Natural history of hepatitis D viral superinfection: significance of viremia detected by polymerase chain reaction

BACKGROUND/AIMS

Polymerase chain reaction (PCR) is very sensitive. The aim of the study was to reevaluate viral replication in hepatitis D virus (HDV) superinfection by PCR.

METHODS

HDV and hepatitis B virus (HBV) were detected by PCR in 185 patients.

RESULTS

The acute hepatitis group had the highest detection rate of HDV RNA compared with chronic hepatitis, cirrhosis, hepatocellular carcinoma, and remission groups (63 of 64 vs. 35 of 47, 17 of 23, 19 of 30, and 7 of 21) and the highest alanine aminotransferase (ALT) levels (mean, 1741 U/L vs. 266 to 27 U/L; P < 0.05). The detection rate of HBV DNA was the lowest in the acute group (41%) compared with 66%, 70%, 80%, and 57% in the remaining groups (P < 0.02). At the chronic stage, 13%-25% of cases had HDV RNA, and 30%-48% of cases had HBV DNA detected by PCR but not by traditional method. HDV RNA was associated with ALT levels in horizontal and longitudinal analyses.

CONCLUSIONS

HDV superinfection may be divided into the following three phases: acute phase, active HDV replication and suppression of HBV with high ALT levels; chronic phase, decreasing HDV and reactivating HBV with moderate ALT levels; and late phase, development of cirrhosis and hepatocellular carcinoma caused by replication of either virus or remission resulting from marked reduction of both viruses.

Treatment of porto-systemic encephalopathy with lactitol verus lactulose: a randomized controlled study

BACKGROUND

Lactitol (beta-galactosido-sorbitol), a novel disaccharide analogue of lactulose, has been suggested as an alternative to lactulose in the treatment of portosystemic encephalopathy (PSE) in Western country. In order to assess its therapeutic effect and adverse reaction in PSE in the Chinese, we conducted this study.

METHODS

Forty-one patients with PSE were enrolled in this study. Patients were randomly divided into 2 groups to receive lactitol (n = 21) or lactulose (n = 20) for 5 days. The doses of both drugs were adjusted to keep daily bowel movement of 2 to 3 times. The PSE index (mental state, EEG, asterixis, number connection test [NCT], and ammonia) was evaluated in each patient before and after treatment. Daily doses of lactitol and lactulose, stool frequency, and side effect were recorded.

RESULTS

The mean dose of lactitol used was 66.3 +/- 36.4 gm and that of lactulose was 56.9 +/- 32.1 ml of lactulose. The majority of patients (37/41) gained clear consciousness after 5 days' treatment. In the lactitol group, blood ammonia, EEG, NCT, asterixis, mental status and PSE index before treatment were 208 +/- 62 micrograms/ml, 2.9 +/- 0.8, 4.0 +/- 0.0, 2.7 +/- 1.5, 2.9 +/- 0.7 and 77.1 +/- 10.5, respectively. All parameters decreased significantly after 5 days' treatment (119 +/- 50 micrograms/ml, 1.1 +/- 1.0, 2.9 +/- 1.2, 1.7 +/- 1.1, 0.7 +/- 0.7, and 34.4 +/- 16.0, p < 0.05). The lactulose group had the similar results. However, the improvement of PSE index after therapy in the lactitol group was significantly higher than that in the lactulose group (42.7 +/- 19.3 vs 31.1 +/- 13.7, p < 0.05). In addition, more patients in the lactitol group than in the lactulose group (67% vs 20%, p = 0.003) favored the taste of their assigned drugs. No patient who received lactitol experienced any side effects; however, six patients treated with lactulose complained of meteorism and flatulence, and four complained of nausea.

CONCLUSIONS

Both lactitol and lactulose are effective in the treatment of PSE, though the effect of lactitol seems slightly superior to that of lactulose in our study. Lactitol is more acceptable to our patients due to better palatability and less side effects. Lactitol is another good alternative in the treatment of PSE.

Brain and behavioral effects of dietary n-3 deficiency in mice: a three generational study

Feeding mice a diet deficient in n-3 fatty acids for three generations resulted in a 53% decrease in docosahexaenoic acid (DHA, 22:6n-3) in the brain. Maternal pup retrieval and social learning of a food preference are both tasks based on olfactory function. All dams made contact more readily with pups of their own dietary group, and animals of both dietary groups demonstrated the ability to learn a food preference through exposure to a conspecific that had previously eaten the food. Both groups showed similar ability to learn the location of the hidden platform in the Morris water maze, while the n-3 deficient animals were marginally faster in locating the platform on the cued trial. They were also more active when tested in the open field. While they did not differ in their duration of immobility in a forced swimming test, the deficient animals did have longer paw-lick latencies on a hot plate. Thus, in this study a significant reduction in brain n-3 fatty acid composition, while associated with some indications of change in emotional reactivity, did not impair olfactory function or learning of either a latent or spatial nature.

Metabolism of n-6 fatty acids by NIH-3T3 cells transfected with the ras oncogene

N-6 fatty acid metabolism was compared in NIH-3T3 cells and DT cells, which differ only in the presence of the v-Ki-ras oncogene. Non-dividing cells were incubated with [1-14C]-labelled fatty acids (18:2n-6, 18:3n-6, 20:3n-6 and 20:4n-6) at different time intervals (2-24 h) and concentration (0-120 microM). In both cells lines, the uptake of different fatty acids from the medium was similar and reached a maximum at 6-8 h. All fatty acids reached the same maximum level in DT cells, whereas, the relative uptake of added fatty acids by NIH-3T3 cells was different: 20:4n-6 > 20:3n-6 > 18:2n-6 = 18:3n-6. Throughout the incubation (2-24 h), desaturation and elongation of n-6 fatty acids was more active in DT cells than in NIH-3T3 cells. However, in both cell lines, incubated with different n-6 fatty acid precursors, the levels of radiolabelled 20:4n-6 were relatively constant. In DT cells, phosphatidylcholine was found to be the major fraction labelled with n-6 fatty acids precursors and those of endogenous synthesis, whereas, in NIH-3T3 cells the neutral lipid fraction, particularly triglycerides, was also strongly labelled. In concentration dependent studies, phospholipid labelling by fatty acids was saturable. At lower concentrations, especially in DT cells, phospholipids were labelled predominantly. As the concentration increased there was an overflow into the triglyceride fraction. Since the differences in fatty acid metabolism between the two cell lines cannot be related to the growth rate, it is suggested that they were a consequence of the expression of the v-Ki-ras oncogene.

Solubilization and purification of A-esterase from mouse hepatic microsomes

A-esterase(s), an enzyme(s) that hydrolyzes certain organophosphate compounds, is located in mammals, primarily in serum and liver. Although considerable information is available regarding serum A-esterase(s), little is known about the hepatic form(s) of this enzyme. In the present study, hepatic A-esterase activity was quantified by measuring the EDTA-sensitive hydrolysis of the organophosphate paraoxon (O,O-diethyl-O-p-nitrophenyl phosphate). EDTA-insensitive hydrolysis was assumed to be the nonenzymatic phosphorylation of proteins with appropriate serine hydroxyl groups. Resuspension of mouse hepatic microsomes in 50 mM potassium phosphate buffer, pH 7.4, containing 100 microM calcium chloride, 0.25% sodium cholate, and 0.1% Triton N-101, resulted in the solubilization of A-esterase activity, as evidenced by the failure of activity to sediment after centrifugation at 100,000 g for 1 hr. Gel permeation chromatography followed by ion-exchange chromatography and nonspecific affinity chromatography resulted in a peak of A-esterase activity judged to be homogeneous by SDS-PAGE. A typical purification resulted in a 1531-fold increase in specific activity, with a recovery of 10%. SDS-PAGE with and without an acrylamide gradient indicated a molecular weight of 40,000 and 39,000 Da, respectively, while analyses of amino acid composition revealed similarities with human and rabbit serum paraoxonase. And finally, although this protein hydrolyzed both paraoxon and methyl paraoxon (O,O-dimethyl-O-p-nitrophenyl phosphate), it did not hydrolyze p-nitrophenyl acetate.

