(a) excess in plasma

OBJECTIVE

To estimate the stability and reliability of lipoprotein(a) cholesterol measurement, and explore the possibility to evaluate lipoprotein(a) excess in plasma by using lipoprotein(a)-cholesterol assay alternatively to assay lipoprotein(a).

SETTING

Number 255 Hospital of PLA, Tangshan, Hebei, China.

PRACTICE DESCRIPTION

A total of 396 plasma samples from 100 healthy people (control), 107 chronic renal failure patients, 114 coronary heart disease patients, and 75 cerebral infarction patients, respectively, were measured for lipoprotein(a) cholesterol and lipoprotein(a) mass; lipoprotein(a) cholesterol and lipoprotein(a) mass levels among control and diseased groups were compared; and lipoprotein(a) cholesterol levels and lipoprotein(a) mass values from the control group were subjected to linear regression analysis.

MAIN OUTCOME MEASUREMENTS

The affinity between oligosaccharide contained in lipoprotein(a) and lectin wheat germ agglutinin to isolate lipoprotein(a) from other lipoproteins; lipoprotein(a) cholesterol and lipoprotein(a) mass detected by total cholesterol kits and enzyme linked immunosorbent assay kits, respectively.

RESULTS

Both lipoprotein(a) cholesterol and lipoprotein(a) mass levels of the chronic renal failure, coronary heart disease, and cerebral infarction groups were significantly higher than those of the control (P < 0.05 or P < 0.01) whereas no difference was seen among the diseased groups at the 0.05 level. Regression analysis within the control group showed a very high correlation between lipoprotein(a) cholesterol and lipoprotein(a) (r = 0.9932).

CONCLUSION

The results suggest that lipoprotein(a) cholesterol assay may be used in the place of lipoprotein(a) measurement for evaluating lipoprotein(a) excess for chronic renal failure, coronary heart disease, and cerebral infarction patients. Further studies about the mechanism of this association between lipoprotein(a) cholesterol and lipoprotein(a) levels are needed.

Molecular biology of hepatitis D virus: research and potential for application

Superinfection by hepatitis D virus (HDV) leads to acute hepatitis and causes progression to liver cirrhosis in a significant proportion of hepatitis B surface antigen (HBsAg) carriers. Current regimens (interferon) to treat hepatitis D patients has only transient but no lasting effects. New approaches are, therefore, warranted. Recently, several laboratory studies have discovered interesting properties of HDV that may become targets for antiviral chemicals. Viral replication requires the small hepatitis delta antigen (s-HDAg). The s-HDAg is a nuclear phosphoprotein. There is evidence indicating that phosphorylation is important for HDV replication. A second step of replication requires HDV-RNA self-cleavage and self-ligation. Interestingly, one group of antibiotics, the aminoglycosides, exerts strong suppression effects on HDV ribozyme activities. In the following stage of viral assembly, two post-translational modifications, namely isoprenylation of large HDAg and glycosylation of HBsAg are involved. Agents capable of blocking the two modifications should reduce viral production. These four possible targets are reviewed. For prevention, effective vaccines are not yet available. Two novel approaches are discussed. The first demonstrates the immunogenicity of a nucleic acid vaccine in mice. The second approach assembled an empty HDV particle in yeast. Advances on such laboratory investigations may provide new methods for the control of hepatitis D in the future.

Augmentation of protein kinase C activity and liver cell proliferation in lead nitrate-treated rats

It is shown that lead alters calcium mediated cellular processes in several biological systems. Calcium enhances the activity of protein kinase C (PKC) which takes part in eliciting cell mitosis. In this study, the effects of lead nitrate on the activity of PKC enzyme were investigated in rat liver. The PKC activity was determined at 12, 24, 48, 72, 120, 168 hours after treatment with a single dose of lead nitrate in male Wistar rats. The results showed that the specific PKC activity of the purified particulate fraction was increased and reached a maximum at 24 hour, and lasted for 48 hours. This augmented activity of PKC was parallel with the increase of the lead level in the purified particulate fraction, although the protein levels of PKC alpha, PKC delta and PKC zeta were unchanged. Moreover, the frequency of mitotic cells also exhibited a significant increase, and like PKC activity, reached its maximum at 24 hour with accompany signs of liver enlargement. The results suggest that the PKC activation may be involved in promoting liver cell proliferation in lead nitrate-treated rats.

