Small-intestinal bacterial overgrowth in patients with liver cirrhosis, diagnosed with glucose H2 or CH4 breath tests

BACKGROUND

Small-intestinal bacterial overgrowth (SIBO) has been considered a predisposing factor of spontaneous bacterial peritonitis in cirrhotic patients by bacterial translocation or hematogenous spread during spontaneous bacteremia. We investigated 45 cirrhotic patients and 28 healthy subjects to assess the prevalence of SIBO and its relationship with the severity of liver dysfunction and the presence of ascites.

METHODS

Bacterial overgrowth was measured by the glucose hydrogen and methane breath test.

RESULTS

SIBO was documented in 16 (35.6%) of the 45 cirrhotic patients and in 1 (3.6%) of the 28 healthy controls. The prevalence of SIBO was significantly higher in patients with Child-Pugh class B or C (50%) than in those with class A (19%) and had no relationship with the presence or absence of ascites.

CONCLUSIONS

We conclude that the prevalence of SIBO in cirrhotic patients is approximately 35.6% and that it is related to the severity of liver disease. There was no difference among various causes of cirrhosis, such as viral, alcoholic, or idiopathic.

Indoor environmental risk factors and childhood asthma: a case-control study in a subtropical area

This study examined the relation between indoor environmental factors and childhood asthma in a subtropical area. A hospital-based case-control study was performed in Kaohsiung, Taiwan, between July of 1995 and June of 1996. Eighty-six children seen in the out-patient clinic of our university hospital and who had a first-time diagnosis of asthma made by a pediatrician were the test group; 86 control subjects were selected from children attending the Childhood Orthopaedic Clinic in the same hospital and who had no previous diagnosis of asthma or asthma symptoms and no history of physician confirmed atopic diseases. The control subjects were matched with test case children on the basis of gender and age. Information was obtained from parents using a structured questionnaire. Of the many indoor environmental factors included in this study, only home dampness showed an association with asthma (adjusted odds ratio=1.77; 95% confidence intervals, 1.24-2.53). We conclude that dampness in the home is a new public health risk factor related to asthma in subtropical areas.

Childhood asthma and the indoor environment in a subtropical area

STUDY OBJECTIVES

The objective of this study is to examine the relationship between indoor environmental factors and childhood asthma in a subtropical area.

DESIGN

A case-control study was performed using participants of a prevalence survey that included 165 schoolchildren with asthma and 165 age- and gender-matched control subjects.

SETTING

The study was confined to 4,164 schoolchildren aged 6 to 12 years attending eight primary schools in Kaohsiung County rural municipalities who participated in a prevalence study concerning the health effects of the indoor environment.

PARTICIPANTS

Cases (n=165) were defined as children with current asthma confirmed by a physician. Control subjects (n=165) were selected from the same school and class and matched for age and gender, and they did not have a previous diagnosis of asthma, history of physician-confirmed atopic diseases, persistent wheezing, cough, or phlegm, or reported chest illness, pneumonia, or bronchitis.

MEASUREMENTS AND RESULTS

Information regarding the home environment was obtained using a structured written questionnaire, completed by the parents of the children. Of the many indoor environmental factors included in this study, only home dampness showed an association with asthma (odds ratio=2.65).

CONCLUSIONS

We conclude that dampness in the home is a new public health issue in subtropical areas.

Surface characteristics of Ti6Al4V alloy: effect of materials, passivation and autoclaving

The properties of passivated films for Ti6Al4V alloy prepared by various methods (as-polished, brazed at 970 degrees C for 2 h and brazed at 970 degrees C for 8 h) were investigated. Four passivations (non-treated, nitric acid passivation, 400 degrees C-treated in air, and aged in boiling water), with or without autoclaving treatments, were adopted for evaluating the changes of surface properties, including chemical composition, chemical structure, and oxide thickness. From X-ray photoelectron spectroscopic (XPS) analyses, surface elements of copper and nickel in brazed samples were undetected for non-treated, acid-passivated and boiling water-aged specimens, while they were found in the 400 degrees C-treated specimen. The relative contents of Ti2++Ti3+ to Ti4+ were determined by passivation treatments, but were not related to the experimental materials and autoclaving treatment. Passivation and autoclaving decreased the Ti to Ti4+ ratio by virtue of an increase in oxide thickness. Of the four types of passivation treatment, the 400 degrees C thermal treatment exhibited the lowest content of suboxides and metallic elements and the thickest oxide by XPS analysis; however, this treatment may cause a desorption of the basic OH group in the hydration layer on the surface of titanium alloy.