Abdominal wall hernia complicating continuous ambulatory peritoneal dialysis

Continuous ambulatory peritoneal dialysis (CAPD) is a well-established treatment modality for end-stage renal disease. Abdominal wall hernia is not uncommon in patients on CAPD. Two factors are responsible for the occurrence of these hernias: anatomically weak sites and increased intraperitoneal pressure by the dialysate. Abdominal wall hernia was reviewed in 44 patients on CAPD from 1987 through 1991. Eight abdominal hernias (5 inguinal, 2 incisional and 1 umbilical) were found during CAPD treatment (18.18%). Surgical treatment was applied in 6 symptomatic hernias (5 inguinal and 1 incisional). After surgery, 5 patients returned to CAPD without recurrence and the remaining one died of strangulated incisional hernia. Our series shows that: (1) a detailed examination of the preexisting hernia and repair prior to CAPD treatment are suggested. (2) symptomatic abdominal wall hernia should be evaluated carefully and treated promptly. (3) awareness of the complication of these hernias can reduce the morbidity and mortality.

Functional approach to treatment of back pain in primary care: a preliminary report

BACKGROUND

Back pain is one of the most common problems encountered in primary care clinics and causes great loss of work time, economy and expenditure of medical care. Knowledge of the cause of low back pain and effective treatment are rudimentary. We studied the functional approach to treatment of back pain of two acute (M:F = 1:1) and thirty chronic (M:F = 12:18) patients with back pain seen at a rural primary care clinic in September and October 1992.

METHODS

Patients were included after completing an agreement form regarding the treatment plan (emphasizing therapeutic exercise, health education and as little medication as possible) in the first interview. A primary care physician specialised in family medicine personally gave treatment to the patients with free attendance to the clinic. A functional approach was adopted in four categories-therapeutic exercise, static and dynamic body biomechanics, awareness of proprioception, and maintenance of relaxed and balanced muscle tone. The patients were encouraged to perform daily activities rather than rest.

RESULTS

Two patients with acute back pain gained complete relief without medication, modalities, equipment or other treatment one and two weeks after the first visit, respectively. Among the 30 chronic patients, after eight weeks of treatment, 12/30 (40%) gained complete relief from pain, 4/30 (13.3%) obtained more than 3/4 and less than complete relief, 7/30 (23.3%) had more than 1/2 and less than 3/4 relief, 2/30 (6.7%) gained less than 1/2 pain relief, 1/30 (3.3%) had no improvement, 1/30 (3.3%) deteriorated, and 3/30 (10%) were lost during surveillance. The patients reported no loss of work time attributed to back pain. Two acute patients visited the clinic four times and three times, respectively. The former received three prescriptions for an upper respiratory infection one month after complete remission of back pain, and the latter received no prescriptions for medication. On average, each chronic patient visited the clinic 4.83 times in 8 weeks. In only 25 of 145 (17.2%) visits was medication prescribed for other indications, and in 8 of 145 (5.5%) visits vitamin B complex or Alinamin-F for placebo was prescribed. We used neither modalities nor equipment. Only 7/30 (23.3%) patients received concurrent treatment from other medical institutions. Regarding compliance with the programmed exercise at home, two acute patients complied well. Among the 30 chronic patients, 22 (73.3%) had good compliance, 3 (10%) had poor compliance, 2 (6.7%) failed to comply and 3 (10%) were lost in follow up.

CONCLUSIONS

Treating patients with back pain in primary care clinics with a functional approach by physicians appropriately trained in primary care was a good, efficacious, economic, and practical way, although neglected elsewhere. Further research and practice in our society might be worth while.

Management of the perineal wounds following excision of the rectum for malignancy

In a retrospective study, 103 patients undergoing abdominoperineal resection or total proctocolectomy due to rectal adenocarcinoma or familial polyposis with malignant change in the rectum were included. The methods for treating the pelvic and perineal wounds were divided into four categories: (1) suture of the pelvic peritoneum with open drainage, (2) suture of the pelvic peritoneum and perineum with simple drainage, (3) suture of the pelvic peritoneum and perineum with suction drainage, and (4) suture of the perineum with omental pedicle graft. The parameters analyzed were incidence of perineal wound infection, primary healing of the perineum, extraperineal complications and mean hospital stay. The infective rate of the group 1 was significantly higher than for the other groups. The incidence of primary wound healing for groups 2, 3, 4 was 73%, 78%, 81% respectively compared with group 1 of 20% at one month. There was no significant difference between the various groups regarding extraperineal complications. There was no significant difference in hospital stay among groups 2, 3, 4, but they were significantly shorter than for group 1. Primary closure of the pelvic peritoneum and perineal wound with simple drainage is now adopted by us due to its low infection rate, short hospital stay and easy performance.

The effects of dietary fatty acid composition combined with environmental enrichment on brain and behavior in mice

In this study we investigated the effects of dietary fatty acid (FA) composition combined with postweaning environmental enrichment on brain fatty acid composition and behavior in mice. There were three dietary conditions: a saturated fat group deficient in essential fatty acids, a group deficient in n-3 fatty acids only, and a control group containing both n-3 and n-6 fatty acids in a ratio of 0.27. Animals were fed these diets during pregnancy and lactation and after weaning. Brain fatty acid composition was determined on days 1, 9, 17 and 25 after birth and in adult animals at 3 months. At weaning two females from each litter were assigned randomly to either an enriched or standard environmental condition. After six weeks in these environments they were tested in the Morris water maze and open field. Adult percentages of 22:6n-3 were present in the brain within the first week after birth. These values were reduced by 50% in the n-3 deficient diet and by 80% in the saturated fat diet; adult animals on the saturated fat diet were also severely retarded in growth. Animals fed the saturated fat diet were initially slightly slower in locating the hidden platform in the Morris maze relative to the control group, but this was not apparent in the reversal learning phase; a cued learning task using a visible platform indicated that these effects did not appear to be related to differences in motor or motivational capacities. The n-3 deficient group did not differ from either the saturated fat group or the controls. All dietary groups showed beneficial effects of environmental enrichment in decreasing their latency to locate the hidden platform, and these effects appeared to be partially independent of the increased swimming speed of the enriched animals. Enriched animals in all groups showed less rearing activity in the open field and spent more time stationary; the animals fed saturated fat reared less and travelled shorter distances more slowly. In all cases the effects of diet and environment were additive, thereby providing little support for the hypothesis that dietary fatty acid composition would affect the animals' capacity to benefit from the functional effects of environmental enrichment.