The role of nitric oxide in the control of plasma glucose concentration in spontaneously hypertensive rats

Glucose homeostasis was studied in the spontaneously hypertensive rat (SHR). The fasting plasma glucose levels were similar in the SHR and normotensive Wistar-Kyoto (WKY) rat (102.7+/-2.4 vs. 107.4+/-4.2 mg/dl, P > 0.01). One hour after glucose challenge, the plasma glucose level was slightly but insignificantly increased in both SHR and WKY rat (117+/-2.5 vs. 114.3+/-3.2 mg/dl, P > 0.01). After N(G)nitro-L-arginine methyl ester (L-NAME) 20 mg/kg per day was administered intraperitoneally (i.p.) for 4 days, the plasma glucose level was significantly increased in the rats (SHR 167.3+/-4.9; WKY rat 136.0+/-4.8 mg/dl); the increase was significantly more pronounced in the SHR. The fasting insulin levels were similar in the SHR and WKY rats (2.3+/-0.4 vs. 2.0+/-0.3 ng/ml, P > 0.01). One hour after glucose challenge, the insulin level was significantly increased in the WKY rat (4.8+/-0.7 ng/ml) but not in the SHR (2.2+/-0.4 ng/ml). With L-NAME treatment, plasma insulin increase was noted in the WKY rat but not SHR (4.6+/-0.6 vs. 2.6+/-0.4 ng/ml, n = 8, P < 0.01). One hour after insulin 1 IU/kg was injected intramuscularly (i.m.), the plasma glucose level was significantly decreased in both the SHR (from 115.0+/-6.5 to 48.6+/-3.6 mg/dl, n = 8) and WKY rat (from 108.3+/-3.8 to 52.6+/-4.2 mg/dl, n = 8). No significant difference was noted between the decrease of the two groups (P > 0.01). The present findings suggested that NO plays a role in the glucose homeostasis of rats. NO-synthase blockade resulted in an increase of plasma glucose level. The SHR maintains normal glucose level and tolerance in spite of a defective insulin release response. This is probably due the compensatory effect of a more prominent NO-dependent glucose homeostatic function.

Combined-modality therapy for squamous carcinoma of the buccal mucosa: treatment results and prognostic factors

BACKGROUND

Reports on locoregional control and survival of squamous cell carcinoma of buccal mucosa are scarce in literature. In this study, a single institutions's experience of combined surgery and postoperative radiotherapy (RT) for buccal mucosal malignancy with favorable results was analyzed and presented. The prognostic factors on locoregional control were also discussed.

METHODS

From January 1988 to July 1994, 57 patients with squamous cell carcinoma of buccal mucosa treated by surgery and RT were reviewed. The distributions according to American Joint Committee on Cancer (AJCC) staging were: stage II, 6; stage III, 21; and stage IV, 30 patients. Total dose of RT at the buccal area ranged from 45 Gy to 68.4 Gy, median 61.2 Gy. Tumor-related factors (AJCC stage, T stage, histologic grading, pathologic tumor invasion to skin of cheek, adjacent bony structures, and regional lymph nodes) and treatment-related factors (surgical margin, radiation dose, and the time interval between operation and RT) were analyzed to determine their influence on locoregional control.

RESULTS

Three-year actuarial locoregional control rate, overall survival rate, and disease-specific survival rates were 64%, 55%, and 62%, respectively. Ten of these 22 patients (45%) with recurrent tumors were reoperated, but only 2 patients were successfully salvaged. Positive surgical margin and tumor invasion to skin of cheek were significantly poor prognostic factors on locoregional control by univariate analysis. In multivariate analysis, tumor invasion to skin of cheek was the only prognostic factor (p = .0014).

CONCLUSIONS

Locoregional failure was the major cause of death for squamous buccal mucosa cancers managed with surgery and RT. Few recurrences could be detected early and successfully salvaged. Skin of cheek involvement is an important prognostic factor for buccal mucosa cancers.

Lying-on position of total skin electron therapy

PURPOSE

A technique for whole-body electron therapy with the patient in a lying position has been developed. This technique allows Total Skin Electron Therapy (TSET) for those patients who were previously unable to be treated in a conventional standing position.