The effect of intracameral adrenaline infusion on pupil size, pulse rate, and blood pressure during phacoemulsification

Pupillary constriction during phacoemulsification (phaco) and irrigation/aspiration (I/A) is found to be the major cause of iris damage, incomplete cortex removal, posterior capsule rupture, vitreous loss and even posterior lens material dislocation. Cataract surgery is performed more easily if mydriasis can be maintained. Irrigation fluid containing adrenaline is thought to be of benefit in this respect. We designed a prospective study assessing the efficacy and safety of using perioperative adrenaline during phacoemulsification, as an adjunct to preoperative topical mydriatics. Forty-two cases were randomized to receive intraocular irrigation fluid with or without 1:1,000,000 adrenaline, as a study or control group. Diameter of the pupil, pulse rate, systolic and diastolic pressure before-phaco, after-phaco-before-I/A and after-I/A were measured. All of the operations were performed by the same surgeon with the same technique. The pupil size after-phaco-before-I/A was 8.00 mm in the study group and 5.96 mm in the control group. The mydriasis maintained during phacoemulsification was significantly greater in the study group, p < 0.00001. The pupil size after-I/A was 8.03 mm in the study group, and 5.54 mm in the control group. The mydriasis maintained during I/A was significantly greater in the study group, p < 0.00001. Pulse rate and blood pressure in patients of the study group, even those with hypertension, showed no significant fluctuation during the surgery. We concluded that intraocular irrigation with 1:1,000,000 adrenaline was a safe and effective way of maintaining mydriasis during cataract surgery.

A comparison of the corrosion behaviour and surface characteristics of vacuum-brazed and heat-treated Ti6Al4V alloy

The corrosion characteristics of the brazed Ti6Al4V specimens were analysed and compared with respect to the conventionally heat-treated specimens by an electrochemical corrosion test. The object of this research was to explore the potentiality of the brazed titanium for biomaterials. The characteristics of the 1300 degrees C heat-treated and the 970 degrees C brazed specimens, with passivation and sterilization treatment, were evaluated by measurement of corrosion potential, Ecorr, corrosion current densities, Icorr, polarization resistance of the reacted surface films, Rp, in a potentiodynamic test. The experimental results show that the corrosion rates of the heat-treated and the brazed samples are similar at Ecorr, and the value of Ecorr for the brazed sample is noble to the heat-treated samples. The passive current density of the brazed specimen is either lower or higher than the heat-treated specimen, depending on the polarization potential. By Auger electron spectroscopic and high-resolution X-ray photoelectron spectroscopic analysis on specimens from the potentiostatic test, the elements of copper and nickel in the brazing filler were not detected while less alumina was found in the reacted film of the brazed specimens when compared with the heat-treated specimens. The implication of the results is discussed.

Nodal disease in purely glottic carcinoma: is elective neck treatment worthwhile?

OBJECTIVE

Although there is a generalized understanding of the relatively low overall incidence of nodal disease from purely glottic carcinoma, the exact role for elective neck treatment in the management of this disease remains controversial. The purpose of this study was to identify the incidence of occult nodal disease (including paratracheal) in patients who have glottic carcinoma without significant extraglottic extension and to identify which patients are at risk for this. A retrospective chart review of 92 such patients who had either undergone neck dissection or been observed for a minimum of 2 years was performed.

RESULTS

For the 92 patients, neck treatment consisted of observation in 68 patients, paratracheal node dissection in four, unilateral neck dissection in four, unilateral neck dissection and excision of paratracheal nodes in 14, and bilateral neck dissection with paratracheal node excision in two. Of the 24 nodal dissections performed, four were positive for occult metastatic disease. No patient in the observation group developed nodal disease.