Differences in the metabolism of 18:2n-6 and 18:3n-6 by the liver and kidney may explain the anti-hypertensive effect of 18:3n-6

The present study examined the in vitro and in vivo metabolism of 18:2n-6 and 18:3n-6 by kidney and liver in the male adult spontaneously hypertensive (SHR) and normotensive (WKY) rats. In liver and kidney slices incubated for 1 h with either [1-14C]18:2n-6 or [1-14C]18:3n-6 (60 microM), substantial amounts of radioactivity were incorporated into triacylglycerol and phospholipid fractions. Approximately 15% of the radiolabeled 18:2n-6 was converted into 18:3n-6 in liver slices but no conversion was found in kidney slices. When incubated with radiolabeled 18:3n-6, over 40% of the radioactivity was metabolized mainly to 20:4n-6 in liver slices, but evenly to 20:3n-6 and 20:4n-6 in kidney slices. There were no differences between the results from SHR and those from WKY. In WKY rats given an oral bolus of radiolabeled 18:3n-6, most of the radioactivity was recovered in the liver and significantly less in the kidney. In both tissues, the radioactivity was associated initially only with 18:3n-6 and later with its elongation product, 20:3n-6. These findings indicated that the kidney, although unable to metabolize 18:2n-6, could metabolize 18:3n-6 taken up from the circulation. The effectiveness of 18:3n-6, compared to 18:2n-6, as an anti-hypertensive agent may result from the provision of a post-delta 6-desaturation metabolite which can be directly converted to blood pressure-regulating eicosanoids in the kidney.

Effects of dietary protein and cholesterol on phosphatidylcholine and phosphatidylethanolamine molecular species in mouse liver

The present study examined the effects of two atherogenic factors, animal protein and cholesterol, on the distribution of fatty acids and the molecular species of major liver phospholipids in mice. Weanling mice were fed a semisynthetic diet supplemented with either casein or soy protein (20%, w/w) in the presence or absence of 0.5% cholesterol for 4 wk. Results from mouse liver showed that animal protein and, more so, dietary cholesterol modified the fatty acid profiles of the phospholipids. Animal protein had no significant effect on the concentration of lipids, but it altered the relative distribution and fatty acid profiles of the phospholipids, phosphatidylcholine and phosphatidylethanolamine. Dietary cholesterol, on the other hand, significantly increased the concentration of liver lipids, but it did not alter the relative distribution of phosphatidylcholine and phosphatidylethanolamine. In cholesterol-fed mice, the proportions of molecular species containing 18:2n-6 were increased, whereas those containing 20:4n-6 were decreased, indicating that dietary cholesterol suppressed linoleic acid metabolism. Since cholesterol feeding selectively decreased the ratio of 18:0/20:4n-6 in phosphatidylcholine, whereas it increased the 18:0/18:2n-6 ratio in phosphatidylethanolamine, this finding suggests that dietary cholesterol may affect the incorporation of fatty acids but not the rate of synthesis of phosphatidylcholine and phosphatidylethanolamine.

Adrenic acid delta 4 desaturation and fatty acid composition in liver microsomes of spontaneously diabetic Wistar BB rats

We examined the delta 4 (n-6) desaturation and the fatty acid composition of liver microsomes in the insulin-dependent spontaneously diabetic Wistar Bio-Breeding (BB) rat. The desaturation of adrenic acid to n-6 docosapentaenoic acid was decreased in the normo- and hyperglycemic diabetic rats. Insulin treatment with 1.0 IU. 100 g body weight-1 twice a day for 2 days restored the reduced activity during the hypoglycemic period. The pattern of responses was similar to that of linoleic acid delta 6 and dihomo-gamma-linolenic acid delta 5 desaturases, with a non-parallel relationship between the desaturation system and the glycemia. The microsomal fatty acid composition of BB rat liver reflected only partially to the delta 4 desaturation at different states of glycemia. Factors other than impaired desaturation system are involved in the fatty acid metabolism of spontaneously diabetic rats.

Effect of vagotomy on cholecystokinin release and gallbladder contraction in patients with complicated duodenal ulcer

In this prospective study, we investigated gallbladder (GB) contraction and plasma cholecystokinin (CCK) levels in response to food intake before and 1 month after vagotomy in 27 patients with complicated duodenal ulcer. Highly selective vagotomy (HSV) was carried out in 6 patients, truncal vagotomy and pyloroplasty (TVP) in 4, truncal vagotomy and antrectomy (TVA) in 7, selective vagotomy and pyloroplasty (SVP) in 5 and selective vagotomy and antrectomy (SVA) in another 5 patients with pyloric stenosis. The results of our studies indicated that (1) basal plasma CCK levels increased significantly after vagotomy, (2) none of the vagotomy operations altered the integrated CCK response, (3) unlike HSV, SVA and TVA, SVP and TVP decreased GB emptying and (4) antrectomy significantly enhanced CCK release after food intake. We concluded from these findings that the operative procedure of HSV, SVA or TVA to circumvent bile stasis-related postvagotomy cholelithiasis is superior to SVP or TVP in the surgical treatment of complicated duodenal ulcer.

Psychosocial stress, catecholamines, and essential fatty acid metabolism in rats

To examine the effects of psychosocial stress and the "stress hormone," epinephrine, on essential fatty acid metabolism in rats, two studies were conducted. In the first, the effects of four weeks of (i) social isolation and (ii) group housing (control) on liver microsomal delta 6 and delta 5 n-6 desaturase activity were studied in group-reared male normotensive (Wistar Kyoto) and spontaneously hypertensive (SHR) rats (n = 5/group). The second study examined the effects of acute ip epinephrine (0.0, 1.0, 2.0, and 4.0 mg/kg) 6 hr prior to and following an ig dose (4 g/kg) of safflower oil (rich in 18:2n-6, LA) on plasma and liver LA, 20:4n-6 (AA), and LA/AA ratios in adult essential fatty acid deficient Sprague-Dawley rats (n = 6/group). In the first experiment, isolation stress significantly inhibited the activity of delta 6 (P < 0.05) and delta 5 (P < 0.01) desaturase in the normotensive rats and of delta 5 desaturase in the SHR (P < 0.05). In the second study, epinephrine increased plasma and liver LA at doses 1.0 and 2.0 mg/kg in most of the fractions examined, and suppressed AA levels. The response of the LA/AA ratio to epinephrine varied between tissues and among lipid fractions, but increased this ratio at the moderate doses (2.0-4.0 mg/kg) of epinephrine in most cases. These data suggest that psychosocial stressors are capable of inhibiting the rate limiting steps of essential fatty acid metabolism and that this response is more pronounced in the SHR than in the Wistar Kyoto. They also suggest that epinephrine is capable of altering the in vivo metabolism of essential fatty acids in the rat.

Effects of maternal dietary n-3 and n-6 fatty acids (pre- and post-delta 6 desaturation) on tissue glycerophospholipid fatty acid compositions in dams and suckling mice

The present study examined the effects of supplementation of either 18:3n-3 or a mixture of its post-delta 6-desaturation metabolites, 20:5n-3/22:6n-3, in combination with either 18:2n-6 or its immediate delta 6-desaturation product, 18:3n-6, in the maternal diet (n-3 to n-6 ratio at 0.25) on brain, liver, heart, and kidney glycerophospholipid fatty acid composition in dams (B6D2F1 mice) and their 12-day-old suckling pups. As expected, n-3 and n-6 fatty acids competed for incorporation into tissue glycerophospholipids in both dams and their suckling pups. Feeding a 20:5n-3/22:6n-3 as compared with an 18:3n-3 rich diet increased the tissue levels of 20:5n-3 and 22:5n-3, whereas it decreased those of 20:3n-6 and 20:4n-6. Replacing 18:2n-6 with 18:3n-6 in the maternal diet increased significantly the levels of 18:3n-6, 20:3n-6, and 20:4n-6, whereas it reduced those of 20:5n-3. However, the effects of maternal dietary fats on tissue fatty acid compositions in pups were qualitatively similar to but quantitatively smaller than those in dams. The discrepancy might be due to differences in the composition of fatty acids taken up and synthesized by the dams and that transferred to the pups.