METHODS AND MATERIALS

This study was carried out on a Varian 2100C linear accelerator with a 6 MeV high dose rate electron beam. The collimator was open to a width of 36 x 36 cm. There were two main procedures, with six dual-field techniques: 1) two static AP/PA vertical dual fields (VDF): the patient laid on the floor transversely under the collimator when the gantry was in a vertical position. A 0.6 cm acrylic board was placed 15 cm away from the patient, then the gantry was rotated 25 degrees clockwise and counterclockwise to treat the patient in the supine and prone positions, respectively. 2) Four oblique junction fields (OJF): the patient laid on the floor in a prone and supine position parallel to the wave guide at (227 - body thickness x tan 60 degrees) cm away from the vertical axis of the gantry, then the gantry was rotated 60 degrees toward the patient. A 0.6 cm acrylic board was placed 15 cm away from the patient perpendicular to the beam. The patient was move along the field central axis. It allowed the patient's body to be within the 160 cm effective treatment profile. When the patient's body axis move 5 degrees toward the lateral side of the field central axis, we could obtain a better dose distribution in the vertex of the scalp and the soles of the feet. The angle of the VDF was measured by chamber detectors to obtain the effective treatment profile. Likewise, the optimal profile for the OJF was determined by the same procedures. The Rando phantom was used to measure the superficial dose of the body.

RESULTS

The dimension of effective treatment profile for the VDF was 188 x 72 cm at 87% dose level For the OJF, we had to move the patient along the field central axis to obtain the effective treatment profile in a 180 x 85 cm dimension at a 87% dose level. The vertex and sole dose measured in this setup was in the range of 80-88%.

CONCLUSIONS

The empirical data showed that the lying-on position for TSET was technically feasible. The dose distribution in the body surface was also compatible with the Stanford standing technique. The nonambulatory skin malignancy patient can be treated in a comfortable and reproducible position.

Epidural abscess presented with psychiatric symptoms

Cranial epidural abscesses are unusual in neurosurgical practice. Mostly they are secondary to skull bone osteomyelitis of foreign body implantation as a result of trauma, or infection of paranasal sinus, otitis, and mastoiditis in adults or late adolescents. The purulent inflammatory process of the epidural abscess, thrombophlebitis of the venous drainage, septic thrombosis, direct extension into the orbit, carvenous sinus, superior orbital fissure give the epidural abscess a high mortality and morbidity. We present an interesting case, who has had psychiatric symptoms such as bizarre behavior, auditory and visual hallucination for about two years. Incidental brain computed tomograms, to exclude the organic-somatic disorder, revealed a huge brain abscess. Emergent surgical intervention was carried out and the episodes of talking to himself and auditory hallucination subsided. The removal of the epidural abscess eliminated the symptoms and cured the patient. All the right amygdata, entorhinal area, cingulate gyrus, hippocampus and parahippocampal gyrus of this patient were compressed by the huge abscess. All these structures belonged to limbic system. Diseases involving the limb system may cause emotional disturbances, such as delusions, illusions and hallucinations, emotional lability, pathological laughing and crying, rage reaction and aggression, apathy and placidity, even endogenous fear, anxiety, depression and euphoria. Dramatic improvement of the patient was found after surgical removal of the abscess. We highlight this interesting case for it will undoubtedly bring together a large cooperation of psychiatrists, neurologists and neurosurgeons.

The relapse patterns and outcome of postoperative recurrent tongue cancer

PURPOSE

The relapse patterns and salvage treatment results for patients who developed locoregional recurrence after surgery for squamous cell carcinoma of the tongue were retrospectively analyzed.

MATERIALS AND METHODS

Between April 1986 and January 1995, 77 cases with recurrent squamous cell carcinoma of the tongue were evaluated. Most of them were males in the early stages of initial disease. Although the surgical margins were negative in most cases (67 of 77), relapse eventually occurred. The relapse patterns showed 15 patients with primary recurrence, 45 patients with regional neck lymph node (LN) relapse, and 17 patients with relapse in both sites.