CONCLUSION

The incidence of occult nodal disease in NO glottic carcinoma is low, 0% in early stage disease (T1-T2) and 19% in late stage disease (T3-T4). Nodes at highest risk included only the paratracheal, level II, and level III. Elective neck treatment should only be undertaken for advanced (T3-T4) disease and even then is of questionable benefit. If undertaken, it should have a low potential morbidity, such as selective neck dissection or radiation. Computed tomography was not useful in staging the neck for this subset of patients.

Colon cancer mortality and total hardness levels in Taiwan's drinking water

The possible association between the risk of colon cancer and hardness levels in drinking water from municipal supplies was investigated in a matched case-control study in Taiwan. All eligible colon cancer deaths (1,714 cases) of Taiwan residents from 1989 through 1993 were compared with deaths from other causes (1,714 controls) and the hardness levels of the drinking water used by these residents were determined. Data on water hardness throughout Taiwan have been collected from Taiwan Water Supply Corporation (TWSC). The control group consisted of people who died from other causes and the controls were pair matched to the cases by sex, year of birth, and year of death. The results show a significant negative relationship between drinking water hardness and colon cancer mortality. Odds ratio and 95% confidence intervals were 1.22 (1.04-1. 43) and 1.46 (1.22-1.75), respectively, for exposure to moderately hard water and soft water compared with the use of hard water. Trend analyses showed an increasing odds ratio for colon cancer with decreasing levels of hardness in drinking water. This is an important finding for the Taiwan water industry and human health.

Chlorination of drinking water and cancer mortality in Taiwan

Chlorination has been the major strategy for disinfection of drinking water in Taiwan. An ecologic epidemiological study design was used to examine whether chlorination of drinking water was associated with cancer risks. A "chlorinating municipality" (CHM) was defined as one in which more than 90% of the municipality population was served by the chlorinated water while an "nonchlorinating municipality" (NCHM) was one in which less than 5% of the municipality population was served by chlorinated water. Age-adjusted mortality rates for cancer during 1982-1991 among the 14 CHMs were compared to rates among the 14 matched NCHMs with similar urbanization level and sociodemographic characteristics. The results of this study suggest a positive association between consumption of chlorinating drinking water and cancer of the rectum, lung, bladder, and kidney. Although these findings must be interpreted with caution because of limitations in the ecological study design, their public health significance should not be disregarded because chlorination of water is so widely practiced in Taiwan.

Adverse effect of air pollution on respiratory health of primary school children in Taiwan

This study is a part of the Study On Air Pollution and Health In Taiwan (SOAP&HIT), an ongoing research project involving cooperation of several universities in Taiwan. In this study, the objective was to evaluate the effects of ambient air pollution on respiratory symptoms and diseases of school children, in addition to considering indoor air pollution. Six communities were selected: one community located in a rural area (Taihsi), two in urban areas (Keelung and Sanchung), and the other three in petrochemical industrial areas (Toufen, Jenwu, and Linyuan). We sampled 5,072 primary school students in six communities from the main study population of SOAP&HIT. Respiratory health was assessed by evaluation of the children's respiratory symptoms and diseases using a parent-completed questionnaire. Data were analyzed using logistic regression analysis to compute odds ratios of adverse effect. The school children in the urban communities had significantly more respiratory symptoms (day or night cough, chronic cough, shortness of breath, and nasal symptoms) and diseases (sinusitis, wheezing or asthma, allergic rhinitis, and bronchitis) when compared with those living in the rural community. However, only nasal symptoms of children living in the petrochemical communities were more prevalent than in those living in the rural community. Although the association with ambient air pollution is suggestive, the cross-sectional study cannot confirm a causal relationship; thus further studies are needed.

Absence of a seasonal variation in myocardial infarction onset in a region without temperature extremes

To evaluate whether the incidence of acute myocardial infarction (AMI) attack would have circadian, weekly and monthly variations in a subtropical area, 540 consecutive patients with AMI who were admitted to our coronary care units were analyzed. Six-hour intervals over 24 h, daily intervals in a week (7 days) and monthly intervals in a year (12 months) were studied, respectively. Results showed that there was a circadian variation in the onset of AMI with a morning (6 a.m. to noon) peak (34%, p < 0.01) but no secondary late evening (18-24 p.m.) peak. The incidence of AMI was significantly lower on Sundays (9%) than on the other weekdays (Monday through Saturday; p < 0.05). However, no monthly and seasonal variations in the incidence of AMI (no winter or summer peaks) were observed in this series. This study demonstrated a circadian variation in the onset of AMI attack with a predominant morning peak. The fewer AMI cases on Sundays compared to the other weekdays suggested that freedom from 'stress' or 'work-load' on Sundays might have an important impact on this low incidence of AMI. Unlike the large ranges in cold or hot weather found in temperate regions, the warm climate of a subtropical region does not affect the frequency of AMI.