[Thromboxane and prostacyclin imbalance in the pathogenesis of early damage after severe burns]

To define the pathogenesis of hemodynamical and hemorrheological changes as well as multiple organ failure (MOF) during early postburn stage, we determined the levels of thromboxane A2(TXA2) and prostacyclin (PGI2) and some other related variables in 57 patients, of which 14 were complicated by MOF. The results showed that TXA2/PGI2 ratio increased markedly within 3 days postburn, and its dynamic change paralleled well with changes of hemodynamical and hemorrheological parameters as well as myocardial enzyme spectrum. Both plasma and visceral levels of TXA2/PGI2 ratio were significantly higher in MOF than those in non-MOF cases. The altered TXA2/PGI2 ratio coincided with the clinical course of MOF patients. These findings suggested that TXA2/PGI2 imbalance may be one of the important factors of early postburn damage.

Mutagenesis analysis of a hepatitis delta virus genomic ribozyme

We conducted extensive mutagenesis analysis on a hepatitis delta virus (HDV) genomic ribozyme to study the sequence specificity of certain region and to derive the secondary structure associated with the catalytic core. The results confirmed that the autocatalytic domain of HDV genomic RNA contained four base-pairing regions as predicted in the 'pseudo-knot' model [Perrotta & Been (1990) Nature 350, 434-436]. The size and sequence of one of the base-pairing regions, i. e. stem-and-loop, could be flexible. Helix 3 and the first basepair of helix 1 required specific sequence to retain self-cleavage activity. The structural requirement of helix 2 was less stringent than the other base-pairing regions. Moreover, the size of helix 1 affected self-cleavage whereas the length of hinge could be variable even though the first three residues of hinge had stringent sequence requirement.

Measuring lidocaine metabolite--monoethylglycinexylidide as a quantitative index of hepatic function in adults with chronic hepatitis and cirrhosis

Lidocaine is metabolized to form monoethylglycinexylidide (MEGX) via oxidative N-deethylation in the liver. To assess the clinical value of this lidocaine metabolite as a quantitative liver function test, we measured the serum MEGX concentration 15 min after intravenous administration of a single dose of lidocaine (1 mg/kg) in 24 adults with chronic hepatitis, 47 patients with cirrhosis and 26 normal controls. A fluorescence polarization immunoassay was used to obtain the MEGX value. The MEGX concentration in controls was 67 (54-95) ng/ml (median with 16th-84th percentile in parentheses), which was higher than 43 (23-61) ng/ml in patients with chronic hepatitis and 24 (7-52) ng/ml in those with cirrhosis (P < 0.05). In addition, the serum MEGX levels are proportional to the galactose elimination capacity, and inversely proportional to Pugh's score, the prothrombin time and indocyanine green retention ratio. If a MEGX concentration of below 54 ng/ml is taken as an indicator of hepatic dysfunction, its diagnostic sensitivity for hepatic disorder is 84.5%, specificity 88.5% and accuracy 85.6%. Furthermore, after a 10-month follow-up, patients with MEGX formation above 30 ng/ml had a higher survival rate than those with a MEGX concentration below this level (P = 0.004). In conclusion, the MEGX formation test reflects the severity of hepatic dysfunction quite well, making it valuable both in the quantitative evaluation of liver function and in the prognostic prediction of adults with liver diseases.

[Chloroform-induced hepatic injury: a case report]

Chemical hepatic injury is not rare in Taiwan. We here report such an injury induced by chloroform. A previously healthy 26-year-old married woman was admitted under the impression of acute chemical hepatitis in December, 1991. Two weeks before, she had used chloroform as glue to unite two pieces of plastic pencil sharpener at home. Nasty odor was sensed while working. After series of hepatitis workup, liver echo, site visit, survey of coworkers and gas chromatography for the "glue", the diagnosis of chloroform-induced hepatic injury was confirmed. This case found that neither employer nor employee was aware of the toxicity of chloroform. No ventilation system or personal respiratory protection equipment was provided. Preemployment training and Material Safety Data Sheet were obviously insufficient, also. The diagnostic criteria of chemical hepatic injury were therefore proposed to alert medical professionals, industrial hygienist, safety personnel and factory inspectors, not to prompt an early diagnosis but also hopefully to prevent the occurrence of occupational liver diseases.

Enterolith ileus as a complication of duodenal diverticulosis--one case report and review of the literature

Duodenal diverticulosis is not a rare condition. Usually of little clinical significance, it can produce a variety of disorders such as malabsorption, hemorrhage, diverticulitis, and obstruction. The rarest complication appears to be enterolith formation and obstruction. The case presented is a 70-year-old woman with the chief complaints of intermittent abdominal pain and vomiting. At laparotomy, duodenal diverticulitis and one enterolith obstructing the distal ileum were found. The literature review presents the other 26 cases with small bowel obstruction due to an enterolith formed within a small bowel diverticulum. The diagnosis can be established only by documenting the normalcy of the gallbladder and the presence of duodenal or jejunal diverticula.

Metabolism of radiolabelled 18:2n-6 and 18:3n-6 by NIH-3T3 cells and the DT subclone

The incorporation and metabolism of delta-6-desaturase substrate and product, [1-14C]-linoleic (18:2n-6) and [1-14C]-gamma-linolenic acid (18:3n-6), was examined in NIH-3T3 cells and the DT subclone which differs only in the presence of the v-Ki-ras oncogene. Similar amounts of post delta-6 and delta-5 desaturase metabolites were found in both cell lines indicating that the activity of these important enzymes of fatty acid metabolism was not affected by the expression of the oncogene. However, measurable quantities of the direct elongation product of 18:2n-6, 20:2n-6, were only found in DT cells. Radiolabel was recovered predominantly from the phospholipid fraction at low fatty acid concentrations, whereas neutral lipid labelling occurred when higher concentrations of exogenous fatty acid were present. This effect was most pronounced in DT cells and may result from the presence of the activated ras oncogene.

Glutathione-dependent biotransformation of methyl parathion by mouse liver in vitro

The present study was undertaken in an attempt to reconcile the seemingly conflicting observations that glutathione-dependent biotransformation of methyl parathion (O,O-dimethyl-O-(4-nitrophenyl)phosphorothionate) by hepatic supernatant or partially purified glutathione S-transferases occurs in vitro, but not to any significant degree in vivo in the mouse. While incubation of 20 microM methyl parathion with glutathione-fortified 100,000 x g hepatic supernatant resulted in biotransformation of this insecticide, addition of the carbon monoxide exposed microsomal fraction (without NADPH) to the supernatant abolished this metabolism. HPLC analyses of the distribution of methyl parathion between 100,000 x g supernatant and carbon monoxide-exposed microsomes revealed that little methyl parathion could be recovered in the 100,000 x g supernatant, and that the bulk of this insecticide was associated with the microsomal fraction. Increasing the concentration of methyl parathion to 1 mM resulted in a greater fraction of methyl parathion found in the supernatant compared to that with 20 microM, although the bulk of methyl parathion remained associated with the microsomal fraction. While this increase in the fraction of substrate located within the supernatant led to limited glutathione-dependent metabolism of methyl parathion, it must be emphasized that a liver concentration of 1 mM methyl parathion is far greater than that which could be achieved in vivo. In conclusion, the results of the present study support the hypothesis that in the mouse, glutathione-dependent metabolism of methyl parathion does not occur to a significant degree in vivo because of its limited access to the soluble glutathione S-transferases.