RESULTS

Salvage treatment was given to most of the patients, but their median survival time was only 9 months. Survival data were analyzed and compared with different types of relapse patterns, salvage treatments, disease-free intervals, age, and sex. In univariate analysis, the neck LN relapse and shorter relapse-free interval (< 6 months) were poor prognostic factors (P < .05), and surgical treatment showed a trend for better salvage results (P = .0575). In multivariate analysis, patients with neck LN relapse had the worst outcome (P < .05).

CONCLUSIONS

Recurrence of tongue cancer is not uncommon, but there are little data in literature regarding the prognosis. Although this study showed poor salvage results, various prognoses could be predicted on the bases of the different relapse patterns and salvage methods.

Liver involvement in epidemic haemorrhagic fever: in situ hybridization, immunohistochemical and pathological studies

In the present study, liver biopsy specimens from 37 patients with epidemic haemorrhagic fever (EHF) were investigated by using light and electron microscopy, immunohistochemistry for the EHF virus envelope protein G2 and in situ hybridization (ISH) for EHF viral RNA. Immunostaining and in situ hybridization were both positive, and a few of the aetiological agents, the EHF virus (EHFV) particles, were found individually within the dilated Golgi cisternae and vesicles, and the dilated rough endoplasmic reticulum of the hepatocyte. The pathological alterations of the liver cells infected with EHFV were: hepatocellular degeneration, cytoplasmic vacuolation, and spotty necrosis; moreover, zonal necrosis was present and adjacent to the narrowed and occluded sinusoids. In degenerated and spotty necrotic cells, the positive signals from of ISH for EHFV RNA and those from immunostaining for the virus protein were both stronger than those in the zonal liver cell necrosis area. The results showed that hepatocellular degeneration and spotty necrosis might be directly related to the virus and its duplication inside the liver cells, while the zonal necrosis was ischaemic and thought to be caused by microcirculation dysfunction.

Dislocation of total knee arthroplasty. A report of 6 cases with 2 patterns of instability

We report 6 cases of dislocation of total knee arthroplasty (TKA). We identified 2 patterns of instability in the sagittal plane, one with posterior translation of the tibia, occurring mainly in the postoperative period and usually resulting from a trauma, and the other with anterior translation of the tibia, occurring 6 months to 7 years postoperatively and with no preceding trauma. In the latter group, instability was manifested gradually as a lengthening of the posterior cruciate ligament and the posterior capsule, leading to a recurvatum deformity of the knee.

[Participatory action-research in the development of health policies for Izumo City, Japan]

The method of participatory action-research has been introduced in planning and implementing health and welfare projects for the elderly in Izumo City since 1993. Public health researchers have participated in the projects with other related administrative sectors, citizen and non-profit organizations. This study analyzes the establishment and implementation of health policies of Izumo from the following five aspects: policy-making, priority, education, intersectoral cooperation and community development. The participatory action-research method was useful for developing the ability of health-staff to work with citizens; for integrating community care and community development; for using community resources effectively for primary health care; and for developing community-based education of citizens, medical students and health staff. This method can be and should be adopted for strengthening the policy-making ability of public health researchers who learn through cooperation with citizens and non-profit organizations.

High-dose-rate intracavitary brachytherapy (HDR-IC) in treatment of cervical carcinoma: 5-year results and implication of increased low-grade rectal complication on initiation of an HDR-IC fractionation scheme

PURPOSE

To report the treatment results and rectal/bladder complications of cervical carcinoma radically treated with high-dose-rate intracavitary brachytherapy (HDR-IC). The current policy of using three-fraction scheme was examined.

METHODS AND MATERIALS

Between November 1987 and August 1990, 173 patients with cervical carcinoma were treated with curative-intent radiation therapy. Whole pelvic irradiation was administered with 10-MV X ray. Dose to the central cervix was 40-44 Gy in 20-22 fractions, following by pelvic wall boost 6-14 Gy in three to seven fractions with central shielding. 60Co sources were used for HDR-IC, and 7.2 Gy was given to Point A for three applications, 1-2 weeks apart. Duration of follow-up was 5-7.8 years.