Respiratory symptoms of primary school children living in a petrochemical polluted area in Taiwan

In 1994-1995 a cross-sectional epidemiological study investigating the respiratory health of school children in two Taiwan areas was conducted; one area was located in a region with petrochemical manufacturing complexes (Linyuan), and the other was situated in a reference area with no local industrial emissions (Taihsi). All primary school children residing in the two areas were involved in the study. Four hundred seventy children were studied in the area with high exposure to industrial emissions, and 611 children lived in the reference area. Respiratory health was assessed by evaluation of the children's respiratory symptoms and illnesses, using a parent-completed questionnaire. Particulates, sulfur dioxide (SO2), nitrogen dioxide (NO2), and acid aerosols levels were significantly higher in the exposed area than in the reference area. The school children in the petrochemical area had significantly more upper respiratory symptoms and asthma compared with the children living in the control area. Although the association with known petrochemical air pollution is suggestive, this cross-sectional study cannot confirm a causal relation and further studies are needed.

The relationship between population density and cancer mortality in Taiwan

Many investigators have examined urbanization gradients in cancer rates. The purpose of this report was to identify urban-rural trends in cancer mortality rates (1982-1991) for municipalities in Taiwan. For this purpose, Taiwan's municipalities were classified as rural, suburban, urban, or metropolitan, using population density as an ordinal indicator of the degree of urbanization. Average annual age-adjusted, site-specific cancer mortality rates were calculated for both sexes within each population density group. Significant increasing trends with more urbanization were observed in mortality rates for cancers of the lung, pancreas, and kidney among both males and females, as well as male prostate cancer, and female breast and ovary cancer. In addition, this study revealed a significant rural excess for nonmelanoma skin cancer among both males and females, as well as male non-Hodgkin's lymphoma, and cancers of the female bone, and female connective tissue. Analytic studies for sites with consistent urban-rural trends may be fruitful in identifying the aspect of population density, or other unmeasured factors, that contribute to these trends.

Prediction of equilibrated postdialysis BUN by an artificial neural network in high-efficiency hemodialysis

In urea kinetic modeling, postdialysis blood urea nitrogen (BUN) is usually underestimated with an overestimation of the Kt/V especially in high-efficiency hemodialysis (HD). Thus, an artificial neural network (ANN) was used to predict the equilibrated BUN (Ceq) and equilibrated Kt/V (eKt/V60) by using both predialysis, postdialysis, and low-flow postdialysis BUN. The results were compared to a Smye formula to predict Ceq and a Daugirdas' formula (eKt/V30) to predict eKt/V60. Seventy-four patients on high-efficiency or high-flux HD were recruited. Their mean urea rebound was 28.6+/-2%. Patients were divided into a "training" set (n = 40) and a validation set (n = 34) for the ANN. Their status was exchanged later, and the two results were pooled. In the prediction of Ceq, both Smye formula and low-flow ANN were equally highly accurate. In patients with a high urea rebound (>30%), although Smye formula lost its accuracy, low-flow ANN remained accurate. In the prediction of eKt/V60, both Daugirdas' formula and low-flow ANN were equally accurate, although the Smye formula was not so accurate. In patients with a high urea rebound, although both Smye and Daugirdas' formulas lost their accuracy, low-flow ANN remained accurate. We concluded that low-flow ANN can accurately predict both Ceq and eKt/V60 regardless of the degree of urea rebound.