Effects of saturated fatty acids on n-6 fatty acid metabolism in cultured human monocyte-like cells (U937)

Effects of supplementation of saturated fatty acids (16:0 and 18:0) on metabolism of the cytotoxic n-6 fatty acids in cultured human monocyte-like cells (U937) have been examined. U937 cells were incubated in 5% delipidated fetal bovine serum containing 16:0 and 18:0. Supplementation of either 16:0 or 18:0 has no significant effect on the uptake of 18:2n-6 and 18:3n-6. However, addition of 16:0 to the medium increased whereas 18:0 suppressed the cytotoxic effects of 18:2n-6 and 18:3n-6. In addition, 16:0 supplementation reduced the incorporation of n-6 fatty acids in cellular phospholipid fraction, and enhanced the metabolism of n-6 fatty acids, particularly the conversion of 20:3n-6 to 20:4n-6 in U937 cells. Results with microsomes prepared from U937 cells also showed that 16:0 supplementation increased the delta 5 desaturase activity. This may be related in part to an increase in the availability of 20:3n-6, since results obtained in a separate study have shown that 16:0 competed with 20:3n-6 for incorporation into the phospholipid molecule at sn-2 position. Increasing the availability and formation of long chain n-6 fatty acids, which are cytotoxic, might also be responsible for increasing cytotoxicity of 16:0 supplementation.

[Clinical study on main visceral damage and multiple organ failure (MOF) following severe burns]

A prospective study was carried out on 57 patients with total burned surface area (TBSA) over 30%. It was found that myocardial damage occurred early postburn, which was one of the major causes of cardiac dysfunction and failure. The postburn respiratory failure (RF) might be classified into three patterns. The etiology of each pattern varied. The imbalance between thromboxane and prostacyclin in plasma and visceral tissues played important roles in the genesis and development of postburn MOF as well as the causes of pathophysiological alterations in the main factors (including inhalation injury, severe shock and systemic infection) which contributed to occurrence of visceral damage and MOF.

Prolonged disease-free survival after ablative chemoradiotherapy and autologous bone marrow transplantation in adult malignant lymphoma

From June 1983 to December 1991, 21 adult patients with intermediate or high-grade malignant lymphoma (ML) were treated by ablative chemoradiotherapy, including vincristine, cytosine arabinoside, BCNU and cyclophosphamide plus total lymphoid or body irradiation with boost irradiation over bulky and original tumor areas (Hd-VCCA+TL(B) I) together with autologous bone marrow transplantation (ABMT). Five patients were in advanced stage, 2 in drug-resistant relapse, 6 in drug sensitive relapse, 6 in first complete remission (CR1) and 2 in CR2. One with marrow involvement at ABMT. The 8-year disease-free survival after ABMT in patients with Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) in 89% and 63%, respectively, with a median follow-up up to 34 months. This study demonstrated that our Hd-VCCA+TL(B) I regimen and ABMT performed early in CR or drug-sensitive relapse of adult poor prognosis lymphoma, may potentially cure more than 70% of them. The toxicity of the present treatment is tolerable. The results confirm the value of ABMT in the treatment of adult ML, and suggest that it is necessary to purge the residual tumor cells in the bone marrow at ABMT in patients with marrow infiltration, or lymphoblastic lymphoma.

Relationship between mouse liver delta 9 desaturase activity and plasma lipids

This study was undertaken to investigate the total plasma fatty acid composition and the relationship between plasma triacylglycerol (TG) levels and liver delta 9 desaturase activity in mice fed n-3 and/or n-6 fatty acid or hydrogenated coconut oil (HCO) (maximum 25 mg/g) supplemented diets. Generally, plasma TG levels and delta 9 desaturase activity were inversely correlated with the ratio of the sum of long chain n-6 fatty acids to 18:2n-6 and to the ratio of the sum of long chain n-3 fatty acids to 18:n-3, but they were positively correlated with the ratio of products and substrates (18:1/18:0) of the enzyme in plasma total lipids. The n-3 fatty acid (mainly 20:5n-3) enriched diet, when compared to the HCO diet at 21 d, caused a significant reduction in plasma TG levels but not in delta 9 desaturase activity. However, a marked reduction in plasma TG content (50-60%) and delta 9 desaturase activity (55-70%) was observed when both 20:5n-3 and 18:3n-6 were supplemented in the diet. The plasma TG levels and delta 9 desaturase activity rose again when the animals were fed the HCO diet or chow. The results suggest that low dose supplementation of a mixture of n-3 (mainly 20:5n-3) and n-6 (18:3n-6) fatty acids modified both plasma TG content and liver delta 9 desaturase activity, in parallel.

Comparison of the metabolism of alpha-linolenic acid and its delta 6 desaturation product, stearidonic acid, in cultured NIH-3T3 cells

The incorporation and metabolism of alpha-linolenic acid (18:3n-3) and its delta 6 desaturase product, stearidonic acid (18:4n-3), were compared by NIH-3T3 cells. In the presence of fetal calf serum, cells accumulated exogenously added 18:3n-3 and 18:4n-3 apparently at the expense of oleic acid (18:1n-9). Both 18:3n-3 and 18:4n-3 were elongated and desaturated to eicosatetraenoic acid (20:4n-3), eicosapentaenoic acid (20:5n-3) and docosapentaenoic acid (22:5n-3), but not to docosahexaenoic acid (22:6n-3), and were incorporated into phospholipids and triacylglycerols. Over a 4-d period, the growth of NIH-3T3 cells was slightly stimulated in the presence of 18:3n-3 (20 micrograms/mL) but was strongly inhibited in the presence of 18:4n-3 at the same concentration. This inhibition may be caused by enhanced lipid peroxidation as a result of the high levels of 18:4n-3 present.

Effect of salt-loading and spontaneous hypertension on in vitro metabolism of [1-14C]linoleic and [2-14C]dihomo-gamma-linolenic acids

The present study compared the effect of spontaneous hypertension and salt-loading on in vitro metabolism of 18:2n-6 (linoleic acid) and 20:3n-6 (dihomo-gamma-linolenic acid). Ten weanling spontaneously hypertensive rats (SHR) and 10 normotensive Wistar-Kyoto rats (WKY) maintained on a rodent lab chow were given tap water with (n = 5) or without (n = 5) addition of 1% NaCl for 4 weeks. Thereafter, animals were killed and liver microsomes were prepared. Aliquots of microsomes suspended in the phosphate-sucrose buffer containing MgCl2, ATP, CoA, and NADPH were incubated with 0.3 microCi of [1-14C]-18:2n-6 or [2-14C]-20:3n-6 at 37 degrees C for 15 min. The activity of delta 6- and delta 5-desaturases, and the distribution of radioactivity in different lipid fractions and in phospholipid fatty acids were determined. Results showed that both spontaneous hypertension and salt-loading suppressed the desaturation of radiolabeled 18:2n-6 and of 20:3n-6. Incubation of microsomes with [1-14C]-18:2n-6 resulted in 29% of radioactivity being associated with phospholipid fraction, of which 3% was associated with 18:3n-6. Incubation with radiolabeled 20:3n-6 resulted in 30% of the radioactivity being incorporated into phospholipids, of which 50% was associated with 20:4n-6 (arachidonic acid). Salt-loading suppressed the incorporation of radiolabeled fatty acids into phospholipids, more so in SHR than in WKY. Thus, salt-loading not only suppressed the desaturation of 18:2n-6 and 20:3n-6, but also interfered with the acylation of n-6 fatty acids into the phospholipid fraction.

Synthesis of new amino acid and peptide derivatives of estradiol and their binding affinities for the estrogen receptor

A series of amino acid and peptide derivatives of estradiol have been synthesized by coupling 17 beta-aminoestra-1,3,5(10)-trien-3-ol, 17-hydrazonoestra-1,3,5(10)-trien-3-ol with amino acids or peptides, using tetrahydrothiazole-2-thione, N-hydroxy-1,4-epoxycyclohex-5-ene-2,3-dicarbonylimide, benzotriazolyloxy-tris(dimethylamino)phosphonium hexafluorophosphate, and p-nitrophenol as reagents. N-protected peptidyl steroids were deprotected by traditional methods. The relative binding affinities of the deprotected derivatives to the estrogen receptor were determined by competitive radioligand binding assay.