RESULTS

Twenty-eight patients (16%) developed central-regional recurrences. Overall 5-year actuarial pelvic control rate was 83%. By stage, 5-year actuarial pelvic control rates were 94%, 87%, and 72% for Stages IB + IIA, IIB + IIIA, and IIIB + IVA, respectively. Thirty-one patients (18%) developed distant metastasis. Overall 5-year actuarial survival rate was 58%. By stage, 5-year actuarial survival rates were 79%, 59%, and 41% for Stages IB + IIA, IIB + IIIA, and IIIB + IVA, respectively. Sixty-six (38%) and 19 patients (11%) developed rectal and bladder complications, respectively. For rectal complication, the overall actuarial rate was 38% at 5 years. By grade, 5-year actuarial rectal complication rates were 24%, 15%, 4%, and 3% for Grades 1-4, respectively. Overall prevalence of rectal complications was 37% and 14% at 2 and 5 years, respectively. Prevalence of low-grade rectal complication (Grades 1 and 2) was dominant at 2 years (30%), but declined to 8% at 5 years. Prevalence of high-grade, severe rectal complication (Grades 3 and 4) remained steady at 2 and 5 years (7% and 6%, respectively). Five-year actuarial bladder complication was 9%. Five-year prevalence of bladder complication was 2%.

CONCLUSION

Using a three-fraction scheme, survival rate appeared comparable with the existing results of the low-dose-rate technique. The incidence of rectal complication with this scheme remained relatively high. The increased part of rectal complication was predominantly low grade. This result suggested that therapeutic gain with this scheme may not be good enough to circumvent its biologic disadvantage. Numbers of fractions >3 must be considered in future trials.

A study of the referral patterns of obstetric clinics and the performance of receiving neonatal intensive care units in Taiwan

To study the referral patterns of obstetric clinics, and the performance of receiving intensive care units measured by the survival of transported neonates, transport records were collected prospectively between July, 1991 and June, 1992. Two hundred and fifty-four transported neonates born in 51 obstetric clinics (level I units) in Tainan City and County, in southern Taiwan, were enrolled in this study. Nineteen percent of the transported neonates were very low birthweight infants (< 1500 g). Nearly equal numbers of them were transported to eight district hospitals (level II units) and to a tertiary center (level III unit), but these infants were 1.5 times more likely to die in a level II unit than a level III unit. In addition, equal numbers of infants assisted by mechanical ventilators were transported to level II and III units, but these infants were three times more likely to die in a level II unit than a level III unit (P = 0.006). Seventy-seven percent of the normal birthweight infants (> or = 2500 g) were transported to level II units, and the mortality in this group was 12.3% compared with 0% in those transported to the level III unit. Approximately 56% of these normal birthweight infants in level II units died of severe birth asphyxia. The referral patterns of level 1 units had an unfavorable effect on the survival of neonates requiring mechanical ventilation. Enhancing the skills of the staff in level I units to recognize and stabilize such infants, elevating the capability of level II units in treating some of these cases, and increasing the hospital beds for level III care are necessary to increase their chance of survival.

Microtubule active taxanes inhibit polycystic kidney disease progression in cpk mice

Homozygous cpk/cpk mice develop polycystic kidney disease and die of uremia between the fourth and fifth weeks of age. Cpk/cpk mice treated weekly with paclitaxel (Taxol) can live to over six months of age. This dramatic moderation of polycystic kidney disease progression has been postulated to be a result of paclitaxel's ability to stabilize microtubules. In this study, the ability of taxanes with differing abilities to promote spontaneous in vitro assembly of tubulin dimers into microtubules were tested for their ability to inhibit the progression of polycystic kidney disease in polycystic cpk/cpk mice. We found that taxanes that are active in promoting microtubule assembly, including paclitaxel, 10-deactyl-taxol and cephalomannine increased the survival of polycystic cpk/cpk mice significantly longer than control animals. In contrast, the microtubule inactive taxane baccatin-III has no effect on the progression of renal failure in cpk/cpk mice. We conclude that the ability to promote microtubule assembly may be necessary for paclitaxel and related taxanes to modulate the progression of polycystic kidney progression in cpk/cpk mice.

Effect of megestrol acetate and prepulsid on nutritional improvement in patients with head and neck cancers undergoing radiotherapy

BACKGROUND AND PURPOSE

Anorexia is a common problem in cancer patients who receive radiotherapy. In this current study, we attempt to determine the effect of megestrol acetate and prepulsid on appetite and nutritional improvement in patients with head and neck cancers undergoing radiotherapy.