[A study of color matching of maxillofacial prosthesis]

OBJECTIVE:The color difference between the patient's facial prosthesis and the surrounding skin have long puzzled both of dentist and patient.The purpose of the study was to introduce spectrophotometer into the color matching and set up a set of equations to increase the accuracy of the color matching,Referring to increase the accuracy of the color matching.Referring to color gamut,several sets of shade guide were made according to sixteen kinds of mixture-ratio of four pigments such as red,yellow,white and black,and every shade guide was measured.The mixture-ratio was related to the values of the CIE system by means of statistics,which resulted in the equations for color matching.In a word,use of the spectrophotometer may improve the accuracy of the the color matching of facial prosthesis.

[Stess analysis of conical telescope denture using on the prosthodontic treatment for basic teeth combined periodontal diseases]

OBJECTIVE:Periodontal splints were made both on patients with peridontal absorption of three different degrees and on normal situation respectively followed by finite element calculation.The result sugree that the stesses of the supporting tissues redistributed during mastication in accordance with different degrees of periodontal absorption.The more obvious of the pcriodontal absorption is the more stress value of the periodontal supporting tissue decrease,while those of the subbasal supporting tissues increase.

Arthrodesis with a short Huckstep nail as a salvage procedure for failed total knee arthroplasty

Arthrodesis of the knee with use of a short Huckstep nail was performed in thirty-three patients (thirty-three knees) after failure of a non-constrained total knee arthroplasty. The indication for the arthrodesis was an infection in thirty-one knees and a Charcot joint in two. Three knees had had a failed attempt at arthrodesis with use of external fixation. The Huckstep nail was inserted through the knee, retrograde into the femur, and then antegrade into the tibia. The duration of the operation averaged 104 minutes (range, sixty-five to 155 minutes). Local bone graft was used in all knees. At the time of follow-up, at an average of forty-seven months (range, eighteen to ninety-four months), thirty knees (91 per cent) had radiographic evidence of union. The average time to union was 5.2 months (range, two to ten months) after the arthrodesis. Eight knees that had a grossly purulent infection were treated with debridement, which was followed by the arthrodesis as a second-stage procedure; the other knees had a one-stage arthrodesis. Only one of the thirty-one knees that had had an infection before the arthrodesis had a recurrence after it. Arthrodesis with a short Huckstep nail provides immediate axial and rotational stability and allows weight-bearing without use of external support as well as placement of the knee in a slightly flexed and valgus position. In addition, the nail does not migrate and it may be used even when there is a standard-size prosthesis in the ipsilateral hip.

Calcium and magnesium in drinking water and risk of death from cerebrovascular disease

BACKGROUND AND PURPOSE

Many studies have demonstrated a negative association between mortality from cardiovascular or cerebrovascular diseases and water hardness. This report examines whether calcium and magnesium in drinking water are protective against cerebrovascular disease.

METHODS

All eligible cerebrovascular deaths (17133 cases) of Taiwan residents from 1989 through 1993 were compared with deaths from other causes (17133 controls), and the levels of calcium and magnesium in drinking water of these residents were determined. Data on calcium and magnesium levels in drinking water throughout Taiwan were obtained from the Taiwan Water Supply Corporation. The control group consisted of people who died from other causes, and the controls were pair matched to the cases by sex, year of birth, and year of death.

RESULTS

The adjusted odds ratios (95% confidence interval) were 0.75 (0.65 to 0.85) for the group with water magnesium levels between 7.4 and 13.4 mg/L and 0.60 (0.52 to 0.70) for the group with magnesium levels of 13.5 mg/L or more. After adjustment for magnesium levels in drinking water, there was no difference between the groups with different levels of calcium.

CONCLUSIONS

The results of the present study show that there is a significant protective effect of magnesium intake from drinking water on the risk of cerebrovascular disease. This is an important finding for the Taiwan water industry and human health.