Effect of n-3 and n-6 fatty acids on hepatic microsomal lipid metabolism: a time course study

The present study examines the time dependent effects of n-6 and n-3 polyunsaturated fatty acids on liver microsomal lipid metabolism in FVB mice fed a diet supplemented with a mixture of free fatty acids (mainly 18:3n-6 and 20:5n-3) at 25 mg/g diet. Significant changes in the fatty acid composition of total liver and microsomal lipids were observed after 7 days on the diets. Thereafter, some animals remained on the same diet while others were fed a diet supplemented with hydrogenated coconut oil (HCO). With the exception of 20:5n-3 which showed a slower recovery, establishment of the HCO pattern was rapid indicating that the diet-induced changes could be easily reversed. The unsaturation index, the cholesterol/phospholipid ratio and the microviscosity of the microsomal membranes were not affected by these dietary manipulations. Unsaturated fatty acid supplementation reduced the activity of delta 9 desaturase by 50%. Feeding the HCO diet to mice previously fed the EPA/GLA diet led to a progressive increase in delta 9 desaturase activity, reaching 80% of the day zero values after 14 days. The monoene content of hepatic total lipids reflected, in most cases, the changes in enzyme activity. This study shows that a low dose of a n-3 and n-6 free fatty acid mixture increases the quantities of members of the n-3 family, without loss of n-6 fatty acids in microsomal membranes and modifies the activity of delta 9 desaturase without altering the microsome physicochemical parameters.

Roles of thromboxane and prostacyclin in the pathogenesis of acute respiratory failure in burn patients combined with inhalation injury

Forty-one severely burned patients were divided into inhalation injury and non-inhalation injury groups. It was found that in the inhalation injury group, TXB2 level and TXB2/6-keto-PGF1 alpha ratio in both plasma and lung tissues were significantly elevated, circulatory platelet aggregate ratio markedly decreased, and blood viscosity greatly increased. Histopathologically, congestion, oedema, haemorrhage and thrombosis were observed in lung tissues taken from patients succumbing to respiratory failure. The changes in TXB2 and TXB2/6 keto-PGF1 alpha ratio accorded with the clinical course of the development of respiratory failure in burn patients with inhalation injury. It is proposed that the imbalance of TXA2/PGI2 plays an important role in the pathogenesis of respiratory failure in severely burnt patients complicated with inhalation injury.

Identification of autoantigen recognized by autoimmune ophthalmopathy sera with immunoblotting correlated with orbital computed tomography

We have demonstrated that there is an antibody related to extraocular muscle enlargement in autoimmune ophthalmopathy (Graves' ophthalmopathy, thyroid-associated correlated with orbital computed tomography (CT). This study was designed to identify the autoantigen and to determine whether there are common antigens among the extraocular muscle, the lacrimal gland, and the thyroid. We prepared a 100,000g sediment fraction of porcine extraocular muscle, lacrimal gland, thyroid, and human thyroid, followed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting with sera from patients with Graves' disease, with or without ophthalmopathy, classified by symptoms and signs combined with orbital CT and normal controls. The results showed there was an approximately 55-kDa protein band which was recognized by the sera in 32.1% (9/28) of patients with autoimmune ophthalmopathy and in 47.3% (9/19) of patients with extraocular muscle enlargement demonstrated by orbital CT. It was significantly higher than the positive rates in patients without autoimmune ophthalmopathy and normal controls (15.8 and 11.1%, respectively, P < 0.025). However, there was no common antigen among the extraocular muscles, the lacrimal gland, and the thyroid. To further confirm this eye muscle-specific antigen, the approximately 55-kDa protein band was cut and solubilized from the nitrocellulose paper after SDS-PAGE, and electrophoretically transferred and used as an antigen in enzyme-linked immunosorbent assay. The absorbance was significantly higher in patients with autoimmune ophthalmopathy than patients without ophthalmopathy (P < 0.005), and normal controls (P < 0.01). Our findings suggest that an approximately 55-kDa protein may be a possible antigen in the eye muscle related to autoimmune ophthalmopathy.

Exocrine pancreatic function in obstructive jaundice rats: studies with isolated dispersed pancreatic acini

This study was conducted to investigate pancreatic exocrine function and pancreatic growth in rats with obstructive jaundice (OJ). OJ was produced in adult male Sprague-Dawley rats by bile duct ligation; control rats underwent laparotomy only. Induction of OJ was associated with significant hyperplasia and hypertrophy of the pancreas in rats as shown by increased DNA and RNA contents of pancreatic tissue. Factors associated with pancreatic growth in OJ rats were further examined in isolated dispersed pancreatic acini from OJ rats and the data were compared with those for control rats. Studies with isolated dispersed acini from OJ rats showed that pancreatic growth was accompanied by significant increases in total cellular amylase content; however, amylase release (percentage of initial) in response to cholecystokinin octapeptide was significantly decreased in OJ rats compared to control rats. Total amylase output in response to 100 pM cholecystokinin (CCK) was higher in the OJ group when compared to the control group (8.6 U/mg protein versus 6.4 U/mg protein), as calculated from the total amylase content and percentage of amylase released. Receptor binding data showed that the capacity of CCK receptors in OJ rats was significantly lower when it was compared with control. In addition, plasma levels of CCK were significantly elevated in OJ rats when compared to controls. These results suggest that obstructive jaundice induces pancreatic growth that is associated with alteration of exocrine pancreatic function. Abnormally high levels of stored amylase in pancreatic acini may be implicated in the development of pancreatitis as often seen in obstructive jaundice patients.

[Autologous bone marrow transplantation for the treatment of malignant lymphoma in adults]

Seventeen adult patients with malignant lymphoma, including Hodgkin's disease(HD) during relapse after first-line chemotherapy (6 cases) or in advanced stage (2 cases) and non-Hodgkin's lymphoma (NHL) of high grades after staging (9 cases) were treated with high-dose chemoradiotherapy (Hd-VCCA+TLI) and autologous bone marrow transplantation(ABMT). 16 cases (94.1%) obtained complete remission (CR) after ABMT. The current long-term disease-free probability is 86% for HD group and 62% for NHL group. One case with marrow involvement proved by marrow harvesting is in prolonged unmaintained CR for more than 3 years after ABMT with marrow purging in vitro by hyperthermia (42 C x 60 min). 4 cases with advanced disease relapsed died within two years. 2 cases with advanced lymphoblastic lymphoma relapsed and died of acute lymphoblastic leukemia. These results confirmed the value of ABMT in the treatment of adult malignant lymphoma and suggest that it is necessary to purge the residual tumor cells in the bone marrow before ABMT in the patients with marrow involvement or lymphoblastic lymphoma.