MATERIALS AND METHODS

One hundred twenty-nine consecutive patients with head and neck cancers treated between July 1993 and June 1994 were prospectively randomized to receive either megestrol acetate, 40 mg qid (megace group), prepulsid, 5 mg tid (cisapride group), or a placebo treatment (control group) during radiotherapy. Before radiotherapy, body weight (kg), appetite score, performance status, biochemical parameters and hematological parameters were evaluated, and the above-noted clinical and biochemical parameters were assessed and recorded every other week. All patients received 6- 10 MV X-rays or Co-60 gamma-ray to head and neck region for a full course of radiotherapy, 61.2-75.6 Gy/7-9 weeks.

RESULTS

Forty-eight patients were enrolled in the megace group, 41 patients in the cisapride group, and 40 patients in the control group. At the 2nd, 4th, 6th and 8th week, as the radiation dose escalated, the megace group had significantly less body weight loss than did the cisapride and control groups (P = 0.045, 0.024, 0.006, 0.003, respectively). The appetite scores of the megace group were significantly higher than those of the cisapride and control groups (P = 0.0001). However, there were no statistically significant differences in the change of albumin level among these three groups at the 2nd, 4th, 6th and 8th week (P > 0.05, respectively).

CONCLUSIONS

Megestrol acetate can significantly decrease the degree of body weight loss, and can prevent the deterioration of appetite in patients with head and neck cancers receiving radiotherapy. However, prepulsid lacks the above-mentioned clinical benefits.

Management of infected total knee arthroplasty

BACKGROUND

Deep wound infection after total knee arthroplasty is an infrequent but very serious complication. Treatment is difficult and challenging. Antibiotic therapy alone can not replace surgery in the management of infected total knee arthroplasty.

METHODS

Fourteen infected total knee arthroplasties in 13 patients were treated by the author. Nine patients underwent two-stage reimplantation, one patient one-stage reimplantation, one patient arthroscopic debridement, and one patient knee fusion. Four knees in three patients were excluded because of less than 12 months follow-up. This study retrospectively analyzed the results of treatment in 10 infected total knee arthroplasties in 10 patients.

RESULTS

All patients were followed up for 12 months or longer. The length of follow-up ranged from 12 months to 69 months with an average of 28 months. All infections were successfully controlled, and there was no recurrence of infection. However, only 67% of the patients showed satisfactory functional results.

CONCLUSION

Based upon the results in this study, most of the infection after total knee arthroplasty could be successfully controlled by combined surgical treatment and intravenous antibiotic therapy. The result of two-stage reimplantation was more consistent and predictable. The functional result of infected total knee arthroplasty was less satisfactory as compared with that of the non-infected counterpart. Furthermore, the impact of infection or the longevity of total knee prosthesis could only be determined by long-term follow-up.

Anatomy and pathology of the septal region

Comprising the septal area and the subcortical nuclei, the septal region is gray matter structures with widespread projection systems and different neurotransmitters. Although their function is poorly understood, lesions of the septal nuclei result in a syndrome of hyper-reactivity, amnesia, and hypersexuality. The pathologic processes affecting the septal region are discussed.

Pituitary transplantation--a study on the response of hypophysis-adrenal axis to physiological stress

Previous studies on experimental intracerebral pituitary transplantation have shown survival and possible function of fetal pituitary glands grafted to the hypothalamic region of inbred strains. In the present study, fetal pituitary tissue was implanted into hypothalamic area of the hypophysectomized rat by stereotactic methods. We investigated the hormonal levels and secretions of fetal pituitaries grafted to the allogenic host and studied the effects of physiological stimuli on hypophysectomized rats with grafted pituitaries. We found that the fetal pituitary allografts released adrenal corticotropin (ACTH) and corticosterone in response to stimulation by corticotropin-releasing hormone (CRH), and released corticosterone alone in response to insulin-induced hypoglycemia. The grafts are acutely responsive to CRH and retain their potential for physiological regulation and function. The ACTH-releasing-signal generated in the host by insulin-induced hypoglycemia failed to activate the graft, so activation by other physiological stimuli cannot be ruled out.