Calcium, magnesium, and nitrate in drinking water and gastric cancer mortality

The possible association between the risk of gastric cancer and the levels of calcium, magnesium, and nitrate in drinking water from municipal supplies was investigated in a matched case-control study in Taiwan. Records of gastric cancer deaths among eligible residents in Taiwan from 1987 through 1991 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair-matched to the cases by sex, year-of-birth, and year-of-death. Each matched control was selected randomly from the set of possible controls for each case. Data on calcium, magnesium, and nitrate levels in drinking water throughout Taiwan were obtained from the Taiwan Water Supply Corporation. The municipality of residence of the cases and controls was assumed to be the source of the subject's calcium, magnesium, and nitrate exposure via drinking water. The subjects were divided into tertiles according to the levels of calcium, magnesium, and nitrate in their drinking water. The results of the present study show that there is a significant positive association between drinking water nitrate exposure and gastric cancer mortality. The present study also suggests that there was a significant protective effect of calcium intake from drinking water on the risk of gastric cancer. Magnesium also exerts a protective effect against gastric cancer, but only for the group with the highest levels.

Immunocytochemical localization of gamma-aminobutyric acid plasma membrane transporters in the tiger salamander retina

Gamma-aminobutyric acid (GABA) plasma membrane transporters (GATs) play an important role in regulating GABA neurotransmission in the nervous system. The distribution of two GATs, GAT 1 and GAT 3, in salamander retina was investigated by using affinity-purified polyclonal antisera directed to the predicted C-terminals of rat GAT 1 and rat GAT 3. GAT 1-immunoreactivity (-IR) was found in type IB and IIB orthotopic bipolar cells (BCs) located in the distal and middle of the inner nuclear layer (INL), respectively; in type IIA and IA amacrine cells (ACs) located in the middle and proximal INL, respectively; and in interplexiform cells and cells in the ganglion cell layer (GCL). No detectable staining was found in horizontal cells (HCs) or in structures resembling Müller cells. GAT 1-immunoreactive fibers were present in the outer plexiform layer (OPL) and inner plexiform layer (IPL) in three bands corresponding to the three bands previously reported to be GABA-IR. GAT 3 antibodies labeled fewer cells and cell types than GAT 1 antibodies. GAT 3-IR was localized to type IIA and IA ACs and cells in the GCL, but not to BCs, HCs, or Müller cell-like structures. There was weak labeling of the OPL and stronger labeling of the IPL, with three distinct bands at the same depth as observed with GAT 1-IR. Double-labeling showed that the majority of GAT 1-IR BCs (88%), ACs (88%), and cells in the GCL (78%) colocalized with GABA-IR. The present study provides the first direct evidence of the expression of two GAT subtypes in neurons of nonmammalian retinas. These transporters could regulate GABA neurotransmission by reuptake and termination of GABA's action and, perhaps, by GABA release mechanisms. The presence of GAT 1-IR/GABA-IR bipolar cells further supports our earlier observations that a subgroup of orthotopic bipolar cells are likely to be GABAergic.

In vitro and in vivo mechanical evaluations of plasma-sprayed hydroxyapatite coatings on titanium implants: the effect of coating characteristics

This study was undertaken to evaluate the effect of coating characteristics on the mechanical strengths of the plasma-sprayed HA-coated Ti-6Al-4V implant system both in vitro and in vivo. Two types of HA coatings (HACs) with quite different microstructures, concentrations of impurity-phases, and indices-of-crystallinity were used. In vitro testings were done by measuring the bonding-strength at the Ti-6Al-4V-HAC interface, with HACs that had and had not been immersed in a pH-buffered, serum-added simulated body fluid (SBF). The shear-strength at the HAC-bone interface was investigated in a canine transcortical femoral model after 12 and 24 weeks of implantation. The results showed a bonding degradation of approximately 32% or higher of the original strength after 4 weeks of immersion in SBF, and this predominantly depended on the constructed microstructure of the HACs. After the push-out measurements, it was demonstrated that the HACs with higher bonding-strength in vitro would correspondingly result in significantly higher shear-strength at each implant period in vivo. Nevertheless, there were no substantial histological variations between the two types of HACs evaluated. The most important point elucidated in this study was that, among coating characteristics, the microstructure was the key factor in influencing the mechanical stability of the HACs both in vitro and in vivo. As a consequence, a denser HAC was needed to ensure mechanical stability at both interfaces.