Effect of dietary linoleic acid content on the distribution of triacylglycerol molecular species in rat adipose tissue

The present study examined the effect of varying dietary linoleate intake (0.01, 0.24, 2.4, 24, 80 or 160 g/kg diet) for 24 weeks on the distribution of triacylglycerol (TG) molecular species in rat epididymal adipose tissue. Adipose TG fractions were purified by thin-layer chromatography and separated into different molecular species by reverse-phase high-performance liquid chromatography. The identification of TG species was based on fatty acid composition, retention time and the theoretical carbon number. When the dietary 18:2n-6 content was equal to or less than 24 g/kg, no significant amounts of n-6 fatty acids (mainly 18:2n-6) were observed in adipose tissue TG despite the fact that the levels of 20:4n-6 in liver phospholipids increased significantly. There were 12 major molecular species in adipose tissue when the dietary 18:2n-6 content was less than 2.4 g/kg. When the dietary 18:2n-6 content reached 24 g/kg, an additional six TG species containing one, two or three molecules of 18:2n-6 were observed. The levels of TG molecules containing two or three 18:2n-6 residues were further increased when the diet contained very large amounts of linoleic acid (160 g/kg). Conversely, those TG species containing only one 18:2n-6 residue became less abundant. It is suggested that the accumulation of these linoleate-rich TG molecular species in adipose tissue, particularly di- and trilinoleoyl containing TG, is the result of an adequate or an excessive intake of linoleic acid.

Effects of repeated gestation and lactation on milk n-6 fatty acid composition in rats fed on a diet rich in 18:2n-6 or 18:3n-6

The present study examined the effect of repeated gestation and lactation on the levels of long-chain n-6 polyunsaturated fatty acids in rat milk fat, and examined whether such levels might be modulated by supplementing the diet of the lactating dams with either (g/kg) 50 safflower oil (SFO; containing 800 g 18:2n-6/kg), or 50 evening primrose oil (EPO; containing 720 g 18:2n-6 and 90 g 18:3n-6/kg). The milk was collected at three different times (days 1, 8 and 15) in each given lactation period from female Sprague-Dawley rats which were successively bred for four pregnancies and lactations. Results showed that dietary fat and breeding frequency had no significant effects on milk triacylglycerol content, but they modified the pattern of milk fatty acids in both triacylglycerol and phospholipid fractions. After three or four successive breedings rats fed on EPO produced milk containing less saturated but more monounsaturated and polyunsaturated fatty acids compared with those fed on SFO. During the course of lactation the levels of n-6 metabolites, e.g. 18:3n-6, 20:3n-6 and 20:4n-6, in milk fat declined progressively. However, they were consistently higher in the EPO group than in the SFO group. These findings suggest that the levels of long-chain n-6 metabolites in the milk fat may be increased through supplementing the maternal diet with 18:3n-6.

Effects of cholesterol on viability and (n - 6) fatty acid metabolism in cultured human monocyte-like cells (U937)

Effects of supplementation of growth-promoting cholesterol on metabolism of the cytotoxic (n - 6) polyunsaturated fatty acids in cultured human monocyte-like cells (U937) have been examined. U937 cells were incubated in 5% delipidated fetal bovine serum containing 0 or 38.7 microM cholesterol. The rate of uptake and the distribution of metabolites of (n - 6) fatty acids (such as 18:2(n - 6), 18:3(n - 6), and 20:3(n - 6), and 20:4(n - 6)) were examined by adding radiolabelled fatty acid at a level of 1 microgram/mL (3.3 microM for 20-carbon fatty acids and 3.6 microM for 18-carbon-fatty acids). For assessing the cytotoxicity, (n - 6) fatty acids were added to medium at a concentration of 5 micrograms/mL (16.4 microM for 20-carbon fatty acids and 17.9 microM for 18-carbon fatty acids). Cholesterol supplementation suppressed the uptake of all (n - 6) fatty acids and reduced the cytotoxic effects of 18:2(n - 6), 20:3(n - 6), and 20:4(n - 6), but not 18:3(n - 6). In addition, cholesterol supplementation increased peroxide production and metabolism of (n - 6) fatty acids in U937 cells. Thus, the differential suppressive effect of cholesterol on the cytotoxicity of different fatty acids could not be attributed to an inhibitory effect on fatty acid delta 6- and delta 5-desaturation, or to an antioxidant effect on peroxide formation.

[Interdigestive and postprandial pancreatic exocrine secretion and cholecystokinin release in dogs]

Interdigestive and postprandial pancreatic exocrine secretion and cholecystokinin (CCK) release were investigated in 5 mongrel dogs with chronic gastric and pancreatic fistulas in this study. The rapidly exaggerated postprandial pancreatic exocrine secretions were shown to be directly correlated to the rapid CCK release after meal. Corresponding to the previous studies, in the interdigestive state, pancreatic exocrine secretion showed cyclic changes which would be abolished by intravenous administration of atropine sulfate. However, we failed to demonstrate any significant correlation between plasma CCK levels and periodic pancreatic exocrine secretions during the interdigestive state through CCK radioimmunoassay. Furthermore, intravenous administration of atropine sulfate did not change the plasma CCK levels significantly in the interdigestive state. Having reviewed the literature, we thought that the periodic pancreatic exocrine secretion during the interdigestive state might be related to motilin release and cholinergic enteropancreatic reflex.

Mondor's disease of the breast--three cases report

Mondor's disease is a rare and relatively little known clinical entity. Clinical features include sudden development of localized pain in the breast, followed by visible and papable, tender, cordlike, branching cutaneous grooves. It involves superficial thrombophlebitis of the thoracoepigastric or lateral thoracic vein occurring mostly in middle-age women. The etiology of Mondor's disease is unknown, and it may be related to trauma, operation, infection, bandaging, or tight clothes. The mammogram of most cases showed no abnormality, but the ultrasonography revealed hyperechoic cordlike pattern in the lesions. The symptomatic treatment is required and surgery will be indicated when it is associated with malignancy or severe painful cord due to pain and traction. It usually resolves over a period of 2 to 8 weeks. We report three cases of Mondor's disease and that we believe to be the first reported cases in Taiwan.

Prevalence of anti-HCV among Chinese patients with acute and chronic liver disease

To assess whether the hepatitis C virus plays an important role in Chinese patients with acute and chronic liver disease, antibodies to HCV (anti-HCV) were measured by enzyme immunoassay in 67 patients with type A and B acute viral hepatitis, 165 patients with non-A, non-B (NANB) hepatitis, 438 patients with chronic hepatitis, 200 patients with postnecrotic liver cirrhosis, 72 patients with alcoholic liver disease, 55 patients with non-alcoholic fatty liver, 24 patients with toxic and drug-induced hepatitis, and 20 patients with other chronic liver diseases. Anti-HCV was not detected in sera from patients with type A and B acute viral hepatitis, toxic and drug-induced hepatitis, primary biliary cirrhosis, Wilson's disease, or lupoid hepatitis. The anti-HCV prevalence was found to be highest in patients with NANB hepatitis (59% in sporadic and 73.2% in transfusion-associated), 16.4% in non-alcoholic fatty liver, 5.6% in alcoholic liver disease, 6.8% in chronic hepatitis, and 16% in postnecrotic liver cirrhosis. In patients with chronic hepatitis, the anti-HCV prevalence was significantly higher in HBsAg-negative (15/34, 44.1%) than in HBsAg-positive cases (15/404, 3.7%; P less than 0.0001). The results indicate that HCV is a major agent of NANB hepatitis and plays an important role in HBsAg-negative chronic liver disease in Taiwan.