Interaction of reactive and inert chemicals in the presence of oxidoreductases: reaction of the herbicide bentazon and its metabolites with humic monomers

The herbicide bentazon (3-isopropyl-1H-2,1,3-benzothiadiazine-4(3H)-one-2,2-dioxide), a relatively inert chemical, and some of its metabolites were incubated with a laccase or a peroxidase in the presence or absence of humic monomers to evaluate the incorporation of the herbicide and its metabolites into humic material by oxidative enzymes. Guaiacol and ferulic acid were used as representative electron donor co-substrates in most of the oxidative coupling reactions. Bentazon and its metabolites, with the exception of hydroxy metabolites, underwent little or no transformation by the two enzymes in the absence of guaiacol and ferulic acid, but in the presence of these co-substrates transformation occurred. The reaction of bentazon with guaiacol in the presence of the laccase or a peroxidase was almost complete in 30 min. 6-Hydroxy- and 8-hydroxy-bentazon were completely transformed by each enzyme both with and without co-substrates. At pH 3.0 and in the presence of laccase and guaiacol, the concentrations of bentazon and its metabolites 2-amino-N-isopropyl-benzamide (AIBA), des-isopropyl-bentazon and 8-chloro-bentazon decreased by 27, 57, 20 and 4%, respectively. The corresponding levels of transformation with peroxidase at pH 3.0 were 9, 70, 30 and 5%, respectively. The extent of transformation decreased with increasing pH. At low pH, the hydroxy-bentazons were completely transformed, followed by (in order of percentage transformation) AIBA, des-isopropyl-bentazon, bentazon and 8-chloro-bentazon. Transformation of bentazon by the laccase increased with increasing guaiacol concentration. In the presence of the peroxidase, the most effective co-substrates for transformation of bentazon were (in decreasing order) catechol, vanillic acid, protocatechuic acid, syringaldehyde and caffeic acid, while in the presence of the laccase, catechol was most effective, followed by caffeic acid, protocatechuic acid and syringaldehyde.

Hepatotoxicity of 1,3,5-trinitro-2-acetyl pyrrole derived from nitrosation of Maillard reaction product in BALB/C mouse

1,3,5-Trinitro-2-acetyl pyrrole (TNAP) is a product derived from the reaction of 2-acetyl pyrrole with nitrite in the model of Maillard browning systems. This compound is moderately mutagenic to the Salmonella strains TA98 and TA100 and is markedly cytotoxic to mouse C3H10T1/2 cells. Experiments are performed to investigate the effects of TNAP on the hepatic toxicity in mouse. Male BALB/C mice were subjected to a dose of 7.2 mg/kg body weight twice a week by i.p. injection for 24 weeks, then followed by a feeding diet for 21 weeks. TNAP-treated mice showed an increase in mortality and time-dependent appearance of lesions in the liver. TNAP is hepatotoxic as demonstrated by a marked increase in the activities of serum alanine transaminase (ALT) and aspartic transaminase (AST). TNAP-related lesions observed histologically in mice, included hapatic atrophy, mild fatty metamorphosis with multilocular cysts in the liver. In conclusion, TNAP was considered to be a toxic compound in mice as evidenced by increased incidences of mortality, and lesions of liver.

Inhibition of protein kinase C and proto-oncogene expression by crocetin in NIH/3T3 cells

Crocetin, a carotenoid isolated from the seeds of Gardenia jasminoides, was found to be a potent inhibitor of tumor promotion induced by 12-O-tetradecanoylphorbol-13-acetate (TPA) in mouse skin. When mouse fibroblast NIH/3T3 cells were treated with TPA alone, protein kinase C (PKC) translocated from the cytosolic fraction to the particulate fraction. Pretreatment with 60 and 120 microM crocetin for 15 min inhibited the TPA-induced PKC activity in the particulate fraction by 50% and 66%, respectively, but did not affect the level of PKC protein. Crocetin also reduced the level of TPA-stimulated phosphorylation of cellular proteins. Cells pretreated with crocetin (120 microM) had 55% less PKC [3H]phorbol dibutyrate-binding capacity. Suppression of TPA (100 ng/mL)-induced c-jun and c-fos gene expression was also observed in the mouse fibroblast cells pretreated with crocetin (30, 60, and 120 microM). Our results provided a basis for understanding the inhibitory effect of crocetin on TPA-mediated tumor promotion.