Primary hyperparathyroidism with cardiac abnormalities: a case report

Primary hyperparathyroidism, characterized by hypersecretion of parathyroid hormone (PTH) leading to hypercalcemia and relative hypophosphatemia, is quite common in the elderly. Most patients with primary hyperparathyroidism have only mild hypercalcemia and are symptomless. But others experience various other organ diseases. Primary hyperparathyroidism is also associated with cardiovascular abnormalities, including QT interval shortening, heart block, cardiac arrhythmias, hypertension, myocardial hypertrophy, myocardial calcification and, though rarely, with valvular heart disease. We described a case of primary hyperparathyroidism associated with cardiac abnormalities. An 82-year-old male presented with the complaints of chest discomfort, fatigue, general weakness, nausea and vomiting over a period of months and was admitted in July 1996. Physical examination with heart auscultation showed a pansystolic murmur over the right sternal border and apex region, and a blowing diastolic murmur over the left sternal border. Biochemistry profiles revealed elevations of serum calcium (14.3 mg/dl) and chloride/phosphate ratio (> 33). Endocrinological studies showed elevations of serum PTH-C (4.8 ng/ml) and PTH-intact (705 pg/ml) concentrations. Kidney ultrasonography revealed a left renal stone. A spine X-ray revealed spondylosis and a compression fracture of the lumbar-spine with osteoporotic change. Thyroid ultrasonography and Thallium (Tl201)-technetium (Tc99m) subtraction scan showed parathyroid adenoma in the low pole of the right thyroid bed. Parathyroid aspiration cytology revealed few and discrete cells. Echocardiogram revealed moderate to severe aortic valvular calcification as well as stenosis with moderate aortic regurgitation, mitral regurgitation and myocardial calcification. The patient received parathyroidectomy one month later. During his postoperative days, he suffered from muscle twitching with positive Trousseau's sign and Chvostek's sign. The patient received calcium carbonate and vitamin D for hypocalcemia, diltiazem and capoten for his heart problems. A repeated echocardiogram two months after surgery showed no improvement of valvular calcification.

Gastric cancer mortality and drinking water qualities in Taiwan

The possible association between the risk of gastric cancer and nitrate and hardness in drinking water from municipal supplies was investigated in a matched case-control study in Taiwan. Data on gastric cancer deaths among eligible residents in Taiwan from 1987 through 1991 (6,766 cases) were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes (6,766 controls) and were matched individually to the cases by sex, year of birth, and year of death. Data on nitrate-nitrogen (NO3-N) and hardness levels in drinking water throughout Taiwan were collected from the Taiwan Water Supply Corporation (TWSC). The municipality of residence for cases and controls was assumed to be the source of the subject's nitrate and hardness exposure via drinking water. There was no difference in gastric cancer rates between the groups with different levels of nitrate. The odds ratios (95% confidence interval) for death from gastric cancer was 0.95 (0.87-1.03) for the group with water nitrate levels between 0.23 and 0.44 mg/L, and 1.02 (0.93-1.11) for the group with nitrate levels greater than 0.45 mg/L. However, the results show a significant negative relationship between drinking water hardness and gastric cancer mortality. Odds ratios were 1.16 (1.07-1.26) and 1.65 (1.52-1.79), respectively, for exposure to moderately hard water and soft water compared with the use of hard water. This is an important finding for the Taiwan water industry and human health risk.

Characterization and purification of a lipoxygenase inhibitor in human epidermoid carcinoma A431 cells

A lipoxygenase inhibitor in the cytosolic fraction of human epidermoid carcinoma A431 cells was characterized and purified. The cytosolic inhibitor lost the inhibitory activity upon heating at 75 degrees C for 15 min or pretreating with 1 mg/ml trypsin at 37 degrees C for 60 min. Cytosol, after dialysis, lost the inhibitory activity but its inhibitory activity recovered when 1 mM GSH was added to the dialysate. The inhibitory activity of cytosol was also abolished by treatment either with 1 mM iodoacetate at 4 degrees C for 1 h or with 0.5 mM H2O2. The pI of the inhibitor was approx. 7.0. In addition to 12-lipoxygenase, the inhibitor inhibited the activities of 5-lipoxygenase and fatty acid cyclo-oxygenase in a cell-free system. The inhibitor was purified by a series of column chromatographies using CM Sephadex C-50, Sephadex G-100 SF and Mono P columns. A major 22 kDa protein was obtained that was distinct from selenium-dependent glutathione peroxidase.