The effect of chemical hepatocarcinogenesis on liver phospholipid composition in rats fed N-6 and N-3 fatty acid-supplemented diets

The effect of dietary fats on essential fatty acid metabolism in rats subjected to chemically induced hepatocarcinogenesis was studied. Sixty male rats were fed a diet supplemented with one of the following three oil compositions: 10% hydrogenated coconut oil (HCO); 5% hydrogenated coconut oil and 5% gamma-linolenic acid (18:3n-6)-rich evening primrose oil (EPO); or 5% hydrogenated coconut oil and 5% marine oil (FO). Half of the animals in each dietary regimen were subjected to hepatocarcinogenesis induction using diethylnitrosamine and 2-acetylaminofluorene (2-AAF) followed by partial hepatectomy, whereas the other half underwent hepatectomy without receiving diethylnitrosamine and 2-acetylaminofluorene. Liver phospholipid composition was analyzed. In comparison to the HCO group, the EPO group showed raised levels of arachidonic acid (20:4n-6) and suppressed n-3 fatty acids. The FO group, on the other hand, showed suppressed levels of n-6 and increased n-3 fatty acids. Hepatocarcinogenesis suppressed the level of 20:4n-6 and this effect was greater in the FO rats. The levels of dihomo-gamma-linolenic acid (20:3n-6) were increased by the hepatocarcinogenic treatment, and this effect was further accentuated in the EPO rats. These results suggest that hepatocarcinogenesis may suppress the activity of delta-5-desaturase, which may be one of the reasons why tumor cell membranes have low levels of long chain fatty acids, especially 20:4n-6 cells, and have an impaired capacity to undergo lipid peroxidation.

Effect of maternal dietary fats with variable n-3/n-6 ratios on tissue fatty acid composition in suckling mice

This report examines the distribution of n-3 and n-6 fatty acids in heart, kidney and liver phosphatidylcholine and phosphatidylethanolamine of suckling mice from dams fed a fat-supplemented diet with variable n-3/n-6 ratios. After conception and throughout the pregnancy and lactation period, dams were fed a fat-free liquid diet supplemented with 20% by energy of oil mixtures (fish oil concentrate, rich in 20:5n-3 and 22:6n-3, and safflower oil concentrate, rich in 18:2n-6). The diets contained similar amounts of combined n-3 and n-6 fatty acids but variable ratios of n-3 to n-6 fatty acids (0, 0.25, 0.5, 1, 2 and 4). In 12-day-old suckling mice, as the n-3/n-6 ratio in the maternal diet increased (up to approx. 0.5), the tissue levels of 20:5n-3, 22:5n-3 and 22:6n-3 increased, whereas those of 18:2n-6 and 20:4n-6 decreased. The responses were similar in both phospholipid subclasses, but varied between different tissues. Generally, the n-3/n-6 ratios were significantly greater in pup tissues than in milk fat, indicating preferential incorporation of n-3 over n-6 fatty acids into phospholipids during growth. However, the incorporation of n-3 fatty acids in pups was significantly suppressed whereas that of n-6 fatty acids was increased when 18:2n-6 was replaced by its delta 6-desaturation product, 18:3n-6 (concentrated from evening primrose oil), as the source of n-6 fatty acid.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical studies on postburn multiple organ failure: its aetiological factors and monitoring

This study demonstrated that multiple organ failure (MOF) developed in 16 of 57 severely burned patients (28.1 per cent). When expressed as a percentage of the 590 patients admitted during the same period, the incidence became 2.7 per cent. Fifteen of the 16 MOF cases died, with a mortality of 93.8 per cent. In those patients with TBSA over 80 per cent with inhalation injury, severe shock and systemic infection, the incidence of MOF was significantly higher. Systemic infection and severe shock were the most important complications. These results indicated that the severity of the burn is the prime prerequisite of MOF, while severe shock and systemic infection are secondary but very important factors in the genesis and development of postburn MOF. The circulatory platelet aggregate ratio (CPAR) started to decrease significantly at 12 h postburn, remaining at low levels and declining further at 5-7 days postburn. However the values of the myocardial enzyme spectrum (MES) remained at significantly higher levels, indicating significant and continuous increases of microaggregate formation and the continuous existence of visceral and tissue ischaemia and cellular destruction. Changes of CPAR and MES in MOF patients were directly related to the development of MOF. It is advisable to use CPAR and MES to monitor the possible development of postburn MOF.

The effects of dietary n-3/n-6 ratio on brain development in the mouse: a dose response study with long-chain n-3 fatty acids

This study examines the effects of the ratio of n-3/n-6 fatty acids (FA) on brain development in mice when long-chain n-3 FA are supplied in the diet. From conception until 12 days after birth, B6D2F1 mice were fed liquid diets, each providing 10% of energy from olive oil, and a further 10% from different combinations of free FA concentrates derived from safflower oil (18:2n-6), and fish oil (20:5n-3 and 22:6n-3). The range of dietary n-3/n-6 ratios was 0, 0.25, 0.5, 1.0, 2.0 and 4.0, with an n-6 content of greater than 1.5% of energy in all diets, and similar levels of total polyunsaturated fatty acids (PUFA). In an additional group of ratio 0.5, 18:2n-6 was partially replaced by its delta 6 desaturation product, 18:3n-6. Biochemical analyses were conducted on 12-day-old pup brains, as well as on samples of maternal milk. No obvious effects on overall pup growth and development were observed, apart from a smaller litter size at ratio 1. Co-variance analysis indicated that increasing the n-3/n-6 ratio was associated with slightly smaller brains, relative to body weight. We found that 18:2n-6 and 20:5n-3 were the predominant n-6 and n-3 FA in the milk; in the brain these were 20:4n-6 and 22:6n-3, respectively. Increasing dietary n-3/n-6 ratios generally resulted in an increase in n-3 FA, with a corresponding decrease in n-6 FA.(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective clinical study on the pathogenesis of multiple organ failure in severely burned patients

This study has shown that multiple organ failure (MOF) is one of the major causes of death in patients with severe burns. Both the plasma and visceral levels of TXB2 and the TXB2/6-keto-PGF1 alpha ratio were significantly increased. The changed plasma levels of TXB2 and the TXB2/6-keto-PGF1 alpha ratio paralleled the deterioration of the general condition in MOF patients. The circulatory platelet aggregation ratios (CPAR) in the MOF patients initially declined then dropped profoundly at 5-7 days postburn, indicating more microaggregate formation. CPK, LDH and GOT had increased markedly by 1 day, were elevated further at 2-3 days, and remained at supranormal levels for the first 7 days postburn. Degeneration, destruction, oedema, haemorrhage and thrombosis were observed in tissues from patients who died due to heart, lung, renal and hepatic failure. Clinically, 13 of the 16 MOF cases developed organ failure and 11 died between 3 and 7 days postburn. These findings confirmed that the increases of TXA2 and the TXA2/PGI2 ratio in plasma and visceral tissues can be an important factor in the genesis and development of postburn MOF.

[Antioxidative effect of three water-soluble components isolated from Salvia miltiorrhiza in vitro]

The antioxidative effect of three water-soluble components isolated from Salvia miltiorrhiza has been investigated. All the three components were found to inhibit both NADPH-vit C and Fe(2+)-cysteine induced lipid peroxidation (malondialdehyde formation) in rat brain, liver and kidney microsomes in vitro. The order of their inhibitory effect is as follows: salvianolic acid A, salvianolic acid B and rosmarinic acid. The inhibitory effect on lipid peroxidation induced by NADPH-Vit C was more than that induced by Fe(2+)-cysteine. In addition, the three compounds lowered the production of superoxide anion radical (O2-) in xanthine-xanthine oxidase system. The order of their potency was similar to that in antilipoperoxidation. The above results suggest that the three components have strong antilipoperoxidant activity in vitro, which may be partly through scavenging O2-..

Application of sulcated half-ring external fixator for treating bone and joint injuries of burned lower extremities: a report of four cases

Four patients with burned lower extremities complicated with severe bone and joint injuries were treated with sulcated half-ring external fixators. The results were satisfactory. This apparatus is simple, easy to handle and effective. Using this fixator, the burn wounds as well as the bone and joint injuries could be managed at the same time, without mutual interference. As it seems a desirable method for the management of such compound injuries, the advantages and disadvantages of this apparatus are discussed.