Effect of bromocriptine on the sensitivity of pituitary tumor cells to radiation

GH3 cells, a PRL-secreting rat pituitary tumor cell line, are sensitive to bromocriptine, and provide a useful model for the present studies. GH3 cells, in the presence or absence of 2.5 x 10(-5) M bromocriptine, were irradiated at doses ranging from 0 to 10 Gy. After irradiation the bromocriptine was washed out, cells were seeded at a density of 10,000 cells/ml, and growth curves were obtained by counting the cell number at weekly intervals for 1 month. Cell growth was inhibited by the radiation in a dose-dependent fashion, with complete inhibition of cell growth by 9 Gy. However, no protection against radiation damage was afforded by bromocriptine. These results might suggest that the combined therapies of tumor shrinkage by bromocriptine and stereotactic irradiation of the sella might be a useful clinical therapeutic strategy, particularly in patients with large tumors, severe hyperprolactinemia, and pre-existing hypopituitarism.

Inhibitory effect of crocetin on benzo(a)pyrene genotoxicity and neoplastic transformation in C3H10T1/2 cells

Crocetin is a major component in the fruit of Gardenia jasminoides Ellis, a Chinese herbal medicine. In the work, we investigate the protective action and mechanism against benzo(a)pyrene [B(a)P]-induced genotoxicity and neoplastic transformation with a non-toxic dose of crocetin (0.01-0.10 mM) for 1 hour prior to the administration of 0.1 mM B(a)P. B(a)P genotoxicity was inhibited significantly by crocetin in a dose responsive manner. Pretreating C3H10T1/2 cells with crocetin (0.1 mM) also caused a decrease in the covalent binding of B(a)P-diol-epoxide to DNA, to about half that of cells without crocetin treatment. Crocetin also inhibited B(a)P-induced transformations. When the culture was treated with crocetin (0.01, 0.05 and 0.10 mM) for 7 days, the transformation frequencies were lower than that of the culture without crocetin treatment. Furthermore, pretreating cells with crocetin (0.01-0.10 mM) also caused an increase in the activity of GSH S-transferase (GST) to 18-71% that of the cells without crocetin treatment. These results suggest that the inhibition by crocetin of B(a)P-induced genotoxicity and neoplastic transformation in C3H10T1/2 cells is due to a mechanism that increases the activity of GST and decreases the formation of a B(a)P-DNA adduct.

Vital statistics of premature and low birthweight infants in Tainan area

Birth weight and gestational age are strongly associated with perinatal mortality and morbidity. This study was conducted to survey the vital statistics of premature and low birthweight infants in the Tainan area. Between July 1991 and April 1992, fifteen medical institutions were included on a voluntary basis: eight from level I (obstetric specialty clinic), six from level II (regional hospital), and one from level III (tertiary care center). A total of 14,307 deliveries were enrolled, accounting for about 60% of the total delivery for that year in the area. The proportions of delivery among level I, II and III were 52%, 41% and 7%, respectively. The incidence of premature singleton live birth was 4.6%, and the percentages of gestation between 20-27 weeks, 28-31 weeks and 32-37 weeks were 0.2%, 0.6% and 3.8%, respectively. The premature births accounted for 3.5%, 4.8% and 11.3% of live births at the level I, II and III hospitals, respectively. The incidence of low birthweight and very low birthweight singleton live births was 4.4% and 0.5%, respectively. The low birthweight births accounted for 3.5%, 4.5% and 11.1% of live births at the level I, II and III hospitals, respectively. The data revealed that the higher the level of hospital, the higher incidences of premature and low birthweight infant. Teenage mothers (< 20 year of age) had higher low birthweight rate. The risk of having low birthweight infants decreased progressively in mothers of age < 20 (6.3%), 20-24 (5.4%), 25-29 (4.1%) and 30-34 (3.8%), whereas it became higher in mothers older than 35 (4.8%).

CONCLUSION

The incidence of premature and low birthweight births in the Tainan area was low. Teenager or those with maternal age older than 35 year were high risk groups for producing these infants.